Making the most of an imperfect WHO

The World Health Organization made mistakes in its initial response to COVID-19, but as it comes under criticism, it's important to remember the world still needs the agency.

Why it matters: President Trump's decision this week to withhold money from the agency could damage its efforts to fight the next pandemic and other health threats. For all its problems, the WHO remains the only global institution charged with combating the global threat of infectious disease.

Background: Despite its grand name and purpose — to "keep the world safe" — the actual scope of the WHO is limited by both its budget and the political realities of international governance.

With a biennial budget of $6.3 billion, the WHO has about as much cash to spend as a large urban hospital system in the U.S., and significantly less than the U.S. Centers for Disease Control and Prevention.

• Like all UN agencies, the WHO is not independent in any real sense from its member countries.
• In the case of its early response to COVID-19, this meant the agency was ultimately dependent on the Chinese government. It wasn't until mid-February — weeks after the outbreak began in Wuhan — that a WHO team was permitted to enter China to begin investigations.

Early on, many WHO officials appeared to underplay the potential global threat posed by the novel coronavirus.

• What they're saying: In a press conference the day after Trump's attacks, WHO Director-General Tedros Adhanom Ghebreyesus told reporters the agency's performance would eventually be reviewed, as it was after previous outbreaks, but "for now, our focus — my focus — is on stopping this virus and saving lives."

What's next: Without a revolution in how national governments treat international governance, the WHO will likely continue operating under inherent limitations. But there are steps the agency could take to improve global disease response in particular.

• The WHO could be more transparent about what it can and what it can't do, and what it knows and what it doesn't know. While it may not be realistic for the WHO to publicly criticize a government like China for holding back information, it could make it clearer to the rest of the world what it isn't being told about an outbreak.

In an increasingly politically divided world, the need for a global broker of some kind on infectious disease will only grow. Geopolitics may still be driven by nation-states, but as we've learned with COVID-19, viruses do not respect borders.

• Defunding the WHO is like voting to "de-fund fire depart in the middle of a fire, on the grounds they ought to have got to the fire sooner," Lawrence Gostin, the director of the O'Neill Institute for National and Global Health Law at Georgetown University, tweeted on Thursday.
• While the focus with COVID-19 has been on the U.S. and China, the biggest losers in a world without the WHO would be poor countries that are much more dependent on the UN agency for assistance. And the next pandemic is just as likely to come from one of them.

The bottom line: An imperfect WHO is still better than a nonexistent one, and policymakers can make the best use of the agency if they fully understand what it can and cannot do.

Go deeper: The U.S. gives far more money to the WHO than China does