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C o g e s o a R e s a r c S e r v i c
0
February 1, 2021
Rejoining the World Health Organization (WHO):
Reform and Related Issues
The Biden Administration is working to restore U.S.
involvement in the World Health Organization (WHO). On
January 20, 2021, President Joe Biden sent a letter to
United Nation (U.N.) Secretary-General Ant6nio Guterres
indicating that the United States would remain a member of
WHO. The letter retracted a July 6, 2020, decision by the
Trump Administration to withdraw the United States from
WHO effective July 6, 2021. The withdrawal determination
followed assertions by the Trump Administration that
WHO failed to independently investigate reports
conflicting with Chinese government's accounts of the
pandemic and repeated grossly inaccurate or
misleading claims made by Chinese authorities about
Coronavirus Disease 2019 (COVID-19). On January 21,
2021, U.S. officials announced a resumption of regular
engagement with WHO and an end to the drawdown of
U.S. staff seconded to WHO. The White House also issued
a directive, which among other things, directed the
Assistant to the President for National Security Affairs to
make recommendations for reforming and strengthening
WHO.
The unprecedented attempt to withdraw the United States
from WHO raised questions about congressional authority
to inform the withdrawal process. It also reignited calls for
reforming WHO, some of which conflated shortcomings of
WHO with limitations of the International Health
Regulations [IHR (2005)]-the rules governing responses
by WHO and Member States to public health emergencies
of international concern (PHEIC).
WHO Background and Structure
Established in 1948, WHO is a member-driven U.N.
specialized agency that directs and coordinates global
health efforts within the U.N. system. Duties include
* engaging international partners on global health;
* shaping the international health research agenda;
* establishing norms and standards;
* articulating evidence-based health policy;
* providing technical support to countries; and
* monitoring and assessing global health trends.
The World Health Assembly (WHA)-comprised of all
U.N. Member States-authorizes funding for and
implementation of WHO programs. The WHA also vote on
amendments to IHR (2005). The WHO Director-General,
requests funds for and leads implementation of WHO
programs, which are carried out by the Secretariat. For
more information on WHO, see CRS In Focus IF10289,
World Health Organization (WHO): Background and
Issues, by Tiaji Salaam-Blyther.
WHO Outbreak Response: Challenges
WHO Dual Role
Allegations by the Trump Administration that WHO's
initial recommendations for and responses to COVID-19
were unduly influenced by China highlights the dual role of
WHO: to be the international authority on global health and
to balance relationships with and among Member States. In
the early months of the pandemic, WHO seemed caught
between this duality. On the one hand, for example, the
organization appeared to acknowledge on January 15, 2020,
findings by China that there is no clear evidence of
sustained human-to-human transmission.... On the other
hand, WHO seemed to recognize contradictory information
from other sources by tweeting on the same day that we
cannot exclude the possibility of limited human-to-human
transmission.
Questions about possible motives shaping WHO actions
were raised during past health events and led to related
reforms. During the 2005 H5N1 bird flu outbreak, for
example, several low- and middle-income (LMIC)
countries accused WHO of enabling pharmaceutical
companies to profit off virus samples they shared for free
with WHO collaborating centers. The concerns ultimately
led to the development of the Pandemic Influenza
Preparedness Framework in 2011, which includes terms for
sharing and using influenza virus samples, including a
payment scheme for participating pharmaceutical
manufacturers. The agreement only applies to influenza
viruses, and not to coronaviruses like SARS-CoV-2, which
causes COVID-19 illness.
In 2010, the Parliamentary Assembly of the Council of
Europe (Parliamentary Assembly) asserted that the
pharmaceutical industry had influenced WHO to
characterize the 2009 HiN1 swine flu outbreak as a
pandemic. Then-Director-General Chan convened a
committee to review the functioning of IHR (2005) and
WHO's response to the 2009 HiN1 pandemic flu. The
committee found no evidence of malfeasance, but
identified systemic difficulties and shortcomings, and
issued a number of policy and program recommendations.
WHO and its governing bodies instituted some reforms in
response to the recommendations. For example, WHO
revised its ethics rules to manage potential conflicts or
concerns. It also now publishes the names and affiliations
of all members of Emergency Committees, which, among
other things, recommend whether to declare a PHEIC to the
WHO Director-General.
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