A ‘WHO’ for democracies


The pandemic has thrown the defects of the existing world order into sharp relief.  Most obviously, it has exposed the deficiencies of the World Health Organization (WHO) due to excessive Chinese influence over its leadership.

On May 29, the Trump administration responded by ending US participation in the U.N. agency. “The world is now suffering as a result of the malfeasance of the Chinese government. China’s cover up of the coronavirus allowed the disease to spread all over the world, instigating a global pandemic that has cost more than 100,000 American lives. And over a million lives worldwide,” Trump said in a Rose Garden speech announcing the end of U.S. funding for the WHO.

But the problem runs deeper than the WHO. China’s corruption of the WHO reveals the need to rebuild the international institutions established by the United States and its victorious allies at the end of World War II, three-quarters of a century ago.

The WHO was part of an ambitious, American-led effort to construct a liberal world order that would provide the security and free trade within which friendly, democratic nations would blossom.  It also created institutions, such as the International Monetary Fund, the World Bank, and UN organizations such as the WHO, to cooperate on public health, welfare, and education to help less developed nations.

These international institutions can provide great benefits for nations, such as reducing the costs of cooperating on responses to trans-border problems, including pollution, terrorism, drug-trafficking, and money-laundering. They can provide permanent fora where nations can share information and negotiate credibly. But the world’s democracies have starkly opposing perspectives from authoritarian states on how international institutions should function.

In view of these divergences, it is no longer be possible or desirable merely to “reform” these institutions. A more radical approach is needed:  reconstruction, not reform.

The WHO is not the only case in which China has attempted to manipulate, even commandeer, institutions that are dedicated to promoting international public goods, and using them as platforms to advance its hegemonic ambitions. And even as China seeks to extend its influence over existing organizations, it also establishes new international institutions that it can readily dominate.

In response, the U.S. can use the great pandemic of 2020, terrible as it has been, as the opportunity for a new round of global institution-building. If that means the emergence of a parallel universe of international institutions, one consisting of authoritarian regimes like China and its client states, and the other composed of democracies like the U.S., the U.K., the EU,  Japan, South Korea, Brazil, India, Canada, the Anzac nations, Israel and (not least) Taiwan, we should welcome that outcome.

The process of creating new international institutions is already underway, and China has taken the lead. China has been active in building new networks at which it is the center. These new institutions include the New Development Bank (NDB, formerly referred to as the BRICS Development Bank) and the Asian Infrastructure Investment Bank (AIIB). The AIIB grew out of China’s dissatisfaction with continued Western dominance of the World Bank and the IMF. Thus, in addition to seeking broader influence within existing international financial institutions, Beijing is devising a separate but parallel system designed to use Chinese capital to exert political influence and control in the developing world. China seems to be instrumentalizing both existing and new institutions to serve its hegemonic ambitions.

If China can create new international organizations, so can, and should, the world’s democracies. Here we focus on the case of the WHO, because recent events have made its defects especially glaring. Replacing the WHO could serve as a model for the democracies in other contexts, perhaps including Asian security, global trade, and international finance. Just as WWII led to new international institutions, designed to suit the realities of the new world order, the global pandemic should prompt the U.S. and its allies to reconstruct a new set of institutions to ward of the authoritarian challenge led by China.


The WHO, under the leadership of Director General (DG) Tedros Adhanom Ghebreyesus, has been compromised by China’s communist dictatorship. Tedros was a highly controversial DG even before the pandemic.  He was criticized for selecting the 93-year-old Robert Mugabe, the longtime dictator in Zambia, as a goodwill ambassador for the WHO in Africa. And after a meeting with Vladimir Putin, Tedros short-circuited normal WHO hiring processes to appoint a little-known Russian official to manage the WHO’s tuberculosis program.  Like an old-fashioned Tammany Hall boss,  Tedros has rewarded his cronies with WHO patronage.  As a result, the WHO’s reputation, which was questionable even before Tedros became DG in 2017, has been damaged even more badly, and many serious questions about its conduct remain unanswered.

President Donald Trump has halted U.S. subsidies to the WHO, pending an investigation of WHO’s performance.  Both Secretary of State Michael Pompeo and Australian Prime Minister Scott Morrison have indicated that they are open to replacing the WHO with an institution chartered and funded by the world’s democracies.  There is also academic support for creating an alternative global public health institution.

China’s culpability in spreading the coronavirus

A mass of evidence assembled and circulated by government officials and political leaders, scientific researchers, doctors, scholars, reporters (both professional and amateur) and others establishes that the Chinese central government became aware of the danger of the Coronavirus outbreak by December 2019.  The government’s reaction was to silence the Chinese doctors who raised the alarm, to shut down laboratories where evidence of the virus’ origins could have been found, to suppress Chinese reporters and internet writers and expel foreign journalists who were publicizing the events, to falsify information about how many lives the disease had claimed, to provide spurious reassurances to world leaders about the risks involved, and to refuse offers from other governments to assist in coping with the crisis.

The communist government deliberately kept the rest of the world in the dark, denying or minimizing the extent of the crisis, keeping travel between China and other countries open, and spreading the virus to unwitting nations long after its leadership knew of the health risks. Even well-informed public health experts in the U.S. and elsewhere, like Dr. Anthony Fauci, were lulled into a false sense of security because China concealed vital information about the disease.

China’s pattern of concealment, delay, obfuscation and outright lying caused irreparable harm to the rest of the world. Despite knowing of the nature, infectiousness and lethality of the disease, China’s government did not begin to quarantine the city of Wuhan, where the pandemic had broken out, until January 23. Before that announcement, the Chinese government had allowed millions of people to enter and leave Wuhan during the Chinese New Year, thus spreading the contagion to other parts of China.

China also knowingly allowed the virus to spread to other countries, including the U.S. Until President Trump barred flights from China, the Chinese government allowed some 750,000 people to fly to this country, many of them potential carriers. In January alone, some 350,000 travelers from China landed in or near New York City airports, the primary U.S. destination from China. (New York City soon became the epicenter of the virus in this country.)  Moreover, China allowed the virus to spread through trade and tourism to other countries even after taking steps to quarantine the rest of China from the area around Wuhan. In other words, China knowingly inflicted risks on other nations, while at the same time protecting itself from them.

The WHO as China’s enabler

What did the WHO do during this critical period? While the WHO cannot be faulted as much as the Chinese government, it must share the blame. In effect it was the willing, and often the knowing, accomplice of the Chinese government. It aided and abetted the communist government’s policy of lies and concealment.

Tedros and his WHO colleagues should certainly have recognized that China’s record in handling infectious diseases was badly flawed and that conditions in that country facilitate the spread of such diseases. For years, China has bred respiratory ailments including MERS and Swine Flu. In early 2003, a highly dangerous SARS epidemic broke out in China, though it was eventually contained. The disease spread in days from mainland China to Hong Kong, Singapore, and Hanoi. In March 2003, the WHO began putting pressure on China to provide full information on the outbreak. Even so, China delayed WHO inspection of the site where the virus had started, in the hopes of finding measures of prevention. Yet despite China’s cover-up in 2003, the WHO chose to believe Beijing, and even to applaud it, in 2020.

Hundreds of millions of Chinese people live in congested city conditions in which the transmission of diseases can readily occur. (Wuhan itself had a population of about 12 million.) Other hundreds of millions live impoverished lives in the countryside, with close and regular contact with chickens and other domestic animals that can infect human being.  Trafficking in wild animals for human consumption is open and notorious in Chinese markets.

These circumstances should have instilled skepticism in the WHO about the Chinese government’s account of the Covid virus. But they did not. Thus, even though the first case of the virus in Wuhan was confirmed last November 1, the WHO says that it first received a report about the outbreak from China on December 31.

What had it done in that lengthy interval to investigate the alarming reports it had received from other sources (including an alert Taiwan gave the WHO on December 31 about the risk of human-to-human transmission of the virus)?  Why did the WHO continue to deny the existence of evidence for human-to-human transmissibility despite knowing of a confirmed case outside of China (in Thailand) on January 13? Why, despite the evacuation from Wuhan beginning on January 20, did the WHO fail to declare an international public health emergency until January 30? (By mid-January, it was known to Western news agencies that Chinese officials were badly underestimating the true number of infections.)  Why, despite all the evidence that China was being unforthcoming or deceptive, did Tedros say on January 30 that “the speed with which China detected the outbreak, isolated the virus, sequenced the genome, and shared it with the WHO and the world are very impressive, and beyond words.  So is China’s commitment to transparency”?  Indeed, on the same date, Tedros expressed the WHO’s opposition to any trade and travel restrictions on China – opposition that the WHO maintained until the end of February.

The evidence is compelling that Tedros and the organization he led were tracking the official Chinese line instead of doing their duty.

Tedros’ motivation

What was Tedros’ motivation in enabling China to pursue its appalling policies?  Professor Bradley Thayer and Lianchao Han note that Ethiopia, Tedros’ home country, is commonly called East Africa’s “Little China” because it has become the beachhead for China’s “Belt and Road” initiative in that region.  Ethiopia is itself the destination for significant Chinese investment.  Indeed, Ethiopia’s government, in which Tedros made his career, is so beholden to China that until quite recently it kept regular flights to and from China going, despite the grave risks to the Ethiopian people.

With China’s backing, Tedros was elected as DG in 2017.  He succeeded the Hong Kong-born Margaret Chan, who was first elected in 2006.  According to The British Medical Journal, Chan was not, objectively, the best candidate; her election was secured through China’s promises of financial aid to poorer WHO member states. Chan’s handling of the 2013-6 Ebola outbreak was roundly criticized by scholars, NGOs such as Doctors without Borders, and medical experts. Under Chan, the WHO took five months to declare a public health emergency of international concern over Ebola — a delay that some experts believe contributed to the scale of that plague.

Tedros pledged to bring major reforms to the WHO.  He was chosen despite the fact that he was the first DG not to be a medical doctor, although he had both training and experience in public health management. He had earlier been Ethiopia’s Minister of Foreign Affairs and was a former Minister of Health.

Tedros’ main credential for his post seems to have been his pliancy – which eventually served China well but the global community badly.  He played the diplomat when he should have played the doctor.  China handpicked him, and it got the man it wanted.

The democratic alternative to the WHO

As the Trump administration’s decision to end US participation in the WHO demonstrates, it is simply too late to reform the agency. The U.S. and other democracies should abandon it. It has become a platform for China, to the clear detriment of global public health. Any attempt at “reforming” the WHO would be as futile as the ill-fated U.S. attempt to “reform” the United Nations Human Rights Council.

We are not attacking all international institutions.  The United States benefits from cooperating to solve global problems.  In the public health area alone, an international organization can help put nations on alert of a potential pandemic, send resources to the countries most at risk of outbreaks, share information and technical expertise, and foster cooperation to find vaccines and cures.  It allows wealthier nations to grant resources and support to poorer nations (which might fear a drop in business and travel) in exchange for access to potential disease hotspots.  A properly functioning international institution can help nations overcome their suspicions over each other’s motives by providing a neutral, independent forum for information, negotiation, and collaboration.

But the response to the coronavirus pandemic shows that China seeks to turn the WHO away from these goals and into an instrument of Chinese foreign policy. Beijing used its relationship with Tedros in order to deploy the WHO to spread Chinese propaganda designed to obscure the origins and strength of the coronavirus pandemic. The WHO loses its ability to advance global public health when it no longer has credibility as a source of impartial information and expertise. There is little benefit in remaining in such a corrupted organization. Only the “exit” option is left.

An international public health organization, designed to perform essentially the same functions as the WHO but founded and funded only by the world’s democracies and free from the taint of China’s corrupting influence, would have many advantages over the current WHO.

First, its methods of gathering, evaluating and disseminating information would be more transparent. Communication of information from local health authorities to the national center would not be inhibited or delayed by fear of political reprisals from the center if the localities have bad news to report. (The independence of state and local governments in the U.S. from the federal authorities in Washington is demonstrated by the fiery exchanges between President Trump and the governors of New York and Georgia.) Likewise, the relaying of timely epidemiological information from one democratic nation to another would not be impeded by hostility between them. Even when democracies disagree on vital issues (as the U.S. and France did over the Second Gulf War), they are not enemies (as China and Taiwan are).  And they continue to recognize important underlying commonalities. Thus medically vital information will flow more freely, both vertically and horizontally.

Second, the information that is gathered and shared will be more reliable. Doctors will not “disappear,” have their careers wrecked, or be “disciplined” for bringing emerging medical disasters to the attention of the authorities. Investigative journalists and whistleblowers on the internet will not be censored, gagged or expelled from host countries. Constitutional protections for the press, for speech, for lobbying and for scientific research will work to bring potential disasters to light. Where a civil society operates more freely than the Chinese government allows, the quality of information about epidemic diseases is far likelier to be higher.

Third, a league of democracies will likely cause the wealthier and more powerful member states to encourage the improvement of the public health systems of the less developed states. Say, for instance, that democratic India or South Africa joined the new health organization. Other members, acting out of both altruism and self-interest, will want to take steps to ensure that both India and South Africa have the resources to track the rise and spread of epidemics and to prevent their occurrence in other states.

Fourth, some member states may choose to be more stringent in issuing visas to tourists and travelers from countries that are not in the league. In a globalized world, international flights from countries with poor public health systems may bring deadly diseases to safer countries in a matter of hours. League membership could thus function as a method of disease control.

But what of countries that, for ideological or financial reasons, would choose to align with China, and not join together with the democracies? What about, say, Russia and Venezuela, which have authoritarian regimes?  Or the African states that may have fallen into the debt traps that China has set for them?

The short answer is that, having chosen to belong to a Chinese-dominated universe for public health, they must live with the consequences of that choice. And in any case, the competition between the two public healthcare leagues, one democratic and the other authoritarian, may lead to improvements in both, and thus to higher global healthcare standards overall. American withdrawal from the WHO could bring the world closer to achieving the purposes which that organization has betrayed.

Just as importantly, replacing the WHO could take the first step toward a reconstruction of the institutions of the world order.  That system arose out of the ashes of World War II, 75 years ago.  Even during the paralysis of the Cold War, international institutions centered on what was once called the Free World were able to perform great good: consider the successes of NATO, the WTO, and the IMF and World Bank.  But the rise of China, and Beijing’s desire to replace the rules of the U.S.-led global order, will require the United States and its allies to construct new international institutions for a different strategic environment. Withdrawal from the WHO and erecting a new international public health agency in its place will become the test case for this new effort.

John Yoo is a visiting scholar at the American Enterprise Institute. 

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