As the World Health Organization convened its Executive Board of 33 select member states last week for the first time since May, the United States appeared to be fully back inside the WHO boardroom – despite the fact that President Donald Trump had announced in July that he would leave the global health organisation due to its alleged China bias in the handling of the COVID-19 pandemic.

While the currents could change again, and yet again, depending on the course of the US elections in November, the US presence in the chambers of WHO decision-making was an important signal, both geopolitically as well as financially for the organisation, after months of being battered by the White House. In past years, United States contributions have represented between 15-20 per cent of WHO’s budget, and even though funding was sharply cut by Trump for 2020-21, it still represents hundreds of millions of dollars for the organisation.

Politicisation of pandemic response

The executive board is WHO’s core governing body. It sets agendas, priorities, reviews and approves budgets before decisions go to the wider World Health Assembly (WHA), which includes all 194 WHO member states. The EB session last week was the first since the May WHA meeting, when geopolitical sparring between China and the US – as well as impromptu declarations by Trump to the media – disrupted the normal decorum of the meetings – and worse yet the focus on combatting the pandemic.

Return to decorum

This time around, US Deputy Secretary of Health and Human services, Brett Giroir, not only joined the WHO Executive Board meeting (5-6 October) but even referred positively to the “progress” being made by a series of independent panels and committees that are reviewing the WHO’s pandemic response — as well as that of WHO member states.

“We appreciate the progress made,” said Giroir, asking that EB members be briefed again in November and in early 2021. Significantly, he also made no reference to Trump’s earlier announcement that the US would withdraw from WHO.  Although European observers who are close to the proceedings said that it remained unclear if the United States was back for good — or only until 2021, when the written commitment by Trump to withdraw would actually take effect.  Wait until after the election and then we will know more, they whispered.

However the demeanor of Giroir, at least, was revealing, in what he did not say.  While he did pointedly refer to the “billions” of people impacted by Covid-19, as well as the “failure” of some member states to quickly respond, he politely refrained from attacking China by name:

“Despite the many advances in technology, international cooperation and instantaneous communication, and the positive steps in response outlined this morning,… we cannot overcome the failure of any member state to provide accurate, complete and timely information on outbreaks and potential health emergencies,” Giroir said.

China’s EB representative, Zhang Yang, was similarly restrained. Sidestepping the simmering debate over the timing of China’s alerts to the global community on the virus, he focused on the role that the various review panels could play in recommending measures that could “further support countries with weak health systems.”

He also called about the review panels to “inform members states of their work in a timely manner and use their platforms to enhance direction with member states.”

Overall, such exchanges represented a kind of “return to decorum” that is the traditional hallmark of WHO member-state meetings.

Perhaps member states were also reflecting on the interim findings of the Independent Oversight Advisory Committee (IOAC), which were presented at the EB meeting. The committee, charged with reviewing WHO’s Health Emergencies response, also pointedly noted in its summary findings that:

“The politicization of pandemic response is a material impediment to defeating the virus.”

Europe steps forward

Although US and Chinese remarks were subdued, European Union flexed its muscles.

Germany, speaking on behalf of the European Union bloc on Tuesday, said member states need to consider “strengthening WHO’s perogative in terms of access to information”:

“We look forward to discussing ideas such as increased accountability of member states on preparedness, for example, through the establishment of a periodic review mechanism, as proposed by the African Union, and all strengthening WHO’s prerogatives in terms of access to information… Emphasis must also be placed on development of proper and unified health data collection at all levels.” Björn Kümmel, Germany’s EB representative.

Criticis have said that one of the main shortcomings of the current legal frameworks in which WHO operates is that it has no real legal perogative to demand access to information from a sovereign nation – which may be vital to coping with an emerging global health crisis. Regardless of whether China really did delay the release of data about the emergence of a mysterious pneumonia-like virus in Wuhan by days or weeks in late 2019, as the US has claimed, European member states and other nations are deeply concerned.  They want more transparency to be built into global health emergency alert systems, so that potentially devastating delays in reporting don’t occur and such questions don’t arise again.

In that light, Kümmel’s frank appeal to the three panels that are now exploring the pandemic response from various angles is also particularly striking:

“In your evaluations, do not be afraid to tell uncomfortable truths. In your recommendations, do not be afraid to challenge…member states, to questions current modes of operation and to show boldness and vision. You can count on the full support of the EU and its member states.”

Weathering the pandemic storm

If the WHO organisational boat seemed to be riding through rough waters in May, with major leaks in the budget engine, this recent meeting signalled a kind of stabilisation, and a back-to-business approach. And so far, WHO director general Dr Tedros Adhanom Ghebreyesus, who faces re-election in May 2021, seems to be weathering the storm while also remaining firmly at the helm himself, despite the blistering criticism directed at him in past months by WHO’s most powerful member state: the US.

Bright spots on horizon –  maybe?

There are some bright spots on the horizon – however distant they still may be. The pandemic continues to expand daily, with some 37 million reported infections and over one million deaths now reported  worldwide.

China or not, many insiders say that WHO’s early guidance on issues such as masks or travel restrictions was clumsy and delayed – saying neither would be useful when in fact both proved to be essential as containment strategies used by countries worldwide.

At the EB meeting, Austria also asked the organisation to develop more detailed and up-to-date guidance about how airlines and countries can safely organise travel now as countries seek to revive their airline industries – using a patchwork of testing and quarantine approaches. It is often precisely around such guidance that WHO is particularly hesitant – either lacking the in-house expertise or else fearing that it might tread on the sovereign toes of member states.

But on the more positive side, the organisation has in fact, been key to the mobilisation of an unprecedented global response.

This has included everything from bolstering COVID lab test capacity across Africa and doling out millions of pieces of protective gear for health workers in the early days, to far more sophisticated initiatives.  These include the massive WHO-coordinaed “Solidarity” trial that is pooling methods and results for the hundreds of clinical trials going on around the world to test Covid-10 therapies. In addition, WHO in partnership with the Global Fund and others, is also now rolling out the procurement of hundreds of millions of rapid tests in low-income settings, where they could make a huge difference. And WHO has ramped up its daily reports and commenting on pandemic trends and issues, from not only headquarters but also its African, Americas and European regions, to a level where media is chasing to keep track of the latest news release.

Perhaps its most stunning achievement to date is the co-creation with Gavi, The Vaccine Alliance of a massive “COVAX” vaccine procurement pool, to which some 180 high and low-income countries have formally committed, most recently China and the Republic of Korea.  The broad buy-in, described by WHO officials as “moving from success to success” is intended to help reduce the costs of manufacture, and facilitate the rational distribution of available supplies of the most effective vaccines, as soon as they become available, to health workers, older people, and other groups most at risk. The Covax pool has so far drawn over $16bn in donor support and World Bank finance.

So while the recent EB meeting was largely dominated by diplomatically-framed debates centred around the independent reviews of WHO’s performance and ideas for improvement going forward, Dr Tedros and his team also had their moment in the sun to explain what they have accomplished so far. The list in the powerpoint slides certainly looked impressive – and member state reactions were largely supportive.

And speaking at the GLOBSEC 2020 forum, the day after the EB sessions concluded, it was clear that Dr Tedros was clear about what he thought the key message of the independent reviews and evaluations should be:

“We look forward to the findings and recommendations of these reviews. But there are several lessons that are already staring us in the face.

“First, we must learn from this pandemic, and make political and financial commitments now, to address critical gaps in national and global preparedness. We must renew our determination as a global community – that never again will a new pathogen be allowed to spread with such destructive impact on our populations.

“The time to prepare for emergencies is before they occur. WHO support for country preparedness is rooted in the idea that the best defence for health emergencies is strong health systems based on universal health coverage and primary health care. So we need to have a real and strong commitment to universal health coverage.”

• Originally published in Geneva Solutions,a non-profit journalistic platform dedicated to International Geneva, with which Health Policy Watch is collaborating.  With reporting by Pip Cook.

Image Credits: Johns Hopkins University.