Translated by S Chan
Dr Alex He Jingwei
Department of Asian and Policy Studies (APS)
Faculty of Liberal Arts and Social Sciences (FLASS)
The Education University of Hong Kong
The world has been under the enormous threat caused by COVID-19, as the disease has been raging across the world. Millions of people have been infected, and there may be tens of millions of patients displaying no symptoms at all – some of whom are government heads and celebrities. Some economists are worried that this unprecedented crisis may lead to the biggest global economic disaster in a century and a half which is far worse than the Great Depression a century ago. In the past few months, the disease has spread around the world rapidly. Governments around the world have been implementing their own strategies against the disease. To give a few examples, China imposed total lockdown, Singapore previously reacted passively and slowly, and the UK proposed “herd immunity”. These approaches have received widespread of criticisms around the world. Compared to SARS in 2003, H1N1 in 2009, Ebola in 2014, and Zika in 2016, the COVID-19 pandemic underscores the failure and marginalisation of the World Health Organization (WHO) and the global health governance system that the WHO represents.
Failure of WHO & global health governance
After the SARS outbreak in 2003, the World Health Assembly passed the International Health Regulations in 2005 in response to the weaknesses of global health governance. As a specialized agency of the United Nations, the WHO is mandated to enforce this piece of international law. Unlike previous passive regulations imposed by the WHO in response to global health threats, the International Health Regulations are much more proactive and empower the WHO to play a central role in monitoring threats to global health, assessing health risks and coordinating responses. In this global health governance system, WHO has the authority to declare a “Public Health Emergency of International Concern (PHEIC)” which urges members to take prompt actions as they have the legal obligation to respond quickly.
However, the delayed response of the WHO against COVID-19 has been widely criticized. On 30 January, the WHO declared the PHEIC. Various WHO statements gave confusing messages to the world and contradicted with each other. In early March, WHO Secretary General Tedros Adhamon Ghebreyesus said that it was not a global pandemic, suggesting that 90% of the cases occurred in China. At that juncture, it was already known that the virus is infectious during its incubation period, and there had been many asymptomatic infected individuals. The WHO allegedly ignored the enormous health risks caused by frequent international human movements and raised the global alert level only at a very late stage. Only one week later, on March 11, the epidemic was declared a global pandemic, but much precious time which could have been used to combat the disease had already been wasted. At this point, the debate over whether COVID-19 is an “epidemic” or a “global pandemic” has already lost its relevance. Secretary General has been criticised for leaning towards China early on. The credibility of WHO has therefore faced unprecedented challenges. Some people have even launched a web petition, demanding Tedros Adhamon Ghebreyesus to step down.
Rapid development of NGOs weakens WHO’s influence
In fact, there have long been criticisms against both the WHO and the global health governance system which the WHO represents. As an international agency, the WHO is inevitably characterized by its bureaucratic habits and an innate lack of both human and financial resources. These weaknesses were evident in the response of the WHO to the Ebola outbreak in West Africa in 2014.
On average, the WHO spends $200 million a year on travel – a sum far greater than its expenditure on global public health projects such as those against AIDS and tuberculosis. Due to great budget shortfalls, the WHO has to beg for money around the world. The WHO faces a lack of fiscal stability as it sometimes runs out of money. After taking office, US President Donald Trump cut the government contribution to the WHO by 30%. Meanwhile, receiving donations inevitably means that the budget must be prioritized in certain areas, undermining the ability of the WHO in agenda setting. In addition, international non-governmental organizations (NGOs) in the field of global health have grown rapidly over the past two decades. Public health-focused foundations such as the renowned Gates Foundation and The Global Fund to Fight AIDS, Tuberculosis and Malaria have emerged. They are not only financially stronger and more active than the WHO, but also have a greater voice in their field because they focus on specific diseases. Existing international organizations such as the World Bank and UNAIDS have also taken part in global public health. As a result, the importance and influence of the WHO are undermined.
International politics involved in WHO actions
The WHO is an international organization for public health, but as part of the UN system, its actions often involve international politics and power struggles. For example, geopolitics is often involved in every Secretary General election. In the seven-decade-long history of the WHO, people from North America, South America, Asia and Europe had become WHO Secretary General, while Africa, the continent which needs public health support the most, had not had anyone taking the office. Such a sentiment won Tedros Adhamon Ghebreyesus a lot of support in the 2017 Secretary General election. Moreover, the one-country-one-vote electoral system gives the Asian, African and Latin American countries an advantage. Of note, People’s Republic China earned its seat in the United Nations in 1971 just because the UN adopted the same electoral system.
The global outbreak may have something to do with the poor initial responses of the Chinese authorities. However, with the sympathy and support of the WHO, China was able to gain international support. Beijing is aware that if international public opinion continues to attack China, the damages to its international image and even foreign trade can be great and long-lasting, adding to an already unfavourable diplomatic situation. Therefore, through international public relations campaigns and propaganda, the Chinese government has tried its best to re-narrate the whole story, downplaying China’s responsibility for its poor response to the epidemic early on and highlighting favourable concepts like “virus has no borders”, “great powers should bear the responsibility” and “COVID-19 is the common fate of humanity”. To reshape the narrative, China has been sending medical teams and supplies to different countries. China has also continued to support the WHO led by Tedros Adhamon Ghebreyesus.
Global governance depends on support of sovereign states
In the era of globalization, the structure of global governance is diverse and includes a wide range of systems, from the traditional United Nations system to the emerging mechanisms like the G20 and the BRICS. However, global governance ultimately depends on the support of sovereign states, particularly the major powers. If heavyweights like the United States, China and the European Union do not want to take part, efforts on international governance will fail. The WHO is unable to coordinate global actions against the pandemic, and it plays a very limited role in information exchange and R&D. The global health governance system has become dysfunctional, so the burden of safeguarding people’s health has to be borne by sovereign states. However, the lack of international coordination and guidance will inevitably lead to problems on border control, cross-border transportation, evacuation, expropriation of supplies, and even the lack of a landing place for cruise ships full of tourists – all of which require proper solutions. Perhaps a new order of global health governance will take shape in the midst of this unprecedented public health disaster.