Public health experts have savaged President Donald Trump’s decision to cut U.S. funding to the World Health Organization (WHO), which he says failed in its “basic duty” during the coronavirus pandemic by promoting “disinformation” from China.
“Today I’m instructing my administration to halt funding of the World Health Organization while a review is conducted to assess [its] role in severely mismanaging and covering up the spread of the coronavirus,” Trump said at an April 14 briefing.
The move represents another stunning turnaround for Trump, who in late February praised the WHO for “working hard and very smart,” before souring on the world body in recent days as the U.S. death toll soared. Still, it remains in line with his longstanding distrust of multilateral institutions more generally.
Critics have accused the President of attempting to shift blame away from his own torpid response to the pandemic. The WHO declared a public health emergency on Jan. 30, after which Trump continued to speak at rallies and belittle COVID-19 as “the flu.”
Trump’s funding announcement has already drawn condemnation from all quarters. U.N. Secretary General António Guterres said in a statement that this is “not the time to reduce the resources for the operations of the [WHO] or any other humanitarian organization in the fight against the virus.”
Richard Horton, the editor-in-chief of the Lancet medical journal, wrote that Trump’s decision was “a crime against humanity. Every scientist, every health worker, every citizen must resist and rebel against this appalling betrayal of global solidarity.”
Critics agree the WHO’s response suffered missteps at the outset of the coronavirus outbreak. There was a
- focus on government information rather than non-official sources, such as whistleblowers like Dr. Li Wenliang.
- Officials could have investigated how many healthcare workers had become infected, which was
- clear evidence of human-to-human transmission before official confirmation came Jan. 23.
- It advised nations not to close borders.
“The WHO could have been more diligent in determining the nature of the outbreak and how serious the problem was,” says Dr. Yanzhong Huang, a global health expert at the Council on Foreign Relations.
Trump’s scapegoating of the WHO comes after he spent two months ignoring warnings about a disease that has now killed more than 26,000 people in the U.S., the highest national death toll. In late January, influential White House economic advisor Peter Navarro wrote a memo to Trump that warned COVID-19 had the potential to claim hundreds of thousands of American lives and derail the national economy unless immediate and sweeping containment efforts were implemented.
Trump’s sluggish response stands out against the examples of other nations. South Korea, for one, confirmed its first case of COVID-19 just one day before the U.S. Yet a robust public health response that tested three times as many citizens per capita has kept reported cases under 11,000 compared to more than 600,000 in the U.S., which also has a triple the fatality rate.
“President Trump is trying to rewrite history to divert criticism from his own administration’s failures,” Adam Kamradt-Scott, associate professor specializing in global health security at the University of Sydney, tells TIME. “Lives will be lost as a result.”
Yet most public health professionals agree that the WHO is desperately in need of reform. It has been for a very long time. Despite a sprawling global mandate, the U.N. agency, which was founded in 1949, has an annual budget of just $2.2 billion—smaller than the largest American hospitals and a fraction of the $11.9 billion allocated to the U.S. Centers for Disease Control.
The U.S. is the largest single donor to the WHO, contributing over $400 million in 2019 including both assessed (mandatory) contributions and voluntary top-up donations from government and private sources (Though, in fact, the U.S. is currently $200 million in arrears.)
The WHO’s shoestring budget is largely because assessed contributions were frozen in the early 1980s amid the Reagan Administration’s outrage that U.N. bodies—particularly UNESCO—appeared to be tilting toward Moscow as more Kremlin-aligned third-world states joined up. As a result, assessed contributions have not risen in real terms since then and continue to be based on a combination of GDP and population. The U.S. today still provides around twice the assessed contributions of second place China.
But assessed contributions only account for $246.8 million in 2020, meaning over 80% of the WHO’s total budget comes from voluntary contributions. The U.S. comes top again while China’s voluntary contributions are negligible. But the greater problem with voluntary funds is that they are ringfenced for specific purposes and so cannot be diverted to address sudden crises, such as Ebola or COVID-19.
Ultimately, the WHO has little freedom to decide for itself where to spend its meagre resources; those decisions are made by the donors, whether government or charitable entities like the Gates Foundation. This is why 27% of the WHO’s total budget is spent towards polio eradication despite just dozens of cases annually. “The funding structure is unpredictable and allows donors to dictate the agenda,” says Huang.
This lack of resources contributes to various missteps. In 2009, the WHO was criticized for declaring a pandemic for H1N1 flu too early and for a virus that wasn’t sufficiently virulent. During the 2014 West Africa Ebola Outbreak, it was condemned for delaying the declaration of a public health emergency.
The irony of Trump’s funding cut is that, by its own questionable record, the WHO’s COVID-19 response was “fairly good,” says Kamradt-Scott.
In turns of accountability, the WHO does now livestream its World Health Assembly meetings every year to boost transparency. But the lack of criticism—and fulsome praise—of China’s COVID-19 response despite obvious problems with the reported numbers of infected and dead has galvanized suspicions of politicization. WHO Director Tedros Adhanom Ghebreyesus praised China’s “extraordinary” efforts against COVID-19 that were “setting a new standard for outbreak response.”
There is unquestionably an effort to avoid an adversarial culture within the WHO’s 194 member states. It has consistently sought to try and cajole and co-opt countries into doing the right thing as opposed to publicly naming and shaming.
The notable exception was in 2003-04, when various WHO officials criticized China for downplaying the SARS outbreak. “It would have been much better if the Chinese government had been more open in the early stages,” said WHO director-general Gro Harlem Brundtland said at the time.
In the review that followed that crisis it was decided that the WHO should in future take a less confrontational approach when dealing with member states. The U.S. was party to that conversation and has, arguably, been a key beneficiary over the years. The periodic rolling back of family planning provisions in the U.S. during conservative administrations has escaped censure from the WHO despite a documented deleterious impact on the health and wellbeing of women and children. The same could be said about the lack of comprehensive universal healthcare like that enjoyed in so many other developed nations.
Ultimately, of course, it’s not strictly up to Trump whether to keep funding the WHO. The White House is not technically allowed to block funding of international institutions mandated by Congress, though the administration has found creative ways around constitutional hurdles through the application of sanctions or diverting funds by other means.
Still, the very threat of slashing funding has the potential to turn Trump’s specious claims about a “China-centric” WHO into a reality. Beijing has steadily been increasing its influence and putting nationals into key posts in nearly all multinational institutions—from the U.N. and Interpol, to the IMF. As Trump orients the U.S. away from the world stage, a presumptive superpower like China stands poised to fill the gap. Says Kamradt-Scott: “It would seem that Trump has just given China an opportunity on a silver platter.”
We’re all for free speech, but maybe the height of a global crisis isn’t the best time to “floss” your $8 billion net worth like you’re making a cameo in a Cash Money Records music video.
That’s the lesson someone should have told DreamWorks co-founder David Geffen, who pissed off the world when he posted photos of his “quarantine” on his superyacht on Instagram last week. Geffen posted photos of his yacht, which according to the Washington Examiner, cost $590 million, accompanied by a caption that said:
“Sunset last night…isolated in the Grenadines avoiding the virus. I’m hoping everybody is staying safe.”
Social media users instantly became outraged with Geffen, pointing out that his post was “tone-deaf” in light of the hardships that many people dealing with the coronavirus outbreak in the U.S. are facing.
The View co-host Meghan McCain tweeted: “David Geffen is worth 8 billion dollars! For God’s sake help this country get ventilators, our health workers masks and the medical supplies they need! Or no, just stay on your f—ing yacht instagramming. This is just shameful and grotesque.”
New Yorker writer Lauren Collins tweeted out Geffen’s photo with one word: “psychopath”.
Film producer Robby Starbuck asked: “Is anyone shocked that Democrat donor David Geffen posted such an out of touch photo? He might as well have take a picture flipping everyone in America off.”
Starbuck continued: “David Geffen’s thought process: ‘Hey you know what, millions are losing their jobs, can’t pay their rent and they’re worried about a deadly pandemic, I bet they’d love to know how I’m doing. Fire up the copter so we can take some more pics of my yacht! They’ll love this!!!'”
Blog site A.V. Club destroyed Geffen, writing last week: “It’s getting to the point where it almost feels like some sort of cash-induced brain disease, a hideous and infectious need to say something about their vast reserves of wealth, safety, and power, when “nothing” would certainly have sufficed.”
Geffen has now locked down his Instagram account, but of course, the damage has already been done. With forward thinking and impeccable timing like that we’re surprised Geffen isn’t working at a portfolio manager at one of Wall Street’s “forward looking” long only funds.
The debate is splitting into two broad camps: Call them the “growthers” and the “base-raters.”
Just how bad will the new coronavirus be? I can’t answer that question, but I have observed the debate splitting into two broad camps: Call them the “growthers” and the “base-raters.”
The term growthers refers to the notion of exponential growth, and indeed the number of Covid-19 cases appears (by some accounts) to be following an exponential pattern. Some scientists have estimated that the number of cases doubles about every seven days. If you play that logic out, it is easy enough to see how people might be complacent at first, then in a few months there is a public health crisis.
Of course, that process of doubling won’t go on forever. At some point, the number of people who have already been exposed to Covid-19 would become so large that their immunity could lower the subsequent rate of spread. Furthermore, society would adjust by having fewer large gatherings — many conferences already are being canceled — and by taking other precautions.
Still, the growthers find it easy to imagine that the number of cases might overwhelm the capacity of the U.S. health care system. Even if you think a speedy American (or more likely Singaporean) response argues against this scenario, it is harder to be equally sanguine about all the world’s nations, most of which are much poorer and have lower-quality public health systems than the U.S.
The growther approach seems most common among people trained in mathematics, finance, and those who work in technology. Finance is centered on the idea of exponentially compounding returns, where small initial gains turn into something quite large. So financial professionals understand the growther perspective.
In tech, the major companies have grown from nothing to very large fairly quickly, often by taking advantage of a (positive) network or contagion effect for their products. Tech people are also familiar with Moore’s Law, which says that computing power increases exponentially as its cost decreases dramatically. It is no surprise that Bill Gates recently suggested that Covid-19 may be the once-in-a-century pathogen the world has been worried about.
Overall, the growthers tend to be analytical people who work a lot with numbers and are used to modeling the problems they face. The mindset in Washington, by contrast — and indeed much of America — is much closer to the base-raters.
The base-raters, when assessing the likelihood of a particular scenario, start by asking how often it has happened before. That is, they estimate its base-rate likelihood. And history shows that major pandemics have lately been rare. The SARS and Ebola outbreaks largely petered out, HIV-AIDS was of a very different nature, and the 1957 and 1968 flu epidemics are now distant memories.
Base-raters acknowledge the exponential growth curves for the number of Covid-19 cases, but still think that the very bad scenarios are not so likely — even if they cannot exactly say why. They view the world as hard to model, and think that parameters do not remain stable for very long. They are less convinced by analytical and mathematical arguments, and more persuaded by what they have seen in their own experience. They tend to be pragmatic and rooted in the moment.
Political scientist Philip Tetlock, in his work on superforecasters, has shown that base-rate thinking is often more reliable than the supposed wisdom of experts. Most of the world, most of the time, does not change very quickly. So there is an advantage to considering broadly common historical probabilities and simply refusing to impose too much structure on a problem.
That said, there are some cases where base-rate thinking clearly goes askew. Base-rate thinking obscured the ability to foresee the highly unusual 2008 financial crisis, for example. If applied in, say, 2014, base-rate thinking would not have predicted the election of Donald Trump.
As for the health-care establishment, epidemiologists understand exponential growth rates very well. But many medical professionals think in terms of what are called “normal” statistical distributions. If someone visits your office with what appears to be a typical flu case, it is usually exactly that. The result is that there is not much surge capacity in America’s hospitals and public-health institutions.
I still don’t know which of the two perspectives on Covid-19 is the wiser. But as someone who has studied exponential growth rates for economies, I confess that my concerns are rising.
co-founder Bill Gates said Tuesday morning that the U.S. acted too slowly and missed its chance to avoid mandatory stay-at-home orders to deal with the COVID-19 crisis, saying that “everybody should have taken notice back in January” when the first case was detected in Washington state.
“There’s the period between where we realized it was transmitting and now where we should’ve done more,” Gates said during a video discussion with Chris Anderson of TED, a non-profit organization that hosts talks and online communities.
“It’s very tough to say to people, ‘Hey keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner, we want you to keep spending because there’s some politician that thinks GDP growth is what counts,’” Gates said. “It’s hard to tell people during an epidemic … that they should go about things knowing their activity is spreading this disease.”
“It’s disastrous for the economy, but the sooner you do it in a tough way, the sooner you can undo it and go back to normal,” Gates added.
President Trump has said over the past day that he wants to quickly reassess shutdowns across the country to lessen the economic impact.
In his talk Tuesday morning, Gates acknowledged that the economy would suffer but said that “there really is no middle ground.” He suggested that we maintain a mandated shutdown of six to 10 weeks across the country.
A leading philanthropist on global public health, Gates over the past decade has foreshadowed something like the novel coronavirus, which has now infected 408,892 people worldwide and killed 18,259. His TED Talk from 2015 titled “The next outbreak? We’re not ready” has been viewed more than 16 million times on YouTube.
The Bill and Melinda Gates Foundation has pledged up to $100 million to combat COVID-19 worldwide. The foundation is also giving an additional $5 million to help Washington state officials deal with the crisis.
Gates said on Tuesday that the U.S. needs to accelerate and better navigate COVID-19 testing.
“We can figure out which antiviral drugs work within two or three weeks and get those scaled up and we can make the vaccine if we’re really ready probably in six months,” Gates said.
Continue reading for highlights from Gates’ responses on TED.
How will the U.S fare amid the coronavirus outbreak?
Gates: The clear message is that we have no choice to maintain this isolation, and that’s going to keep going for a period of time. So this is not going to be easy. We need a clear message about that. It is really tragic that the economic effects of this are very dramatic. I mean, nothing like this has ever happened to the economy in our lifetimes. But money, you know, bringing the economy back, that’s more of a reversible thing than bringing people back to life. So we’re willing to take the pain in the economic dimension, huge pain in order to minimize the pain and disease in the death dimension.
What are you thoughts on the idea of reopening the economy?
Gates: It is very irresponsible for somebody to suggest we can have the best of both worlds. What we need is an extreme shutdown. If things go well then you can start opening back up.
How should countries who don’t have the luxury of social distancing or great health systems in place be handling this virus?
Gates: But in the developing countries, particularly in the Southern hemisphere, the seasonality is large. The ability to isolate — when you have to go out to get your food every day and earn your wage, when you live in a slum where you’re very nearby each other — it gets very hard to do. I think it’s way more difficult as you move down the income ladder than it is in a country like the United States…and so we should all accelerate the vaccine, which eventually will come.
What can people do from their own homes right now to try and help?
Gates: “Well, there’s a lot of creativity. Can you mentor kids who are being forced into an online format where school systems weren’t really ready for that? Can you organize some giving activity that gets the food banks to step up where there’s problems there? The U.S. has this tradition of philanthropy, traditional civil society coming together. There’s a few things the government needs to do, but most of the things that will moderate the pain, the isolation, the damage here…everyone can think how they jump into that. These are such unprecedented times, and it really should draw out that sense of creativity, while complying with the isolation mandates.