"According to the WHO", "the WHO has decided", "on the recommendation of the WHO" ... In the midst of a global coronavirus epidemic, and as with every health crisis, the name of the World Health Organization comes up regularly .
As of Thursday, 170 people have died in China since early January, while 7,700 cases have been detected worldwide. And the epidemic is spreading to more and more countries. In France, there are five hospitalized patients, and at least four of them have recently traveled to China. However, the WHO did not decide last week to declare a global health emergency. This leads to the suspicion of pressure from China, when a new meeting of the emergency committee is scheduled to take place on Thursday.
What is WHO for?
The mission of the World Health Organization, established in 1948, is to "lead and coordinate global health within the United Nations system", as stated on its website. Since 2017, it has been headed by the Ethiopian politician Tedros Adhanom Ghebreyesus, and it has 192 member states.
Its actions are very varied: establishment of standards and essential drugs, advice on eating behavior (such as the famous recommendation “five fruits and vegetables per day”), fight against infectious diseases and epidemics, medical research on vaccines, etc.
The WHO had a budget of $ 4.4 billion for the years 2018 and 2019, according to the most recent figures. Most of this amount (more than 800 million) is devoted to the fight against communicable diseases, such as AIDS. Nearly $ 600 million is used to improve health systems, especially in the poorest countries. Non-communicable diseases (heart attacks, diabetes, etc.) represent a budget of $ 351 million.
Where does its funding come from?
Member States pay a fixed contribution, with a different scale depending on their size and standard of living. The top five contributing countries are, in order, the United States, Japan, China, Germany, and finally France, which contributed around $ 60 million for 2016 and 2017.
But most of the funding for WHO (about 80%) comes from voluntary contributions, by these same countries or from private funds, foundations, and other international organizations. These sums are often intended for specific programs, such as the fight against such disease or aid to such country. "All of these contributions must come within the framework of the budget voted by the member states every two years", specifies Marie-Paule Kieny, director of research at Inserm and former deputy director of WHO (2011-2017) .
In 2017 alone, the United States paid more than $ 400 million more. Among the non-state contributors, the most generous was the Bill & Melinda Gates Foundation, with nearly $ 325 million. “Thirty years ago, when we founded Microsoft, we had an ambitious project: a computer for everyone. Today, we are pursuing an even greater ideal, namely good health for every human being, ”proclaimed Bill Gates in a sequence from the documentary“ WHO, a great sick body ”, broadcast on Arte last year.
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In the end, fixed and voluntary contributions combined, the Member States finance approximately half of WHO.
How does it work in a crisis?
In the event of a global health crisis, WHO forms an emergency committee from among its members, responsible for issuing recommendations to the Director-General. It is the latter who chooses the members of this committee from a list of international leaders specialized in different medical sectors.
These experts must say whether the current crisis constitutes a "public health emergency of international concern", that is to say "an extraordinary event which has been determined to constitute a risk to public health in other States because of the risk of international spread of disease and that it may require coordinated international action. " This system was put in place in 2005, after the SARS epidemic from China. "There are at least two things: that there is a serious epidemic in one country, and that there is a proven demonstration of person-to-person transmission in at least one other country," says Marie-Paule Kieny.
Are its recommendations binding?
If the Director-General of WHO decides to declare an emergency, international, he can impose certain measures on the countries concerned "to protect populations from the consequences of epidemics", while "avoiding creating unnecessary obstacles to international traffic and trade “, Specifies the site of the WHO.
This may involve restricting the movement or transport of goods, or through increased monitoring of populations, for example. In July 2019, to fight against Ebola fever, the WHO asked the states concerned in Africa to strengthen surveillance at airports and ports with systematic passenger checks.
"These recommendations are binding on member states," said Marie-Paule Kieny. But in the UN sense of the term. "WHO does not in fact have sanction mechanisms, [but] countries which do not follow these recommendations would put themselves in a difficult situation and could be subject to pressure from other countries," added the expert. .
Why is it criticized on the coronavirus?
The coronavirus emergency committee is made up of 15 members, including a French and a Chinese. Meeting for the first time last Thursday and Wednesday, these experts did not recommend declaring a "public health emergency of international scope", judging that it was "too early" for that. According to Le Monde, the Chinese representative declared on this occasion that "there was no question of declaring" such an emergency.
"China had no interest in the WHO deciding an international emergency, so there is also political motivation in the committee's decision. But it should be remembered that there were not many affected countries, and not yet secondary cases [human-to-human transmission, note], says Antoine Bondaz, researcher at the foundation for strategic research and specialist from China.
However, over the past week, the number of victims and deaths has continued to increase. The first case of human-to-human transmission in Europe has been detected in Germany. Returning from China on Wednesday, the director general of the WHO also announced that he had convened the emergency committee again on Thursday, due to a "risk of global spread".
. @ WHO is monitoring the new #coronavirus outbreak every moment of every day. My respect and appreciation to my colleagues @WHO who are showing great commitment. We will have more news following tomorrow's Emergency Committee meeting.
- Tedros Adhanom Ghebreyesus (@DrTedros) January 29, 2020He wishes to be "advised on the question of whether the current epidemic constitutes a public health emergency of international concern". Which should be declared at the end of the day, according to Antoine Bondaz, because "all the conditions are now met".
What are the previous cases of global emergency crisis?
Such a measure has already been taken during previous serious crises, such as the H1N1 swine flu, the Zika virus or even Ebola fever. During the H1N1 flu, the organization had, unlike today, been accused by some observers of having declared a little too hastily the state of pandemic. Some of the experts consulted were linked to pharmaceutical groups, beneficiaries of the sales of medicines and vaccines, which could lead to conflicts of interest.
Suspicions which WHO had been largely cleared by an official report in November 2011. “We are witnessing a rise in conspiracies. I, who was on the front line, can tell you that the WHO was not influenced, ”enraged Marie-Paule Kieny, judging that the organization“ is always criticized, whatever it does ”.
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