The WHO and the Viral Politics of Nationalism

Part II of “Who’s Responsible:  The WHO, Internationalism, and the Coronavirus Pandemic”

The WHO’s record in helping contain the transmission of viruses, many of zoonotic origins, that have created global public emergencies over the last two decades and that are quite likely poised to become even more critical in the decades ahead is rather more mixed.  It may be that the organization was created with the intention of liberating the world from those diseases that had long been the scourge of humankind and whose very name evoked dread:  typhoid, malaria, yellow fever, and especially cholera and smallpox.  No one by the second half of the 20^th century was quite thinking of the “plague”, even if the outbreak of pneumonic plague in Surat in 1994 (with bubonic plague discovered in three villages in Maharashtra), was a grimly reminder that this ancient pestilence had by no means disappeared.  The incidence of death from the plague in Surat was only 56, and it was soon relegated to the background as an anomaly, as something that was merely an unpleasant reminder of “medieval times” in a modern age that had purportedly moved beyond such calamities.

Surat, 1994, during the plague. Source: Getty Images.

The Indian Military enforcing quarantine at a hospital in Surat, 1994. Photo: Laurie Garrett. Source: https://www.pri.org/stories/2016-03-12/us-ready-next-big-pandemic

The point here is that the WHO may have been somewhat ill-prepared for the 21^st century and for the kind of viruses that appear to proliferate partly in consequence of the relentless pressure placed upon the land by large-scale mechanized farming, the substantial decrease and often decimation of the habitats for wildlife, the enormous increase in greenhouse gases, and the increasing incidence in zoonotic diseases.  Nevertheless, the WHO was still able to profit, at least into the early years of the 21^st century, by the fact that most countries had not yet succumbed to extreme forms of nationalism and that international organizations still commanded considerable respect.  The case of SARS, Severe Acute Respiratory Syndrome, is illustrative of the influence, largely unthinkable today, that the WHO was able to exercise less than 20 years ago.  In mid-November 2002, the Chinese government first became aware of cases of SARS, but it failed to report them to WHO.  Three months later, the Guangzhou city government was still putting on a bold face in declaring that it had the disease comprehensively under control.  But the WHO was in any case on to the fact that something was amiss:  the organization’s then Director-General, Gro Harlem Brundtland, had in place a system of rigorous monitoring and the WHO’s staff surmised that an atypical pneumonia outbreak had taken place in China.  Brundtland, whose stern and disciplined leadership of the WHO won her some admirers even as it raised a few eyebrows, chastised China for keeping the outbreak a secret, arguing that it could have been contained if the WHO had been brought into the picture and allowed to share its medical expertise.  On February 7^th, China responded by sending the WHO the first detailed report on the outbreak; thereafter, as the disease spread, China and other countries regularly shared their data with the WHO.  Though SARS spread to 29 countries, worldwide fatalities numbered around 800, with China and Hongkong alone accounting for 75% of the deaths.

The WHO had played its part in containing SARS, but its role in subsequent crises, according to some critics, is far more questionable.  It declared the H1N1 “swine flu” of 2009 a “pandemic”—the first time it did so under revised international protocols—and was heavily criticized by many countries for having over-reacted.  Perhaps, chastened by this experience, it may have taken too long to send an international health warning to other countries after the Ebola outbreak in West Africa in 2014.  But these controversies may pale into insignificance in comparison with the storm that has been brewing over the WHO’s role in the present coronavirus pandemic. In early April, President Trump let loose a volley of highly critical remarks blaming the WHO for having withheld information about COVID-19 from the US (and the rest of the world, though it need not be said that Trump cares not an iota for other countries), and thereby holding it just as responsible as China for the rapid spread of the disease around the world.  In subsequent remarks, Trump threatened to withhold US funding from the WHO: no small matter this, considering both that the WHO has to call upon all its resources to fight the pandemic and that the US makes the largest contribution among member states to the organization.  Sentiment against the WHO runs very high among many Republican lawmakers, who have long complained that China gets a free hand in bullying other nations and international organizations alike, and the feeling is widespread among them, and other critics of the UN and its agencies, that WHO was far too willing to pander to China.  That the United States is not wholly singular in taking this view is clear from the fact that the Japanese Deputy Prime Minister and Finance Minister, Taro Aso, noted scathingly that many people were referring to the World Health Organization as the “Chinese Health Organization”.

If Beijing sought to keep knowledge of SARS from the rest of the world, its credibility in the present pandemic is obviously questionable.  The supposition, on the part of the United States, is that the WHO abetted China in disguising some known facts about SARS-coV-2, more particularly the question of whether human-to-human transmission of the virus was possible.  The WHO continued to deny publicly that such transmission was possible as late as 14 January 2020, as its tweet of that day made clear, but by January 24 the Chinese government had sealed off the entire province of Hubei, which has a population of 50 million, and thereby signaled to the world that SARS-coV-2 does indeed transmit from one person to another.  The WHO now had to make a call:  should it declare COVID-19 a “public health emergency of international concern” (PHEIC)? Its emergency committee met on January 22 but the committee was split down the middle:  though the United States has declared the WHO complicit with China, it was represented on the 15-member committee along with representatives of many of its allies, including New Zealand, Australia, Sweden, France, Canada, The Netherlands, Japan, South Korea, Singapore, and Saudi Arabia.  Indeed, only Russia among the committee’s members can be counted as hostile to the US:  evidently, then, at least some of the US’s friends were against the decision to designate COVID-19 an international public health emergency (PHEIC).  However, in an attempt to forge a unanimous opinion, Director-General Ghebreyesus did not go public with the committee’s decision and ordered it to reconvene the following day, with similar results.  It wouldn’t be until January 29 that the WHO would declare the coronavirus a PHEIC—a far more critical decision than its decision, six weeks later, to designate it a “pandemic”.

The evidence on whether the WHO acted decisively, and early enough, in sounding a warning to the world about the origins, modes of transmission, and advance of SARS-coV-2 remains inconclusive.  But, whatever position one might adopt, what is incontrovertibly true is that the United States, and similarly countries such as the UK and Brazil, did not take the threat seriously for weeks after the WHO had declared that there was a public health emergency of international concern.  Consequently, the debate over the WHO should be recognized for what it is, namely a form of scapegoating.  A pure narcissist such as Trump has no other interest at the moment besides trying to ensure his electoral triumph this November, and it is imperative that one recognize the much larger considerations that are raised by the present controversy over the WHO.  The real question revolves around the future of international organizations considering that nations are increasingly veering towards authoritarian populism, mindful only of some of their constituents at home, and that disdain for international opinion in many countries is all too visible.  Even as these remarks are being penned the news has come in that the United States is thinking of placing sanctions on the International Court of Criminal Justice (ICCJ) for daring to launch an investigation into possible war crimes by the armed forces of several nations, including the United States, in Afghanistan. The United States has long acted on the supposition that its own sovereignty is supreme and that it owes no responsibility to any supra-national organization.  Can new forms of “internationalism” emerge in the wake of COVID-19 that take the place of organizations such as the WHO that superficially appear to be supra-national but are, in actuality, entirely built upon the notion of the nation-state as the ultimate expression of human community?  The speculations that one might entertain about such possibilities are, however, the subject for another essay.

(concluded)

See also Part I:  “The World Health Organization (WHO): Testing Times for Medical Internationalism”

The two parts together were published in a slightly shorter and different version under the title of “Who’s Responsible: The WHO, Internationalism, and the Coronavirus Pandemic” at ABP Live, here.