WASHINGTON -- The coronavirus pandemic has exposed the inherent weaknesses of the World Health Organization, which has no authority to force foreign governments to divulge medical information or open doors to its hospitals and labs, public health experts and foreign diplomats say.
The Trump administration and Republican lawmakers have lashed out at the U.N. agency for its response to the COVID-19 pandemic, accusing it of helping China conceal the extent of the outbreak at a critical early stage by relaying information from Beijing without sufficient caveats.
But public health experts and foreign diplomats said that although the WHO has often displayed a deferential tone to China during the outbreak, it is misleading to suggest it has the power or the leverage to force Beijing or any other foreign government to share information or grant access to medical facilities.
"There's no power that WHO has that would have enabled it to uncover any lack of transparency on the part of China," said Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University.
"That's been the case ever since WHO's founding in 1948. They are always subject to the powers of sovereign states, to be invited to their territories or excluded from their territory, and whether that country's going to be opened or closed."
China's failure to share relevant information about the virus from the outset meant that the world was put at much greater risk, but the blame lies with Beijing not a U.N. agency with a broad mandate and no authority to enforce it, he added.
The WHO, constrained by rules that rely on the goodwill of its 194 member states, faced a dilemma. Instead of confronting Beijing and losing any prospect of cooperation, it sought to coax Beijing into granting access, public health experts and diplomats said.
"It was a tactical decision, and it was probably the only way to get access. But the optics are uncomfortable," said one European diplomat.
The organization's effusive praise of China and its apparent reluctance to criticize Beijing publicly has triggered fierce criticism from Trump and others, who accuse the U.N. organization of being an accomplice to an alleged cover-up.
The WHO's director general, Tedros Adhanom Ghebreyesus, the former Ethiopian foreign minister and health minister, has become a lightning rod for the organization's critics, who portray him as a mouthpiece for the Chinese regime.
During his time in government, he was credited with reducing infant and maternal mortality. While he was health minister, however, a senior U.N. official accused Ethiopia of trying to downplay a cholera outbreak in 2007, a charge Tedros has vehemently denied. As Ethiopia's top diplomat, he oversaw increasingly friendly ties with China, which built highways and a new African Union headquarters in the nation's capital.
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"They didn't get it right. The WHO failed in its mission to provide the information to the world in a timely fashion about the risk that was emanating from China," Secretary of State Mike Pompeo told the Jack Heath Radio Show on Thursday. "They knew it; they saw it. There was pressure from the Chinese government not to declare this a pandemic, and it became a political institution rather than a medical, scientific institution that it was designed to be."
Democrats say President Donald Trump's WHO bashing is all about domestic politics and deflecting attention from what they say is his administration's slow and botched response to the pandemic at home. White House critics argue that even when WHO did ring the alarm in late January, the Trump administration did not take urgent action to stockpile medical equipment, prepare hospitals and plan for large-scale diagnostic testing.
China has vehemently denied it concealed details about the outbreak, and the WHO has strongly defended its response, saying it took urgent action at the first signs of the epidemic in Wuhan.
"From the beginning, WHO has acted quickly and decisively to respond and to warn the world. We sounded the alarm early and we sounded it often," Director General Ghebreyesus said at a briefing last week.
The International Health Regulations that govern the WHO, which the U.S. helped draft, have no enforcement mechanism to override a country's sovereignty. One provision allows WHO to consider reports from a non-state source, and another permits the organization to share information without the consent of a government under exceptional circumstances -- when a member state fails completely to cooperate.
Last September, the WHO learned of possible Ebola virus cases in Tanzania, but the government repeatedly refused requests to provide laboratory test results or other details about the suspected infections. As a result, WHO publicly shared the information it had from other sources, a rare move only taken when a government stonewalls the organization. But beyond that, the WHO had no recourse, and Tanzania refused to budge.
In the case of China, there was at least some level of cooperation from the outset, so the WHO could not invoke its regulations to share non-state information without consent from Beijing. But it took weeks before a full-fledged WHO delegation was allowed to travel to the country.
The WHO and its director have come under scrutiny for their response in the early weeks of the outbreak, after China reported a cluster of pneumonia cases in Wuhan on Dec. 31. The WHO initially asked for more information from China and put itself on an emergency footing.
For the next three weeks, China maintained there was no evidence of human-to-human transmission. But Chinese health officials and doctors had come to the conclusion there was such transmission by Jan 14, almost a week before it was first publicly announced, according to the Associated Press. Chinese doctors who tried to alert their colleagues about the gravity of the virus were reprimanded and some were detained.
Taiwan said it wrote to the WHO on Dec. 31 about media reports of several patients with atypical pneumonia in China who were under isolation, asking the organization to share any "relevant information." The WHO ignored its query, according to Taiwan.
The WHO said it has been in regular contact with scientists in Taiwan, that it never concealed crucial information about the virus and that the email made no mention of human-to-human transmission.
Taiwan argues even though it did not use the phrase human transmission in its email, the point of the note was clear as it referred to patients placed under isolation. Under U.N. rules, Taiwan is not a member of the WHO, due to China's objections as it considers the island one of its provinces.
Skeptical of China's official accounts of the outbreak, Taiwan began screening arrivals from Wuhan as early as Dec. 31.
On Jan. 14, WHO posted a tweet repeating China's official stance that authorities "have found no clear evidence of human-to-human transmission of the novel #coronavirus."
For the Trump White House and critics of the WHO, that tweet has been cited repeatedly as proof of the organization's supposed favoritism to China.
But on the same day, Maria Van Kerkhove, an American doctor serving as acting head of WHO's emerging diseases unit, offered a different assessment. She told a press briefing in Geneva that there was "limited" human-to-human transmission of the virus and warned of the risk of a wider spread.
"This is something on our radar, it is possible, we need to prepare ourselves," she said.
On Jan. 20, China confirmed human-to-human transmission of the virus, raising fears of a potential pandemic in the making. At the same time, a WHO expert team conducted a field visit to Wuhan, issuing a statement two days later citing evidence showing human-to-human transmission and that further analysis was needed to determine the full extent of the outbreak.
The WHO praised China's "rapid identification of the virus and sharing of the genetic sequence" and convened a meeting of its emergency committee, composed of scientists from different countries. The United States was represented at the Jan. 23 meeting by Martin Cetron from the Center for Disease Control's division on Global Migration and Quarantine.
The WHO committee failed to reach an agreement that the coronavirus outbreak constitutes a "health emergency of international concern."
Although President Donald Trump now castigates the WHO and China, he repeatedly praised China's efforts and WHO officials throughout January and February and into March. The day after the emergency committee session, Trump thanked China in a tweet for its work to prevent the spread of the virus, saying the "United States greatly appreciates their efforts and transparency. It will all work out well."
As Trump dismissed the virus as no major risk to Americans, the WHO's tone grew more urgent in the coming days and weeks.
"The whole world needs to be on alert now," Dr. Mike Ryan, head of the WHO's Health Emergencies Programme, said on Jan. 29.
The scientists on the WHO's advisory emergency committee met again on Jan. 30 and this time agreed the outbreak represented an international emergency, urging countries to prepare to take measures to detect and isolate infected patients and prevent the spread of the illness.
'Caught in a bind'
Could the WHO have adopted a tougher stance in those early weeks that might have alerted the world earlier to the threat? Public health experts disagree, but some argue the WHO should have issued warnings earlier that the virus posed a global threat beyond China, and pushed Beijing harder for information.
Yanzhong Huang, a global health fellow at the Council on Foreign Relations and director of Seton Hall's Global Health Studies, said the WHO was too willing to accept what they were told by Chinese authorities.
"Recognizing the concern to make China happy in order to get cooperation, they could have done a better job in pressing China," Huang said.
During the 2003 SARS epidemic, the WHO took a more critical tone with China, calling on the government to give it access to look at outbreaks in Beijing and other infected areas.
For COVID-19, the WHO could have chosen to add caveats to the information they were getting from China instead of passing it along with the organization's implicit endorsement, Gostin said.
"The only thing WHO might've done differently is at the time to say these are the data that China's reporting, but we have no means to independently verify it," Gostin said.
"If WHO had done that it would have been honest and straightforward and transparent, but it would have angered China and probably pushed them even further from international cooperation and transparency," he said. "So WHO was caught in a bind."
The WHO, along with China, has become a favorite target for Republican lawmakers. The National Republican Senatorial Committee sent a memo last month encouraging candidates to slam China's response to the outbreak and "hit" the World Health Organization, instead of trying to defend the Trump administration's handling of the pandemic, Politico reported.
An American scientist in China
It took nearly a month before China allowed a WHO delegation to visit the country after it acknowledged the human-to-human transmission. Beijing approved a joint WHO-China mission, composed of international scientists and Chinese experts.
Two Americans were part of the WHO-China joint mission, including Dr. Clifford Lane, from the National Institutes of Health.
Lane, who oversees clinical research at the National Institute of Allergy and Infectious Diseases, said at no point did he sense Chinese authorities were providing evasive answers or blocking inquiry into certain topics.
He told NBC News the Chinese scientists and doctors he spoke to were well-informed and working in ultra-modern facilities, and ready to discuss key scientific questions that needed to be addressed. "I could have been visiting a lab at NIH," Lane said.
"I'm sure there are things we didn't see or learn about, but I thought what we did get, I thought was quite reliable," Lane said.
Initially, however, China did not invite the WHO delegation to visit Wuhan, the center of the epidemic.
"Originally, there were no plans for anyone to visit Wuhan. Everyone felt that was not good, that the credibility of the mission would be compromised if there was no visit to Wuhan," Lane said. Wuhan was then added to the itinerary, with a smaller group traveling to the city and reporting their findings.
Lane visited the cities of Guangzhou and Shenzhen but was not part of the smaller team that traveled to Wuhan. "I would like to have gotten to Wuhan, I would like to have heard more about what was going on," he said.
The WHO-China mission issued a 40-page report, drafted jointly by WHO and Chinese officials. Under the WHO's rules, the organization did not have the authority to write its own report and instead had to work out language with the consent of the host government.
The reported included glowing praise for China's management of the crisis: "In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history."
As for criticism that the joint WHO-China report painted an overly positive picture, Lane said he distinguishes between the more subjective passages and sections with clinical data and details of how patients were being treated or isolated. Some language should be taken "with a grain of salt," but he said "the data in the report was quite solid and, I thought, quite informative."
The WHO also has come under criticism for discouraging travel restrictions such as the ban imposed by the U.S. and by other governments in early February, prompting accusations the U.N. body was allegedly promoting China's agenda.
Trump administration officials say the travel restrictions on non-U.S. citizens coming from China were a crucial step that helped stem the spread of the virus in the United States. Public health experts say such measures are only effective in the short-term and have to be accompanied by other action -- including large-scale diagnostic testing -- to have a lasting impact. Trump falsely claimed the WHO "fought" the United States over the travel ban but the WHO never directly criticized the United States over the travel restrictions.
The Trump administration, which has halted U.S. funding for the WHO, has struggled to rally international support for its stance on the U.N. organization, with only Australia joining calls for an independent inquiry into how the agency responded to the epidemic. Other U.S. allies favor a review and possible reforms of the WHO but not until the emergency has passed, foreign diplomats said. "Now is not the time," said one Western diplomat.
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Despite its criticisms of the WHO, the United States has arguably exerted more influence over the Geneva-based organization over decades than any other country, former public health officials said. The United States has more of its citizens working at the agency than any other government, with more than 200 on the payroll, and Washington is the single biggest donor to the organization. The annual U.S. contribution to the WHO last year came to $400 million, roughly 15 percent of the agency's budget, while China's contribution is far less - at about $43 million.
In 2018, the Trump administration at one point threatened to cut U.S. contributions to the WHO if other member states proceeded with a resolution to encourage breastfeeding.
Founded in 1948 as part of the United Nations, the WHO for years focused on sharing technical advice with health ministries and leading vaccination programs. But after coming under scathing criticism for moving too slowly during the Ebola virus crisis in West Africa in 2014, the United States and other countries backed reforms to help WHO better respond to epidemics.
Some of the attacks from Republicans have focused directly on the WHO's director, Tedros, painting him as an apologist for China's leadership.
"Director General Tedros is a puppet of the Chinese Communist Party," Rep. Michael McCaul of Texas, the ranking Republican on the House Foreign Affairs Committee, told USA Today. "He used the WHO to trumpet their lies about the virus."
As foreign minister of Ethiopia from 2012-2016, Tedros presided over a blossoming of relations with China, which has financed major infrastructure projects and become the country's biggest trading partner. After his trip to Beijing in February, Tedros said China had set "a new standard for outbreak control" and he told the Munich Security Conference that Beijing's actions had "bought the world time."
Tedros' unreserved praise for China has raised eyebrows even among WHO's supporters, who fear his tone could damage the organization's role as an impartial platform for sharing scientific information on pressing global health problems.
Tedros drew criticism early in his tenure at the WHO in 2017 when he proposed Robert Mugabe, Zimbabwe's president at the time, as a WHO goodwill ambassador, praising his efforts to promote universal health coverage.
Tedros has fiercely defended his performance, saying the WHO showed no bias in favor of one country over another. "We are close to every nation, we are color-blind."