Multilateralism Without Universalism: Hard Lessons from WHO During COVID-19
Trump made headlines in announcing that the US will be suspending financial support to the World Health Organization (WHO) until completing an investigation into its handling of the COVID-19 pandemic. While this action has been rightly decried as an attempt to deflect blame for his own response, which was too slow and too dismissive, there is some truth to his accusations. The WHO has not performed well, and it does seem likely that they were influenced by China’s desire to downplay the disease for as long as possible. However, the response should not be to abandon internationalism altogether, but rather to look at more selective multilateralism as a supplement to universal systems.
Internationalism has not failed
The defense of international systems is critical, as that’s the most immediate danger—the argument will run that when the chips were down, we couldn’t actually depend on international cooperation, thus justifying semi-autarky as an “insurance policy.” This approach is wrong headed: autarky cannot prevent or even blunt the impact of pandemics, and a global response will likely be important in mitigating this and future crises. However, even as multilateral cooperation remains essential, the COVID-19 debacle has shown the weakness of universal international institutions. In an international context where some of the largest and most influential powers are brazenly illiberal, liberal cooperation is of limited efficacy. Multilateral organizations with membership determined by certain shared ideals—as opposed to geography or economic achievement—need to be strengthened to present a united front in the face of future crises.
There are of course incidents where the usual rules of international commerce have been suspended. The dispute over N-95 respirators being exported to Canada or imported from China has been one example, and has led to vows of increased self-sufficiency in the future. However, abandoning (relatively) free trade would be a foolish choice. Even now, international trade in ventilators, masks, and other key equipment is critical to keeping healthcare systems afloat. Mexico, which thus far has not experienced the pandemic to the extent that the US and Europe has, is dramatically increasing exports of those goods, while China, having weathered the worst of it, is beginning to export those goods again. If the pandemic strikes the global south next, the United States and Europe should reciprocate. Indeed, as the pandemic hits various areas of the world in sequence, there is no question that free, rapid trade will be critical to minimizing its ability to swamp local medical systems. Insistence that every country should be completely self-sufficient would mean that lifesaving equipment would stand idle while patients died across borders that could have easily been crossed.
As the effort against the pandemic shifts to developing treatments and vaccines, international trade and cooperation will be even more important. Numerous vaccines and treatments are in development around the world, and while it’s unclear which, if any, are going to yield results, all talk of medical autarky will appear even more foolish if a foreign country develops this life saving vaccine. Indeed, the decision by the United States to take exactly this strategy regarding testing—failing to use or replicate tests developed in other countries and instead taking valuable time developing its own—likely worsened the outcomes here, as compared to Hong Kong, South Korea, or Singapore, where dense populations in close proximity to China nonetheless suffered far fewer deaths than the United States.
A specifically liberal internationalism
Thus, it is necessary to push back against anti-globalists using this virus to argue for American Juche. However, the international system must become more effective if is going to be defended in the long term, and that means honestly assessing and correcting its weaknesses. As it currently stands, that system has suffered from one glaring error: the lack of transparency coming from China, the most critical country in the current pandemic. China’s opaque policies had a deleterious effect on the entire World Health Organization’s efficacy during the crisis. At the very beginning of the crisis, Dr Li Wenliang attempted to spread information about the novel disease, but was silenced by local officials. Well into January, Chinese officials insisted that the virus was not showing signs of person-to-person transmission, and the WHO did not recommend travel restrictions from China. Indeed, on January 23, the WHO reiterated its recommendation that neither travel restrictions nor traveler screening be put in place despite endorsing travel screening inside China itself. This was in line with China’s general determination to prevent its neighbors and allies from implementing travel restrictions—even as the country essentially isolated Hebei province from the rest of the country, and has now enforced travel restrictions on individuals entering China.
The World Health Organization’s actions—and perhaps more importantly, inactions—do not primarily indicate a failing of the individuals who run it, who I assume are competent and dedicated professionals. Rather, it is the inevitable consequence of the structure of the WHO and UN. They depend on their constituent states for their funding and effective operation, and they depend on larger states more than smaller ones. While China’s funding commitments are only about half those of the United States, they are larger than any other single country (though their additional voluntary contributions are far less prominent). More than simply money, China holds a permanent seat on the UN security council and is highly influential in the General Assembly, both critical bodies for governing international response to any crisis. Openly condemning or even disagreeing with the Chinese ruling party would jeopardize the larger goals of the WHO.
Nonetheless, this surely works to the detriment of smaller or more liberal states that depend on the WHO. Smaller states lack the resources to push back against Chinese influence, and liberal states are constitutionally restricted from responding with the same restrictions that China used to control COVID-19. Liberal states rely instead on open reporting and accurate information from partners, which China did not allow in the first period of the crisis and the WHO was unable to provide until it was too late.
If liberal states are to deal with future pandemics, it will be necessary to create or strengthen multilateral—but not universal—organizations. The WHO, for example, is valuable for improving global health, but an organization that included only countries achieving a certain level of government transparency would likely be more trusted by democratic states looking for cooperation in pandemic response. Existing liberal institutions are poorly suited for the role. Most, like the OECD, have no real humanitarian focus at all, and deal strictly in terms of economics. This may be valuable in recovering from a pandemic-induced economic crash, but not in preventing its core causes. The EU is hypothetically better positioned, but the agency that would be in charge—the European Center for Disease Prevention and Control—has a miniscule budget of $58 million. This is roughly a third of Germany’s voluntary contribution to the WHO, and less than one percent of the US CDC budget.
On the other side of the Atlantic, the Organization of American States has no equivalent agency. Faced with a pandemic, liberal states must either rely on their own internal organizations—which is, by definition, insufficient for facing a global disaster—or the WHO, which seems for the time to be unduly influenced by Chinese political priorities.
The solution is not to abandon the WHO entirely; after all, in a true pandemic a truly global response is required. However, if the WHO is restrained from providing transparent information and making unbiased recommendations, other international organizations will be needed that actively limit membership to states meeting certain standards for liberal policies. Such organizations would have greater capacity to analyze data from numerous countries, and more credibility when issuing guidance, than individual country’s health bureaus.
Whether a single global institution or a series of cooperating regional ones would better serve this purpose is an open question; most of the current bureaucratic infrastructure exists at a regional level, and so those may have to be built before a truly global system can be created. The critical difference between such an organization and the WHO, however, needs to be its selectivity. Countries that do not tolerate a high level of media freedom and critical reporting need to be excluded. Furthermore, there need to be mechanisms to expel, after a series of warnings and time to address issues, countries who fail to meet these requirements. The current situation in Hungary is a demonstration of how complex this is; however, some expulsion mechanism is important in order to maintain some unity of vision within an international liberal organization.
Would exclusive internationalism completely take the place of the WHO? Hardly. For one thing, for a pandemic that begins in an illiberal country, the world will still have to depend on that state to give the initial information. And the WHO will still need to do important work for the health of people living in illiberal states; their health is important even if their governments are poor partners. And working with those regimes on critical international initiatives will be necessary.
Liberal alternatives to the WHO, however, would allow for a rapid international deployment of resources between liberal countries. This could lead to more appropriate recommendations, since such organizations would not be constrained by illiberal regimes. A health organization where Taiwan, Hong Kong, Singapore, and South Korea were the dominant East Asian voices, for example, may have been able to issue more effective guidance based on those countries’ experiences with SARS, MERS, and the current pandemic, less influenced by concerns about the impact on China’s political standing. Undoubtedly, states would still attempt to exert influence on these new organizations for their own benefit, but in a context of free media and multi-party elections, this would be less effective.
Although the comparison is imperfect (because H1N1 was a better understood virus than COVID-19), a comparison of the H1N1 pandemic with the current COVID-19 pandemic shows profound differences: H1N1 was reported to the WHO after the second patient was identified, while COVID 19 had at least 27 active cases before the WHO was notified. Within four days, a public statement was made about the two H1N1 cases. There was no doubt strong incentives to downplay such information; after all, it not only created the potential for restrictions on the travel of US citizens, but directly threatened the massive US pork industry. Nonetheless, there was no way to intimidate the first doctors and patients as has been done with Dr. Li in China; both local officials and the CDC quickly moved to present the situation transparently to both the public and the WHO because the information was impossible to hide.
The next question is whether in the immediate future this means defunding the WHO, as the president has set out to do. In the short term this is more of a knee-jerk scapegoating than a true solution. Imperfect as it is, the WHO remains the only effective international health organization, and while its recommendations may be suspect, its expertise is still needed to mitigate this pandemic.
What is needed instead is a deliberate plan to create a better organization or set of them—starting in our own backyard. So far, the United States is hardest hit of countries in the Americas. Border closures with the relatively less impacted Canada and Mexico have been mutually agreed upon; this will hopefully slow the spread from the US into those countries. The next step will be more politically difficult: when and if Mexico, Brazil, and other countries in Latin America are stricken more acutely than the United States, it is critical that the US offer help and support. There will be a hesitancy about exporting medical devices and PPE on the tail end of the epidemic in the United States—this hesitancy must be overcome. The United States must be open about what worked and did not in its own response in order to help our neighbors. On the basis of successful hemispheric cooperation, we can build real institutions designed to help our neighbors—a well-funded American States Health Organization, dedicated to hemispheric cooperation in preventing the spread of epidemic disease and stamping out remaining endemic contagions, such as malaria, much as was done historically with Yellow Fever.
Overseas, funding for the European Centers for Disease Prevention and Control, naturally, needs to be a European priority, but close cooperation between the US CDC and its European counterparts will be important. Perhaps most important will be the creation of formal avenues of medical cooperation with South Korea, Taiwan, Japan, and other democratic states in Asia. Their experience with epidemic disease is invaluable, and the odds are good that future pandemics will also originate in this densely populated region of the world. Being able to immediately share information with these countries should allow every country to respond more quickly to future pandemics. This will be especially valuable in the case of Taiwan, a model case for fighting this pandemic but which is largely locked out of cooperation with the WHO.
As these organizations gain the infrastructure to include liberal states around the world, they can also begin to offer assistance to non-members. Of course for pandemics originating in powerful illiberal states, the WHO will still have to at least provide the initial response. However, a respected multilateral alternative, less subject to political pressure, could be a valuable resource even to non-members by providing recommendations, funding, and emergency response to pandemics. Moreover, once a true alternative to the WHO exists, it will increase leverage exercised by countries like Germany and Canada, which provide a huge portion of the WHO’s budget but whose public opinion (rightly) makes cutting off this funding unthinkable. Whether this pushes the WHO to improve or simply creates a viable alternative, it will have improved the global health situation.
If this effort works, it can be extended to other realms of international cooperation. It has long been remarked that the mission of the UN Human Rights Council, for example, is difficult to reconcile with the actual records of many of its members. And if nothing else, hopefully membership in numerous genuinely helpful organizations with exclusive rules requiring basic standards on elections, press freedoms, and human rights will constitute a disincentive to liberal members backsliding into authoritarian ways.
All of this may seem wildly ambitious, and to an extent it is. Getting such an organization off the ground will cost billions of dollars, in a period that will be filled with (misguided) calls for austerity. However, there is also popular sentiment that “we can’t go back to normal,” that COVID-19 has created an opportunity and necessity for permanent change. In the United States, and many other states, conservatives have been quick to blame China and the WHO for the devastation accompanying the pandemic, while liberals can point to the overall lack of pandemic preparedness that many western governments suffered from. There is truth to both of these claims—and a well funded liberal supplement or alternative (the WHO’s response will likely determine which) to the WHO would be a fitting response to both. More than that, it could be the start of a new sort of multinationalism, one built on the peaceful advancement of global humanitarian priorities via cooperation between like-minded democratic states.
Featured image is the World Health Organization flag
