On New Year’s Day 2020, China received the first request from the World Health Organisation (WHO) on a cluster of “viral pneumonia” cases in Wuhan. This was the first step in a herculean effort to mitigate a pandemic that has left more than 500,000 people dead. As the outbreak developed into a global catastrophe, China’s approach to the early stages of the pandemic came under scrutiny amid claims of a cover-up in Wuhan. The WHO, however, stood by China’s side. In a statement made on the 30th January 2020 an Emergency Committee of the WHO “welcomed the leadership and political commitment of the very highest levels of Chinese government” and “their commitment to transparency”. The Director General of the WHO, Dr. Tedros Adhanom Ghebreyesus, personally expressed his support for China’s response to the virus at the end of January, and the WHO has repeatedly expressed that it “works closely with Chinese experts” in order to ensure that any future outbreaks are brought under control. The proximity of this relationship has, however, come under fire amid suggestions that the WHO has failed to hold China accountable for its role in covering up the epidemic in Wuhan.
One of the WHO’s most notable detractors is America President Donald Trump, who stated in April that he plans to withdraw US funding for the organisation. This is a serious threat: the US supplied more than $890,000 to the WHO between 2018-2019. Expressing his “deep concerns” about the use of American funding and the WHO’s supposed failure to “call out China’s lack of transparency”, Trump’s argument was predicated on the assertion that the WHO had failed in their duty to hold China to account for their early failures, which include the existence of ‘wet markets’ that are ideal breeding grounds for disease and the Chinese government’s decision to suppress Dr Li Wenliang after he noticed the virus’s existence. The WHO’s sympathetic stance towards China in light of these problems indicates, in Trump’s eyes, an unacceptable level of influence over the organisation. Although Trump’s public disdain for China’s foreign policy make it tempting to dismiss this criticism as thinly-veiled nationalism, Trump is not alone in his concern about its relationship with the WHO.
China’s influence on the WHO has grown with its funding for the organisation, which, although it is still dwarfed by American spending, has increased by 52% since 2014. The WHO’s funding structure relies on voluntary donations, which critics have argued leave it open to influence by wealthy nations and third parties. China’s increased contribution to the WHO is part of a wider drive for UN influence that has seen Beijing become the second greatest source of funding for the international organisation as a whole. Dr Ghebreyesus, who currently leads the WHO, has also been criticised for his ‘fondness’ for China during his Director General election. In the months leading up to his election he was invited to give a keynote speech at Peking University, in which he expressed a desire for China and Africa to work together to improve global health. This determination hasn’t faded: Dr Ghebreyesus was the guest of honour at an online China-Africa summit that emphasised the importance of continuing medical collaboration during the coronavirus. This is not necessarily an individual issue; other candidates for the post of Director General were also highly involved in campaigns with China. This election brought another central criticism of China’s influence over the WHO to the fore: Taiwan’s inability to participate in the World Health Assembly.
The day after Dr Ghebreyesus was elected as Director General he emphasised the organisation’s continuing support for the ‘one-China’ policy, which views Taiwan and China as a single entity. The election had taken place in the context of a Taiwanese attempt to gain representation on the World Health Assembly, which was roundly rejected. Dr Ghebreyesus won amid suggestions that his support came in large part from his unwillingness to challenge China over Taiwan. Out of context, the suggestion that China wields disproportionate influence over the WHO seems plausible. However, when placed in the context of increasing American derision for the international body coupled with China’s critical position with regard to global health, a more complex picture emerges.
Dr Ghebreyesus was Obama’s preferred candidate, not Trump’s. The Trump administration’s proposed WHO budget in 2017 would have seen a $2.2 billion reduction in global health spending. The US, as the single greatest contributor to the WHO, enjoys significant financial power over the organisation. Amid budget cuts and withdrawals during a global pandemic, the organisation has been forced to look elsewhere. China’s funding, in contrast, has surged. China has been responsible for the creation of the Global Health Drug Discovery Institute, as well as pledging more than $8.8 billion to global health initiatives. During the coronavirus outbreak China’s swift response has allowed it to assist other nations, particularly in Africa, by sending “emergency medical teams” to help local health services to cope with the pandemic. In contrast, the US has cut support for the WHO during its greatest emergency to date.
Through the lens of American nationalism, the WHO’s support for China seems unfair. However, viewed in the context of a changing geopolitical situation in which the US is increasingly unwilling to fund or participate in the WHO’s missions, it seems that China is simply filling in the gap. Although the WHO’s lack of recognition for Taiwan is clearly motivated more by politics than health, China’s influence does not seem disproportionate to its contributions. Despite issues of transparency, China followed WHO advice at the start of the pandemic extremely well, providing key genetic data that Dr Ghebreyesus argues “bought the world time”. Following this advice has kept Chinese total reported COVID-19 deaths to 4,648, in contrast to the US, which eschewed WHO warnings and now has a death toll of more than 127,000. COVID-19 will shift the priorities of the WHO, which may well be forced to rely on China if the US continues down the route it has set out. The question for the future will be how China responds to this increasing influence.