What role is the World Health Organisation supposed to play during a pandemic?

Sara Davies: In the ideal scenario the country with the first case reports this to the World Health Organization promptly and transparently, and an emergency committee is convened to assess the available information and determine what global advice should be issued. then all countries comply with that advice. Everyone's coordinating their travel advice, the release of information about the outbreak and how they’re tracing and treating it. That's one of the reasons why in the article we describe the WHO as the conductor and the countries as instruments within a larger ensemble. There would be agreement that some states can do things better than others, and respect for these differences. This does not mean that the WHO has all the power. In fact the Director General is quite aware that they need states to cooperate. But ideally countries would recognize that the WHO is the best means of coordinating an international response, and verifying the flow of information through a trusted process.

How have we seen this scenario play out during COVID-19?

Clare Wenham: What we've seen here is very different. The first part of the process worked relatively well. There were some tensions regarding the timing of China’s reporting and how much they knew at an earlier stage, but when the WHO was notified it began doing what it was expected to. It sent epidemiologists out to conduct field studies, and called an emergency committee to review all available data and the unfolding situation. Following this, at the end of January it declared a public health emergency of international concern, and issued very clear guidance about how governments should respond. Then the organisation led fundraising efforts to provide the most vulnerable countries with the capacity and resources to implement the best possible public health response – focused on testing, tracing and isolating. It was then that we saw tensions rise and this not so perfect world falling apart. States failed to see the WHO as a real authority. From March we saw many states depart from the WHO guidance, not least the UK and US who are often seen as ‘good’ players in this sort of situation. This led to a cascade effect with other states following suit. Countries like New Zealand took an ultra-conservative approach and went beyond the WHO guidance, while others like the US and Brazil (at least initially) ignored the warning calls.  The WHO could not act as the conductor as intended, partly because of the membership structure of the organisation and its financing model, which both limit the organisation’s ability to act autonomously. 

What has been driving this resistance by countries to engage with the WHO processes?

Sara Davies: One important contextual shift in recent years has been what we think of the rules-based international order. The UN Security Council has been deadlocked on a range of different issues and there have been fierce debates around what activities should be funded in the development space, from sexual and reproductive rights to climate change. In international policy circles it is common to hear that the events of 2020 are an unprecedented threat to global institutions. But we must remember the pre-existing stresses and strains of the international system. All COVID-19 has done is add another, albeit sizeable, strain to the mix. A number of the key players—the United States, China, Russia and even the UK—have had divided attentions due to pre-existing domestic and international tensions, and this had a knock-on effect in the first six months of COVID-19.

Could the WHO have enhanced international cooperation by approaching this crisis in a different way?

Clare Wenham: Previous outbreaks have taught us that trust-building exercises between national governments take a long time, and are very hard to sustain when crises abate. It is all too easy for states to lose that sense of a shared responsibility based on the cosmopolitan ideals of global security. I think the WHO could have been doing more routinely to build trust. I also think the WHO has buried its head in the sand around the politics of COVID-19. That is not a critique: the WHO is bound by the fact that it is a member state organization. So instead of calling out actions by the likes of the United States, it has been very diplomatic. Similarly, it did not want to rock the apple cart and risk losing really valuable data by calling out China in January. It is a difficult position to be in to have to maintain trust and good relationships between member states. However we suggest that the WHO shouldn’t shy away from this, and instead engage with political debates to ensure better outcomes during the pandemic. 

Sara Davies: The WHO relies upon donor funds to do the work that it does. From 2014 to 2019 the majority of its funding has been from bilateral engagements between the WHO and individual countries, to make sure that they are pandemic ready. This is where the money has been going, rather than towards building consensus and strengthening cooperation. And this is why you see states going it alone at the moment.

Previous outbreaks have taught us that trust-building exercises between national governments take a long time, and are very hard to sustain when crises abate.

What would a deeper engagement with political expertise bring to pandemic responses?

Sara Davies: The first benefit it would bring is that it would require more consistent engagement from foreign ministries in the process of formulating cooperation around global health policy. A real problem is the fact that the WHO’s membership requires only health ministries to engage with its processes and, outside of doing so in the annual World Health Assembly and Executive Board meetings, many ministries do not. So you get a situation where there is an absence of the very group knowledge and expertise that is needed at that moment when everyone is having to make very quick decisions. In the Australian context, the federal Department of Health and the Department of Foreign Affairs have had meetings about how to organize their engagement with WHO. The WHO misses out on being a diplomatic priority due to its health-only membership rules. Also missing for a lot of countries is an inter-connected government approach to these issues. A lot of domestic and international health cooperation decisions are being made without everyone in the room. We need experts involved who can consider what other regional and international bodies are out there, from human rights defenders to regional organizations. Under the WHO mandate health expertise and health knowledge is all that is required. This is flawed. In this pandemic we are seeing very clearly that economics, human rights and governance expertise also matters. 

Looking ahead, do you think COVID-19 will make public health a much higher priority for government officials involved with national security and economic policy? 

Clare Wenham: Yes and no. Pandemic outbreaks have always been in the minds of officials beyond health ministries, particularly amid the security agendas and departments of defence. What we see now is the need for public health engagement with social sciences. During the Ebola outbreak public health officials became really appreciative of the work of anthropologists because they were the ones who understood how affected communities functioned. Recent events have shown that we need political science and economic expertise. Governments cannot go it alone. Last year a team in the USA tried to work out how prepared countries were to respond to outbreaks and they looked at a whole range of indicators that would demonstrate preparedness. This included politics but it was very binary: it was about whether or not a country had a plan. It did not consider variation in how events would play out, nor why it would matter who was in charge. There was little consideration of whether countries would follow  plans precisely or what the competing factors at play would be. That is the type of analysis we need to include in future preparedness mechanisms. 

Sara Davies: COVID-19 is an urgent humanitarian emergency and a lot of resource is understandably being put into immediate relief responses. However, I am worried that we are missing the longer-term work that must be done to enhance our resilience to future pandemics. More work is needed to create sustainable healthcare systems and build community trust. How should the international community repair and build cooperation for future shock events? Preparedness is always difficult to fund. As the economic situation worsens states may have fewer resources to put towards international cooperation, when they may need it more than ever. Former Prime Minister of New Zealand Helen Clark recently said that her nightmare scenario is less COVID-19 and more the socio-economic and political devastation that is on the horizon. I hope that governments and societies will approach the coming months with the necessary long-term outlook. 

This interview builds upon a longer research article published in the September 2020 issue of International Affairs, titled 'Why the COVID-19 response needs International Relations'.