The World Health Organization (WHO) is facing mounting pressure to answer critics worldwide who say Chinese influence has hindered its response to the coronavirus pandemic.

United States President Donald Trump suspended WHO funding Tuesday, alleging the organization failed to respond to “credible” information in December in Wuhan, China that suggested the new virus could be spread through human-to-human transmission.

However, Trump did not cite sources for his allegations.

But WHO defenders, including Canada’s prime minister and health minister, maintain that the WHO has worked with its partners to share the best scientific evidence possible in order to respond to the coronavirus pandemic.

What is the WHO’s purpose?

The United Nations created the WHO in 1948, giving it a broad mandate to co-ordinate international health policy and set guidelines with the objective of promoting co-ordinated medical responses in an increasingly interconnected world. As the Council on Foreign Relations explains, in 2019, the WHO set three strategic priorities:

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Providing health coverage to one billion more people

Ensuring another one billion people enjoy better health and well-being, including protection from non-infectious diseases

Protecting one billion more people from health emergencies such as epidemics

But the WHO’s response to the coronavirus pandemic has raised new questions about its funding and structure as well as perceptions that politics caused the organization to drag its feet while setting COVID-19 guidelines in an effort not to upset China.

How do the WHO’s funding and governance work?

The WHO is headquartered in Geneva, Switzerland and has 149 country offices. Its most recent two-year budget goal was $4.4 billion, but only 20 per cent comes from member states. The WHO must raise the rest of its funding through voluntary contributions. The United States is the top donor, providing about $400 million per year, followed by the United Kingdom and the Bill and Melinda Gates Foundation. According to the most recent WHO budgetary data, Canada and China both contribute about $45 million per year.

According to the Kaiser Family Foundation, a non-profit that analyzes global health issues, the WHO’s funding and governance structure are increasingly causing institutional challenges, including:

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Scope of responsibility that has grown over time while budget is flat or reduced

Less flexible budget with greater reliance on voluntary contributions that are earmarked for specific initiatives

A dual mandate of being a health expertise agency and a political body where states debate and negotiate on divisive health issues

What can the WHO do in an epidemic?

Under the organization’s International Health Regulations (IHR), the WHO is authorized to take a number of actions in response to the outbreak of disease with the goal of protecting people worldwide and guarding against undue economic harms.

Firstly, the WHO is authorized to gather disease information from non-governmental sources, verify the information with governments and, if warranted, share the information with other states. Next, the WHO director-general can declare a public health emergency of international concern. Third, the WHO is authorized to ask any country that implements travel or trade measures to protect against disease spread to justify the measures with scientific and public health data if the measures don’t conform to the WHO’s guidelines. Finally, the WHO is supposed to monitor states’ responses to disease outbreaks to ensure that human rights are not being violated.

In the case of the coronavirus pandemic, the WHO has come under fire from critics worldwide, mostly for its activities in the first three areas of its IHR mandate.

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China’s alleged misreporting and WHO relationship

China has been accused by U.S. intelligence agencies and political critics worldwide of intentionally misrepresenting the incidences and infectiousness of the new coronavirus, starting with the suppression of warnings from whistleblower doctors in Wuhan in December. The critics, including former Liberal justice minister Irwin Cotler and a number of Conservative MPs in Canada, note that the WHO’s statements throughout January and February closely matched China’s in downplaying the scale, infectiousness and risk of global spread of COVID-19.

“There is absolutely no doubt the WHO has been slow to recommend concrete measures, and that has negatively affected Canada’s response to the virus,” Conservative MP Matt Jeneroux said Tuesday in a health committee hearing. “In fact, the WHO has gone above and beyond to thank China for its response, which has been to mislead the world on the gravity of the virus.”

1:39 Coronavirus outbreak: U.S. intelligence agencies raise further concerns regarding China’s COVID-19 reporting Coronavirus outbreak: U.S. intelligence agencies raise further concerns regarding China’s COVID-19 reporting

It wasn’t until March 11 that the WHO declared COVID-19 a pandemic, Jeneroux noted, after the virus had rapidly spread worldwide.

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And a broad range of critics worldwide have commented on a Jan. 14 WHO tweet that closely hewed to public information issued by China’s government in mid-January.

“Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China,” the tweet read.

However, an Associated Press investigation that cites a leaked Chinese government memo reported that on Jan. 14, Chinese officials received confidential instructions from President Xi Jinping on the coronavirus response based on documents that said “clustered cases suggest that human-to-human transmission is possible.”

“With the coming of the Spring Festival, many people will be travelling, and the risk of transmission and spread is high,” the leaked memo said, according to the AP. “All localities must prepare for and respond to a pandemic.”

One of the WHO’s critics, Jerome Beaugrand-Champagne, a Canadian lawyer, lecturer and Chinese law expert, said he believes WHO officials ended up reporting misinformation from China in January, rather than conducting the independent verification measures authorized by its IHR mandate.

China eventually admitted underreporting in the early stages of the 2003 SARs outbreak, Beaugrand-Champagne noted, and he believes this factor should have caused the WHO to be more skeptical of China’s early COVID-19 reporting.

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Beaugrand-Champagne also noted that in January, WHO director-general Dr. Tedros Adhanom Ghebreyesus travelled to China and heralded the country for “setting a new standard for outbreak response.”

Tedros’ WHO leadership bid was supported by China, Beaugrand-Champagne says.

“I think the WHO, some of the doctors were blinded by visits to China,” Beaugrand-Champagne said. “They went and reported on what they were meant to see.”

The WHO did not respond to questions for this story that included a list of accusations from critics, including Beaugrand-Champagne.

“I invite you to check the timeline of events — for example WHO declared public health emergency on 30 January, which is our highest level of aleam [sic] under IHR (document agrees [sic] by all countries in the world),” spokesperson Tarik Jasarevic stated in an email response.

Taiwan, China and the WHO

For years, there has been controversy surrounding Taiwan’s exclusion from the United Nations and the WHO, which is a policy favoured by China, as it does not recognize Taiwan as a sovereign state. When China joined the United Nations and the WHO in 1971, Taiwan was removed from both international bodies. Taiwan, meanwhile, has pressed the WHO for inclusion.

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Recently, Canadian doctor Bruce Aylward, a WHO assistant director-general and co-lead of the organization’s China coronavirus mission, has attracted controversy by appearing to hang up on a reporter who asked about Taiwan’s membership status and pandemic response. Footage from a Hong Kong broadcaster showed Aylward saying he couldn’t hear the question properly and asking the reporter to skip to the next question before appearing to hang up. The broadcaster and the WHO are still disputing over the editing of the video, which went viral.

Some critics, including Taiwanese historian Patrick Tung, have noted the paradox that Taiwan’s pandemic response has led the world in health outcomes, likely because Taiwan was not a WHO member.

As of mid-April, the country of 23 million, which has close links to mainland China in many ways, has recorded just six deaths and under 400 cases in the COVID-19 pandemic.

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A Brookings Institute piece titled “Taiwan shows its mettle in coronavirus crisis, while the WHO is MIA” concluded that Taiwan learned from the devastating spread of the SARS epidemic in 2003 and quickly implemented its new epidemic response plan in January 2020, using travel restrictions for passengers from China and Hong Kong and strict testing and quarantine measures at airports.

A study in the Journal of the American Medical Association noted that Taiwan paid attention to troubling signs in Wuhan in December and sent its own fact-finding team into China to make an assessment of pandemic risk.

“Taiwan [does] have ears on the ground in China, and they also have their intelligence, and they know what Xi Jinping is doing and they are not afraid to stand up and say they will protect their own,” Beaugrand-Champagne said in an interview. “Right away, they closed the flights down and banned the exports of face masks.”

In the health committee hearing this week, Jeneroux summarized similar conclusions.

“Taiwan flattened the curve proactively by enhanced border measures before China even admitted to having a new disease,” Jeneroux said. “No doubt there are mounting questions about the WHO’s refusal to recommend enhanced border measures and the use of masks. We have serious questions about the WHO’s data and who is really making decisions that are impacting Canadians.”

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1:17 Academics, politicians warn China’s COVID-19 response is its “Chernobyl” moment Academics, politicians warn China’s COVID-19 response is its “Chernobyl” moment

Canadian health officials, including Health Minister Patty Hajdu, were asked to respond to the criticisms of the WHO, questions about the WHO’s relationship with China and Canada’s reliance on the WHO’s COVID-19 guidelines.

A ministry spokesperson instead pointed to Hajdu’s response to these questions on Tuesday at a press conference.

“I’ll just add to what we’ve already said about the role of the WHO and its importance in terms of understanding, sort of, global pandemics and the trajectory of illness around the world and how we work together to manage that,” Hajdu said.