The news that President Trump has threatened to freeze funding for the World Health Organisation is yet another example of the way that responses to the Covid-19 pandemic have retreated from global cooperation and action to behind national borders and narrow national self-interest. And it is this nationalisation of health responses that presents perhaps one of the biggest threats to global efforts to contain, control and ultimately limit the threat the virus presents to everyone across the world.
In his latest outburst of outrage, Trump accused the WHO of failing to respond early enough to the initial outbreak, of taking an overly ‘China-centric’ approach in its policy and recommendations, and (in what is probably the real reason Trump is so cross with the WHO) the organisation’s criticism of the decision by the US government to ban flights from China. Whether the announcement presages a move to genuinely cut US funding for the WHO, or another thin-skinned impetuous tantrum from the Toddler-in-Chief, we’ll see.
But whilst Trump stands out for a response characterised by denial, bluster, confusion and contradiction, the retreat to national-self interest in the face of global crisis is hardly unique to his administration. Across the world, and perhaps especially across the global North, governments have retreated to the post-Westphalian nation-state in their responses: pulling-up drawbridges, setting out their own policies and approaches, pulling back on international commitments, and in doing so have undermined much progress towards meaningful global health governance and global health responses and fed a resurgence of health nationalism just when a global perspective is most needed.
To be sure, this is not a new process. Since the 1980s, major donors have undermined the capacity of the WHO to respond to both global health and health crises by shifting their funding from support for its general budget (over which the WHO determines allocations) to special-funding for specific diseases and health issues (over which donors have far more control). The creation of disease-specialist institutions and the focus on a limited number of health issues in processes like the MDGs, have created vertical programmes rather than supported national health systems, and encouraged the atomisation of global health.
Following the SARS crisis in the early 2000s, there was some progress in international collaboration to contain and limit global contagion, as governments recognised the need for coordinated responses and a global perspective in overcoming regional and global health threats. What has happened in the first months of 2020, then, is a re-nationalisation of global health strategy, as governments pursue their own policies, listen (or, in the case of some, don’t listen) to their own health experts, compete for vital medical supplies, blame other powers for the outbreak and spread of the infection, and fail to provide the resources for tackling the pandemic in areas of the world which would struggle to do so without international support. Whatever lessons were learnt have seemingly been forgotten in the race to secure sufficient ventilators or personal protective equipment for health workers before other nations.
This retreat to nationalism in the midst (and under the cover) of global health crisis can also been seen in the ways in which regional and global power rivalries have sought to attach blame for it. The repeated use of the term ‘the Chinese disease’ by Trump and others in his administration is deliberate, using the immediate crisis to continue to attack China as part the wider Chinese-American economic and political tensions. Similarly, the accusation by a senior minister in Bolsanaro’s administration that China was using Covid-19 to assert global power is not so much an irrational outburst, than the framing of geopolitical rivalries through the convenient excuse of epidemic. Politicians and leaders have sought to use a medical framing for accusations about China (and it has been China rather than just the Chinese government, as seen in the racist comments on Chinese culture and disease by people like Senator Cornyn* that are really not at all about health and disease: nationalist xenophobia in a face-mask.
This matters, most immediately because failure to control Covid-19 in any part of the world, in the absence of drugs for treatment or more importantly a vaccine, leaves every country vulnerable to re-infection once controls on movement are lifted. Even in the hardest-hit regions, the majority of the population is unlikely to have been infected, and therefore will have no immunity (although the science is still not sure as to what level of immunity infection provides). Global cooperation is therefore essential to ensure that the infection chain is sufficiently broken for the virus not to come sweeping back when restrictions are lifted (as they will inevitably have to be) amongst a still largely non-immune population. So it matters to those living in Europe or North America how countries in sub-Saharan Africa, south Asia, and so on, manage their own epidemics. That alone should give pause to ill-considered threats to withhold funding for the organisation charged with protecting global health. Without a strong, internationally-coordinated and collaborative, and science- (not national self-interest) driven approach, some governments will simply not have the capacity or resources to put in place effective control measures, never mind treat and care for large numbers of people who become sick.
But it also matters in the longer-term. Although a pandemic on this scale has not been seen for a century, it is luck and a bit of good management that has so far limited other threats from making the jump to this scale. For decades, we have been warned of the potent and very real threat that global pandemic presents. And we have experience in dealing with other pandemics and regional epidemics (HIV, Ebola, SARS, to name but three) of how cooperation can help protect all. Yet too many governments have (as we can now see) woefully failed to prepare (the UK is currently suffering for its lack of preparedness and long-term under-funding of health services), both for their own national preparedness, but also in supporting and strengthening global institutions and their ability to respond effectively
Sure, the WHO is not a perfect organisation, and some of its regional bodies have shown themselves in relation to other epidemics very poor in their response. But some of those failures are the result of donors pulling back from multilateralism, and retreating to nationalism, in their funding and willingness to support and promote global institutions and responses. The cost has been the weakening of the WHO, of wider global health governance, and of global health policy and preparedness. The recent resurgence of populist nationalism could not have come at a worse time in respect of global readiness for the emergence of Covid-19.
Health crises, and the response to those crises, do not exist in a vacuum. Science provides the data, experts the analysis and advice, but politicians and governments must decide and implement policy. Yet many of those politicians have increasingly looked inwards and to national self-interest across a whole swathe of policy and decisions. It is no coincidence that the fragmentation and atomisation of responses to Covid-19 have emerged during a populist-nationalist turn in global politics. After years of donors tying their own national economic and political interests to international aid; of resurgent economic nationalism; of the construction of physical and legal walls to keep people locked out of countries and blocs; the consequences for global cooperation and collaboration in response to a global crisis are not only ominous, they could be literally deadly on an unimaginable scale.
* Interesting to note that Cornyn accused China of being responsible for the MERS outbreak (first identified in Saudi Arabia in 2012), and for swine flu (first detected in the United States in 1998). As I said, this is not really about science, but nationalist xenophobia.