World Health Assembly Prepares For Show Of Unity On Global COVID-19 Response; Contest Over Taiwan & Possible US Funding Resumption
World Health Assembly 70th meeting in 2017, at Geneva’s Palais des Nations – This year’s virtual format to be a first.

The world seems set to make at least a symbolic display of unity in the battle against the COVID-19 pandemic  at the upcoming World Health Assembly (WHA), which begins on Monday. The WHO’s 194 member states are expected to overwhelmingly approve a European Union-led resolution that aims to step up the global COVID-19 response, and ensure equitable access to treatments and future vaccines. Along with EU member states, the resolution, published Friday on the WHO website, is supported by an impressive list of 28 other countries worldwide, including Canada, Brazil, Chile, Norway, Indonesia the Republic of Korea, South Africa, Zambia and the United Kingdom.

But the show is unlikely to go off as smoothly as some might hope, and not only because the 73rd Assembly is meeting for the first time ever in a virtual format.

Rising geopolitical tensions between the United States and China – are also likely to be vivid display at the very beginning of the two day event. Before countries can start talking about COVID-19, they face a likely vote over a procedural proposal to invite Taiwan to the Assembly as an Observer.

The proposed has been made by 13 countries, including Guatemala – is set to be the first country speaking at the WHA.

The issue is less about Taiwan, however, than about the conviction in Washington as well as in other western capitals that China’s reporting on the SARS-CoV-2 virus and its possible origins has not been entirely transparent, particularly in the early days. Lining the COVID issue are strong US concerns, shared by countries in the Western Pacific region and beyond, about the expanding web of Beijing’s geopolitical influence.

Meanwhile, as US and WHO legal and technical teams worked behind the scenes to mitigate effects of the recent US suspension of funds to WHO, Fox News reported that the White House was now considering an agreement “to pay up to what China pays in assessed contributions,” according to a draft letter obtained.

Fox News Report aired Friday in the United States

Sources in Geneva told Health Policy Watch if the deal is successful, it could even be announced at the WHA. China’s assessed contribution for 2020 is US$ 28.7 million – about half of the US$ 57.8 million due from Washington. However, the US also has almost US$ 41.3 million in unpaid bills outstanding from last year, according to the 30 April 2020 WHO account.

“This is an unprecedented moment for WHO. It is also in the line of fire as it has never been before. We see WHO walking a tightrope between two major world powers,” said Suerie Moon, co-director of the Global Health Centre of the Geneva Graduate Institute, which is hosting a two-week series of events around the WHA that kicked off Thursday.

She described the COVID-19 pandemic as “a stress test for the global health community. It’s a stress test that can narrow or widen the divisions that we already see.  What we need to do is to think  beyond business as usual, to move beyond politics as usual – and the WHA will be a test for that.”

So while things could still change rapidly over the weekend, here is the latest state of play for the WHA.

European Union Resolution Has Large Consensus

On the unity side of the coin, Thursday, member states quietly endorsed the draft of a proposed WHA resolution on COVID-19 response. The draft resolution, the main item on this year’s official  agenda,  includes far-reaching provisions for the creation of a voluntary pool of patents for COVID-19 treatments [see related story]; investigation into the origins of the virus; and strong affirmation of WHO’s central role in global health balanced by a call for a “stepwise examination” of the agency’s response to the pandemic.

“I think we are seeing possibly the best… in terms of international cooperation. I am not saying we won’t also see the worst,” said French Global Health Ambassador Stephanie Seydoux, referring to the range of COVID-19 initiatives that have been launched by the global community in recent weeks, and which are captured somehow in the draft WHA resolution.

In a modest victory for civil society, the resolution also makes several references to the rights of countries to legally override international patent rules during a health emergency, making use of so-called “flexibilities” in World Trade Organization Trade Related Aspects of Intellectual Property Rights (TRIPS).

The resolution had been the subject of tense, closed-door deliberations for weeks. It was characterized by usual sparring between countries more protective of industry and those member states, backed by civil society groups, keen to break what one key advocate, James Love, described as “patent monopolies” over critical health products.

“Everything right now should be preparing to scale up as fast as possible, use as many manufacturers as possible, and have no monopolies on any of these technologies,” said Love, head of Knowledge Ecology International, speaking at a webinar Thursday on the planned WHO COVID-19 Technology Pool, including leading civil society and UN advocates.

The formal WHA resolution is focused on voluntary pooling of innovations and recognizes the private sector role. But it’s worthy of noting that major European powers, including France, the United Kingdom, Switzerland and Germany, all home to large pharma interests, back a final compromise draft that also repeatedly referred to the rights of countries to break patent rules.

This is no doubt due, in part, to the growing fears among Europeans also been hard-hit by the virus, that reliance purely on market mechanisms to ensure equitable distribution of the next treatment or the first vaccine might also leave them out in the cold. The inherent challenges to  ensuring access is equitable and broad were immediately visible this week in the French uproar over a Sanofi statement that the US would get the first pick of any vaccines that it produces because they had invested more in its development.

United States Sought Last Minute Changes – Mostly Technical or Cosmetic
President Donald J. Trump listens as Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases briefs media Saturday, April 4.

In the final hours of the negotiations over the EU draft text, it appeared that the United States was the main actor still trying to make changes.  And even there, seasoned observers say, Washington’s proposals were in fact fairly technical or cosmetic in nature – an extra nod to industry in some key clauses as well as requests for clearer definitions of terms like “equitable access” – but not opposition to the concept, as such.

It still remains to be seen if the White House will indeed back the final COVID-19 Response resolution when it finally comes before the plenary – where the resolution is expected to adopted.

In the WHA, where tradition has most resolutions adopted by consensus and support for the  measure is overwhelming, the US is unlikely to demand a vote. Washington may still choose to “disassociate” itself from the resolution or from certain sections with which it doesn’t agree  – particularly language referring to the continuation of health services, including services for “sexual and reproductive health” regarded as code for abortion by the White House.

But there are also clearly elements in the draft resolution that the United States appears keen to support. This includes the call for a thorough, science-based investigation into the sources of the virus; as well as an “examination” of the performance of WHO (as well as other UN agencies and countries) in the overall pandemic response – in a  “stepwise” approach – that countries hope can make the investigation timely without detracting from the overall pandemic response.

While deferring comment on the resolution, per se, a US Mission spokesperson told Health Policy Watch: “The United States will be present and vocal at the World Health Assembly, as in all years past. Addressing global health threats effectively would be impossible without the United States, which contributes close to 40 percent of the world’s global health assistance – nearly five times larger than the next largest donor, and more than 20 times more than China…. We expect the Secretary of Health & Human Services Alex Azar to be the leader of our delegation to the WHA this year.”

Amidst Attempts to Show Unity – Taiwan Is Thorny Reminder of a Divided World
Taiwanese President Tsai Ing-wen, speaks about the health system response to the COVID-19 pandemic

Admidst the attempts to display global unity, however, the simmering issue of Taiwan is a sober reminder of the big divisions that shape real-time political responses to the virus.

Thirteen WHO member states have asked for the inclusion of a supplementary WHA agenda item, iinviting Taiwan to attend the health assembly as an observer.

“Consultations are going on, to reach an arrangement. But if there is no arrangement and there has to be a vote, it could be a vote by a roll call and it could take a long time. It could be disruptive,” said Gian Luca Burci, former WHO legal counsel speaking at a WHA Overview webinar, convened by the Geneva Graduate Institute’s Global Health Centre, yesterday.

This is hardly the first time the issue of Taiwan has surfaced at the WHO.  Between 2009 and 2016, Taiwan was invited personally by then WHO Director General Margaret Chan, herself a native of Hong Kong, with the tacit agreement of both China and the United States.  That was when relations were also warmer between the Taiwanese government and mainland China.  But after the 2016 election of Taiwan’s new president, Tsai Ing-wen, a China-skeptic, chill set in, and the protocol for WHA changed.  For the past several years, since WHO Director Tedros Adhanom Ghebreyesus took the helm, two member states would propose to the WHA Committee setting the meeting agenda that Taiwan be included.  Two other countries would object. And then the matter would be quietly set aside.

Already at February’s WHO Executive Board meeting the atmosphere was heating up around the Taiwan issue.

Pointed references then by some Latin American and African member states to Taiwan’s role in supporting their COVID-19 response, met with sharp protests from Chinese delegates at the meeting, who objected to Taiwan’s name even being mentioned in WHO meetings.

At that time, however, Washington was still making friendly overtures toward Beijing. Weeks later, as the United States began to blame China publicly for holding back on vital information about the new coronavirus, WHO was also drawn into the fray, with positions US President Donald Trump described as “China-centric”.  Taiwan revived and circulated its initial emails to the WHO, particularly one sent on 31 December 2019 referring to the emergence of a mysterious virus in Wuhan that had some patients in isolation, which it says was ignored. Soon after that, President Trump said he would suspend WHO funding for 90 days, pending an investigation of its response.

But the US concerns go well beyond the virus or WHO’s performance. In fact its about China. Washington is increasingly concerned about web of influence that Beijing is building not only in the Pacific region, but also as a result of its “Belt and Road” initiative reaching westward to Europe and the eastern Mediterranean. Strikingly, a visit by US Secretary of State Mike Pompeo to Israel last week was more focused on the perceived strategic threat from new Chinese investment in Israeli infrastructure, including ports, a light rail system and a desalinization plant – than regional conflicts, Israeli media reported.

So while striking a positive note, vis a vis the upcoming WHA, the US position on the inclusion of Taiwan in the Assembly is unequivocal:

“We look forward to participating in this year’s WHA, and remain determined to see Taiwan join those conversations as an observer,” the US Geneva Mission spokesperson told Health Policy Watch.

“We have long supported Taiwan’s membership in international organizations where statehood is not a requirement, and believe their successful actions in response to COVID-19 would be of significant benefit to the rest of the world.  The People’s Republic of China would rather that success not be shared, no doubt to avoid uncomfortable comparisons.”

Is a US Funding Resumption to WHO in the Cards?

The US suspension of funds to the WHO, announced last month, was linked to the US criticism of the agency over its alleged tilt towards Beijing.  Hints now about a possible resumption of funds  come on the heels of several weeks in which WHO’s African Region, in particular, warned of serious impacts on its heavily-US-funded operations. Rumors of possible fallout, including the risk of layoffs, had begun to circulate among staff at WHO’s Geneva headquarters. Meanwhile, WHO legal and technical teams have been negotiating behind the scenes with their US counterparts over ways to mitigate the damage – including possibly funneling urgently needed monies directly to those groups or agencies working directly in the field so that vital frontline disease control activities are less seriously harmed.

Announcement at the WHA of a partial resumption in monies, then, would be a huge breakthrough.  Payment of even part of the $US 57.8 in assessed funding to WHO for 2020, would be an important symbolic step forward in breaking the ice around the current impasse, paving the way for a full restoration of funding, more quietly later on.

Closing the hefty back bill owed by the US from last year would also certainly help cover any immediate shortfalls. And in this area, WHO has some leverage to wield – since this US$41.3 million is legally-owed to the organization in any case and pre-dated the White House announcement of the COVID-19 related suspension.

Also worthy of note:  so-called “assessed funding” due from the United States for the current budget period of 2020-21 is US$ 116 million. But that represents only a fraction of its total spending. In 2018-19 the US channeled nearly US$ 500,000 to the Agency- including so-called voluntary contributions for specific programme activities.

Total US contributions, in turn represent about 15% of WHO’s total budget – and an even higher proportion of its activities in Africa.

What remains to be seen if any White House announcement of a partial funding resumption will be somehow be tied to a WHO or a WHA member state gesture that restores “observer” status to Taiwan, which recognized or not, is represented by a democratically-elected government.

Updated 18 May 2020

Image Credits: WHO, WHO, Fox News , flickr/The White House. Official White House Photo by Andrea Hanks, By Office of the President – Flickr, CC BY 2.0,.