If WHO Is Broken, Who Broke It? - MedPage Today

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While President Trump and other politicians are ready to cut ties with the World Health Organization (WHO), infectious disease and policy experts continue to caution against such a move, advocating instead for a "reimagining" of the organization's funding and stronger commitments from member nations.

The beleaguered WHO not only came under fire from President Trump for the agency's response to COVID-19, but Congress has also been looking into the agency. On Monday, the Republicans on the House Foreign Affairs Committee released an interim report about the COVID-19 pandemic, claiming the WHO has "repeatedly violated their own [International Health Regulations, IHR] and their obligations to Member States."

Moreover, the report claims WHO Director-General Tedros Adhanom Ghebreyesus, MBBS, PhD, "delayed the announcement of a Public Health Emergency of International Concern for political, not medical reasons."

But infectious disease experts have cautioned that taking the U.S. out of the WHO is not the answer, saying it would be detrimental to public health around the world.

"The WHO's convening authority ensures all the science is convened in the right place ... it has been invaluable against the coronavirus," said Charles Holmes, MD, of Georgetown University in Washington, on an Infectious Diseases Society of America (IDSA) briefing call on Friday.

Holmes, a member of IDSA, said if the U.S. were to withdraw from the WHO, it would be like "cutting off our nose to spite our face" and that the CDC would "forfeit a seat at the table" for issues such as selection of strains for next year's flu vaccine.

"Without WHO's leadership in science and public health, the world would be adrift. The decision puts the administration on the wrong side of history," he argued.

Lawrence Gostin, JD, of Georgetown University Law Center, argued in an article in JAMA published Tuesday that reform was the answer. He said member-state compliance in the WHO should be more vigorously enforced, and the agency should be given a larger budget to respond to the world's global health threats, such as the COVID-19 pandemic.

Gostin acknowledged the WHO's missteps, including its assent to China's early statements that SARS-CoV-2, the virus that causes COVID-19, was not "readily transmissible" between humans.

"The agency should not have praised China's transparency when it suppressed information on community transmission," he wrote.

At the same time, Gostin noted that China withheld information from the WHO on COVID-19; the agency "relies on member state cooperation, including access to a member state's territory to get WHO experts on the ground."

Moreover, he suggested that WHO doesn't need reform so much as do its member states, which exert political pressure on the organization while starving it for funds.

"The WHO director-general must have freedom to act in the best interest of public health and science without political interference," Gostin wrote.

He noted that while WHO member states are legally obligated "to develop core health capacities to detect and respond to public health emergencies," compliance remains "spotty." Gostin argued the IHR should be reformed, so WHO could not only incentivize member states to meet their IHR duties, but specify "severe noncompliance" could result in having voting privileges or other services suspended.

Gostin also characterized the WHO as "chronically underfunded" with a budget similar to a large U.S. hospital, and at $4.8 billion, it is $2 billion lower than the CDC's budget. He added the WHO is "too reliant on voluntary funds," with only less than $1 billion of the agency's 2018-2019 budget coming from member states' mandatory assessment, and the rest from "voluntary earmarked funding." Gostin recommended raising the WHO's budget to be more in line with the CDC's.

"The WHO has achieved so much even with paltry funding," he wrote. "Out of the COVID-19 pandemic, the WHO could be reimagined as a stronger, more responsive international agency."

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  Molly Walker is an associate editor, who covers infectious diseases for MedPage Today. She has a passion for evidence, data and public health. Follow

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