Wednesday, April 15, 2020

Health experts condemn Trump's halting of funding to WHO

Gates Foundation and Wellcome heads among those dismayed by ‘dangerous and short-sighted’ action amid coronavirus pandemic


Sarah Boseley Health editor Thu 16 Apr 2020 

 

President Trump accused the WHO of covering up the Covid-19 threat, even though it declared a public health emergency on 30 January. Photograph: Fabrice Coffrini/AFP via Getty Images

Global health leaders have rounded on Donald Trump, warning that his decision to suspend funding to the World Health Organization is recklessly endangering the chances of ending the pandemic as fast as possible.

Experts said they were dismayed and appalled at the US president’s announcement, which will not only deprive the WHO of the resources it needs to lead the fight, but potentially undermine international collaboration between scientists.

“Halting funding to the WHO is a dangerous, short-sighted and politically motivated decision, with potential public health consequences for all countries in the world, whether they are rich or poor,” said Peter Piot, director of the London School of Hygiene and Tropical Medicine and formerly head of UNAIDS.

“The Covid-19 pandemic is the greatest global health challenge facing our societies and economies for more than 100 years.

“We need the World Health Organization now more than ever. Its technical expertise, guidance and leadership is supporting countries to implement optimum science-based strategies to prevent and control Covid-19, and will catalyse global action against future health emergencies.”

Trump announced late on Tuesday that US funding would be put on hold for 60 to 90 days pending a review of the WHO’s warnings about the coronavirus and China. He accused the global body of “severely mismanaging and covering up” the threat, even though it declared a public health emergency on 30 January.

On 26 February, during a coronavirus task force press briefing at the White House, Trump said: “I want you to understand something that shocked me when I saw it that – and I spoke with Dr Fauci on this, and I was really amazed, and I think most people are amazed to hear it: the flu, in our country, kills from 25,000 people to 69,000 people a year. That was shocking to me.

“And, so far, if you look at what we have with the 15 people and their recovery, one is – one is pretty sick but hopefully will recover, but the others are in great shape. But think of that: 25,000 to 69,000.”


WHO warned of transmission risk in January, despite Trump claimsMark Suzman, chief executive of the Gates Foundation – the second largest funder of the WHO after the US – said he would “strongly oppose” any cuts to the funding of the WHO which was critical to the Covid-19 crisis. He also announced a further $150m donation towards the hunt for a vaccine, for which the foundation plans to build factories and therapeutics.

The UK government’s response was lukewarm. Asked about Trump’s decision, Boris Johnson’s spokesman said: “Our position is that the UK has no plans to stop funding the WHO, which has an important role to play in leading the global health response. Coronavirus is a global challenge and it’s essential that countries work together to tackle this shared threat.”

Asked if this meant No 10 was disappointed by the president’s move, the spokesman said: “I can only set out the UK’s position and that is we have no plans to stop funding the WHO.”

At his daily press briefing in Geneva, the director general of the WHO expressed regret at the US move and warned that the coronavirus would exploit divisions among those trying to fight it.

When the pandemic was over, WHO’s performance against Covid-19 would be scrutinised, said Dr Tedros Adhanom Ghebreyesus, but now was not the time. “Covid-19 does not discriminate between rich nations and poor, large nations and small. It does not discriminate between nationalities, ethnicities or ideologies,” he said.

“This is a time for all of us to be united in our common struggle against a common threat. When we are divided, the coronavirus exploits the cracks between.”

The US had been a long-standing and generous friend to WHO and they hoped it would continue to be so, said Tedros. “We regret the decision of the president of the United States to order a halt in funding to WHO.”

He and his colleagues mounted a robust defence of their actions. WHO had not hesitated to warn of the possibility of human-to-human transmission, they said. As early as 11 January, it issued guidance on the dangers of droplets spreading from one person to another, which could transmit the infection to frontline health workers, as happened in Sars, said Dr Maria Van Kerkhove, an American infectious diseases epidemiologist working at WHO.

Experts fear that the work of the WHO in fighting disease and improving health and healthcare systems around the world could be jeopardised. At issue is not just the response to the current pandemic, and major programmes such as polio eradication which receives substantial funds from the US, but the collaboration between scientists and doctors at institutions around the world, who will hesitate to pool their knowledge and expertise if they think there may be political consequences.

“The WHO is a place where anxieties and concerns can be discussed without the sense that you are going to be somehow called out,” said David Nabarro, professor of global health at Imperial College London who worked at the highest levels of WHO for many years.

“The challenge for the director general of WHO is always to maintain the core values of public health even when this goes against some of the political priorities of elected leaders. It is not unusual for there to be some form of conflict. The challenge is to try to create an environment where the opportunity for people to share is maintained and they are not having to look over their shoulder in fear that they are going to fall foul of the political priorities of leaders.”

David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, also emphasised WHO’s role as a forum for the world’s scientists and health experts.

“The strength of WHO is that it is able to bring together public health experts from around the world to exchange information, review scientific evidence, and make evidence based consensus recommendations on disease prevention and control,” he said.


Public health and infectious diseases experts said the WHO needed more funds, not less, to lead the fight against the pandemic and help low and middle-income countries, where it plays a crucial role.

“We are facing the greatest challenge of our lifetime and the WHO is doing an extraordinary job ensuring every country can tackle this virus, protect citizens and save lives,” said Dr Jeremy Farrar, director of research charity the Wellcome Trust. “No other organisation can do what they do and we owe them all our respect, thanks and gratitude. This is a time for solidarity not division.”


What does the WHO do, and why has Trump stopped supporting it?
Trump has suspended funding to the World Health Organization over its coronavirus response

Peter Beaumont and Sarah Boseley Wed 15 Apr 2020 
 

Photograph: Fabrice Coffrini/AFP via Getty Images

What is the World Health Organization’s remit?


The World Health Organization (WHO) was founded as the UN global health body in 1948 in the aftermath of the second world war with a mandate to promote global health, protect against infectious disease and to serve the vulnerable. It was inspired by the international sanitary conferences of the 19th century set up to combat communicable diseases such as cholera, yellow fever and plague.

Its current programme envisages expanding universal healthcare to a billion more people, protecting another billion from health emergencies and providing a further billion people with better health and wellbeing.

What does that involve?

In practical terms, the badly underfunded WHO acts as a clearing house for investigation, data and technical recommendations on emerging disease threats such as the coronavirus and Ebola. It also supports eradication of existing diseases such as malaria and polio and promotes global public health.

While its role on emerging diseases is most familiar in the developed world with its more resilient healthcare systems, its practical involvement is far more marked in the global south, where it has been working to expand basic healthcare, support vaccination and sustain weak and often stressed health systems through its emergencies programmes. Its 2018-9 budget was $4.8bn, which became $5.7bn when emergencies were included.

Why is the WHO under fire from Trump?

Trump has presented the freezing of US funding to the WHO as a direct response to what he claims was its slow reaction in raising the alarm over the global threat from the coronavirus and being too “China-centric” in its response. But the organisation’s funding was already in his sights on 7 February, when his administration was suggesting cutting the US contribution, about $400m annually, by half as part of $3bn cuts to US global health funding across the board.

The WHO, to whom the US theoretically contributes roughly 10-15% of its budget as its largest contributor, has been appealing for an extra $1bn to help fight the coronavirus.

The allegation by Trump and his supporters that the WHO was slow to warn of the risk of human-to-human transmission, and that it failed to cross-examine Chinese transparency early on, is largely not borne out by the evidence. WHO technical guidance issued in early January was warning of the risk of human-to-human transmission and the organisation declared coronavirus a public health emergency of international concern a day before Trump announced his partial ban on flights from China.

Instead, it appears Trump is following a familiar playbook: finding others to blame amid his own handling of the coronavirus outbreak, which has included calling it the “Chinese virus”, blaming the previous Obama administration and taking aim at state governors.

How does the WHO’s performance in the coronavirus crisis compare with the 2014-15 Ebola outbreak?The WHO, under the then-director general, Margaret Chan, was savaged from all sides for responding so slowly to an Ebola outbreak that began in a remote forested part of Guinea where the borders with Sierra Leone and Liberia were virtually non-existent. By the time the WHO acted, six months late, it had reached the dense cities.

The fallout for the WHO was serious and undermined its credibility. US critics suggested scrapping it and setting up a new global public health body, although the idea did not take off and President Obama did not support it. An independent report commissioned by Chan said the WHO’s funding was inadequate and governments had not increased their contributions in years. Dr Tedros Adhanom Ghebreyesus, the current director general, and all other candidates for the role after Chan stood down pledged to reform its governance and funding.

Most health experts agree the organisation under Tedros has performed much better over the coronavirus.

How big an impact will the US funding cuts have?


While the suspension of funding by the US for 60-90 days is relatively small – not least because the US is so far in arrears in its annual payments – the potential for a general US withdrawal from global health funding under the cover of this announcement would be very serious and felt most profoundly in places that need the most support.

Even before the Trump announcement, the organisation was looking at potential cuts to already underfunded programming. Such impacts could be felt in programmes already complicated by the coronavirus, such as vaccination for communicable diseases and in building up early warning systems and resilience to deal with diseases such as Ebola in African countries.

Devi Sridhar, the chair of global public health at the University of Edinburgh, called Trump’s decision extremely problematic, noting that the WHO was leading efforts to help developing countries fight the spread of Covid-19. “This is the agency that’s looking out for other countries and leading efforts to stop the pandemic. This is exactly the time when they need more funding, not less,” she said.
What other impacts will there be?

Trump’s assault on the reliability of WHO data and early warning systems, in pursuit of his own agenda against China, threatens its leadership role. While global health diplomacy is a balancing act when dealing with countries like China, which have a poor record on freedom of speech, transparency and human rights, the information provided to health officials by the WHO is designed to be scientifically and clinically useful in the control of the spread of disease.


No comments:

Post a Comment