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.

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.)

Inequities and Injustices Laid Bare by the Pandemic

Given that there’s enough anxiety and bad news going around, I’ve been consciously minimizing sharing anything negative here. But it’s hard not to vent about the tremendous amount of unnecessary suffering out there.

Its bad enough that tens of thousands of Americans are dying in a country with literally trillions of dollars sloshing around in its financial markets and economy (and that millions more have or will face grinding poverty, even as “essential” workers). But the developing world is about to face a reckoning as well.

Given how devastating the virus has been for richer nations, imagine countries with even fewer resources. There are already tens of thousands of confirmed cases in countries across Latin America, Africa, and South Asia; it’s very likely there are even more that haven’t been detected due to the lack of public health infrastructure.

Not only is it difficult to test and treat the infected, but imagine forcing hundreds of millions of already-poor people in their homes and out of work. Pakistan and India alone have together quarantined a fifth of humanity, which, while necessary, poses tremendous risks (the mantra is, either die of the disease or we die of hunger). Both countries have rolled out plans to provide support, but the sheer cost and logistics will pose tremendous challenges (look how hard a time we’ve had).

In the end, none of this should be surprising. In a “normal” year, we lose millions of people to preventable diseases with treatments and cures worth literally pennies. Hundreds of thousands of kids die of something as banal to us as diarrhea. A mere eight people have more wealth than half of humanity (about 3.5 billion people). This pandemic has dramatically highlighted the horrifically stark and senseless disparities within our species, and many of us feel frustrated at our apparent powerlessness to do anything about it.

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.

How the World Views China, Russia and the U.S.

Researchers at Pew asked populations in different countries about which countries they saw as their biggest allies and threats.

Nearly a quarter of Americans saw Russia as the country’s greatest international threat, which put it on par with China.

One in ten Canadians named Russia as their greatest threat — but one in five said the same about the U.S.

The number of people who see Russia as the greatest threat has decreased as Putin has helped the country achieve more visibility on the international scene. Across 25 nations, 42 percent of people believed that Russia had become more influential globally; more than half of Americans concur.

Of course, this didn’t mean more people seeing Russia more positively: With the exception of India and Turkey — at 15 percent and nine percent, respectively — no more than four percent in any country named Russia as their most dependable ally.

As for China, the majority of people in most countries agree that its influence on the world stage has grown considerably, in particular seeing China as the world’s biggest economic powers alongside the U.S.

But only a median of six percent considered China their most reliable ally, compared with 27 percent who named the US.

Moreover, China is considered a threat by many neighbors: 62 percent of Filipinos, half of Japanese, 40 percent of Australians, 32 percent of South Koreans and 21 percent of Indonesians. Among the last two, the perception of China has worsened, though among the Japanese, it has gotten better.

In Canada, 32 percent of people saw China as a threat, the biggest figure for any state there.

Finally, as for the U.S., things are rosier than one would think. Many countries saw the U.S. as their biggest ally, including China’s neighbors (South Korea at 71 percent, the Philippines at 64 percent and Japan at 63 percent). Unsurprisingly, Israelis are the most enthusiastic in this regard, at 82 percent.

The caveat: Though large numbers of Canadians, Australians, and South Korean saw the U.S. as an ally, many also saw it as a big threat, making the country’s place in the world more polarizing.

Source: TRT World

The 2019 Human Development Index

The United Nations published its latest Human Development Index (HDI) rankings—using data from 2018—which is calculated based on three categories: Life expectancy, education, and per capita income. (Read the official announcement here.)

A country scores a higher HDI when its people live longer, have higher rates of education, and enjoy higher gross national income (GNI), adjusted for local purchasing power.

Norway and Switzerland are once again No. 1 and No. 2, respectively, while Ireland, Germany, and Hong Kong have risen to round up the top five. The U.S. ranks a respectable 15th.

However, note the second through fourth columns, which adjust the scores based on inequality. While countries may have an overall high rate of education, life expectancy, and income, how these benefits are shared among the general populace will vary.

Hence, Hong Kong would descend 17 places down if inequality were taken into account; the U.S. would drop by 13 points. Conversely, egalitarian Japan would climb 15 spots from 19th place, while the Czech Republic and Slovenia would also rise significantly.

Norway uniquely would remain in the same spot even if you adjust for inequality. Switzerland would drop just one point.

How Globalization Vanquished a Scourge of Humanity

On this day in 1979, the United Nations World Health Organization (WHO) certified that its efforts led to the global eradication of smallpox, the only human infectious disease to date to have been completely eradicated.

This millennia-long scourge of humanity was responsible for 300 million deaths in the 20th century alone, and even in the early 1950s an estimated 50 million cases occurred worldwide annually, with a mortality rate of about 30 percent.

Like so many examples of human progress, this remarkable achievement was a product of globalization and international collaboration.

The Chinese developed the earliest recorded form of inoculation in the 16th century, and possibly as early as the 10th century. Smallpox scabs from the infected would be ground up and blown them up the noses of healthy people. They would then develop a mild form of the disease and become immune to it. While 0.5-2.0 percent would die, this was far less than the usual 20-30 percent rate of a full-blown infection.

It was not until centuries later, in 1796, that the true vaccine was developed by English physician Edward Jenner. Shortly thereafter the British and Spanish governments implemented vaccination programs both at home and in their colonies worldwide.

The first regional effort to eradicate smallpox was made in 1950 by the Pan American Health Organization founded in 1902 by the U.S. and eleven countries in the hemisphere. The campaign succeeded in wiping out the disease across the Americas in all but four countries.

The first global effort came in 1958 at the urging of Russian virologist Viktor Zhdanov, who called on member states of the WHO to act. At the time, smallpox was still killing 2 million people every year. After initial delays and failures, in 1966 an American-led international team was formed solely to eliminate smallpox, and one year later the WHO contributed $2.4 million annually to the effort, utilizing a new disease method advocated by Czech epidemiologist Karel Raška.

The WHO established a vast network of consultants who assisted countries in setting up surveillance and containment activities. Initially, vaccines were donated overwhelmingly by Russia and the U.S., but by the early 1970s, more than 80 percent of all vaccines were produced in developing countries.