A few hours after his inauguration on January 20, President Donald Trump signed a decree starting with the withdrawal of America from World Health Organizationknown as WHO.
The international agency, which is part of the United Nations, was founded in 1948 and brings together 194 countries working together to combat the most serious public health problems in the world. It is the cornerstone of global health efforts, with a multinational team fighting both against transmitted diseases-such as COVVI-19, ZIKA and HIV-and against chronic diseases, such as heart disease, diabetes and cancer.
WHO also strives to combat malnutrition, provide vaccines and provide assistance and technical advice to the populations of the poor and bruised regions of the world. Its biennial budget is $ 6.8 billion. The United States is among the largest donors.
Over the years, WHO has tried to eradicate smallpoxreduce worldwide polio case of 99% and considerably reduce the prevalence of malaria and trachomaThe first cause of blindness in the world.
According to the Kaiser family foundationWHO also has played a key role in other significant health achievementsIn particular the Alma-Ata Declaration on Primary Health Care (1978), the framework agreement for the fight againstbacco (adopted in 2003) and the 2005 revision of the international health regulations, an international agreement which defines roles and responsibilities in the preparation and response to international health emergencies.
Trump’s decree is his second attempt to withdraw the United States from the agency. His previous plan, presented during his first mandate, was canceled by former president Joseph Biden.
Trump has been criticizing WHO for a long time for what he calls “his inability to adopt urgent reforms”. He also deplored that the American financial contribution to the international organization is “expensive”.
Trump’s announcement was not a surprise, but it was overwhelming for the public health community. WHO withdrawal could isolate the American health system, including federal agencies such as the National Institutes of Health, Food and Drug Administration and Centers for Disease Control and Prevention.
We interviewed Stefano M. BertozziFormer dean and current professor of policy and health management at the School of Public Health of the UC Berkeley, on the risks that the WHO withdrawn.
Bertozzi previously worked with the Bill & Melinda Gates Foundation, the Mexican National Institute of Public Health, UNAIDS, the World Bank and the Government of Zaire. He is also the former acting director of the World WHO AIDS Fighting Program, a precursor of Onida.
UCBPH: What was your reaction to the decree of President Trump providing for a withdrawal from the World Health Organization and recalling US WHO staff?
Bertozzi: As the dean Michael C. Lu said, it is very important to recall that we must distinguish between rhetoric and action. I do not think that none of us know if it is a boastful negotiation position or if it is really something that will be done. I think we have to take this very seriously because President Trump did the last time.
If it’s true-if it happens-it’s tragic for the United States, and of course for the rest of the world too. I would have thought that we learned very well from the pandemic of COVID-19 that there is no way to isolate oneself from the world and to be sheltered from the many health threats which do not respect borders – Infectious diseases being only one of them. . Everything we do that decreases our ability not only to collaborate, but also to collaborate effectively with countries around the world – whether or not we agree with them – to end the world health threats, is really important.
Why is WHO so crucial to public health?
One of the things that WHO does is to provide a neutral forum where we can discuss health issues with all the countries of the world, whether or not we have diplomatic relations with them.
We can work together to prevent threats from transforming into global pandemics or threatening the world in another way. This ranges from the recognition of a new propagation of an animal to a person who triggers an epidemic of a brand new illness; to work together on the safety of laboratories to prevent laboratory leaks; To work together to follow the emergence of antimicrobial resistance for existing diseases for which we have effective antibiotics, but for which we risk losing this effectiveness as antimicrobial resistance is spreading. The fires cross borders, just like smoke – I think of a very recent example. There are so many problems that cross borders.
You consider the WHO as unique among multilateral agencies and treaties, right?
It is extraordinary that the United States withdraws from WHO without finding an alternative! What would the United States do if it created its own bilateral health agency that collaborates with all the countries of the world? Frankly, it is quite inconceivable.
This is one thing when the United States has withdrawn from UNESCO (late 2018) because we do not have the same level of interdependence in global education that we have in terms of global health. But that would amount to saying that we will withdraw from the World Trade Organization and that we will stop respecting everyone’s patent rights. Or, withdraw IATA and say that we no longer want to participate in the establishment of global standards for international air transport. In any case where we are interdependent, the withdrawal is harmful to everyone, but it is up to us that it is the most. At the moment, it is we who have the most say our say on what is happening at the WHO; How could we be in a better situation when this is no longer the case?
Let’s talk about COVID-19. WHO reviews complained of the time it took the agency to recognize that COVVI-19 was airborne. Is it a valid criticism? After all, it was a big mistake.
It is a valid criticism. This is a serious mistake that the United States has also made. It was very unhappy. I was upset at the time because we had fairly solid evidence of aerosol transmission on the cruise ship Diamond Princess – and it was very early. From the start, convincing data was provided from China and Taiwan. So yes, it took too long.
But we do not withdraw an organization because it makes a mistake. What you do is understand why the error was made and try to improve the organization so that it is better prepared for the next time.
I mean, the idea that we would withdraw from WHO because it was too slow to recognize air transmission is crazy. What we have to do is work more closely with the WHO to guarantee that this does not happen again next time. The CDC and WHO must improve to determine more quickly what are the transmission pathways of a new pathogen.
What will happen if the United States is actually withdrawing from WHO?
What will probably happen is that even if the United States is withdrawing from WHO, many arrangements for indirect communications will continue, the United States participating in key forums. And that could simply mean that it is a cosmetic withdrawal rather than a real withdrawal. But it may be my optimistic side. My pessimistic side says that it will take a disaster to bring the United States back to the fold.
I hope this is not the case. I hope that we will not need to see something horrible happen so that the United States realizes that being disconnected from the WHO is not in their own interest, not to mention the interest of other countries of the world.
The avian flu is now raising more and more worries. Is it something that WHO would have a role to play in follow-up?
Yes, and that certainly concerns me. The avian flu is already there. We do not know if, in the future, the avian flu will mutate enough to become highly transmitted from one person to another.
This is not the case for the moment, but it could change as it will become better suited to humans’ infection. This is exactly the kind of thing we want to monitor worldwide, and we want to collaborate with all other countries, not just with those with whom we are currently friends.
What role did WHO play in the AIDS crisis?
During the HIV pandemic, WHO was truly the only one to provide support to African countries faced with these explosive epidemics. I mean, there was a small American presence in Congo – which was then Zaire – and later a presence in Côte d’Ivoire, but each African country has set up a national AIDS fight program and that only occurred so quickly because very firm support for WHO staff present in each country to help launch these programs.
WHO’s response was absolutely crucial, and was led by a certain Jonathan Mann, an American epidemiologist.
What will happen to the WHO without the American contribution?
Losing American support would be a blow for WHO. The United States is the largest contributor-around 20 % of the budget-and many other countries would have to intensify their efforts to fill this budgetary vacuum. And I hope that other countries will do the same, because a large part of the work accomplished by the WHO is of crucial importance. By listening to the information, you might think that supporting WHO is very expensive, but it is not true. He is responsible for supporting health efforts worldwide and yet his annual budget represents about half that of the UCSF. Rather than reducing the American contribution, the United States should contribute more to the capacity building of WHO in many areas, including prevention, preparation and response to pandemics!