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AFTER THE second world war the world decided it needed a new global department of public health. Andrija Stampar, a round-faced, bespectacled, Yugoslavian doctor, opened the first-ever World Health Assembly (WHA) in 1948. The leading lights of global health assembled in Geneva to hear him explain how the effort to create the World Health Organisation (WHO) was “never impaired by any important disharmony”.
How the world has changed. The 73rd WHA, to be held on May 18th and 19th, will be unprecedented for many reasons. It is taking place as the covid-19 pandemic has killed hundreds of thousands of people and is causing a deep global recession. The deliberations will be held by video-conference, and have been cut from a week down to two days. And they are taking place in an atmosphere of bitter recrimination between America and China.
The geopolitical battle has ensnared the WHO just when it is supposed to be co-ordinating the response to the coronavirus. America has halted some $400m of funding to the WHO pending an investigation into accusations that it failed to investigate China’s covid-19 outbreak promptly. America also accuses the organisation of being “China-centric”.
America-centric would be more accurate. The agency is stuffed with American experts from the National Institutes of Health, the Centers for Disease Control and Prevention, the Department of Health and Human Services, and many others. Moreover, America is the biggest financial contributor to the agency by far. China, for its part, is tightly vetting the research that its scientists are allowed to publish on covid-19.
President Donald Trump has sought to brand the virus as a Chinese export. He is also promoting an unproven theory that the virus escaped from a Chinese laboratory, even though a natural origin is still the most likely explanation. America has withdrawn funding from one of its own NGOs that was working with Chinese scientists to try to identify places in southern China that are at a high risk of transferring coronaviruses to humans. A Chinese official has meanwhile accused American soldiers of bringing the virus to Wuhan, where it was first detected.
Lawrence Gostin, head of the O’Neill Institute for National and Global Health Law, at Georgetown University in Washington, DC, says he expects China to block any kind of independent investigation of how the outbreak began. He also argues that Mr Trump’s actions mean that America is likely to lose much of its voice and influence in the assembly.
That will make it even harder for America to win support in its campaign to get the assembly to admit Taiwan as an observer. Observer status, granted to major NGOs such as the International Committee of the Red Cross and Gavi (an alliance to promote vaccines), gives members the right to speak at the WHA but not to vote. But observer status is also a step towards recognition of a state’s sovereignty, which is why Taiwan seeks it and China opposes it. In practical terms, Taiwan is free to attend the assembly and follow proceedings over the internet.
Although regarded by China as its own territory, Taiwan attended as an observer between 2009 and 2016—when it was led by a president, Ma Ying-jeou, who was considered more accommodating towards China than the current leader, Tsai Ing-wen.
This year, however, if Taiwan is rejected it will be particularly unfortunate. Its action to control covid-19 has been exemplary. A country of 24m people, with strong connections to mainland China, it has suffered just seven deaths caused by the coronavirus. Its request for admission to the WHA, tabled by Belize, is likely to be supported by America, Japan, Australia, New Zealand and a collection of mostly small Pacific and Caribbean island-states, and some Latin American countries. But many more countries will be reluctant to cross China by voting in Taiwan’s favour.
The clash has drawn fire on the director-general of the WHO, Tedros Adhanom, a mild-mannered and amiable Ethiopian. Taiwan’s supporters say he has the power to invite Taiwan anyway. In fact, he does not have the authority because he is not empowered to over-rule member-states. To some extent these political machinations are taking place where they should: in the assembly, whose role is to set policy. On Sunday it looked likely that members would agree that discussions about Taiwan could take place later this year, when health officials are able to meet in Geneva.
America’s criticism of Dr Tedros is wide of the mark. Global health co-operation is far from perfect. But keeping politics out of the WHO has allowed the world to cajole even secretive and repressive regimes to keep their doors open wide enough to allow scientists, doctors, and experts to work together across borders and save lives. Dr Tedros, elected by governments to run a technical and scientific organisation, is the diplomatic grease on the hinges of those doors. He must be polite to everyone for the sake of global health. He has to tend the dying flames of international co-operation, and even praise how countries respond when there is much to criticise. He is also facing constant, and ugly, racist harassment online. Like many other scientists in the public eye at the moment, he receives death threats.
The new geopolitics may make for spectacle, but are an enormous distraction from the pressing issues of global health, not least the effort to curb the spread of covid-19, which has killed 300,000 people so far on its march across the planet. One such issue is how new medicines and vaccines against covid-19 are going to be distributed. Although Mr Trump last week spoke about co-operation on vaccines, America is reported to oppose language in a resolution that seeks to ensure access to treatment for all countries. The contested wording calls for firms to donate their patents for covid-19 treatments to a global pool that can be used by any state. “Vaccines, tests and treatments should be distributed according to need, not auctioned off to the highest bidder,” says José María Vera of Oxfam International, an anti-poverty campaign group. Perhaps because of its large pharmaceutical industry, America also objects to a passage endorsing countries’ right to overturn international patent rules when there is an urgent public-health requirement.
In the world envisaged by Dr Stampar, the WHO would now be coming into its own, harnessing international co-operation to halt the coronavirus. But that world has passed, at least for now, replaced by one in which both America and China find it convenient to blame each other for their own failures at home.