How Coronavirus Has Challenged the World Health Organization

World Health Organization | Modern Ethiopian History | Novel

The fight over the WHO has become yet another front in the emerging fight over American geopolitics in the era of a rising China.

The World Health Organization’s handling of the coronavirus pandemic, like so many complicated narratives that must be simplified in today’s head-spinning news cycle, has become an ideological Rorschach test. If, before the pandemic, you were nationalistic, skeptical of international organizations, and hostile to China, you’re probably inclined to view the WHO’s deference toward Beijing as the inevitable response of a toothless organization that has been co-opted by China. If, on the other hand, you believed strongly in international cooperation, were opposed to President Trump, and sympathetic to the WHO’s mission, you may be quicker to forgive the organization for praising Beijing’s transparency.

Indeed, this divide emerged again and again as I asked global health experts, politicians, and advocates their opinion of the WHO response in the early days of the coronavirus pandemic. Of course, this ideological split is to be expected among the general public. But that it persists among experts and policymakers to the degree that it does reflects a lack of direction that may forestall any attempt to meaningfully reform America’s relationship with an enormously consequential international institution.

 CCP Misdeeds 

China, we now know, lied brazenly in an attempt to preserve its reputation on the world stage at the expense of global health. Beijing concealed evidence of human-to-human transmission for weeks after its own scientists became aware of it; refused to provide live virus samples to researchers in other countries for weeks after they were identified, delaying the development of a vaccine; and resisted limits on travel and trade for weeks after it understood the seriousness of the threat posed by the virus.

In the wake of the SARS outbreak of 2003, the WHO adopted a new set of rules known as the International Health Regulations (IHR), which require, among other things, that member states disclose threats to public health as soon as they are discovered. According to much of the congressional Republican caucus and many observers in the press, CCP officials clearly violated their reporting duty when they failed to inform the WHO that they had uncovered clear evidence of human-to-human transmission.

CCP authorities learned on or before December 30 that a number of doctors had been infected with the little-known virus, which amounts to clear evidence of human-to-human transmission, but insisted until as late as January 14 that no such evidence existed. The WHO credulously repeated the claim until January 22, when they finally admitted what CCP authorities had known for at least a month. During his briefing on January 29, after precious time had been wasted, Tedros Adhanom Ghebreyesus, director-general of the WHO, touted China’s handling of the virus, calling it “incredible.”

“We should have actually expressed our respect and gratitude to China for what it’s doing,” Tedros said. “It has already done incredible things to limit the transmission of the virus to other countries.”

Explaining WHO’s Deference

So what explains this obsequiousness? Was Tedros unaware that China was placing its self-interest above global health?

According to Jianli Yang, a Chinese political dissident who founded and serves as the president of the Citizens Power Initiative for China, the WHO didn’t immediately uncover and publicize the overwhelming evidence of Beijing’s duplicity early in the pandemic because they weren’t looking.

The WHO sent a team of experts to China in late January to visit the Hubei provincial Center for Disease Control (CDC) and the Zhongnan Hospital. The experts notably did not visit the Wuhan Central Hospital, Jinyintan Hospital, or Wuhan Pneumonia Hospital, which were then the main hospitals treating COVID-19 patients — the very patients who were then being treated by the doctors warning of the slowly unfolding calamity.

Before the WHO delegation arrived at the Zhongan hospital, authorities warned staff not to discuss anything that might embarrass Beijing. “Be mindful of political implications about what you are going to say to WHO,” the health authorities told the hospital staff, according to a Chinese media report.

The hospital head, Dr. Wang Xinghuan, reportedly insisted that he would tell the delegation about the scale of the problem, specifically the abundant evidence of human-to-human transmission.

“I must tell them the truth. Have we learned any lesson from SARS? Saving lives is the biggest politics, so is telling the truth,” Xinghuan reportedly told the CCP authorities. His recalcitrance earned him a private visit that night from a “friend,” who was dispatched by the CCP authorities to put a scare into him. Still, the doctor reportedly held fast, telling his “friend” that integrity “requires us to stand with the people and would be good for the Party’s overall image.”

Comfort with Dictators

Did Xinghuan relay his message to the WHO delegation when they visited on January 20 as he said he would — and if he did, why did the WHO wait until January 30, ten days later, to declare COVID-19 a Public Health Emergency of International Concern? Even if Xinghuan’s message never made it to the WHO delegates, a number of Taiwanese and Hong Kong doctors had already sounded the alarm at that point, only to be duly ignored. Why, exactly, was the WHO so strident in its repeated claims that there was “no evidence” of human-to-human transmission until January 22, despite its own technical lead admitting in April that she suspected that human-to human transmission was occurring as early as December 31?

“Right from the start, from the first notification we received on the 31st of December, given that this was a cluster of pneumonia — I’m a MERS specialist, so my background is in coronaviruses and influenza — so immediately thought, given that this is a respiratory pathogen, that of course there may be human-to-human transmission,” WHO’s COVID-19 technical lead, Dr. Maria Van Kerkhove, said during an April 13 press conference.

Yang, who has observed Beijing’s geopolitical tactics from both sides of the Chinese border, believes that the likeliest explanation is that Tedros was personally compromised through a bribe or an offer of political support, although no evidence has yet emerged to support this theory.

“Based on my experience as an observer in China’s government, it’s very plausible that the Chinese government put effort to work on him specifically, in order to coopt him with money and maybe something else,” Yang told National Review.

But he also allowed for a more subtle, systemic explanation.

“He feels comfortable working with dictators for money and especially the rich dictatorships,” Yang said, citing Tedros’s nomination of the brutal African dictator Robert Mugabe to serve as a “goodwill ambassador” for the WHO. (His nomination was later rescinded following an overwhelming public outcry.)

Yang made clear that Beijing wouldn’t necessarily have had to bribe Tedros personally; increased contributions to the WHO, which Beijing agreed to provide after the U.S. announced its withdrawal earlier this year, would have sufficed to secure Tedros’s complicity. Yang explained that his work with pro-democracy activists and dissidents in countries such as Iran supported this view. His contacts in the Iranian pro-democracy movement explained that Tedros has only ever visited the country once because the regime is strapped for cash and therefore of no use. Yang juxtaposed this treatment with the attention Tedros lavishes on wealthier authoritarian nations in Africa and elsewhere.

“Tedros got a lot of money from the Central African dictators. They organized a very strong campaign in the U.N. and even hired a U.S. lobby firm,” Yang said. “They spent a lot of money, where did it come from? The dictators.” (The specifics of Tedros’s lobbying campaign and of who funded it remain unknown.)

Defense of the WHO?

Public-health experts who have seen firsthand the importance of international cooperation in meeting global health challenges reject the notion that Tedros is in any way compromised. They defend the organization’s moves as necessary to avoid confrontation with China. The WHO wasn’t eager to praise and pander to the Communist dictatorship; it merely displayed a reluctance to openly challenge China. For these figures, the WHO is an organization in the midst of a tug-of-war between two great powers, doing the best it can to sidestep geopolitics while containing a once-in-a-generation threat to global health.

This is the position held by Dr. David Heymann. As chairman of the Strategic and Technical Advisory Group for Infectious Hazards, he helps to analyze coronavirus data that’s been “freely given” to the WHO by member countries.

Speaking to National Review in late April, just days after hosting a conference with China’s CDC, Heymann cast Beijing’s conduct during the pandemic outbreak as a drastic improvement over their behavior during the SARS outbreak in 2003.

“Historically, China has come quite a long way,” he told National Review.

During the SARS outbreak, Heymann explained, China refused to provide information about the disease until a Chinese doctor traveled to Hong Kong and infected a group of travelers who then seeded a group of other countries with the disease. Only then — after SARS popped up in Vietnam, Canada, Singapore, and elsewhere — did China acknowledge its existence. But that acknowledgment was to some extent coerced by then WHO director-general, Gro Harlem Brundtland, who publicly accused CCP officials of lying about the disease and demanded that they come clean.

During the COVID outbreak, by contrast, Beijing at least acknowledged that there was a potential health threat on the horizon and hosted a WHO delegation that included Tedros himself. For Heymann, who has spent 22 years at the WHO, China’s conduct during the coronavirus outbreak represents progress when viewed through a sufficiently long lens, and so any attempt by the WHO or its member states to punish China for its well-documented malfeasance is counterproductive. (It is possible, of course, that Heymann’s position has changed owing to new reporting that’s emerged since we spoke in April.)

Avoiding Confrontation

So what explains Tedros’s decision to coddle Xi instead of deploying the Bruntland playbook and aggressively calling out Xi’s mendacity on the world stage, using Beijing’s IHR violations to ground his attacks?

David Fidler, senior fellow for cybersecurity and global health at the Council on Foreign Relations, claims that Tedros’s reluctance to aggressively challenge China was the result of a general skepticism regarding the IHR and the usefulness of the expanded authority it granted to the WHO to question the information provided by its member states.

“WHO officials had become resistant to really utilizing IHR regulations in a proactive way,” Fidler said. “And this wasn’t about China, we saw this over the course of two Ebola outbreaks in Africa. It’s not about geopolitics, it’s a sense that global health officials have become resistant to exercising the political authorities they have under the IHR.”

In Fidler’s view, the WHO is not equipped to stand between two member states and adjudicate their great-power competition. He believes that the organization is at its most effective when its leaders focus on a narrow public-health mission.

Inexcusable Failures

While the WHO’s defenders emphasize the broad strokes of its mission and the limitations inherent in a multilateral institution, its detractors continue to point to specific examples of its failures in the early days of the COVID outbreak as evidence that its political positioning makes its public-health mission impossible.

China hawks in Congress, for example, believe that Tedros has sided firmly with Beijing and compromised its public-health mission in the process. They, like Yang, believe that Tedros was in some way personally compromised. Various versions of this argument have cropped up in countless think pieces on the WHO’s handling of the coronavirus. The idea being that Beijing provided crucial support for Tedros when he ran for director-general in 2017, in exchange for a tacit — or, depending on whom you ask, explicit — agreement to soft-pedal his response to their inevitable malfeasance. This narrative makes for effective political fodder because of both its simplicity and its apparent consistency with how China’s leaders have behaved in the past, strategically backing pliant officials in their bids to lead other international organizations and corporations.

“While Chairman Xi was running a CYA propaganda campaign, Dr. Tedros gave the Chinese Communist Party all the cover they needed. The World Health Organization repeated China’s lies as facts — saying that travel restrictions weren’t necessary (they were), that there was no evidence of human-to-human transmission (there was), and that face masks don’t help (they do),” Senator Ben Sasse told National Review when asked about Tedros’s leadership. “People are dying and the Chinese Communist Party is hiding data, but Dr. Tedros is still holding Chairman Xi’s hand and tweeting claptrap — hokey motivational posters won’t find a cure, real data will.”

“While we are focused right now on defeating this virus, accountability for WHO leadership, including director-general Tedros Adhanom Ghebreyesus, is fast approaching,” Senator Marco Rubio said when reached for comment. “The Chinese Communist Party used the WHO to mislead the world, and Dr. Ghebreyesus is either complicit or dangerously incompetent. Neither possibility bodes well for his future at the helm of this critical organization.”

Fidler, who said he and his colleagues were shocked by the degree to which Tedros praised China in the early days of the outbreak, rejected the cut-and-dried explanation proffered by Yang and the aforementioned Republican lawmakers, arguing that the simple transactional account of Tedros’s behavior glosses over important context in the service of political expedience.

Tedros, Fidler explained, is sympathetic to autocrats and suspicious of Western democracies by virtue of his background as a government minister in Ethiopia.

“I don’t believe that Tedros has been compromised or corrupted by support from China,” Fidler told National Review.

Understanding Tedros

In seeking to understand Tedros’s accommodation of Beijing, one must look no further than his résumé, and specifically his tenure as Ethiopian health minister during three successive Ebola outbreaks in the mid-aughts, Fidler says.

During this time, Tedros came to understand that aid supplied by Western democracies, and by the NGOs that do their bidding, came with strings attached in the form of pesky human-rights mandates, which African leaders viewed as cynical attempts to infringe on their sovereignty. The same process played out in the 1990s as African governments struggled to get a handle on AIDS.

“He came into the leadership role in global health with that background. So he knows that, as a government minister, he didn’t like it when international organizations or the U.S. or anybody else tried to tell Ethiopia what to do inside their sovereign territory,” Fidler said. “So his go-to is not to start poking around in the sensitive spots of a sovereign state with regard to health issues.”

China, by contrast, has been considerably less scrupulous when making investments in Africa and is unbothered by the routine human-rights violation in many developing African nations.

David Steinman — an economist and the author of Money, Blood and Conscience, a recent novel about Ethiopian politics, as well as a number of nonfiction works on the same subject published in Forbes, the New York Times, and the Washington Post — takes Fidler’s explanation a step further. In Steinman’s telling, Tedros is not simply responding to sovereignty concerns, he actively favors governance by force and censorship because that’s how he came to and held power in his home country.

Tedros entered the turbulent world of Ethiopian politics as a member of the Tigray People’s Liberation Front (TPLF), an ethnocentric political party backed by a brutal militia group that came to power in 1991 after being designated as an international terrorist organization by the U.S. Homeland Security’s Global Terrorism Database. Tedros began as a rank-and-file party member and eventually rose to become a member of the group’s nine-man politburo. That ascension led to his appointment as health minister in 2005 and foreign minister in 2012.

A Pattern Emerges

During his time at the commanding heights of Ethiopian government, the TPLF and its proxies conducted a campaign of mass terror, rape, torture, and murder of rival ethnic groups, much of which was documented by Human Rights Watch. While Tedros did not personally carry out these atrocities, Steinman claims he is at least partly responsible for them, since he was one of the top-ranking government officials in Ethiopia when they occurred. And he not only stood by while human-rights violations occurred, he actively used his position to downplay the violations and resist transparency efforts pushed by human-rights NGOs. Sound familiar?

When a severe drought led to starvation in the Horn of Africa, Ethiopian government ministers discouraged NGOs from using the term “famine” and used intimidation tactics to force compliance, the Guardian reported at the time.

One year later, Tedros objected to the European Union’s call for an investigation into what observers labeled an act of genocide carried out by the state security forces against the Oromo, an ethnic minority that has long been persecuted by the TPLF. According to numerous observers who spoke to Human Rights Watch, the state security force opened fire on a group of protesters, causing a stampede that led to 55 deaths. Tedros, then serving as Health Minister, wrote a blog post defending the police actions and denying that live rounds were fired. Rather than cracking down on overzealous and violent police, Tedros blamed the protesters, who were there to voice their concerns about farmers being displaced by a government development project.

The protest-turned-stampede was just one of a number of massacres documented in the Oromia region during Tedros’s tenure in Ethiopian government.

“State security forces in Ethiopia have used excessive and lethal force against largely peaceful protests that have swept through Oromia, the country’s largest region, since November 2015. Over 400 people are estimated to have been killed, thousands injured, tens of thousands arrested, and hundreds, likely more, have been victims of enforced disappearances,” reads a Human Rights Watch report based on 125 interviews with witnesses, victims, and government officials.

Human Rights Watch also documented instances in which the state security service tortured Oromo children, placed them in concentration camps, and placed political prisoners in cages with live lions and hyenas in order to coerce confessions.

Given his government’s track record, it’s not hard to imagine that Tedros would have the stomach to help an authoritarian government cover up evidence of a deadly virus.

Struggle over WHO Control

Whatever Tedros’s motivations, his actions seem to have cost his organization the support of its largest donor: President Trump announced in May that the U.S. is withdrawing from the WHO. The U.S. contributed $893 million over the two-year 2018–19 funding cycle, only $237 million of which was required membership dues; the rest was given voluntarily. Incidentally, the second-biggest donor after the U.S. government is the U.S.-based Bill and Melinda Gates Foundation, which gave $531 million over the same period. China has announced that it intends to increase its contributions to partially fill the void left by the U.S.

The Trump administration’s short-term strategy of withdrawal is now clear, but the question of how to respond to Tedros’s handling of the current crisis in the long term remains. Critics such as Steinman and some of the more hawkish members of Congress are demanding that Tedros step down from his perch. When asked about this proposed solution, many of the think-tankers and academics I spoke with pointed out that many of the underlying dynamics that led to the conflagration would persist regardless of who succeeds the current director-general. Whoever takes Tedros’s seat would be forced to triangulate between two hostile and powerful member states intent on using what is supposed to be a public-health-oriented organization to wage geopolitical combat.

“We’re using the WHO as a weapon to focus critical attention on China and I don’t think that’s helpful. I think there are other ways of doing that,” says David Fidler, the Council on Foreign Relations fellow. “We’re risking the things that WHO does quite well. If we didn’t have it we’d have to invent it because African nations and other poor countries need that kind of functional help.”

And this is ultimately what separates the two factions: The WHO’s defenders see it as a necessary, if imperfect, institution that an entirely self-interested U.S. would have to invent if it didn’t already exist. They view the saber-rattling of congressional Republicans as a misguided intrusion of politics into global health. But for critics such as Sasse, Rubio, and Yang, Chinese corruption vitiates the WHO’s ability to fulfill its mission. Geopolitics comes first. Only when WHO has tossed off the yoke of China and the leaders who allow Beijing to bend the organization to its will can it truly succeed. This debate fits neatly into the larger and long-running argument between those who have kept faith with the post–World War II liberal international order — and view the events of the past five years as mere challenges to it — and those who view them as its death knell. And so the fight over the World Health Organization has become yet another front in the emerging fight over American geopolitics in the era of a rising China.