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US President Donald Trump speaks during a roundtable discussion with industry executives on reopening businesses during the COVID-19 pandemic in the State Dining Room at the White House in Washington, on Friday. Image Credit: REUTERS

Geneva: US President Donald Trump’s decision to sever ties with the World Health Organisation is a setback for global health and makes the world less safe, world leaders and health experts said yesterday.

After spending weeks accusing the World Health Organisation of helping the Chinese government cover up the early days of the coronavirus epidemic in China, President Donald Trump said Friday that the United States would terminate its relationship with the agency. “The world is now suffering as a result of the malfeasance of the Chinese government,” Trump said in a speech in the Rose Garden. “Countless lives have been taken, and profound economic hardship has been inflicted all around the globe.”

In his 10-minute address, Trump took no responsibility for the deaths of 100,000 Americans from the virus, instead saying China had “instigated a global pandemic.” There is no evidence that the WHO or the government in Beijing hid the extent of the epidemic in China, and public health experts generally view Trump’s charges as a way to deflect attention from his administration’s own bungled attempts to respond to the virus’s spread in the US.

German Health Minister Jens Spahn said on Saturday the WHO “needs reform” if it is to “make any difference”, something the EU must now take a lead in doing.

What’s the background to this?

Trump’s criticism of the WHO’s handling of the pandemic began last month when he threatened to permanently withdraw US funding, suggesting the UN health agency had “failed in its basic duty” in its response. “It is clear the repeated missteps by you and your organisation in responding to the pandemic have been extremely costly for the world,” he wrote in a letter to WHO chief Tedros Adhanom Ghebreyesus on May 18. He later labelled the WHO a “puppet of China”.

In April, when he was asked about Trump’s accusation that the WHO was “China-centric,” Tedros said: “It is wrong to be any ‘country-centric.’ I am sure we are not China-centric. The truth is, if we are going to be blamed, it is right to blame us for being US-centric.”

How have public health experts reacted?

Public health experts in the US and elsewhere reacted to Trump’s announcement with alarm. “We helped create the WHO,” said Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention, which has worked with the organisation since its creation in 1948. “We’re part of it; it is part of the world,” Frieden said. “Turning our back on the WHO makes us and the world less safe.” The Infectious Diseases Society of America “stands strongly against President Trump’s decision,” said Dr. Thomas M. File, its president. “We will not succeed against this pandemic, or any future outbreak, unless we stand together, share information and coordinate actions.”

Does Trump have the power to pull the US out of WHO?

It is not clear whether the president can simply withdraw the US from the World Health Organisation without Congressional approval. “The president can’t unilaterally withdraw us,” said Lawrence O. Gostin, director of the World Health Organisation Collaborating Centre on National & Global Health Law at The Georgetown University Law Centre. “It’s a non-starter,” he added. “This is literally a whim of one man, without any consultation with Congress, in the middle of the greatest health emergency of our lifetime.”

The reaction among Democrats in Congress was swift and negative. Rep. Ami Bera, D-Calif., the chairman of the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation, called Trump’s announcement “shameful and irresponsible.” The WHO “is not a perfect organisation,” he said on Twitter, “but leaving will make the United States and the world less safe. President Trump is ceding US global leadership and handing it over on a golden platter to China.”

Is this why the WHO has set up a new alliance?

Thirty-seven countries and the WHO appealed on Friday for common ownership of vaccines, medicines and diagnostic tools to tackle the global coronavirus pandemic, taking aim at patent laws they fear could become a barrier to sharing crucial supplies. But the timing of the action has also coincided with the US pulling out of backing the WHO.

While the push by mostly developing nations, called the Covid-19 Technology Access Pool, won praise from groups including Doctors Without Borders, a drug industry alliance questioned if the effort to pool intellectual property would really broaden access to medicines. Developing and some small nations fear rich countries pumping resources into finding vaccines — more than 100 are in development — will muscle their way to the front of the queue, once a candidate succeeds.

“Vaccines, tests, diagnostics, treatments and other key tools in the coronavirus response must be made universally available as global public goods,” said Costa Rica President Carlos Alvarado.

The effort, originally proposed in March, aims to provide a one-stop shop for scientific knowledge, data and intellectual property amid a pandemic that has infected more than 5.8 million people and killed more than 360,000.

What’s the WHO’s ‘Solidarity Call to Action’ all about?

The WHO issued a “Solidarity Call to Action”, asking other stakeholders to join the voluntary push. “WHO recognises the important role that patents play in fuelling innovation but this is a time when people must take priority,” the WHO Director General told an online news briefing. The International Federation of Pharmaceutical Manufacturers & Associations raised concerns about undermining intellectual property protections, which the group said already enable collaboration and will also be needed after the pandemic is over. Anna Marriott, health policy manager for anti-poverty group Oxfam, said the divide over how to handle patents illustrated how some regions could wind up losers. “The pharmaceutical industry’s attempt to rubbish the World Health Organisation’s initiative suggests they care more for profits than people’s health,” she said.

Why has the US handling of the pandemic come under scrutiny?

The administration’s response to the emergency has been fumbling and inadequate, many public health experts say, especially when compared to China’s. The coronavirus has been the leading cause of death in the US since mid-April, killing roughly 100,000 citizens to date. By comparison, only 4,600 Chinese citizens have died of the infection. About 20,000 Americans are infected each day, while China virtually ended its outbreak by April.

But haven’t the US and donors shaped WHO policy for decades?

The US government and private donors, including the Bill and Melinda Gates Foundation, Bloomberg Philanthropies and Rotary International, have wielded enormous influence on WHO policies. For example, although the war on smallpox that was begun in the 1960s was at first largely a Soviet initiative, the WHO chose American doctors, including Dr. William Foege and Dr. Donald A. Henderson, to lead the global campaign. The agency also chose American-made vaccines over Soviet ones for the war on polio.

For many years, the US government, working on behalf of the Western pharmaceutical industry, pressured the WHO not to publicly fight for lower drug prices that might threaten the patent monopolies of US companies. That changed in the early 2000s, when many US companies began sublicensing their patents and technology to generics-makers in India and elsewhere.

No American has ever been director-general of the WHO, but that is because of a decades-old understanding that the World Bank and the United Nations Children’s Fund would always be run by Americans, while the leadership of some other UN agencies, including the WHO, would be taken in turn by other nations.

What is the WHO and how did it respond to the COVID-19 outbreak?

• The WHO was founded in 1948 as part of the postwar creation of the United Nations and is the world’s premier global health organisation.

• Trump supported and generously funded the organisation as it fought an Ebola outbreak in Africa for three years but abruptly turned on the WHO a few weeks ago, when he began accusing the organisation of doing too little to warn the world of the spread of the coronavirus.

• In fact, the agency issued its first alarm on Jan. 4, just five days after the local health department of Wuhan — at the time, a city few non-Chinese had even heard of — announced a cluster of 27 cases of an unusual pneumonia at a local seafood market. The WHO followed up with a detailed report the next day.

• On Jan. 20 and 21, a WHO field team visited China and reported that there could be human-to-human transmission of the new pneumonia-causing virus.

• Almost simultaneously, China’s leading epidemiologist, who had just completed his own investigation on behalf of the Beijing government, confirmed during a Jan. 20 interview on state television that transmission to doctors was occurring in Wuhan, although he said on a recent interview with CNN that local officials had lied about it and even tried to mislead him.

• Within three days, Beijing had shut off all travel out of Wuhan. Trump did not order any restrictions on travel from China until Jan. 31.

• The US has been by far the WHO’s largest donor since its inception. The budget for the WHO is about $6 billion, which comes from member countries around the world. In 2019, the last year for which figures were available, the US contributed about $553 million.