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expert reaction to letter sent from Donald Trump to Dr Tedros Adhanom, Director-General of the WHO

US President Donald Trump has sent a letter to the Director-General of the WHO Dr Tedros Adhanom regarding US funding of the organisations and the WHO’s COVID-19 response. 

 

Prof George Davey Smith, Professor of Clinical Epidemiology, University of Bristol, said:

“This letter is not about dealing with the coronavirus pandemic, rather it is an undisguised political attack on China. Most of it is straightforwardly wrong, and the rest twisted out of recognition. Take the first point:

‘The World Health Organization consistently ignored credible reports of the virus spreading in Wuhan in early December 2019 or even earlier, including reports from The Lancet medical journal. The World Health Organization failed to independently investigate credible reports that conflicted directly with the Chinese government’s official accounts, even those that came from sources within Wuhan itself.

The Lancet did not publish such things in December, indeed they have released a statement today stating that the first reports published in the Lancet about the outbreak in Wuhan were on the 24th January 2020. On that day the editor of the Lancet, Richard Horton, tweeted “A call for caution please. Media are escalating anxiety by talking of a “killer virus” and growing fears. In truth from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language”. Far from being behind The Lancet – as Trump’s letter claims – the WHO were well ahead, calling appropriate attention to the issue.

“The rest of the points could be gone through in detail, but this would be achieving Trump’s aim of distracting attention from his ludicrous record of self-contradictory and self-exculpating bombast. This is encapsulated in the many compilations of his own words (e.g. https://www.youtube.com/watch?v=HvE9hCZ-jaU) in which his position on China flip-flops, depending on what he sees as giving him home political advantage at the time he is speaking. The main purpose of the letter is revealed by its last sentence – that Trump sees the WHO as an organisation that should be ‘serving America’s interests’. The world being hit by the SARS-CoV-2 pandemic whilst a populist like Trump is President of the U.S.A. simply magnifies the level of damage that will be caused by the virus.”

 

Dr Sharifah Sekalala, a Public International lawyer with a research focus on law and diseases, University of Warwick, said:

“The US is the biggest contributor to the WHO budget. As of 2019, it provided approximately 15.9 percent of the WHO budget. Without funding from the USA, the WHO would have to cut funding in a lot of key areas. However, if the USA leaves the WHO it will also lose influence and it won’t necessarily make the management of pandemics easier as it will be acting unilaterally.

“After every serious epidemic, SARS, Ebola, etc, the WHO has had an independent investigation that has allowed it to look at the ways in which it reforms its essential functions. The World Health Assembly which is the governing body of the WHO is expected to vote on Tuesday on a resolution drafted by the European Union calling for an independent evaluation of the WHO’s performance appeared to have won consensus backing among the WHO’s 194 states.

“This could be brought forward in order to satisfy Trump but it is very problematic to move people who are trying to manage the crisis into an account of what went wrong before it is over. They are also dangers that it could create a defensive response to the crisis as the people who are in charge are thinking more about how to apportion blame as well as opposed to the best ways of dealing with the crisis.

“There are some credible suggestions about amending not the WHO itself but the International Health Regulations (2005) which govern the spread of infectious diseases in order to give the WHO greater clarity on its role in managing of infectious diseases. Many countries have traditionally been reluctant to extend the WHO’s powers for instance in the duty to alert the WHO when there is an infectious disease. 

“There are some valid criticisms of the WHO: It has been criticised for taking too long to declare COVID-19 a PHIEC but in the past it has been criticised for doing this too quickly in the past and so there is always a fine balance. Moreover this body is meant to be independent. However they are good suggestions that we can have greater transparency.

“Some claims are however untrue or at least stated unhelpfully:

1. “There are American representatives on the WHO Executive board and Trump himself and also praised China. On the 22, 24, 29. 30 Jan 7, 10, 13, 18, 23 26 27 , 29 Feb

2. “He also falsely claims that Taiwan had warned about human-to-human transmission of the disease on 31 December. On that date Taiwan sent a letter to the WHO noting the reported spate of unexplained pneumonia cases in Wuhan, China, and that the patients were in isolation, and asking for further details.

3. “The WHO has no authority to force foreign governments to divulge medical information or open doors to its hospitals and labs.

4. “Trump makes lots of claims about travel restrictions but those are restricted within Article 43 of the IHR.   I joined a group of 15 global health scholars in writing this piece in The Lancet on travel restrictions (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30373-1/fulltext)  Besides, Trump had travel restrictions in the USA but these did not curb the spread of COVID-19.

5. “The speed of transmission is an important point of difference between the two viruses. Influenza has a shorter median incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the time between successive cases) than COVID-19 virus. The serial interval for COVID-19 virus is estimated to be 5-6 days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than COVID-19. On the 17 March, the WHO made it very clear that spread of both diseases was very context specific.”

 

Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:

“The decision by the Trump administration to withhold funding from the WHO is neither helpful, nor justified, and comes at a time when the nations of this planet should unite rather than divide; the WHO is the vehicle by which this is most readily achieved in terms of handling the COVID19 pandemic.

“The US is the largest contributor to the WHO budget, so this action is almost certain to have an impact upon our ability to counter the threat of SARS-CoV2. What the immediate consequences will be remains to be seen, but given that the COVID19 epicentre has now switched to the Americas, this move seems strangely self-destructive. In particular, it is clear that the healthcare systems in lower and middle income countries across the globe are already starting to struggle with the influx of COVID patients, often in areas already affected by severe endemic diseases.

“The notion that WHO somehow colluded, and in so doing should be held jointly responsible, with China for the SARS-CoV2 pandemic appears baseless at best. Whilst the very start of the outbreak may have been obscured at a very local level, both the Chinese Government and WHO have helped orchestrate an unprecedented public health initiative as well as the rapid sharing of information and scientific data. Without this effort we would be in an even more difficult scenario than that in which we currently find ourselves. Notably, the WHO declared a public health emergency of international concern (PHEIC) on 30th January, in stark contrast to the US response for several weeks following.

“Viruses with pandemic potential do not respect money, power, or international borders. They spread globally as a result of our colonisation of the planet and to prevent them doing so requires concerted effort, co-operation, and sacrifice across all quarters. Whilst initially the most hard-hit country, China has since successfully controlled the SARS-CoV2 outbreak within its borders and in doing so undoubtedly bought the rest of the planet time to prepare for the worst. Whether or not that opportunity was taken appears to vary from country to country.”

 

Dr Michael Head, Senior Research Fellow in Global Health, Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, said:

“Much of what Trump is demanding of the WHO is outside their powers and scope, and therefore outside of what the United States has agreed the WHO role should be. The US has representatives supporting decision-making at the WHO, including a member on the Executive Board. The WHO have limited powers, in terms of what they can demand of countries where outbreaks are taking place. They provide expert guidance and not enforcement by law.

“The WHO response from this pandemic is notably swifter than, for example, the large Ebola outbreak in West Africa in 2014, where they were rightly criticised. Right now, it’s reasonable that there should be reflection on where the WHO has done well or been limited in its response, and that will likely be the main topic on the agenda at the World Health Assembly. However, there are also clear gaps in governance elsewhere that has facilitated the spread of the virus, for example within the United States.”

 

Prof Devi Sridhar, Professor of Global Public Health, University of Edinburgh, said:

“President Trump doesn’t understand what the WHO can and cannot do. It is a normative, technical agency which needs to keep member states at the table. If he thinks they need more power, then member states should agree and delegate it more. This letter is written for his base and to deflect blame. China and the US are fighting it out like divorced parents while WHO is the child caught in the middle trying not to pick sides. In January, WHO needed to get genetic sequencing of the new virus out of China (to create testing kits) and secure access for an international mission to enter the country and get crucial data. If the cost for access and data was praising China publicly then that’s diplomacy.”

 

 

https://twitter.com/realDonaldTrump/status/1262577580718395393/photo/1

 

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

 

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