U.S. President Joe Biden made the right decision for the United States to remain engaged in the World Health Organization (WHO), reversing former U.S. President Donald Trump’s misguided plan to withdraw from the global health body. This diplomatic U-turn provides Washington with an important platform to advocate for improved global health standards—as well as increased accountability for China and other WHO members with a history of rogue behavior that has exacerbated the spread of pandemics. The move also allows Washington to lead a multilateral movement aimed at streamlining the WHO’s sprawling operations and core functions, which have strayed significantly from the organization’s original mandate.
That’s the good news.
The downside is China and Russia are already undermining efforts aimed at restoring the WHO’s international credibility. This includes joining forces to derail a European Union-led proposal designed to address the organization’s flawed pandemic response by strengthening internal accountability and establishing institutional guardrails to neutralize pandemic disinformation. The EU’s proposal, intended for discussion during the WHO’s annual agenda-setting meeting beginning on May 24, would also mandate a fixed timetable for releasing the WHO’s final report on the origin and initial spread of the COVID-19 virus, a topic of keen interest not just to the Biden administration.
If history is any guide, achieving consensus among the WHO’s 194 members for even one of the EU’s proposed reforms is a long shot. What’s worse, Washington’s notable absence from ongoing discussions on WHO reform as well as its failure to nominate a U.S. representative to the organization’s executive board does not bode well for a near-term diplomatic breakthrough. With the clock quickly counting down to the late May gathering, the Biden administration needs to regroup—and fast. It also needs to realize the road to reforming the WHO does not run through Beijing, Moscow, or even Geneva, where the WHO is based, but rather through Washington, where Biden enjoys broad bipartisan support to counter China’s illiberal takeover of the United Nations and its various specialized agencies like the WHO.
But first, a painful WHO history lesson.
The devastation wrought by China’s COVID-19 playbook is all too familiar to those who lived through the severe acute respiratory syndrome (SARS) pandemic in the early 2000s. Although China’s SARS cover-up was ultimately exposed by a whistleblower, Chinese authorities largely succeeded in preventing WHO teams from visiting outbreak locations in China. The Chinese government’s propaganda apparatus also wasted little time launching an all-out disinformation campaign to obfuscate the virus’s true origins, claiming SARS was a U.S. bioweapon. It was not until then-WHO Director-General Gro Harlem Brundtland issued a public rebuke of China’s stonewalling that Beijing finally budged.
The deadly SARS outbreak resulted in the ratification of the 2005 International Health Regulations, which mandated WHO member states establish domestic pandemic surveillance systems to detect acute outbreaks and report them to the WHO in a “timely manner.” The problem is regulations rely entirely on voluntary compliance; the WHO lacks a compulsory dispute mechanism capable of compelling member states to abide by their obligations.
These same limitations and the WHO’s history of prioritizing political sensitivities over medical and technical imperatives were similarly on display during the 2014 Ebola outbreaks in West Africa. Then, just as with COVID-19, the WHO took several weeks to declare an official outbreak even though there was ample evidence of spiraling caseloads. Afterward, an independent panel proposed significant WHO reforms to help rebuild the organization, including dramatically scaling back the WHO’s expansive range of activities to focus on its core mission. The panel, after reviewing leaked WHO emails, also chided the organization for failing to declare an outbreak for fear of political opposition from African leaders. Nearly all of the panel’s recommended reforms remain unrealized.
Enforcing even the most explicit and unambiguous international treaties is notoriously difficult. What’s worse, it can take years—or decades, as in the case of the World Trade Organization—to negotiate a new international accord to resolve seemingly benign issues, such as fishing. Spoilers like the governments of China, Russia, and Syria almost always find ways to weaponize loopholes or unilaterally reinterpret language, tying former diplomats like myself into knots. Although ideas to revise the 2005 International Health Regulations and modernize the WHO have been passed on and the EU reform proposal will be up for discussion, Washington and its allies need not hold their breath waiting for an unlikely agreement—or the next pandemic—before taking collective action.
For starters, China’s illiberal, aggressive behavior all but consumed the recent G-7 foreign ministers meeting. Former pro-China holdouts, such as Germany and France, have embraced much of Washington’s rhetoric on Beijing, as evidenced by Europe’s decision to levy sanctions for the genocidal treatment of Uyghur Muslims and China’s hostile takeover of Hong Kong.
Coordinated sanctions, though imperfect, are a geoeconomic tool that has, to date, been notably absent from discussions in the United States and Europe about holding Beijing accountable for its COVID-19 deceptions. These were especially egregious during the early phase of the outbreak when it might still have been contained. With sanctions against China now broken in Brussels, the time is right for Washington to recommend the G-7 establish a framework for first-ever global health sanctions to punish countries that disregard their commitments under the 2005 International Health Regulations. This could include retroactive designations of countries determined to have misled WHO investigators.
Surprisingly, WHO member states have also rarely leveraged their financial contributions to promote institutional change. Since the WHO’s funding structure allows member states to earmark their voluntary contributions for specific programs, governments are well-positioned to exercise greater control over the organization’s scope of work. Without hundreds of millions of dollars in funding from the United States and its allies, redundant and, in some cases, fraudulent WHO programs will cease to exist. The WHO’s history of wasteful spending also extends to its management, which spent more on executive travel and hotel rooms than the organization’s budgets for fighting AIDS ($71 million), tuberculosis ($59 million), and malaria ($61 million) combined in 2019.
Rather than continuing to defer to the executive branch about how U.S. funding to the WHO can and should be spent, it’s time for the U.S. Congress to get in the game. Lawmakers, with advice from public health experts, need to determine which WHO programs are a good return on taxpayer investments and propose ways to increase transparency and accountability across the organization. For instance, Congress should fund an audit of the organization’s documented culture of discouraging open debate about sensitive issues, such as when and how to declare a public health emergency involving a virus outbreak. Aligning earmarks with other member states, particularly democracies in Europe and elsewhere, would significantly increase donor leverage over the WHO’s scope of work. Done right, this would lead to renewed emphasis on pandemic prevention, not politics.
Washington must also take a more forceful position on the WHO’s deeply flawed investigation into the origins of COVID-19. Just as Washington called for an independent investigation into the United Nations’ notorious Iraq Oil-for-Food Program, the Biden administration and Congress should demand the U.N.’s in-house auditor, the Office of Internal Oversight Services, open an inquiry into the WHO’s early decision-making on the pandemic and China’s mismanagement of the outbreak. Owing to the oversight office’s independent mandate—isolated from the U.N. Security Council—neither China nor Russia are positioned to interfere in its work.
Finally, Washington should make it clear to WHO Director-General Tedros Adhanom Ghebreyesus that any hope of garnering necessary U.S. support for his upcoming reelection will hinge on enhancing Taiwan’s WHO role. This is something he has the power to do and that his predecessors did on multiple occasions. Such a move would be an important step in neutralizing Beijing’s efforts to exclude higher-level Taiwanese participation at the United Nations. It would also signal the director-general’s interest in reestablishing his credibility with the organization’s top funder.
With so many countries still in the grips of the COVID-19 nightmare, the least Washington and its partners can do is make sure the world is better prepared for the next pandemic. Biden’s vow to “build back better” should start with the WHO.