Listen: It’s a Small World Health Organization

What happens if the United States pulls out of the WHO during the pandemic?

On this episode of Social Distance, James Hamblin and Katherine Wells talk with Kelley Lee, a professor of public health at Simon Fraser University, about the history, necessity, and vulnerability of the World Health Organization.

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What follows is an edited and condensed transcript of their conversation.

Katherine Wells: What exactly is the WHO?

Kelley Lee: In a nutshell, it is the United Nations’ specialized agency for health. It was formed in 1948 and it was created to be the directing and coordinating body for international health cooperation. After the Second World War, there were a lot of epidemics because of the war. People were in very bad shape. Health systems were destroyed in many parts of the world, and there were outbreaks of all sorts of infectious diseases that needed to be brought under control.

Wells: What does the WHO do?

Lee: When it was created, it was an amalgamation of a lot of preexisting organizations largely focused on collecting statistical data and standardizing practices. If you ever wondered why a disease like MERS is called MERS, there’s a committee in the WHO that deals with the classification and naming of diseases. When people think of global health, they think of scientists peering down a microscope or frontline health workers swinging into action. But really, it’s a lot of these people sitting around the table and figuring out how to classify and organize diseases.

The WHO has also become more action-oriented, so it’s not just committees classifying diseases. WHO does a lot of work with disease-eradication and disease-control programs. The most successful one was smallpox, a disease we no longer have. It’s the biggest achievement in the history of the WHO. Some say the biggest achievement of humanity in the 20th century was the eradication of that disease.

Polio is the disease that the WHO has been focusing on now. It’s something like 98 percent eradicated, but there are small pockets in countries where it’s very difficult to access the cases, like Afghanistan, Pakistan, and Nigeria. Health workers have been attacked and killed trying to find these last cases and vaccinate children. And now we have COVID-19, so that’s kind of shut down the polio-eradication efforts.

James Hamblin: What is the total budget of the World Health Organization?

Lee: WHO is funded for about $2.2 to $2.3 billion a year. That’s about the size of one medium-size hospital, and it has to cover 194 countries. The objective of WHO, as stated in its constitution, is the attainment by all peoples of the highest possible level of health. That’s a huge goal, and you’re spreading this budget extremely thin.

The budget is made up of two pots of money. The first part is a membership fee, so every country that wants to be a member of WHO pays a certain amount depending on their population and on their wealth. That’s why the U.S. pays more than, say, Sierra Leone. The second part of the budget is paid for by voluntary contributions. Member states or charities or even individuals can step up and put money into WHO. But the people that give the money decide what the money is spent on. It’s not necessarily the most important things; it’s just the favorite things. WHO doesn’t really have a lot of control over most of its budget.

Hamblin: What is the U.S. contributing to the WHO annually?

Lee: The U.S. is the largest donor. It gives around, like, a third of the budget, so these threats about withdrawing money are very worrying. It’s going to hurt WHO and now is not the best time to do that. If the U.S. stopped funding WHO, it would hurt. I would hope that other countries would step up and fill the gap.

But if the U.S. withdraws its voluntary contributions, all these programs which the U.S. government earmarked these funds for will lose out. The U.S. gives something like 25 percent of the money for polio eradication. So that program is going to really suffer. In my decades studying WHO, I’ve seen ups and downs, but I have not seen this kind of existential threat.

Hamblin: What do you make of President Trump’s accusations about China? Is it just scapegoating, or is there something there?

Lee: We’ll know who knew what when in due course, once there is an investigation, which everyone agrees is going to happen. There’s just a lot of innuendo and accusations flying around right now, and this is not the time.

When WHO alerts member states, it’s the member states that need to act. Everyone got the same information from the WHO at the same time. An alert went out on December 30, and then in January, the public-health emergency was called. Member states have to then act. It’s really disingenuous to say there was a week where we didn’t have that information and that is why thousands of Americans have died.

Hamblin: What does history tell you about this moment?

Lee: We’re at a really important, defining historical point. This is not the last pandemic we’re going to have, so what lessons are we going to learn? Are we going to go close down and hide away and cut the global connections we have created? Or are we going to say, “Look, the world is different. We value globalization, but we haven’t invested enough in the kinds of protections that we need to make globalization work. We haven’t invested enough in health security.”

We really barreled forward in terms of economic globalization and let the market drive that process. But we didn’t value the roles governments play in globalization. We can’t have economic globalization without strong societies, without strong governments. It’s almost like the post–World War II conferences where world leaders came together and created the UN system. We may be at a moment where we needed another historical event like this to take us forward.