Events tend to reveal. A little more than a year ago, the World Health Organisation (WHO) was one of the United Nations’ less controversial agencies. Its director general was not much more than a chancer jumping ship while the regime in which he played a leading part in Ethiopia imploded. “The wrong man at the right time”, the top job at the WHO would allow him to “wash his hands of the Tigray’s People Liberation Front’s (the dominant party of Ethiopia since 1991) crimes”, Professor Al Mariam of California State University said, adding despondently that he was merely the “politically correct choice”.

That was then. With the world coming to terms with the virus and its aftermath, the WHO and its leader, Tedros Adhamon, were thrown into the limelight. The question of “influence” quickly came to the fore. On whose behalf did the WHO speak? 

Between January and April 2020, over a million people signed a petition demanding the resignation of Dr Tedros. A month later, the Aids Health Foundation wrote: “Dr Tedros’s actions and comments relative to China, coupled with the incomprehensible delays in critical emergency declarations, are simply unforgivable”.

In addition, he “downplayed the severity of the outbreak in January 2020”. As a final straw, he praised China for the “extraordinary measures it has taken to contain the outbreak” after the regime destroyed evidence, stopped the publication of findings, and — it is alleged — silenced doctors.

Many in the United States and elsewhere were adamant that Dr Tedros was China’s man. As a member of the Tigray People’s Liberation Front leadership, an Ethno-Marxist organisation listed on the Global Terrorist Database, with a long record of crimes against humanity, the link with the Chinese Communist Party was there to be made. 

It was also during his four year tenure between 2012 and 2016 at the Foreign Office that his country’s debt dependency on China grew, borrowing sixty percent of the $13.7 billion accumulated with the lender over a 20 year period. China provided around half of all of Ethiopia’s external debt stock by 2019. This reliance on Chinese capital was seen as material evidence that the Middle Kingdom was seeking to buy influence at the WHO, despite contributing less than one percent to its budget.  

The WHO, therefore, could feasibly give any country, regardless of size, the kiss of economic death

In short, there are plausible grounds linking Tedros & the WHO, Ethiopia and China. However, there are other potential avenues to investigate. 

The first one is simply that bureaucrats at the WHO simply overpromised – as is the wont of all bureaucracies worldwide.

Even before the outbreak of the Covid pandemic, health experts were already saying that something had gone wrong with the organisation. Adam Kamradt-Scott, an academic at the University of Sydney, wrote that calls for reform have become a “common refrain”. 

Events such as the 2009 H1N1 influenza pandemic and the 2014 Ebola outbreak had already strained the organisation’s credibility to breaking point. 

An article in The Lancet reported that the organisation had created “needless suffering and death” across West Africa in 2013 due to its slow response in declaring “Ebola an international public health emergency – five months after Guinea and Liberia had notified it of outbreaks”. 10,000 people are said to have died of the disease. Liberia was more decisive than the WHO – let us ponder on that. 

A hint regarding the World Health Organisation’s intrinsic structural weakness was dropped during an interview entitled “Global Health Gets a Check Up” between Stuart Reid of Foreign Affairs Magazine and Tedros in 2017. The discussion revealed an important consideration: the organisation is a club of nation states. 

Governments contribute their taxpayers’ money to the World Health Organisation’s budget. It, in turn, has to treat its members with a certain amount of decorum. 

It cannot make rash statements. These could have grave implications for its contributors.  Therein lies the key to the World Health Organisation’s paradox. 

It sells itself as the pinnacle for global health expertise and guidance but it is in large measure dependent for its existence on the very same countries it might need to single-out to contain the spread of a virus or pandemic. 

The WHO, therefore, could feasibly give any country, regardless of size, the kiss of economic death, thereby forcing the organisation into the world of geopolitics. 

The competences of the WHO expand at a speed equal to that at which its incompetence is revealed

This power means that it must tread extremely cautiously. Like economists who are at their best explaining what happened during the last crash, the WHO is best at letting us know what took place after the facts. 

The second one is related to ambition and funding. Whilst the WHO is mediocre at disease control, the organisation comes into its own in the area of Health Advocacy. Indeed, Stuart Reid gives us an insight into how international organisations think. Until recently, funding was earmarked for specific projects. As a disease is dealt with, so the need for funding recedes.  

Using past examples such as polio and smallpox, there were worries that the funding would no longer be justifiable. Reid therefore wanted to understand what funding structures could be created that would not fall away when a disease is eliminated. Tedros said “we need to look for new donors”, pointing to private foundations and corporations.

The way to achieve this meant simply to shift from something dynamic and temporary to something more permanent, specifically from disease control to the politics of health. 

Enter the Bill and Melinda Gates foundation. Currently, Melinda pays over 60 percent more than the United States Federal Government into the WHO’s coffers. She gives close to 12 percent of the organisation’s $8 billion budget. Some inadvertent strings seem to be attached to the ostensible largesse. 

As a result, the WHO is increasingly involving itself in what it calls “health-related human rights” – mostly topics, in the detail, potentially more closely tied to Melinda’s view of the world than to those who live at the coalface, including her birth suppression stance in Africa and South America. 

To many Africans however, including the biologist, Uju Ekeocha, it feels that just as “Africa the fertile” is on the cusp of seeing the promise that the meek will inherit the world fulfilled as the World’s population is set to witness a “jaw-dropping collapse” her future is increasingly threatened by “the Culture of Death” being pushed by “rich western philanthropists”. After all: would you trust someone who wants more of your kind or someone who wants fewer?

The arrival on the scene of gigantic foundations has two important consequences. The first is the confusion of the former international order. Indeed, if the Gates’ gives more to the WHO than the US government whilst depending for a large part of their corporate revenues on doing business in China, it is no longer clear on which side of the aisle they stand.

The second is an intensification of the politics of health, reflecting the personal views of the donor class. It is no accident that the World Health Assembly, the organisation’s parliament, identified “the right to health as a fundamental human right”, deciding for itself that “the aspect of human rights … is within the competence of the WHO”. Indeed, it developed sixty resolutions, no less, in a very short period of time, which address human rights on a variety of WHO programmes.

The range of “competences” is vast. They focus among other things on tobacco, violence, nutrition, women’s health and reproductive health. The breadth of ambition is meaningful. There is something of a Parkinson’s Law at play here: the competences of the WHO expand across ever more unrelated fields of operations at a speed equal to that at which its incompetence is revealed in its core functions – as formerly understood.

Indeed, to prove the point, the World Health Organisation created a “gender, equity and rights” team to focus on these three areas across “all organisational activities” to be injected into the bloodstream of national polities across the world. In addition, during a conversation with Benjamin Mason Meier of the Health and Human Rights journal in April 2017, Dr Tedros makes it clear that the organisation’s top priority would be “universal health care coverage”. Using “leaving no one behind” as a mantra, Dr Tedros said it would offer a unique opportunity “to advance equity in health”.

Aside from the irony that the Health and Human Rights journal deemed it perfectly reasonable to interview Dr Tedros without ever questioning his own personal involvement into one of Africa’s most long lasting and cruel dictatorships (including the kidnapping of British subject Andy Tsege in 2014), many of the topics broached were evidently not related to fighting diseases but instead to building “political commitment” at all levels of governance across the globe. This sounded very much like US West-coast political rhetoric.

As a result, his organisation, is no longer – in so far as it ever was – designed to fight disease. It is seeking power without accountability. Away from national discussions, it can indulge the notion that their bureaucratic interference makes the world a better place whilst the burden of explaining broadly unpopular policies falls on local and national politicians.

Just as an aside, the organisation spent more on travel than on medical supplies and material. Further, only a couple of years ago, the travel budget even exceeded its spend on fighting malaria, HIV, hepatitis, tuberculosis and other tropical diseases, combined.

The question is not just whether the World Health Organisation can be reformed. Defined by its leadership, with Tedros at the helm, there are no grounds for nation states, or anyone else for that matter, to keep funding the WHO.