A few thoughts on the growing critique of the World Health Organization, and this piece by @lymanstoneky in particular, as it has gotten a lot of attention - based on my book on the history of global health politics and the role of @WHO after the Second World War. 1/
To be clear, there is certainly much to be debated about WHO’s response to public health crises in the recent past, and much to be criticized about leadership problems, spending priorities, etc. We definitely need a discussion about @WHO's proper role in the 21st century. 2/
However, I don’t believe taking Trump’s criticism at face value, as an expression of serious concern over WHO's practices, makes much sense, when it is so obviously an attempt to distract from the administration’s disastrous coronavirus response. 3/
More importantly, though, a lot of the assertions about WHO’s past and present in this piece are either not quite right or downright misleading. Let’s start with the history portion. 4/
To begin with, the Sanitary Conferences of the 19th century were not primarily focused on disease notification / surveillance, as @lymanstoneky writes. They were mostly a European affair and emphasized quarantine measures as a way of protecting the continent from disease. 5/
The focus on constant epidemiological surveillance came later, in the early 20th century, with the establishment of permanent international health organizations, such as the International Office of Public Hygiene, founded in Paris in 1907. 6/
WHO’s mission after WW II was not just, as the article suggest, a continuation of these earlier surveillance efforts. Particularly in the 1950s through 70s, much of the organization’s resources and most of the political attention was focused on “disease eradication.” 7/
From 1955 to 1969, for instance, WHO was responsible for planning, coordinating, and evaluating the global Malaria Eradication Program, which was implemented in over 90 countries - one of the most ambitious undertakings of international cooperation in the Cold War era. 8/
And in 1967, WHO embarked on a global Smallpox Eradication Campaign, designed as a massive immunization effort, which succeeded in realizing its central goal: The last smallpox case in history was detected in Somalia in October 1977. 9/
These are just examples – there are other problems, historically speaking. I get that @lymanstoneky didn’t set out to write a history of WHO. But he does provide a historical overview – one that supports his argument. It’s just not an overview that is all that convincing. 10/
What about the present though? Well, he claims that much of what WHO has historically focused on has become superfluous because “Very few countries are truly devoid of functional health departments.” Really? I don’t think many health experts would agree. 11/
If you think back to the Ebola epidemic in West Africa in 2014/15, the entire problem was that the virus affected a region that did very much not have the luxury of a functional health care system (unless you set the bar to “Does the country have a health department at all?”) 12/
Also, according to the piece, WHO’s vaccination efforts have become expendable because “vaccines exist for most major epidemic diseases.” Well, the word “most” does a lot of heavy lifting in this sentence. What about Malaria or HIV/AIDS? Because those are major problems. 13/
That brings me to my larger point: I don’t think this portrayal of what WHO is and has been is particularly balanced, and it fails to acknowledge crucial context. @lymanstoneky claims that people envision WHO as something it is not. But is it really what he presents it to be? 14/
Take @lymanstoneky's discussion of WHO’s budget, for instance. He says “It spends from $200 to $600 million on travel expenses each year, making up between 5 percent and 20 percent of its total budget.“ That’s not wrong – but it’s also most certainly misleading. 15/
Apart from travel expenses, what should people know about WHO’s finances? Well, it has a budget of roughly $4.5 billion – but that’s for two years. And it’s less than the budget of many major U.S. hospitals. That seems noteworthy, no? 16/
Or how about the fact that the vast majority of the budget consists of voluntary contributions from countries and organization, such as the Gates Foundation, with WHO having limited influence on how and where these extra-budgetary funds are used. 17/
What about the regular portion of the budget? Well, it consists of fixed annual contributions by member states – and these member states, led by the United States, have since the 80s steadfastly refused to increase their support for the organization in any significant way. 18/
If your entire argument boils down to “WHO’s work is not up to standard,” shouldn’t you at least mention that one major obstacle for the organization is its dramatically inadequate budget, and that no one deserves more blame for that situation than the United States? 19/
However, instead of asking “What can we expect from an inadequately funded organization that we have constantly starved of the necessary support?” the article presents WHO as “a multi-billion-dollar organization“ characterized by outrageous waste of resources. 20/
Similarly, it’s not @lymanstoneky’s critique of WHO’s “disappointing response to Ebola” per se that is problematic. He’s right that “it was hoped that the WHO would be better prepared for the next major epidemic.” 21/
But we should also mention that few states were willing to do their share to be “better prepared.” The fact that the Office of Pandemic Response that had been created in the White House in reaction to the 2014 Ebola epidemic was dissolved in 2018 is well-known by now. 22/
More generally, the article fails to appreciate that the public health discourse, as agitated as it is at times, is fundamentally fast-paced and oblivious in nature. Western States care for a while about something by which they feel threatened - and then quickly lose interest 23/
Take HIV/AIDS, for instance. WHO got involved in HIV/AIDS towards the late 1980s, when it became clear that this was not, as initially suspected, a strictly “Western” problem, but in fact a pandemic about to devastate the global South. 24/
However, right when WHO made HIV/AIDS a priority, interest in the West started to wane. By the late 1980s it was clear that Western states had contained the virus. And so the UN initiatives struggled to acquire the necessary funding from the industrialized world. 25/
Meanwhile, the pandemic spread around the globe, and the vast majority of infections (over 75 million thus far) and deaths (well over 30 million) have occurred after people in the West simply stopped caring about the disease. 26/
Perceptions of acute danger tend to have a fairly short shelf life. Just compare the massive attention for the 2014 Ebola epidemic in West Africa with the fact that the second worst Ebola epidemic in recorded history in the spring of 2019 barely caused a reaction in the West. 27/
What critics of the World Health Organization need to understand is that WHO has always depended on the ebbs and flows of the international political discourse and can do little itself to influence the tides. 28/
That’s why I find @lymanstoneky’s suggestions unconvincing: how is “going on the warpath against the organization” and providing even fewer resources going to help when the structural problems have often been a lack of funds and a lack of sustained interest from the West? 29/
If we really care about establishing a functional World Health Organization as an important piece in the global health puzzle, then we need to come up with better history, more balanced analysis of the present, and better suggestions than this. /end
PS: I talk about many of these issues in more detail in this @theeuropedesk podcast episode on “The Age of Pandemics. The Threat of Infectious Disease and the Politics of Global Health in the 20th Century”
And, of course, here is the book, in case you’re interested (and read German...) wallstein-verlag.de/9783835319196-…
