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What the W.H.O. Does, and How U.S. Funding Cuts Could Affect It What the W.H.O. Does, and How U.S. Funding Cuts Could Affect It
(7 days later)
President Trump’s decision to halt funding for the World Health Organization, depriving it of its biggest funding source, could have far-reaching effects in efforts to fight diseases and make health care more widely available across the globe.President Trump’s decision to halt funding for the World Health Organization, depriving it of its biggest funding source, could have far-reaching effects in efforts to fight diseases and make health care more widely available across the globe.
Mr. Trump’s order centered on the organization’s response to the coronavirus pandemic, and he is far from alone in criticizing its actions and statements. Some countries have disregarded the W.H.O.’s efforts as the epidemic has spread, failing to report outbreaks or flouting international regulations.Mr. Trump’s order centered on the organization’s response to the coronavirus pandemic, and he is far from alone in criticizing its actions and statements. Some countries have disregarded the W.H.O.’s efforts as the epidemic has spread, failing to report outbreaks or flouting international regulations.
But the W.H.O. is responsible for much more than epidemic response, and it now finds itself financially imperiled by its newfound place in the cross-hairs of American domestic politics.But the W.H.O. is responsible for much more than epidemic response, and it now finds itself financially imperiled by its newfound place in the cross-hairs of American domestic politics.
Here are answers to some common questions about the organization.Here are answers to some common questions about the organization.
Founded after World War II as part of the United Nations, the Geneva-based organization, which has about 7,000 workers spread over 150 offices worldwide, has no direct authority over member nations. Instead, it is intended to be an international leader in public health by alerting the world to threats, fighting diseases, developing policy and improving access to care.Founded after World War II as part of the United Nations, the Geneva-based organization, which has about 7,000 workers spread over 150 offices worldwide, has no direct authority over member nations. Instead, it is intended to be an international leader in public health by alerting the world to threats, fighting diseases, developing policy and improving access to care.
During emergencies like the coronavirus, the W.H.O. is meant to serve as a central coordinating body — guiding containment, declaring emergencies and making recommendations — with countries sharing information to help scientists address outbreaks.During emergencies like the coronavirus, the W.H.O. is meant to serve as a central coordinating body — guiding containment, declaring emergencies and making recommendations — with countries sharing information to help scientists address outbreaks.
But although the W.H.O. is broadly influential, it lacks meaningful enforcement authority and is under budgetary and political pressures, especially from powerful nations like the United States and China and private funders like the Gates Foundation.But although the W.H.O. is broadly influential, it lacks meaningful enforcement authority and is under budgetary and political pressures, especially from powerful nations like the United States and China and private funders like the Gates Foundation.
António Guterres, the secretary general of the United Nations, defended the W.H.O. in a statement on Tuesday, saying it “must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.”António Guterres, the secretary general of the United Nations, defended the W.H.O. in a statement on Tuesday, saying it “must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.”
He said it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”He said it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”
Financing comes from participating nations and private foundations. The United States is the largest contributor, making up 14.67 percent of its budget.Financing comes from participating nations and private foundations. The United States is the largest contributor, making up 14.67 percent of its budget.
Member dues make up about a quarter of the money the United States gives the W.H.O.; they are calculated relative to a nation’s wealth and population. The rest comes from voluntary contributions, which can vary in size year to year.Member dues make up about a quarter of the money the United States gives the W.H.O.; they are calculated relative to a nation’s wealth and population. The rest comes from voluntary contributions, which can vary in size year to year.
In 2019, the United States contributed about $553 million. The W.H.O.’s biennial budget — every two years — was about $6.3 billion in 2018-2019.In 2019, the United States contributed about $553 million. The W.H.O.’s biennial budget — every two years — was about $6.3 billion in 2018-2019.
Most of the money from the United States goes toward programs like polio eradication, developing vaccines and increasing access to essential health and nutrition services. Just 2.97 percent of the U.S. contribution goes toward emergency operations, and 2.33 percent is earmarked for outbreak prevention and control.Most of the money from the United States goes toward programs like polio eradication, developing vaccines and increasing access to essential health and nutrition services. Just 2.97 percent of the U.S. contribution goes toward emergency operations, and 2.33 percent is earmarked for outbreak prevention and control.
Lawrence O. Gostin, the director of the O’Neill Institute for National and Global Health Law at Georgetown University, said about 70 percent of the funding from the United States has gone to programs that it has earmarked, such as those directed toward AIDS, mental health programs, cancer and heart disease prevention.Lawrence O. Gostin, the director of the O’Neill Institute for National and Global Health Law at Georgetown University, said about 70 percent of the funding from the United States has gone to programs that it has earmarked, such as those directed toward AIDS, mental health programs, cancer and heart disease prevention.
“The highest profile is on epidemic control and preparedness,” he said. “But it is actually the least important thing W.H.O. has done historically.”“The highest profile is on epidemic control and preparedness,” he said. “But it is actually the least important thing W.H.O. has done historically.”
The U.S. contribution is nearly twice the next-largest contribution from a nation, the United Kingdom, which funds 7.79 percent of the W.H.O. budget. The Bill and Melinda Gates Foundation pays for 9.76 percent of the budget.The U.S. contribution is nearly twice the next-largest contribution from a nation, the United Kingdom, which funds 7.79 percent of the W.H.O. budget. The Bill and Melinda Gates Foundation pays for 9.76 percent of the budget.
The president has accused the W.H.O. of responding too slowly to the threat of the virus and not being critical enough of China. (The same accusations have been leveled at Mr. Trump, who was warned in January about a possible pandemic and who repeatedly praised the Chinese government for its handling of the virus.)The president has accused the W.H.O. of responding too slowly to the threat of the virus and not being critical enough of China. (The same accusations have been leveled at Mr. Trump, who was warned in January about a possible pandemic and who repeatedly praised the Chinese government for its handling of the virus.)
The W.H.O. has consistently advised against travel restrictions, arguing that they are ineffective, can block needed resources and are likely to cause economic harm. But Mr. Trump has frequently pointed to his decision to limit travel from China in late January as evidence he took the threat seriously.The W.H.O. has consistently advised against travel restrictions, arguing that they are ineffective, can block needed resources and are likely to cause economic harm. But Mr. Trump has frequently pointed to his decision to limit travel from China in late January as evidence he took the threat seriously.
But Mr. Trump is not alone in his criticism. Some experts have said the W.H.O. was slow to declare a public health emergency and was too trusting of the Chinese government, which initially tried to conceal the extent of the outbreak, as the country has gained influence in the organization.But Mr. Trump is not alone in his criticism. Some experts have said the W.H.O. was slow to declare a public health emergency and was too trusting of the Chinese government, which initially tried to conceal the extent of the outbreak, as the country has gained influence in the organization.
Mr. Trump’s decision to halt funding appears to be the first such formal announcement of its kind by an American president, experts said, though the United States has had a sometimes contentious history with the W.H.O. on issues like breastfeeding and tobacco.Mr. Trump’s decision to halt funding appears to be the first such formal announcement of its kind by an American president, experts said, though the United States has had a sometimes contentious history with the W.H.O. on issues like breastfeeding and tobacco.
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said there were legitimate concerns about the need for reforms at the W.H.O. Some member states have undue influence over the organization’s messaging, and after the Ebola outbreak that began in 2013, regional offices were seen as having inadequate autonomy to respond to the emergency, he said.Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said there were legitimate concerns about the need for reforms at the W.H.O. Some member states have undue influence over the organization’s messaging, and after the Ebola outbreak that began in 2013, regional offices were seen as having inadequate autonomy to respond to the emergency, he said.
“There is room to criticize here,” he said. “But I don’t think, in the middle of a pandemic, making a political statement is the best way to address the shortcomings.” Updated June 22, 2020
Updated June 16, 2020 A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“There is room to criticize here,” he said. “But I don’t think, in the middle of a pandemic, making a political statement is the best way to address the shortcomings.”
Mr. Gostin said that the organization has been hobbled for structural and political reasons, and become timid as a result.Mr. Gostin said that the organization has been hobbled for structural and political reasons, and become timid as a result.
“The fact that President Trump is withholding or curtailing funding is exactly the prime example of why we are in this mess,” he said. “The director general is worried that any time he puts a move wrong, they will withdraw funding or undercut the agency politically.”“The fact that President Trump is withholding or curtailing funding is exactly the prime example of why we are in this mess,” he said. “The director general is worried that any time he puts a move wrong, they will withdraw funding or undercut the agency politically.”
Throughout January, the W.H.O. issued advisories about the dangers of the virus. From Jan. 22 on, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, held almost daily news briefings to warn the world that the virus was spreading, and that the window of opportunity to stop it was closing.Throughout January, the W.H.O. issued advisories about the dangers of the virus. From Jan. 22 on, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, held almost daily news briefings to warn the world that the virus was spreading, and that the window of opportunity to stop it was closing.
But the organization initially hesitated to declare a global health emergency even as the virus spread outside of China.But the organization initially hesitated to declare a global health emergency even as the virus spread outside of China.
“This is an emergency in China, but it has not yet become a global health emergency,” Dr. Tedros said on Jan. 23. “It may yet become one.” On Jan. 30, the W.H.O. made the official declaration, which often prompts governments to take action. Soon afterward, the State Department warned travelers to avoid China.“This is an emergency in China, but it has not yet become a global health emergency,” Dr. Tedros said on Jan. 23. “It may yet become one.” On Jan. 30, the W.H.O. made the official declaration, which often prompts governments to take action. Soon afterward, the State Department warned travelers to avoid China.
For weeks, the W.H.O. issued guidance and warnings, and it officially declared the outbreak a pandemic on March 11, calling on governments to work together to battle the virus. Critics said both its declarations came too late, and that earlier decisions could have mobilized governments more quickly. While the W.H.O. is intended to coordinate the worldwide response, there has been little global solidarity, showing the limits of its power. The organization had a plan, but few countries have hewed to it.For weeks, the W.H.O. issued guidance and warnings, and it officially declared the outbreak a pandemic on March 11, calling on governments to work together to battle the virus. Critics said both its declarations came too late, and that earlier decisions could have mobilized governments more quickly. While the W.H.O. is intended to coordinate the worldwide response, there has been little global solidarity, showing the limits of its power. The organization had a plan, but few countries have hewed to it.
Mr. Gostin said that in the long run, the president’s decision to cut the funding could lead to a restructuring of the W.H.O., with new international leadership, new health alliances, and greater control over its budget.Mr. Gostin said that in the long run, the president’s decision to cut the funding could lead to a restructuring of the W.H.O., with new international leadership, new health alliances, and greater control over its budget.
He said the United States has also been “a thorn in the side” of the W.H.O. over the years, blocking some of its efforts on access to medicines or watering down global action plans on migrants and refugees.He said the United States has also been “a thorn in the side” of the W.H.O. over the years, blocking some of its efforts on access to medicines or watering down global action plans on migrants and refugees.
But he added: “I think that President Trump in this singular act has taken a step too far.”But he added: “I think that President Trump in this singular act has taken a step too far.”
“This will enormously erode American influence in the world and in global health and international affairs in the midst of an epidemic of unprecedented scope,” he said. “We will lose our voice, and even our influence, even with our allies. I don’t think we get a say anymore with how this unfolds.”“This will enormously erode American influence in the world and in global health and international affairs in the midst of an epidemic of unprecedented scope,” he said. “We will lose our voice, and even our influence, even with our allies. I don’t think we get a say anymore with how this unfolds.”