Last week, senior House Republicans urged the Trump administration to reconsider its decision to terminate U.S. relations with the World Health Organization. While there is no strong evidence substantiating President Trump’s claim that the WHO has become “China-centric,” the U.S. pullout may actually push the organization in that direction.
How does China engage with the WHO? Here’s what you need to know.
1. Beijing isn’t a top contributor of WHO funding or personnel
The WHO has 40 Chinese staff, less than 1 percent of the organization’s employees. The headquarters leadership team has only one member from China, compared to two from the United States. Based on financial contributions and earmarks, the U.S. government has had more leverage than China in setting WHO program priorities — China contributes just 1.5 percent of the total WHO budget, compared to 16 percent from the United States.
About those earmarks — the WHO’s program budget portal shows nearly three-quarters of U.S. government contributions are voluntary, and earmarked for programs that reflect U.S. global health funding priorities, like polio eradication, health and nutrition services, and vaccine-preventable diseases.
To some extent, U.S. voluntary contributions have a heavy influence on the WHO agenda. Polio eradication accounts for 27 percent of WHO program funding, and contributions from the U.S. government and organizations have supported this effort for three decades. Numbers-wise, there have been just 68 cases worldwide of wild poliovirus type 1 to date in 2020, and other strains appear to have been eradicated. Tuberculosis control, in comparison, received 2.3 percent of the funding, despite 1.5 million TB deaths in 2018.
2. China’s influence within the WHO has grown
But the WHO still has concrete reasons to take China’s priorities into account in its decision-making. China has been the origin point of several major disease outbreaks, for instance. The WHO stepped up its China presence after the 2002-2003 SARS outbreak and has been working closely with Beijing on pandemic response in recent years. Also, China’s huge population and position as a manufacturing giant in the global supply chain suggest the country plays a central role in addressing complex global health, development and security dynamics.
As China broadens its capacity and procedures in disease prevention and control, it becomes even more imperative for the WHO to seek China’s cooperation to effectively coordinate the global response to public health emergencies of international concern, like covid-19. Other organizations like the Gates Foundation and the World Bank have increasingly challenged the WHO’s role as a guardian of global health. This suggests vocal support from a major power like China means a lot to the WHO.
During the 2009 H1N1 pandemic, the WHO refused to chastise Beijing for instituting travel restrictions on Mexican citizens and banning North American pork products, in defiance of WHO recommendations. The Chinese government then referenced WHO support in justifying its aggressive outbreak response. Two years later, in 2011, Beijing hosted the first BRICS Health Ministers’ Meeting, which pledged to “improve the leading and coordinating role” of the WHO in international health cooperation.
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3. China has important — but not decisive — influence over the WHO leadership
In 2006, Beijing mobilized its diplomatic resources to help Dr. Margaret Chan, the director of health in Hong Kong, beat out the other 12 candidates and become the WHO director-general. In 2012, Chan ran unopposed for reelection — potential contestants realized that with China throwing its support to Chan, they had little chance of winning.
Five years later, with the change to a more transparent, one country/one vote election procedure, China was no longer the dominant influence in the WHO director-general selection. Dr. Tedros Adhanom Ghebreyesus, Ethiopia’s public health minister, in June 2017 became the new WHO head largely because of the strong support of the African countries as a bloc.
But Tedros has also sought Beijing’s cooperation and support. The day after his WHO electoral victory, Tedros reiterated his adherence to the “One China” principle — this is “code” for a reassurance to Beijing that the WHO will not invite Taiwan to formally participate without China’s approval.
In July 2018, Tedros went to Beijing to discuss with senior Chinese officials how to build “stronger and more strategic WHO-China collaborations.” These discussions involved improving the health of people in countries covered by China’s Belt and Road Initiative and an agreement to “further expand the number of Chinese health professionals seconded to WHO.” In December of that year, the State Administration of Traditional Chinese Medicine (TCM) signed an MOU with the WHO, which led to the WHO approval of a new version of its International Classification of Diseases that includes TCM as remedies.
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Trump’s pullout will help, not hinder, China’s influence
China’s influence over the WHO became clearer during the novel coronavirus outbreak. In exchange for China’s compliance on information sharing as stipulated in the International Health Regulations — the widely adopted global agreement on ways to prevent the international spread of disease — the WHO not only used China’s rhetoric on the nature of the virus spread but also was reluctant to criticize how Beijing initially mishandled the crisis. Despite its frustration over China’s failure to provide complete information, the WHO praised China for “setting a new standard for outbreak control.”
Since all the conditions that allow Beijing to influence WHO decision-making remain in place, U.S. withdrawal won’t make the organization less subject to China’s influence. On the contrary, the U.S. move is likely to mean the WHO will increasingly look toward China for leadership and support. After Trump’s initial April announcement that the United States would suspend WHO funding, China pledged a $30 million donation for the WHO’s coronavirus effort.
What happens now? Some experts suggest that the United States could work with other stakeholders to push for crucial WHO reforms, such as ensuring member state compliance with WHO norms, to make the WHO stronger and more responsive. Indeed, on Sunday, Tedros gave the commencement speech for the School of Economics and Management at Tsinghua University. Instead of lavishly praising Beijing’s approach to the virus, he emphasized that the pandemic taught us “the best” and “only” way forward is to “be together.”
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Yanzhong Huang (@YanzhongHuang) is a professor at Seton Hall University’s School of Diplomacy and International Relations and a senior fellow for global health at the Council on Foreign Relations. He is the author of “Toxic Politics: China’s Environmental Health Crisis and its Challenge to the Chinese State” (Cambridge University Press, forthcoming 2020).