Analysis: WHO has become a 'proxy battlefield' for a power struggle between the US and China

When US president Donald Trump fired off his angry letter to the World Health Organization last week, he probably expected it to have a greater impact than it did.

In the four-page diatribe he excoriated the WHO’s genial director general Dr Tedros Adhanom Ghebryesus for his handling of the pandemic, accusing him and the wider organisation of repeated and costly missteps.

Mr Trump reiterated his threat to withdraw from the organisation, saying he would pump the approximately $400 million the US gives to the WHO every year to other health organisations.

Mr Trump’s letter arrived during the organisation’s two-day World Health Assembly - the decision-making body of the WHO. The event was a trimmed-down affair this year, held virtually with world leaders sending messages over video-link.

Dr Tedros betrayed no signs of being ruffled by Mr Trump’s outburst, only obliquely referring to it when he said the pandemic “threatened to tear at the fabric of international cooperation”.

One reason for Dr Tedros’s equanimity may have been the intervention of China’s president, Xi Jinping, one of the first world leaders to address the forum, who promised $2 billion over two years to help developing countries fight the virus.

One WHO insider said that Dr Tedros would be guided by the body’s 194 member states - if countries were concerned by the US withdrawal, Dr Tedros would be concerned, he said.

But if anything, Mr Trump’s outburst served to make nations rally together - they gave their full weight to the one and only resolution, which called for an independent investigation in the pandemic and for equitable access to vaccines, treatments and diagnostics. The US went it alone by distancing itself from the latter section, saying any surrendering of intellectual property rights would stifle innovation.

Other world leaders, including French President Emmanuel Macron and German Chancellor Angela Merkel, also pledged their support to the WHO. President Macron told the assembly: "Human health cannot be quarreled over, cannot be appropriated, and cannot be bought and sold."

Many commentators believe that Mr Trump’s anger has little to do with a desire to derail the WHO.

Dr Clare Wenham, assistant professor of global health policy at the London School of Economics, said it was inspired by two things.

“Firstly, he wants to deflect his failure to manage the coronavirus domestically. He’s trying to blame the outbreak on China and the WHO and using the WHO as a scapegoat.

“And secondly the World Health Assembly has become a proxy battlefield for a broader power struggle going on between the US and China. It could have happened at any global forum - it just happened to be the WHO,” she said.

While it is unclear where China’s promised billions will go, Dr Wenham believes other countries will step in to fill the void both in WHO’s finances and in global health more generally.

“What leadership can the USA really show after the botched response to Covid-19?” she said.

Traditionally the US has been WHO’s largest single donor but its funding makes up only 15 per cent of the organisation’s budget - and many commentators believe that WHO will not find it hard to make up the shortfall.

The last time the US pulled the plug on WHO contributions in the late 1980s the effects were much more keenly felt, says Dr Sharifah Sekalala, associate professor of law at the University of Warwick.

“WHO is in a much better place today - you have non-traditional funders such as the Gates Foundation [the second largest funder of the WHO] and other foundations that might chip in and fund things like vaccines. WHO is not as vulnerable as it was in the past,” she says.

She says that other countries - such as Sweden which paid its dues for the next two years in one go - have already stepped into the gap.

In fact, by far the biggest donor to WHO’s separate coronavirus response fund - it needs $1.7 billion up until December - is the UK, which has contributed $104 million, compared to the US’s $30 million.

WHO’s regular funding comes in two parts - assessed contributions, based on a country’s GDP, and voluntary contributions. States have more control over where voluntary contributions go, meaning that traditional US interests such as vaccines or polio may no longer get the same attention in the long term.

Dr Wenham believes what is likely to make a much bigger dent in WHO’s coffers is the drop in GDP many countries will face as a result of any coronavirus related-recession as this will reduce their assessed contributions.

A US withdrawal will also herald a shift in focus at the WHO, says Dr Yu Jie, senior research fellow on China at Chatham House, a think tank.

“Beijing will push the WHO into a more ‘global south’ focused organisation and seek to change the rules and standards in favour of developing countries,” she says.

Another reason for the WHO to be not unduly concerned at the shift in power is China’s increasing position as a scientific and technological powerhouse - it is pumping out highly rated academic studies on the coronavirus at a phenomenal rate and is rapidly racing up the international research rankings in all areas.

Its scientists contribute to highly rated Western publications such as the New England Journal of Medicine and a study by the US National Science Foundation in 2018 found that while the US is still the biggest global spender on research and development  - around US$500 billion a year - China came in second, at roughly $400 billion.

Dr Yu says: “China is quickly catching up [with the US] given the enormous amount of financial resources devoted to scientific innovation and an extremely rigorous talent selection process.”

There are grave concerns over China’s increasing dominance in science, with its commitment to transparency and research ethics coming under scrutiny. At the beginning of the pandemic Chinese scientists were widely praised for their speed in sharing the genome sequence of the new virus but were then criticised for refusing to share samples.

There are question marks over whether we can trust the science coming from an authoritarian regime but Dr Yu says all countries politicise science to some degree - particularly in today’s climate.

The US withdrawal is a blow, says Dr Wenham. “But not an insurmountable one. I don’t think fundamentally WHO will be massively bothered. They have better things to do - they are trying to focus on the outbreak and saving lives. This is a distraction.”

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