How Globalization Brought Us COVID-19 Vaccines (And Better Public Health Overall)

Setting aside my own globalist sentiments, is worth noting that all the top COVID-19 vaccines are products of international collaboration, and a testament to the fruits of globalization.

The Oxford-AstraZeneca vaccine (marketed in some places as Covishield) is the most straightforward example, as it was developed in a partnership between Oxford University in the U.K. and the British-Swedish multinational pharmaceutical company AstraZeneca.

The Pfizer vaccine, which was the first to be confirmed 90% effective, was developed by a German company, BioNTech, founded and led by a Turkish-born married couple of leading immunologists. Pfizer, which was founded in the U.S. by German immigrants, helped provide vital resources for logistics, clinical trials, and manufacturing.

Moderna, which also ranks highly in efficacy (for what that’s worth), was co-founded by a Canadian and is led by a Frenchman. Its breakthrough was attributed to the pioneering work of a Hungarian biochemist who helped develop the world’s first genetically engineered vaccines—and who now works at BioNTech.

The Johnson & Johnson vaccine, like Pfizer’s, was also developed in Europe with the backing of American resources, by Janssen Vaccines in Leiden, Netherlands, and its Belgian parent company Janssen Pharmaceuticals, a subsidiary of J&J.

Heck, even Russia’s “Sputnik V” vaccine—which was technically the first to be developed—has turned out to be more efficacious than initially believed (much to my own surprised and that of many epidemiologists, apparently).

While the pandemic exposed the many perils of an interconnected world, it has also shown the even greater peril of trying to go it alone when it comes to major challenges and threats that disregard political boundaries and nationalities.

I’m hardly the first or only person to notice this: As long ago as 1851, when the Industrial Era helped rapidly globalize trade, travel, and war—and with them, more rapidly and widely spread diseases—the first of several “International Sanitary Conferences” was convened by the Ottoman Empire to coordinate containment strategies for infectious diseases—even among rivals and former enemies. It was the first time that a formal process of international collaboration was devised for public health; but as we’re learning, it remains even more relevant nearly two centuries later.

Of course, one doesn’t have to be a “globalist” to appreciate the logic of multilateralism (in public health and generally). One study in the medical journal BMJ examining the international response to COVID-19 argues:

The reasons for collaboration remain clear, logical, and have endured essentially unchanged from their original conceptualisation in the 1800s. Three of the most central are as follows. Firstly, the many ties between nations create collective health risks that are difficult to manage independently. The rapid spread of SARS-CoV-2 shows the close connections between countries, and the poorly managed economic and social costs are further evidence of their shared fate. Secondly, sharing knowledge and experience accelerates learning and facilitates more rapid progress. Information and knowledge on pathogens, their transmission, the diseases they provoke, and possible interventions are all areas in which researchers and public health professionals can benefit from the experience of others. Thirdly, agreeing on rules and standards supports comparability of information, helps establish good practices, and underpins shared understanding and mutual trust. All three reasons drive nations to collaborate and are reflected in their creation of WHO, a central authority, and its World Health Assembly (WHA), which serves as a forum for countries to share information, debate issues, and take collective decisions.

Little wonder why, despite the rise of nationalism and insularity (which predate the pandemic but was exacerbated by it), some global survey data suggest that a majority of people believe that more global collaboration would help reduce the impact of COVID-19. Far from idealistic, it is simply pragmatic to throw everything we have at his problem, regardless of which national jurisdiction the resources or knowhow happen to be located.

I’ll leave the final word to the above-mentioned study in BMJ, which I think makes a sober, evidence-based case for multilateralism, which is all too often treated as Utopian or naïve rather than realistic and practical:

The covid-19 pandemic painfully shows the reasons why nations are better off when they cooperate and collaborate in health, and also reveals the hazards of their incomplete commitment to doing so. Member states have prioritised themselves by restricting WHO from meaningful oversight of national information and endangered global health security by competing for vaccines rather than allocating them equitably. The inability to verify national data or advance its own estimates is just one of the many crucial dimensions in which WHO is prevented from maintaining the primacy of technical competence over the self-interested obfuscations of some member states. WHO’s independence is compromised also through the manipulation of its budget. The patchwork of institutions active in health reflects the limited, ad hoc agreement among powerful countries. Although generally global institutions have performed well in their missions, their often limited mandates leave the world’s people inadequately protected from new threats. In a pandemic, the cost is expressed in lives and livelihoods. More than 10, 000 people were dying daily at end of 2020, and the world economy was forecast to lose $5tn or more in 2020 alone. The imperative of finding collaborative and collective solutions—solidarity—has never been more obvious, or more urgent, for covid-19, climate change, non-communicable diseases, and the many other pressing and grave challenges that hinge on collective action.

Meaningful international collaboration is a critical part of the road ahead and calls for immediate action in three areas. Firstly, member states must end the systematic weakening of WHO—end ad hoc institutional fragmentation in global health and end budgetary manipulation. Secondly, they must support the independence of WHO—increase its core budget and build its authority over trade and travel related issues, including compulsory licensure for pharmaceuticals. Thirdly, states must uphold fairness, participation, and accountability by granting WHO powers to hold members accountable, including for overcoming deficiencies in national data, and by decolonising its governance to address the undue influence of a small number of powerful member states.

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 Developing Countries Winning 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).

The country’s 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 (with almost 100 million people) and the Indian state of Kerala (roughly the size of 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 pioneered remote learning. Two days after its lockdown, 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.

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.

Do You Want a Strong UN or Not?

The irony of Americans demanding that the WHO stand up to China is that this would require the UN to have the kind of power that Americans repeatedly (and fearfully) object to.

You can’t demand that an organization kowtow to sovereign states…and then complain when it has no choice but to kowtow to sovereign states. (Even so, the WHO used its good relations with China to convince its stodgy government to open up by mid February.)

I think this was put best by Roger Cochetti, who served as director of the D.C. office of the United Nations Association of the United States (UNA-USA). As he writes in The Hill:

Although it’s sometimes popular in Hollywood movies to portray UN agencies as supranational organizations that directly intervene in any country they wish whenever they wish, nothing could be further from the truth. UN agencies are associations of sovereign independent governments. Particularly when it comes to something happening entirely inside a single country, the UN agency is bound to fully cooperate with that country and basically accept what that member country reports. And if some other country does not accept the reporting country’s statements, then that second country is free to object or complain.    

There is no shortage of scholars who advocate that the WHO (and perhaps other UN agencies) should be transformed into a supranational organization whose staff directly and forcibly interfere within any country whenever staff sees fit. National governments — including the U.S. — would have to accept the notion that a multinational WHO bureaucracy would have the authority to directly investigate and interfere with national and local health authorities whenever the WHO staff saw fit to do. Imagine a WHO team of experts forcing their way into Fort Dix, N.J., to independently investigate the U.S. report of Swine Flu in 1976.

Until or unless UN agencies like the WHO are transformed into such supranational organizations, these agencies will rely on national permission about events within a member country. And in case you were wondering, there has been virtually no support within the United States to transform the WHO into a supranational organization.

The reality is that countries like China are far likelier to work with an ostensibly neutral UN bureaucrat than with an American. That’s why the WHO ended up being the one to help Americans from the CDC and NIH get into China. And that’s why organizations like the WHO exist in the first place. Good luck getting close to 200 countries to agree to anything without some sort shared forum for discussion and representation. True, it is often inefficient, sclerotic, and even at times corrupt, but it’s the best thing we’ve got right now — unless we want to give more power, money, and authority to the international institutions we otherwise hate and fear.

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.

The First Global Event

The novel coronavirus outbreak may be the first time in our species’s 250,000 year history that virtually everyone is being affected by the same event simultaneously. As Joshua Keating of Slate notes:

“Global event,” in this case, means a distinct occurrence that will be a significant life event for nearly every person on the planet. This is not to say that we’re all experiencing it the same way. Some become ill or lose loved ones; others lose jobs or livelihoods; for others, it’s merely a source of inconvenience or anxiety. And different countries and local governments are responding to the crisis in very different fashions, leading to wildly divergent outcomes for their citizens. But as the writer Anna Badkhen puts it, not since human beings first began spreading across the globe has a single event “affected everyone, on every continent, as instantly and intimately and acutely as the spread of coronavirus, uniting us as we fear and think and hope about the same thing.” It’s the truly global nature of the crisis that French President Emmanuel Macron was referring to when he called the coronavirus an “anthropological” shock.

This truth says as much about the era in which COVID-19 emerged as it does about the virus itself. It was only in the past 500 years that people in all regions of the Earth even became fully aware of one another and in the last 200 that they’ve been able to communicate more or less instantaneously. And it’s this very interconnectedness that allowed the virus to spread so rapidly across the globe. (The Black Death felt like the end of the world to many who experienced it, but more than a century before Columbus, entire continents of people were unaware of it.)

Previous events have had global impact in the past. Billions of lives have been affected by, say, the French Revolution, or 9/11. Contemporaneous writers have made cases for various events as the “shot heard round the world” or Ten Days That Shook the WorldBut these events were not experienced by the entire world at the same time—not even close.

Even the world wars, contrary to their description, did not impact the day to day lives of most people in Latin America, Africa, and parts of Asia. By contrast, COVID-19 has forced virtually every country in the world to either implement life-changing lock-downs or to endure the impact of the subsequent economic slowdown. Previous pandemics, including the deadly 1918 “Spanish”, were either limited in their geographic spread or occured when the world lacked an international forum for coordination or communications. These things still felt very much localized.

This matters because our species has only recently reached a level of consciousness and moral awareness that extends beyond the interrelated bands and tribes that were the norm for most of our quarter-of-a-million-year existence. Suddenly, we’re feeling for victims across the world, in places most of us have never been; learning from countries we otherwise never give much thought to (or in some cases can’t even find on a map); and enduring the same sorts of shocks to our routine as billions of other humans we pretty much forget exist. (Of course we know there are billions of other humans out there, but how often do we stop at any moment to consider how their lives our playing out at the same time as ours?)

As Keating notes, those of us with an internationalist bend are largely disappointed with the fractured and even divisive response by the world community. The notion that a bigger threat might finally unite humankind in a productive and cohesive response has yet to be proven. (Will it really take an alien invasion or robot uprising!?) I’m a tad bit more optimistic though: Though beleaguered and under siege, international institutions like the World Health Organization are still doing their thing; many countries and international organizations are coming together to pool their funds, resources, and knowledge to tackle this threat. As always, progress is never neat and linear.

However this global even hashes out, one thing is probably certain: Most people will pay more attention to what goes outside their respective countries.

Perhaps a more realistic expectations is that people may change how they view far away events—events like a mysterious virus cluster in Wuhan. Those of us who write about world news are used to making the case that people should care about events that happen in other countries and continents because it could eventually affect them—that political developments in Russia or a drought in Central America can very quickly become a major event in American life. Perhaps after the common experience we’ve all just shared, it will be a little easier to grasp the importance of faraway wars, revolutions, famines, and even “massively distributed” problems like climate change, feel a little more empathy for those directly affected by them, and have a little better sense of how they might soon affect us. For the first time ever, it feels like it’s literally true to say that international news is just news that hasn’t become local yet

While there have been no shortage of wars or diplomatic crises that should have roused us from our parochialism and insularity, maybe the first truly global even should do the trick.

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.)