TRUMP’s decision to withdraw from WHO is a continuation of his wielding a wrecking ball to the international framework of treaties and organisations. Whether it is arms control treaties, climate change, trade and now WHO, the US sees these agreements and institutions as fetters on its hegemonic powers to shape the world. Trump may express this pathology in its most ugly form, but the disease runs far deeper.

Trump’s excuse for withdrawing from WHO is that it did not do its job well on the Covid-19 epidemic and was soft on China. Condemning Trump’s move, Devi Sridhar, Professor of Global Public Health at the University of Edinburgh and advisor to the Scottish government tweeted, “Donald Trump's withdrawal of US from the WHO ignores the key role the agency plays in outbreak prevention and response. Not only for Covid, but also for polio, malaria, TB, plague, yellow fever, cholera, Zika virus, and neglected tropical diseases.” She also pointed out that it is because of such international agreements that WHO received information from China on the novel pathogen on December 30, 2019 and declared the highest alarm bell the world has – a Public Health Emergency of International Concern – on January 30, 2020.

Trump is trying to pass the buck to WHO for his administration’s abject failure to prepare the US for the Covid-19 pandemic and its handling of the pandemic. And the US Centre of Disease Control and Prevention (CDC), could not even prepare a proper test-kit for two months for detecting SARS-CoV-2, the virus that causes the Covid-19 infection. China, Germany and Korea, to name a few, all had working test kits well before CDC. One of this, the Charite Berlin’s test kit was supplied by WHO to more than 120 countries, well before CDC, with a budget three times WHO’s, could get its test kits to work.

The US has a bipartisan unity on being the sole global hegemon. Its wars of invasion – from Korea, Vietnam, Afghanistan and Iraq – has had bipartisan support. Its rightwing, which in any other part of the world would be regarded as the loony right, believes that it can impose its will on the world using military force and economic sanctions alone. The other side, the more globalist right – there is no left or centrist forces in the US leadership of either parties – believes that this hegemony can be exercised more easily from within the global institutions.

What does WHO do and what are the risks to the world of a US pull out?

Almost all countries have reposed their faith in WHO as the only international instrument we have in fighting pandemics and infectious diseases. So the US action will have financial implications, but not a threat to its existence or mandate.

WHO has an annual budget of about $2.2-2.4 billion dollars: two-year budgets for 2018-19 of  $4.4 billion, and 2020-21 of $4.8 billion. 80 per cent of these are from voluntary contributions of countries and other organisations including private trusts and funds, and only 20 per cent from what are called assessed contributions of countries. The assessed contribution of the US is about $120 million for the year 2020, and its voluntary contribution another $320 million, totalling to about 20 per cent of WHO’s current budget. The voluntary contributions from countries and private funders on which the WHO has become progressively more dependent, have led to private interest groups dominating WHO’s agenda. Bill and Melinda Gates Foundation is the second biggest contributor after the US to WHO’s total budget.

Compared to its mandate of health for all, and fighting disease and epidemics across the world, it has a measly budget. Just to put WHO budget numbers in perspective, the US CDC’s annual budget is roughly three times, and its National Institute of Health (NIH) twenty times WHO’s budget. It has no powers over sovereign countries, and has to work with the country governments.

WHO has had remarkable success in eradicating smallpox, bringing down the number of polio infections from the scourge it was earlier, and significant interventions in other infectious diseases. Its controlling of the Ebola epidemic, while had some critics, required multi-country and multi-agency efforts, which would have been almost impossible without WHO. It is the only agency which has technical competence drawn from different countries, which can coordinate the efforts of different countries and their agencies.

Sure, we can criticise WHO for its mistakes, initially on not advising wearing of masks and not emphasising the role of airborne fine droplets or aerosols in closed spaces. But it raised the flag of pandemic early, came out with clear recommendation on testing and tracking, and its multidisciplinary team worked with China to bring out how China had controlled the epidemic. It was this report, made public on February 24 that countries had to follow not a flu protocol but a more stringent one of SARS, that made countries like New Zealand change its policies. Countries such as Vietnam and South Korea, who had experienced the 2003 SARS outbreak, were already following SARS protocol of using masks, extensive testing and isolating those infected. Vietnam, in spite of a shared border with China, has controlled the epidemic completely and has not had a single Covid death.

Why is WHO’s coordinating role so important? Unlike human populations, microbes have no borders. They travel not only locally through water and air, but also with an interconnected world, travel ride passengers travelling through air, water or land. They infect animals and birds, both domesticated and in the wild. That is why quarantining the infected, isolating countries from others is only a short term measure. The only long term way to fight epidemics is either to eradicate it completely, or confine it to small pockets of outbreaks, through vaccines and other public health measures. This battle cannot be won by one country. That is why gutting WHO, the only instrument of global cooperation we have, is a road to disaster.

While the warning of a new pandemic has been given by many, the flu virus was thought to be the major threat. Its ability to mutate rapidly and with reservoirs in domesticated animals – chickens and pigs – and in migratory birds, and with memories of the 1918 influenza epidemic, has been recognised as a long term pandemic threat.

One of the major tasks of WHO has been to create a global network and infrastructure that can monitor flu outbreaks all over the world. WHO has a monitoring system, Global Influenza Surveillance and Response System (GISRS) functioning for last 65 years that monitors the flu strains from all over the globe, and alerts countries of new strains of flu and novel pathogens. It also identifies the likely strains and therefore the vaccine composition for the coming season. It is the only global platform that allows countries to share virus strains so that they can receive vaccines through WHO’s programs at concessional rates, and not at the market rates which would be prohibitively expensive for the poorer countries.

There is nothing that exists globally that can be used to monitor seasonal change of the flu viruses and share its genome, apart from WHO’s GISRS surveillance system. Which countries benefit from such a virus sharing platform? The bulk of influenza vaccines are used in the US and Western Europe, and the US has by far the highest share as a country. With 50 per cent of the global population – Africa, West Asia, South Eastern Asia – use only 5 per cent of flu vaccines, even though the bulk of flu samples come from these countries.

Walking out of WHO leaves at risk not only the global flu program, but also a large number of deaths, with many experts predicting a new flu pandemic that can rival the 1918 flu one. At that time, it killed an estimated 50-100 million people, with British India’s casualties of 15-20 million. Since the world’s population was one-fourth our current one, this means a casualty 200-400 million by today’s count.

Stopping diseases at source is also protecting its population from pandemics. Why then would the US pull out of WHO when it is the net beneficiary of its disease monitoring program? The rightwing thrust opposes public health policies in favour of individual centric, privatised health care. Every person for themselves, and every country for itself, is a part of this larger worldview. The WHO, with its warts and all, still stands for global cooperation and fostering public health policies. It is hated by the rightwing precisely for these reasons. That is why the rightwing friends of Trump – Bolsonaro, Boris Johnson and Modi – are also quiet on the US quitting the WHO.