Thanks so much for putting this together. This action list is a good starting point, but additional steps could add should enhance WHO's governance and delivery of results:
Governance Reforms: Improve the structure and conduct of the Executive Board (EB) and World Health Assembly (WHA) for more transparent decision-making.
WHA Resolutions: Revise the business model to ensure resolutions are inclusive and representative of global health priorities and consider what the resolutions are for.
Enhanced Accountability for delivering results - perhaps a LIVES SAVED TRACKER in addition to other trackers. Strengthen accountability mechanisms for WHO officials and member states through regular audits and independent evaluations.
Balanced Communication: Ensure WHO statements address both attacks on health facilities and their militarization in conflict zones.
We can create a more effective and accountable WHO.
Thanks Peter - balanced and succinct.. sadly no surprises in his (Trump's) actions thus far. However, I bet he didn't expect to be challenged at church - "Episcopal Bishop Gives Sermon Counseling Trump to ‘Have Mercy’" - https://www.youtube.com/watch?v=e6HG0eR6YfM
The inauguration of President Trump has been welcomed and heralded globally as it promises to bring to an end many ‘irrational decisions’ of the previous administration.
There are, however, concerns over some of the positions of the Trump administration. Top among these, is the US’ exit from WHO. Of course this might not be the only controversial position —considering that he also puts a blanket ban on immigrants much as the US is historically a land of immigrants.
Whereas prior articles on the issues have concerned themselves with the legality of the withdrawal and its potential impact on global health, little has been said about what such a move means for the US itself . Disturbingly, these were not irrational knee-jerk reactions; but rather long thought over decisions that began with threats right before Trump’s first term ended. Here, I shall restrict myself to highlighting the negative impact of the US’ proposed exit from WHO with the notion, that perhaps—we can get the administration to appreciate the far reaching ramifications on US/CDC’s national health security agenda.
Lets start by looking at the reasons cited for the exit:
Failures in managing the COVID19 pandemic. These failures reflect not just on WHO, but the entire world’s ill preparedness to deal with disaster. Unless we find ways to institutionalise memory of the negatove impact all disastors and not just pandemics, pose to humanity; we shall forever remain vulnerable. Deliberations at the G20 meeting in Malaysia that proposed revision of the international health regulations (IHR-2005) and the pandemic treaty and fund, were a good start, for which the US should stay and provide strategic leadership.
WHO ripping off the US via contributions: The US is the most developed country of the world; and in its stature as superpower; one wouldn't be expecting it to recede its leadership even in terms of financing a global human agenda. Therefore, talk of being ripped off are not equitable but self defeating and leave one wondering; the US’s continued economic dominance across the world. Alves LGA, et al argue that countries become global leaders by controlling international and domestic transactions connecting geographically dispersed production stages; not vice versa.
Failure to put China to account on the origins of the Wuhan virus: Scientifically, its almost impossible to determine—at least with the tools we have at hand; the difference between a naturally evolved bug; and that produced through gain of function (GoF) research. This because, unlike recombinant DNA technology, GoF research leaves no indels we can effectively trace. That said, it is curious given the involvements of US researchers in the earlier births of GoF research on coronaviruses and evidence of shifting the research to China even against standing federal laws; that the US should expect WHO to comprehensively put this matter to rest. Indeed, we argue that answering this question is of less relevance today; and all efforts must be put towards preventing another similar occurrence.
With the above picture in mind, lets now turn to the negative consequences of the US exiting WHO; specifically for the US itself.
Loss of global solidarity: Pandemics affect, not just one jurisdiction; but regions and the world at large. Solidarity is required across the pandemic response strategy, from alertness, surveillance, insights in best practices for care and management, research into medical countermeasures, and even recovery, etc is key. By leaving the WHO, the US forfeits and forsakes all these. There is no way the US can ever be better prepared for the next pandemic, unless of course it extricates itself from the global village and remains isolated as an island, even in terms of international travel. Most importantly, the US is undermining the very principles that inspired the formation of United Nations and other international bodies. In prospect, one is left to ask what other international body would follow WHO, the WTO, IMF or UNESCO? Ideally, the best thing to do given the circumstances would be to demand for accountability and or reforms, rather than undermine a more than 50 yrs body.
Forfeiting access to global epidemic and pandemic data: As for solidarity, data across the spectrum of the epidemic response is key for informed and evidenced decision making. The idea of having WHO as the UN’s global body is in part, to create a framework for centralized collection and refinement of data and evidence. In otherwords, WHO is a clearing house for most if all the epidemic data there is across the world, which individual nations and the entire world need access to to make the right decisions in terms of response.
Disbanding US USAID and CDC’s international health security programs: Dismantling these programs will not only disadvantage vulnerable communities depending on US government programs for disease control; but they will also remove the field experience for US scientists and doctors who are deployed in these programs. This experience responding to epidemics across the borders is very fundamental for the functioning of the US CDC in Atlanta, when guarding US national health secirity.
Difficulties in access to pathogen isolates and or human biospecimen required for the research and development (R & D) of medical countermeasures. The discovery and initial proof of concept testing of countermeasures against epidemic research not only require access to isolates of the causative agents; but samples from both affected and nornal controls. Moreover, downstream validation of say diagnostics, and clinical trails need to happen within epidemic setting. Would US prefer to pursue bilateral relationships with affected countries then; or exploit already existing mechanisms present, both in WHO’s framework or the US CDC’s country offices? The former disadvantages US scientists and biotechs, in terms of competitiveness to put the first product on the market.
In conclusion, we argue that the US can not triumphantly exit the WHO—without dischenfrising itself. The Trump administration and American people are free to do as suits them on this subject, but the outcomes will only accrue self defeat.
Thank you Peter for your thoughtful comments. As many of us who have been engaged with WHO for decades can comment, that like with all organizations from time to time there is a need for "rethink", revise, and bold leadership. Let's hope that this "crisis" will lead to such effort. While I have limited faith that it will happen one can still hope. One of the WHA actions that often brought me to tears is the "politics" that being played as central to voting on resolutions and agendas vs the essence of "global health". The world needs a WHO but the world needs a different WHO.
Thanks so much for putting this together. This action list is a good starting point, but additional steps could add should enhance WHO's governance and delivery of results:
Governance Reforms: Improve the structure and conduct of the Executive Board (EB) and World Health Assembly (WHA) for more transparent decision-making.
WHA Resolutions: Revise the business model to ensure resolutions are inclusive and representative of global health priorities and consider what the resolutions are for.
Enhanced Accountability for delivering results - perhaps a LIVES SAVED TRACKER in addition to other trackers. Strengthen accountability mechanisms for WHO officials and member states through regular audits and independent evaluations.
Balanced Communication: Ensure WHO statements address both attacks on health facilities and their militarization in conflict zones.
We can create a more effective and accountable WHO.
Thanks Peter - balanced and succinct.. sadly no surprises in his (Trump's) actions thus far. However, I bet he didn't expect to be challenged at church - "Episcopal Bishop Gives Sermon Counseling Trump to ‘Have Mercy’" - https://www.youtube.com/watch?v=e6HG0eR6YfM
On why the US can not triumphantly exit WHO
The inauguration of President Trump has been welcomed and heralded globally as it promises to bring to an end many ‘irrational decisions’ of the previous administration.
There are, however, concerns over some of the positions of the Trump administration. Top among these, is the US’ exit from WHO. Of course this might not be the only controversial position —considering that he also puts a blanket ban on immigrants much as the US is historically a land of immigrants.
Whereas prior articles on the issues have concerned themselves with the legality of the withdrawal and its potential impact on global health, little has been said about what such a move means for the US itself . Disturbingly, these were not irrational knee-jerk reactions; but rather long thought over decisions that began with threats right before Trump’s first term ended. Here, I shall restrict myself to highlighting the negative impact of the US’ proposed exit from WHO with the notion, that perhaps—we can get the administration to appreciate the far reaching ramifications on US/CDC’s national health security agenda.
Lets start by looking at the reasons cited for the exit:
Failures in managing the COVID19 pandemic. These failures reflect not just on WHO, but the entire world’s ill preparedness to deal with disaster. Unless we find ways to institutionalise memory of the negatove impact all disastors and not just pandemics, pose to humanity; we shall forever remain vulnerable. Deliberations at the G20 meeting in Malaysia that proposed revision of the international health regulations (IHR-2005) and the pandemic treaty and fund, were a good start, for which the US should stay and provide strategic leadership.
WHO ripping off the US via contributions: The US is the most developed country of the world; and in its stature as superpower; one wouldn't be expecting it to recede its leadership even in terms of financing a global human agenda. Therefore, talk of being ripped off are not equitable but self defeating and leave one wondering; the US’s continued economic dominance across the world. Alves LGA, et al argue that countries become global leaders by controlling international and domestic transactions connecting geographically dispersed production stages; not vice versa.
Failure to put China to account on the origins of the Wuhan virus: Scientifically, its almost impossible to determine—at least with the tools we have at hand; the difference between a naturally evolved bug; and that produced through gain of function (GoF) research. This because, unlike recombinant DNA technology, GoF research leaves no indels we can effectively trace. That said, it is curious given the involvements of US researchers in the earlier births of GoF research on coronaviruses and evidence of shifting the research to China even against standing federal laws; that the US should expect WHO to comprehensively put this matter to rest. Indeed, we argue that answering this question is of less relevance today; and all efforts must be put towards preventing another similar occurrence.
With the above picture in mind, lets now turn to the negative consequences of the US exiting WHO; specifically for the US itself.
Loss of global solidarity: Pandemics affect, not just one jurisdiction; but regions and the world at large. Solidarity is required across the pandemic response strategy, from alertness, surveillance, insights in best practices for care and management, research into medical countermeasures, and even recovery, etc is key. By leaving the WHO, the US forfeits and forsakes all these. There is no way the US can ever be better prepared for the next pandemic, unless of course it extricates itself from the global village and remains isolated as an island, even in terms of international travel. Most importantly, the US is undermining the very principles that inspired the formation of United Nations and other international bodies. In prospect, one is left to ask what other international body would follow WHO, the WTO, IMF or UNESCO? Ideally, the best thing to do given the circumstances would be to demand for accountability and or reforms, rather than undermine a more than 50 yrs body.
Forfeiting access to global epidemic and pandemic data: As for solidarity, data across the spectrum of the epidemic response is key for informed and evidenced decision making. The idea of having WHO as the UN’s global body is in part, to create a framework for centralized collection and refinement of data and evidence. In otherwords, WHO is a clearing house for most if all the epidemic data there is across the world, which individual nations and the entire world need access to to make the right decisions in terms of response.
Disbanding US USAID and CDC’s international health security programs: Dismantling these programs will not only disadvantage vulnerable communities depending on US government programs for disease control; but they will also remove the field experience for US scientists and doctors who are deployed in these programs. This experience responding to epidemics across the borders is very fundamental for the functioning of the US CDC in Atlanta, when guarding US national health secirity.
Difficulties in access to pathogen isolates and or human biospecimen required for the research and development (R & D) of medical countermeasures. The discovery and initial proof of concept testing of countermeasures against epidemic research not only require access to isolates of the causative agents; but samples from both affected and nornal controls. Moreover, downstream validation of say diagnostics, and clinical trails need to happen within epidemic setting. Would US prefer to pursue bilateral relationships with affected countries then; or exploit already existing mechanisms present, both in WHO’s framework or the US CDC’s country offices? The former disadvantages US scientists and biotechs, in terms of competitiveness to put the first product on the market.
In conclusion, we argue that the US can not triumphantly exit the WHO—without dischenfrising itself. The Trump administration and American people are free to do as suits them on this subject, but the outcomes will only accrue self defeat.
Thank you Peter for your thoughtful comments. As many of us who have been engaged with WHO for decades can comment, that like with all organizations from time to time there is a need for "rethink", revise, and bold leadership. Let's hope that this "crisis" will lead to such effort. While I have limited faith that it will happen one can still hope. One of the WHA actions that often brought me to tears is the "politics" that being played as central to voting on resolutions and agendas vs the essence of "global health". The world needs a WHO but the world needs a different WHO.
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