Look to WHO, experts say, as US Senate searches for pandemic response solutions

WASHINGTON — As the Trump administration continues to consider withdrawing from the World Health Organization, the Senate Committee on Foreign Relations heard from experts about how the U.S. should approach pandemic response. Their message: Stay and reform WHO.

President Donald Trump has said that the U.S. will terminate its relationship with WHO. The latest reports are that the administration intends to move forward with withdrawal and is believed to be drafting a letter to that effect.

Proposals from the administration and Congress have proposed potential new entities to tackle global health security, but most of the experts at the hearing said the U.S. should avoid trying to create any parallel structures and rather look to reform WHO and improve its response capabilities.

They also recommended that the U.S. take a measured approach to internally reorganizing efforts to ensure that implementing agencies retain control and appropriate significantly more funding.

At WHO, the Health Emergencies Programme could serve as the “fire department” for global response, but is hampered due to multiple constraints. Committee Chairman Sen. James Risch said it seems the program is more like a “volunteer fire department” — a characterization agreed to by several of the experts.

The Health Emergencies Programme was created following the West Africa Ebola pandemic as part of a series of reforms and it has shown “proof of concept but needs to strengthen institutional capacity,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development. The program often struggles to make decisions because it doesn’t have enough resources, and it needs greater staffing and more investment in partnerships to succeed, said Konyndyk, who sits on the independent oversight committee of the program.

The program has a Strategic Health Operations Center that is similar to the type of global emergency operations center the world needs under the Global Health Security Agenda, said Dr. Mark Dybul, the co-director of the Center for Global Health Practice and Impact at Georgetown University. But he said it is not funded sufficiently and has some limitations, since WHO doesn’t have the authority to compel countries to act, and is limited in how it can engage with non-state actors, including the private sector.

While WHO has to be a “central driving force,” there may need to be some functions that are supplemental or managed separately to make it effective, particularly when it comes to funding, he said.

It will be necessary to look at WHO reforms, and at potential changes to the International Health Regulations, though many of those efforts should wait until after the pandemic when it will no longer distract from the response, said Dr. Ashish Jha, the director of the Harvard Global Health Institute.

A key criticism of WHO’s handling of coronavirus, including by the Trump administration, has been that it praised China’s response when China hid facts and played down the severity of the virus. Jha agreed with that critique, but said in some ways WHO’s hands were tied.

To be more effective, WHO must have a stronger right of inspection so it can hold countries accountable — a reform that will require changes to the International Health Regulations, said Ambassador Jimmy Kolker, former assistant secretary for global affairs at the U.S. Department of Health and Human Services. WHO members should consider an inspection system perhaps akin to what the International Atomic Energy Agency uses, Kolker said.

WHO also needs to reform its system for alerting the public to crises and improve the way it engages with non-state actors, several of the experts said. But even if some of these structural challenges are addressed, WHO cannot fully succeed as the global leader in pandemic response without more funding, they said.

WHO has a small budget and is reliant on member state contributions. It will need “quantum levels more if it will be anything but a volunteer fire department,” Kolker said at the hearing.

Other U.N. agencies, including UNICEF and the World Food Programme, can raise money from individuals and the private sector, but WHO cannot. While it recently set up a foundation to try to address that issue, the WHO funding model needs to be reexamined, he said.

The witnesses also discussed proposals to restructure U.S. pandemic response, including an administration proposal and a few Congressional proposals.

A key sticking point in those proposals is who would coordinate the U.S. response, with a bill introduced by Senate Democrats proposing the reinstatement of senior National Security Council leadership to coordinate global health security and the administration and Risch proposals suggesting a coordinator at the State Department.

The witnesses had different perspectives. Dybul, who once led the President’s Emergency Program for AIDS Response, said that while the idea of a State Department coordinator “resonates,” there are some challenges, including the need to engage the national security apparatus.

Kolker said it could work, but only if the proposal includes significant new money and doesn’t redirect U.S. Agency for International Development or Centers for Disease Control and Prevention funding, which would just result in gridlock.

Konyndyk offered a different proposal, suggesting that while the State Department plays an important diplomatic role in supporting readiness and coordinating overseas engagement, a  “heavy, PEPFAR-like authority” or coordinator isn’t necessary. Instead, the U.S. should consider a position more akin to a global health security envoy who coordinates closely with a senior leader at the National Security Council, he said.

A U.S. government response must establish clear interagency divisions of labor from the start, Konyndyk said. An upfront division didn’t happen for PEPFAR and it has led to a number of turf battles over the years. By contrast,  in the Ebola response, there was a clear division of labor from the start and budgets and funding aligned with that, allowing for smoother coordination, he said.

Additional key factors for a U.S. program are presidential engagement, bipartisan leadership, a country-by-country implementation strategy and significant new money, Kolker said. The $3 billion proposed in Risch’s bill is insufficient, he said.

Risch said it is clear that more funding is needed to fund global health security than Congress has allocated thus far, and that while it might be a challenge for “those of us who have a difficult time spending money,” there isn’t a choice and it should be seen as defense spending.