The World Health Organisation Part 2: Politics and reforms

29th May 2020

During the COVID-19 pandemic the World Health Organisation (WHO) has experienced increased media coverage and, while in some cases praised, has mainly faced criticism, especially for the perceived influence the Chinese government has over the organisation and how this has potentially affected their actions. In this article, the links between the WHO and China will be explored, with the ways in which this relationship could alter the operating of the organisation also being looked at. This article will also delve into some of the WHO’s past reforms as well as some of the suggestions put forward for how it can be reformed in the future.

As mentioned in our previous article regarding the WHO, the organisation has been very reluctant to criticise Chinese action during the COVID-19 pandemic and at times have praised the government, something which some have since commented as being ‘excessive’ and ‘unnecessary and wrong’ leading to the defunding of the organisation by the USA.1  The USA has also alleged that the WHO is ‘a puppet of China’ and on closer inspection, whilst the allegations levelled by the US are greatly exaggerated, there is an incredibly interconnected relationship between the WHO leadership and the Chinese government.2 Not only was the WHO’s former Director-General, Margaret Chan, a Chinese national, the present Director-General was also China’s candidate for the position and the country’s diplomats were said to have ‘worked tirelessly behind the scenes to help Tedros defeat the UK candidate, David Nabarro’.3 4 Upon being elected Director-General, Tedros Adhamon appointed former Zimbabwean President, Robert Mugabe, as a Goodwill Ambassador to the WHO in what some have suggested to be a ‘payoff’ for China in getting Tedros elected.5 6  The decision to make Robert Mugabe, who at the time was under international sanctions for human rights abuses, was met with outrage throughout the international community and his appointment was quickly rescinded by the Director-General.7 8 During his tenure Director-General Tedros Adhanom also endorsed traditional Chinese medicines in 2019 after extensive lobbying from Beijing, despite any proof of their scientific value.9 

There is also the issue of Taiwan whose participation, and at times existence, in the WHO is seemingly dependent on China’s say so.  Evidence of this can be seen through Taiwan’s admittance to the World Health Assembly (WHA) as an observer for six years from 2009 under the name ‘Chinese Taipei’ which coincidentally coincided with the Taiwanese premiership of Ma Ying-Jeou, a Chinese nationalist.10 Taiwan was once again ejected from the assembly in 2016 in a move orchestrated by the Chinese government after Tsai Ing-Wen, leader of the Democratic Progressive Party, was elected President of Taiwan.11  The exclusion of Taiwan at the 73rd WHA has been even more controversial in light of the country’s resounding success in combating COVID-19, as well as the country having been one of the first to raise the possibility of human-to-human transmission in late December 2019, whilst the Chinese government were reportedly still attempting to suppress news of the outbreak.12 Many have voiced concerns about the continued exclusion of Taiwan and warned that this could prove detrimental to the global effort against the virus.13 In some instances WHO officials have gone to the extent where they have seemingly refused to acknowledge Taiwan’s existence and the organisation have said that they recognise the People’s Republic of China as the ‘one legitimate representative of China’ – a policy which has been in place across the UN since 1971.14 This stance was reinforced in late March by Bruce Aylward, Senior Advisor to the WHO Director-General, who, when asked about Taiwan’s successes in combatting COVID-19 in an interview with Hong Kong radio station RTHK first pretended he could not hear the question and when pressed for an answer, stated that they had ‘already talked about China’.15

Throughout the pandemic the WHO has come under fire for its perceived subservience to China that led to a failure ‘to independently investigate credible reports that conflicted directly with the Chinese government’s official accounts’, as well as the organisations delay in declaring a pandemic – only doing so on 11th March after the virus had been confirmed in 114 countries.16 17 The WHO has been reformed several times over its history with reforms occurring after the West Africa Ebola outbreak, leading to the WHO’s health emergency programme, and more recently in 2017 when it underwent an organisation-wide restructuring at the beginning of Tedros Adhanom’s tenure.18 It is likely that further reforms will follow the COVID-19 pandemic with a review of the organisation having already been agreed at the 73rd WHA. The review is reported to be an ‘impartial, independent and comprehensive evaluation…to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19’.19 It has been suggested that the review will look into reforms which will increase transparency and member state compliance in order to boost the independence of the WHO.20  Several suggestions by member states have been put forward for ways in which to reform the WHO, with the USA presenting the idea of forming a separate body within the WHO to deal solely with pandemics, as well as Australia’s Prime Minister, Scott Morrison, putting forward the idea of WHO health investigators would, during a disease outbreak, act in a similar way to the weapons inspectors used by the UN.21 22

Upon reflection, it would appear that the WHO has been neutered by politics and has become the latest victim in the global tug of war between the USA and China. For the organisation to once again become effective financial reforms need to take place preventing member states from giving ‘strings attached’ contributions. Not only would this prevent the overfunding of certain initiatives and projects, it would also allow the organisation to be able to react independently and fluidly to changing health crises and allow for more effective deployments in emergency situations. Recently finding a solution to this issue has made some progress with the introduction of a new WHO foundation which has the capacity to make independent grants to address the most pressing global health challenges.23 As argued by former Assistant Director-General Keiji Fukuda, member states need to first decide what they want the WHO to be: ‘An independent organization that tells countries what to do, or a consensus-building secretariat’?24 Until this has been figured out all reviews and reforms will likely be severely limited in how effective they can be.