The Outbreaks That Never Happened and the Unseen Success of Global Institutions

Given all the death and dysfunction resulting from the COVID-19 pandemic, it is worth appreciating the many potential outbreaks that never happened, thanks to the efforts of Kenya, Mozambique, and Niger, alongside the United Nations and other international partners

In December 2019, just months before the COVID-19 pandemic came in full swing, these nations managed to halt an outbreak of a rare strain of “vaccine-derived polio”, which occurs “where overall immunization is low and that have inadequate sanitation, leading to transmission of the mutated polio virus”. It is all the more commendable given that Niger is among the ten poorest countries in the world.

The fact that polio remains both rare and relatively easy to quash is the results of a U.N.-backed campaign announced in 2005 to immunize 34 million children from the debilitating disease, which often leaves victims permanently disabled. The effort was led by  by World Health Organization the U.N. Children’s Fund (UNICEF), Rotary International, and the United States Centers for Disease Control and Prevention.

A nurse administers an oral poliovirus vaccine (OPV) to a baby at the Kaloko Clinic, Ndola, Zambia.
© UNICEF/Karin Schermbrucke

A little over fifteen years later, two out of three strains of polio have been eradicated—one as recently as last year—while the remaining strain is in just three countries: Afghanistan, Nigeria, and Pakistan. This once widespread disease is on its way to becoming only the second human disease to be eradicated, after smallpox, which once killed tens of millions annually. That feat, accomplished only in 1979, was also a multinational effort led by the U.N., even involving Cold War rivals America and Russia.

Even now, the much-maligned WHO actively monitors the entire world for “acute public health events” or other health emergences of concern that could portend a future pandemic. As recently as one month ago, the U.N. agency issued an alert and assessment concerning cases of MERS-Cov (a respirator illness related to COVID-19) in Saudi Arabia. Dozens of other detailed reports have been published the past year through WHO’s “Disease Outbreak News” service, spanning everything from Ebola in Guinea to “Monkeypox” in the United States. (WHO also has an influenza monitoring network spanning over half the world’s countries, including the U.S.).

Not bad for an agency with an annual budget of slightly over two billion—smaller than many large U.S. hospitals. (And contrary to popular belief in the U.S., the WHO did in fact move relatively quickly with respect to the COVID-19 pandemic:

On 31 December 2019, WHO’s China office picked up a media statement by the Wuhan Municipal Health Commission mentioning viral pneumonia. After seeking more information, WHO notified partners in the Global Outbreak Alert and Response Network (GOARN), which includes major public health institutes and laboratories around the world, on 2 January. Chinese officials formally reported on the viral pneumonia of unknown cause on 3 January. WHO alerted the global community through Twitter on 4 January and provided detailed information to all countries through the international event communication system on 5 January. Where there were delays, one important reason was that national governments seemed reluctant to provide information

Of course, it goes without saying that the WHO, and global institutions generally, have their shortcomings and failings (as I previously discussed). But much of that stems from structural weaknesses imposed by the very governments that criticize these international organizations in the first place:

WHO also exemplifies the reluctance of member states to fully trust one another. For example, member states do not grant WHO powers to scrutinise national data, even when they are widely questioned, or to conduct investigations into infectious diseases if national authorities do not agree, or to compel participation in its initiatives. Despite passing a resolution on the need for solidarity in response to covid-19, many member states have chosen self-centred paths instead. Against WHO’s strongest advice, vaccine nationalism has risen to the fore, with nations and regional blocks seeking to monopolise promising candidates. Similarly, nationalistic competition has arisen over existing medicines with the potential to benefit patients with covid-19. Forgoing cooperation for selfishness, some nations have been slow to support the WHO organised common vaccine development pool, with some flatly refusing to join.

The tensions between what member states say and do is reflected in inequalities in the international governance of health that have been exploited to weaken WHO systematically, particularly after it identified the prevailing world economic order as a major threat to health and wellbeing in its 1978 Health for All declaration. WHO’s work on a code of marketing of breastmilk substitutes around the same time increased concern among major trade powers that WHO would use its health authority to curtail private industry. Starting in 1981, the US and aligned countries began interfering with WHO’s budget, announcing a policy of “zero growth” to freeze the assessed contributions that underpinned its independence and reorienting its activities through earmarked funds. The result is a WHO shaped by nations that can pay for their own priorities. This includes the preference that WHO focus on specific diseases rather than the large social, political, and commercial determinants of health or the broad public health capacities in surveillance, preparedness, and other areas needed for pandemic prevention and management

In fact, it was this prolonged period of chronic underfunding, and of WHO member states prioritizing nonemergency programs, that precipitated the agency’s abysmal failings in the early phases of the 2014 Ebola outbreak. But once that crisis ended, member states, rather than defund or abandon the organization, opted to reform and strengthen its emergency functions; this overhaul resulted in the Health Emergencies Program, which was tested by the pandemic and thus far proven relatively robust:

On 31 December 2019, WHO’s China office picked up a media statement by the Wuhan Municipal Health Commission mentioning viral pneumonia. After seeking more information, WHO notified partners in the Global Outbreak Alert and Response Network (GOARN), which includes major public health institutes and laboratories around the world, on 2 January. Chinese officials formally reported on the viral pneumonia of unknown cause on 3 January. WHO alerted the global community through Twitter on 4 January and provided detailed information to all countries through the international event communication system on 5 January. Where there were delays, one important reason was that national governments seemed reluctant to provide information.

I know I am digressing into a defense of WHO, but that ties into the wider problem of too many governments and their voters believing that global governance is ineffective at best and harmfully dysfunctional at worst. We Americans, in particular, as constituents of the richest country in the world, have more sway than any society in how institutions like the U.N. function—or indeed whether they are even allowed to function.

As our progress with polio, smallpox, and many other diseases makes clear, what many Americans decry as “globalism” is actually more practical and effective than we think, and increasingly more relevant than ever. We fortunately have many potential outbreaks that never happened to prove it.

Africa’s Little Known COVID-19 Success Stories

As many of the world’s wealthiest countries continue to battle COVID-19, many countries in Sub-Saharan Africa—considered a looming public health crisis given its poverty and lack of healthcare infrastructure—are actually doing a more than decent job at keeping the worst case scenarios at bay. As the Guardian reports:

Senegal is in a good position because its Covid-19 response planning began in earnest in January, as soon as the first international alert on the virus went out. The government closed the borders, initiated a comprehensive plan of contact tracing and, because it is a nation of multiple-occupation households, offered a bed for every single coronavirus patient in either a hospital or a community health facility.

As a result, this nation of 16 million people has had only 30 deaths. Each death has been acknowledged individually by the government, and condolences paid to the family. You can afford to see each death as a person when the numbers are at this level. At every single one of those stages, the UK did the opposite, and is now facing a death toll of more than 35,000.

Ghana, with a population of 30 million, has a similar death toll to Senegal, partly because of an extensive system of contact tracing, utilising a large number of community health workers and volunteers, and other innovative techniques such as “pool testing”, in which multiple blood samples are tested and then followed up as individual tests only if a positive result is found. The advantages in this approach are now being studied by the World Health Organization.

Of all places, Ghana is also the first country in the world to utilize drones to ensure its tests reach distant and poorly connected rural areas.

AS NPR elaborates, Senegal is a particularly exemplary pandemic success story—thanks in large part to the much-maligned WHO, as well as the CDC and UNICEF.

Senegal’s response to the coronavirus is notable not only for its humanity but for its thoroughness. For example, each newly diagnosed individual – no matter how mild or severe the case – is provided a hospital or health center bed where he or she stays isolated and observed– a key element to Senegal’s strategy to contain the virus.

“Senegal is doing quite well, and we were impressed at the beginning at the full engagement and commitment by the head of state,” says Michel Yao, program manager for emergency response for the World Health Organization Africa.

Officials from both Senegal’s ministry of health and WHO stress that the wheels of the response team were set in motion five years ago in response to the Ebola outbreak in West Africa. Yao explains: “What we advised countries to have in place following Ebola in West Africa was to have an operations center, to have in one place the required information for effective decision making. It’s quite an important tool to control the crisis, and this was a good plan from Senegal to have this structure.”

Senegal set up its Health Emergency Operation Center (also known by its French acronym, COUS), in December 2014, in response to the Ebola outbreak spreading in nearby countries. At the start of this year, the center had some 23 staff members – five of them doctors.

Over the past five years, that center, working with the ministry of health and the support of international partners such as the World Health Organization, the U.S. Centers for Disease Control and Prevention and UNICEF, have run simulations of mock outbreaks and crafted emergency measures to activate in case of an epidemic.

Even Rwanda, better known for its horrific genocide over 25 years ago, has rolled out robots in its COVID-19 response.

Launched on Tuesday, May 19 at the Kanyinya COVID-19 Treatment Centre by the Ministry of Health with support from the United Nations Development Programme, the five high-tech robots can perform a number of tasks related to COVID-19 management, including mass temperature screening, delivering food and medication to patients, capturing data, detecting people who are not wearing masks, among others.

Made by Zora Bots, a Belgian company specialised in robotics solutions, they are designed with various advanced features to support doctors and nurses at designated treatment centres, and can also be leveraged into screening sites in the country.

Of course, it helps that these countries are relatively wealthy and peaceful; with the exception of Rwanda, they are also fairly robust democracies.

While many African countries are vulnerable to COVID-19, it’s worth highlighting how much better the continent is weathering this crisis than expected (in part thanks to hard lessons learned from past outbreaks).

The Pandemic Success Story No One Has Heard Of

Senegal is the pandemic success story no one has heard of—which actually tells you how successful it has been! The much-maligned WHO, as well as the CDC and UNICEF, played a key role in that.

In this country of 16 million known for its peaceful democracy and sense of community, Senegal’s response to the coronavirus is notable not only for its humanity but for its thoroughness. For example, each newly diagnosed individual – no matter how mild or severe the case – is provided a hospital or health center bed where he or she stays isolated and observed– a key element to Senegal’s strategy to contain the virus.

“Senegal is doing quite well, and we were impressed at the beginning at the full engagement and commitment by the head of state,” says Michel Yao, program manager for emergency response for the World Health Organization Africa.

Officials from both Senegal’s ministry of health and WHO stress that the wheels of the response team were set in motion five years ago in response to the Ebola outbreak in West Africa. Yao explains: “What we advised countries to have in place following Ebola in West Africa was to have an operations center, to have in one place the required information for effective decision making. It’s quite an important tool to control the crisis, and this was a good plan from Senegal to have this structure.”

Senegal set up its Health Emergency Operation Center (also known by its French acronym, COUS), in December 2014, in response to the Ebola outbreak spreading in nearby countries. At the start of this year, the center had some 23 staff members – five of them doctors.

Over the past five years, that center, working with the ministry of health and the support of international partners such as the World Health Organization, the U.S. Centers for Disease Control and Prevention and UNICEF, have run simulations of mock outbreaks and crafted emergency measures to activate in case of an epidemic.

Along with Vietnam and the Indian state of Kerala, Senegal proves that wealth alone is not a predictor for a successful pandemic response. It also shows the importance of working with international partners to get as many different perspectives, resources, and knowledge as possible.

A Multipolar Post-COVID-19 World?

Russia now has the third highest number of COVID-19 infections after the U.S. and Spain, with Putin reportedly seeing a drop in his usually high approval ratings. (Though the country seems to be faring relatively well otherwise.)

It is interesting how virtually all the major world powers have been brought low by this pandemic. Meanwhile, countries like Germany, South Korea, Taiwan, New Zealand, Vietnam, Costa Rica, and Greece (among others) have seen their geopolitical stars rise, to varying degrees, from their effective responses.

The first three have become especially more influential, with leaders across the world turning to them for guidance and assistance. Taiwan, which is officially shunned by all but fifteen countries, now has more friends in the world fighting for its inclusion in the international system. Germany’s economic and political policies are seen as the gold standard by rich and poor countries alike.

Obviously, different countries were hit in different ways, and larger nations like the U.S., China, and Russia would ostensibly have a harder time containing an outbreak. But that doesn’t matter: These nations—especially the U.S.—claim to have the superior political model with which to lead the world; they also generally have more resources than smaller countries. Thus, they have raised the standard by which they are judged.

Since the turn of the 21st century, there has been much talk about whether we are entering a “multipolar” world, one in which no country really dominates. It’s hard to imagine the U.S. and China not being the most influential nations, but it’s likely their influence will continue to fall in -relative- terms: Not a decline so much as the rise of everyone else.

But I’m just thinking out loud.

The Poorer Nations Standing Firm Against COVID-19

It’s been heartening to see that many poorer countries or regions are faring a lot better than expected. For all the death and suffering that’s occured, it’s important to acknowledge the deaths and pain that haven’t—and to derive some important lessons, since these are places that don’t have our wealth and resources.

Costa Rica has had one of the most successful pandemic responses in the world. It was the first Latin American country to record a case—which is actually indicative of its open and efficient monitoring—and citizens have been able to lean on its universal healthcare system, on which it spends a higher proportion of its GDP than the average rich country (and subsequently has one of the world’s highest life expectancies). It implemented nationwide lockdowns and tests quickly, and has done a good enough job that it stared partially lifting restrictions as early as May 1st—albeit with strict restrictions (only a quarter of seats can be filled in sporting venues, while small businesses are limited in the number of customers they can serve).

Costa Rican President Carlos Alvarado has been transparent: “We have had relative and fragile success, but we cannot let our guard down.” Hence the borders will remain closed until at least this Friday, while restrictions will remain on driving to keep the virus from spreading: Driving at night is banned and drivers may only drive on certain days depending on their license plate number.

Ghana and Rwanda—which hardly come to mind as world-class innovators—each teamed up with an American company to become the first countries in the world to deliver medical aid and tests via drones to out-of-reach rural areas. Doctors and health facilities use an app to order blood, vaccines, and protective equipment that get delivered in just minutes. Rwanda, which has become a little known but prominent tech hub, started using drones as early as 2016 for 21 hospitals; now the drones are used to serve close to 2,500 hospitals and health facilities across Rwanda and Ghana.

Vietnam (pop. 95 million) and the Indian state of Kerala (as populous California), both learned from previous outbreaks and acted quickly and decisively to contain the outbreak. As the Economist magazine put it, despite their poverty, they have “a long legacy of investment in public health and particularly in primary care, with strong, centralised management, an institutional reach from city wards to remote villages and an abundance of skilled personnel.” Lack of wealth did not stop them from making the necessary investments.

Uzbekistan, a former Soviet republic that’s hardly a household name, has become an unlikely pioneer in remote learning. Two days after implementing its lockdown in March, the Ministry of Public Education announced an unprecedented plan to roll out virtual courses and resources for its 6.1 million school students. In a matter of days, it made available over 350 video lessons to go live on national TV channels; the lessons are available in the dominant languages of Uzbek and Russian as well as sign language. Free data access has been granted to educational platforms, making them accessible for all school students and their parents. An average of 100 video classes are being prepared daily.

While it is too soon to tell what’s in store for these nations in the long term, they have proven that you don’t need lots of wealth and power to develop an effective and humane response to crises. If anything, their poverty and historic challenges have made them more resourceful and decisive, thus providing useful lessons for the rest of the world.

Expecting Too Much from the W.H.O.

The World Health Organization’s annual budget is roughly the size of a large hospital and one-fourth the budget for the C.D.C.

With these comparatively small funds, the W.H.O. must carry out its official mission of ensuring “the highest possible level of health” for “all peoples.” That includes eradicating diseases (such as smallpox and soon polio), facilitating research and cooperation (which recently gave us the first Ebola vaccine), promoting nutrition, setting universal healthcare and medical standards, and responding to emergencies like pandemics.

With this small budget, backed by its pleading for further funds, the W.H.O. has shipped more than two million items of personal protective equipment to 133 countries, and is preparing to ship another two million items in the coming weeks. Just a couple days ago, it delivered one million face masks, along with gloves, goggles, ventilators and other essential goods to Africa. More than a million diagnostic tests have been dispatched to 126 countries worldwide and more are being sourced as we speak.

As early as February, the organization brought together 400 of the world’s leading researchers (including from rivals the U.S. and China) to identify research priorities. It launched an international “Solidarity Trial” involving 90 countries, to help find effective treatment, and is currently running a “mega-trial” of the four most promising COVID-19 treatments and vaccines from around the world.

The W.H.O. has developed research protocols and guidelines that are being used in more than 40 countries. It got 130 scientists, donors, and manufacturers to commit to speeding up the development and delivery of a vaccine.

Through its innovative online “OpenWHO” platform, the W.H.O. pools together the world’s knowledge and best practices and delivers it to frontline personnel rapidly through an app. Users take part in social learning network, based on interactive, online courses and materials covering a variety of subjects. OpenWHO also provides a forum for the rapid sharing of expertise, in-depth discussion and feedback on key issues. So far, more than 1.2 million people have enrolled in 43 languages.

Again, all this for the cost of running a big hospital. While the U.S. does contribute one-fifth of the agency’s budget, this amounts to $893 million—a drop in the budget of our annual budget, which includes over $700 billion for the military alone. Talk about bang for our buck.

Moreover, we had pledged $656 million for specific programs, including polio eradication, health and nutrition services, vaccine-preventable diseases, tuberculosis, HIV—and preventing and controlling outbreak. And we’re still trying to do more damage to them.

Even as it launches another international mega-trial of the most promising treatments and vaccines, the U.S. is stubbornly refusing to take part.

Lawfare does a great job of breaking down how absurd our expectations of the W.H.O. are. While it concedes that the W.H.O. dropped the ball with China (something I also admit), it also reminds us of the far bigger and more complex picture regarding its relations with member countries (and the inherently political nature of health problems to begin with).

The work of the WHO is inherently technical; it does not need to make the sort of charged political decisions demanded of the U.N. Security Council, where the vital interests of different countries repeatedly conflict. Nor is it required to take a stance on the sensitive ideological values of different countries, as human rights organizations must. And because the WHO’s mission is narrowly defined in relatively objective terms, its performance can be evaluated with relative ease—for example, by using straightforward public health metrics. This ought to give WHO officials incentives to act appropriately and reduce the risk that countries are unable to discipline it if it fails to. The WHO’s leadership in the eradication of smallpox and in advances against polio seemed to validate this theory.

[…]

It is tempting to blame the WHO itself for its problems—its notoriously complex bureaucracy, its decentralized structure, its “culture” or the persons who run it. But all of those things are a result of the political constraints it operates under, as many reform-minded critics have observed. Big bureaucracies are established to guard against errors. In this context, this means staying away from actions that will offend member states whose support (financial or otherwise) is necessary for WHO’s operations. The sorts of bureaucratic reform that WHO insiders and sympathetic critics have called for over many decades would not protect the WHO from leaders like Trump.

It turns out that even the expert-led technical interventions of the WHO are politically charged. And this is not just because some countries want to hide disease outbreaks from the world. Countries also disagree about the problems that the WHO should focus on in the first place. The setting of priorities and allocation of resources among different public-health challenges are policy choices, not technical choices. The WHO is not an anti-pandemic organization or an infectious-disease organization: It is a health organization, and health policy is intensely contested around the world.

Many of the familiar cleavages in international politics had begun to pull apart the WHO long before the coronavirus pandemic. People disagreed about which health threats should be given priority, and the WHO found itself torn between governments, interest groups, activists and donors who wanted the organization to give priority to different things—HIV/AIDS and other infectious diseases, tobacco use, obesity, even climate change. And then there is intense disagreement about whether the WHO should give priority to developing countries and, if so, how much. The WHO has set itself the goal of correcting global health care inequality, which begins to seem like a redistributive program from north to south—the sort of thing applauded by academics and commentators but politically explosive, to say the least.

As I have previously argued, the W.H.O. doesn’t have the resources or power to stand up to any country, especially since virtually every country plays a role in its funding, governance, and the election of its director-general. If even most of the world is deferential to China—only fourteen nations officially recognize Taiwan instead—how can we expect an organization responsible for so much, with a small budget, few personnel, and no sovereign power, to somehow be any different.

COVID-19 and Glass Houses

China deserves criticism for its initial handling of the COVID-19 outbreak, its continued air of secrecy that makes it difficult to verify its alleged success, and its blocking of Taiwan—a major pandemic success story—from the W.H.O. and other international institutions.

But I feel a lot of American criticism is of the “glass houses” variety. Our response to the virus, both initially and still now, has hardly been stellar. The behavior of governments at all levels, as well as by private citizens and businesses, makes it difficult to claim any moral high ground over the Chinese response (and no, this isn’t to say we’re the same in terms of totalitarianism, etc.).

Insurance companies will reportedly be raising their premiums next year. Many of those treated are left with bills in the tens of thousands. Profit-centered hospitals are actually laying off well needed staff because treating COVID-19 is too costly. A man in Brooklyn was raided for hoarding precious medical equipment, while a Georgia man was fraudulently going to sell $750 million in nonexistent masks to the Veterans Affairs Department. Doctors have been censored and even fired by hospitals for speaking out against the lack of protective equipment, which of course shouldn’t be happening in the first place. Masks are being sold at marked up prices. Many of our “essential workers” are still dying and underpaid; millions are illegal immigrants (ironically the Dept. of Homeland Security reminds them of their essential status while targeting them for their illegal one).

Our economy of nearly $20 trillion, home to most of the world’s billionaires, top innovators, and tech companies, somehow cannot allocate its resources to test and treat people and ensure they don’t starve during the lockdown. Our rapacious and hyper-individualistic attitude to money and self interest is somehow intact, if not thriving, in the face of senseless death and suffering ( notwithstanding the many touching and inspiring stories I’ve acknowledged and shared here about the better side of our society.

Yeah, the Chinese government (among others) has several times dropped the ball on this virus. It’s used it as an excuse to tighten its grip and even to bully Taiwan. The cultural practice of the wet market is problematic on a lot of levels. There are probably many more sordid stories we don’t know about.

But given how our far wealthier and better resourced country has mishandled this—across both the public and private sectors, and as a society—I’m not sure we would have done much better with an outbreak of an unknown disease.

I wish the folks putting all their energy and focus on China would hold businesses, healthcare companies, and government officials accountable—or, at the very least, direct some scrutiny and ire their way—and engage in some introspection about our own problematic practices and values (lack of community engagement and concern, hyper-individualism at the expense of others, employer-sponsored healthcare that leaves us at the mercy of unaccountable and disengaged bosses, etc.)

The Politics and Pragmatism of Progress

We might find the W.H.O.’s politics unseemly. At times they are certainly troubling, especially regarding Taiwan. (Though in fairness, most of the world, including the powerful U.S., has also officially shunted Taiwan in deference to China.)

But they are an inevitable, if not necessary, evil for an organization run by 194 countries full of rivalries, self-interests, and division. Its weaknesses very much reflect our own. International cooperation is not about singing kumbaya and getting along harmoniously; it is the sober and practical realization that, however divided the world is, there are problems bigger than any one country can handle (look at how the richest country in the world has struggled to contain this pandemic). That means making difficult, imperfect, and sometimes even maddening compromises.

It took working with a murderous bastard like Stalin to beat the Nazis in WWII, with the Soviets accounting for 80-90% of Axis losses at the cost of tens of millions of lives. (We also had to work with the bastard Nationalists and Maoists in China to accomplish the same feat against Japan, with the Chinese tying up most Japanese forces at similarly horrific costs.)

In the context of public health, this is nothing new. Even at the height of the Cold War, countries including the U.S. and the Soviet Union managed to set aside their differences and work through the W.H.O. to eradicate smallpox, a scourge of humanity that had killed hundreds of millions just in the 20th century.

With over 50 million cases and 2 million deaths annually, in 1958 Soviet virologist Viktor Zhdanov became the first to call on the W.H.O. to lead a global eradication effort. In 1966 Canadian-American epidemiologist Donald Henderson formed the U.S.-led Smallpox Eradication Unit to assist in this endeavor. A year later, the W.H.O. intensified global smallpox eradication with millions of dollars from around the world and a method developed by Czech epidemiologist Karel Raska. The Americans and Soviets provided most of the initial vaccine donations (no doubt, at least in part, to one up each other).

By 1980, the W.H.O. declared smallpox eradicated—the first human disease wiped off the face of the Earth, thanks to global cooperation.

Image may contain: people playing sports, possible text that says 'WORLD HEALTH THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION MAY 1980 smallpox is dead!'

The Flawed But Indispensable World Health Organization

Withholding funding (even temporarily) from the World Health Organization—in the midst of a pandemic and while it has been providing supplies and training to vulnerable nations, including our own—is foolhardy and utterly without merit.

The W.H.O. is accused of having been too deferential to China at the start of the outbreak. But around the same time, on January 24, the president praised the Chinese response on Twitter, stating that “China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency.”

When confronted about this tweet yesterday, Trump stated he “would love to have a good relationship with China”—which is ironically why the W.H.O. handled China the way it did.

The organization is run by 194 countries (including the U.S. and China), which also elect its Director-General. In order to facilitate global cooperation and knowledge sharing, it has to strike a delicate balance between providing science-based health information and making sure countries aren’t antagonized or allowed to squabble with each other; otherwise the world might lose out on key information and research.

In fact, the U.S. received vital early epidemiological data from China only because the WHO used its good relations to broker access. That’s the same reason the otherwise secretive Chinese eventually opened up and even published the first genetic profile of the virus for the world to use.

Trump himself seemed to acknowledge this with gratitude. In late February, he tweeted “Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart…”

Furthermore, against initial resistance, the W.H.O. managed to pressure China to allow observers into the country; in early February, an international team led by the agency visited Wuhan, including two Americans, (one from the C.D.C. and the other from the N.I.H.).

Of course, it’s totally fair to debate whether the W.H.O. struck the right balance with China. It could have said more about China’s suppression of independent scientists, lack of transparency and human rights violations. It certainly could have been more open to Taiwan and the crucial information it provided. But again, it’s a hard balance to strike given the need to keep China on board (and recall that most of the world, including the U.S., also avoid official relations with Taiwan out of deference to China, too).

From the beginning, the W.H.O. issued urgent advisories throughout January about the potential dangers from the virus and announced that it constituted a “public health emergency of international concern” a day before the U.S. made a similar declaration. The W.H.O. repeatedly said “all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread.”

From January 22, Director General Tedros Adhanom Ghebreyesus held almost daily news briefings to warn the world that the virus was spreading and that countries should do everything they could to stop it. Every day he repeated: “We have a window of opportunity to stop this virus. But that window is rapidly closing.”

The W.H.O. has also been criticized for its decision in January not to impose restrictions on travel from China, which the organization warned would be ineffective— and they were right. We imposed travel bans in February on all foreign nationals who had visited China, but as we know, this did not stop the virus from spreading; we now have more reported cases than anywhere in the world. Meanwhile, countries that did not enact a ban, such as Canada, South Korea, and Taiwan, have fared better those that did.

Finally, the W.H.O. has been taken to task for not declaring a global emergency sooner. But when it made this declaration on January 30, there were still relatively few reported cases outside China. World leaders still had the info and updates to act, and some countries responded immediately; South Korea implemented an effective blend of policies that has made it one of the top success stories. The W.H.O. cannot be blamed for our slow response.

There is no denying that the World Health Organization is a flawed institution. But that’s to be expected of an organization made up of 194 countries, each bringing their own baggage, rivalries, and self interest. For all its problems and missteps, on balance it has done a good job in the face of a very complex and difficult pandemic—one that even the world’s richest country has had a hard time handling.

Perhaps the biggest irony in our abandoning the institution (albeit allegedly temporarily) is that it will give ample opportunity for China to fill the void, as it has been doing throughout the last few years. We bail out of global leadership time and again and then wring our hands at the Chinese for doing the obvious geopolitical thing of stepping in.

COVID-19 and the Impartial Judgments of Nations

With the world responding to the pandemic in a variety of ways—and many countries learning from each other or from the U.N. World Health Organisation (itself made up of experts all over the world)—I am reminded of the largely forgotten words of James Madison, the architect of the U.S. Constitution.

This darling of patriots and conservatives—the Federalist Society uses his silhouette as its logo—once said that “no nation was so enlightened that it could ignore the impartial judgments of other nations and still expect to govern itself wisely and effectively.”

In the Federalist Papers, which were published to promote ratification of the Constitution, he emphasized the importance of respecting global public opinion:

An attention to the judgment of other nations is important to every government for two reasons: the one is, that, independently of the merits of any particular plan or measure, it is desirable, on various accounts, that it should appear to other nations as the offspring of a wise and honorable policy; the second is, that in doubtful cases, particularly where the national councils may be warped by some strong passion or momentary interest, the presumed or known opinion of the impartial world may be the best guide that can be followed. What has not America lost by her want of character with foreign nations? And how many errors and follies would she not have avoided, if the justice and propriety of her measures had in every instance been previously tried by the light in which they would probably appear to the unbiased part of mankind?

This was at a time when the U.S. was virtually the only republic in the world. Even the most patriotic and liberty-loving Founders recognized that whatever the political or cultural differences between the nations of the world, mere pragmatism should permit us to take whatever ideas or resources we can.

Consider that unlike other nations, we declined to use the W.H.O.’s test kits. Back in January, over a month before the first COVID-19 case, the Chinese published information on this new mysterious virus. Within a week, German scientists had produced the first diagnostic test. By the end of February, the U.N. shipped out tests to 60 countries.

As I’ve said ad naseum, global cooperation is not merely idealistic or Utopian: It’s the sober reality of living in a globalized society where we face problems that affect all humans, regardless of where they happen to be born. Even in the 18th century, our political founders and leaders understood this. We ignore it at our peril.