WHO without US: Bane or boon?

The organisation could now emerge as a forum for the developing world and a voice of the South.

Some of President Donald Trump’s executive decisions have shocked the world. Right-wing political decisions, influenced by populism and narrow self-interest, is an emerging global trend. Global solidarity for the welfare of humanity and the protection of the planet for future generations are ideas that are losing ground.

Democratic principles of equality in discussion and participatory decision-making are getting weakened. Bulldozing by affluent countries with stronger military power has become the regular practice in world forums on climate change, trade and commerce, industry, health, education etc.

Whatever lofty goals of peace and development the United Nations tried to achieve among nations after the second world war are breaking up and getting increasingly difficult to pursue. Veto power of the privileged Security Council members has been the UN’s inherent defect.

At least the specialised agencies such as WHO, UNICEF, FAO, and ILO were not handicapped by veto power in the UN system. But the weaker countries in UN organisations get bullied by the Big Power while arriving at conclusions. Can’t we have a better World Parliament? Do we have to toe the line of Trump, Putin, Kim Jong and Netanyahu all the time? What will happen to WHO without the financial support from the US? A major concern globally.

WHO’s core funding comes from the member-states’ assessed contributions (AC). The basis for this mandatory amount is fixed as per the 1982 UN funding criteria factoring in both the size of the economy and population. That is how powers in the Global North such as the US, the UK, and Germany became the major contributors and not China and India. The second source of funds are called extra budgetary funds (EBF) received from various development agencies, other UN agencies, charities, private philanthropies and international NGOs.

Over the last few decades, AC from member-states has not increased but EBF has gone up to 80%. When Trump made a similar threat of fund stoppage to WHO in April 2020, several European countries and some other countries compensated for this loss. It can happen this time too.

Skewed power dynamics

The US has been sending strong technical delegations to hundreds of theme-based discussion groups prior to the World Health Assembly with a camouflaged agenda and hidden commercial interests. Occupying many senior leadership positions, they dominate over the scientists and experts from the developing world in WHO and many bilateral donors to WHO, influencing policy and funding decisions. Public health issues of the developing world are of low priority in the global agenda. Malaria, Tuberculosis or Trypanosomiasis are not their problems. Public health forums are used more to serve the US corporate interests in medical marketing. This is a vestigial manifestation of past Imperialism and colonisation. It is time for decolonisation at least among the scientific circles and health professionals.

The real voice of criticism against harmful products promoted by transnational pharmaceutical corporations often gets muffled. The South Africa-initiated, India-supported resolutions on the TRIPS waiver in WTO had the backing of many WHO experts from developing countries but it faced stiff opposition from big pharmaceuticals in the US and European countries.

The US, followed by Canada and Germany, set a bad example of hoarding Covid-19 vaccines more than its actual requirement by pre-orders to the vaccine manufacturers. So, the Global Alliance for Vaccines and Immunisation (GAVI) could not abide by its supply plan due to inadequate procurement from manufacturers, resulting in an unjust denial of vaccines to Africa and Latin America.

WHO, the only leader in international health, cannot shelve its core mission of achieving a healthy, humane global order. It provides a global framework for health protocols and affirmative actions for pandemic control based on multilateralism, cooperation and equal participation of members in research and policy formulations. The middle-income countries and emerging economies will rally around and support it in larger measures than before to tide over this crisis. It is their need.

This is an opportunity for BRICS to offset the void left by the US in WHO. India, South Africa, Brazil, Mexico, Thailand, Indonesia, Bangladesh, and Sri Lanka have rich experience of experimentation in public health.

Only a strengthened public health system to provide comprehensive primary, secondary and tertiary care can ensure universal healthcare, not a privatised, insurance-dependent health delivery. WHO alone has that global mandate to handle a health crisis through science, solidarity, cooperation and commitment to reach all with fairness and equity. Trump’s walkout from WHO is a blessing in disguise. It is an opportunity for WHO to become a forum of solidarity of the developing world and an emerging voice of the South.

(The writer is a public health consultant who served UNICEF as a health and nutrition specialist)