Global Health, Global Britain Contents

---

1Multilateral health system

The role of the WHO

4.The pandemic has exposed the limitations of the multilateral health system. The World Health Organization (WHO) has done crucial work in difficult circumstances but has at times fallen short in failing to challenge the Chinese government for concealing information on the outbreak, instead praising its “transparency”;1 and being slow to declare a “public health emergency of international concern”2 amid lobbying from Beijing.3 When the WHO finally made the declaration, on 30 January 2020, it was largely ignored by many states. We heard evidence that these issues are due to the WHO’s lack of powers to demand information from or access to member states; its precarious funding situation; shortcomings in the pandemic alert system; and to failures of leadership, transparency and accountability. As a member-led body, the WHO is constrained by what governments will allow.4

5.Information-gathering: The WHO can dispatch teams into a country only with the permission of its government, which often requires lengthy negotiations after an outbreak has been reported.5 The former Foreign Secretary, Rt Hon Jeremy Hunt MP, told us that it was “ridiculous” that the WHO had to get China’s permission before sending teams in during a global emergency, and that there should be an independent arm of the WHO with power to travel freely and gather information on outbreaks, with parallels to the inspection of nuclear facilities.6 The Independent Panel for Pandemic Preparedness and Response (IPPPR), which was commissioned by the WHO to review the response to the pandemic, also recommended that member states should give the WHO greater powers to independently investigate outbreaks.7 The EU has made a similar recommendation.8 When we asked Minister Wendy Morton for her views on these proposals, she did not give a substantive answer.9

6.Funding: Eighty percent of the WHO’s funding comes from voluntary donations, which are usually earmarked for specific projects, and only 20 percent from fixed member state fees.10 This makes its funds unpredictable, difficult to manage, and reliant on the good will of member states, and makes the organisation less agile and flexible in response to crises such as covid-19.11 The IPPPR found this has “serious impacts” on the organisation’s performance, and recommended that member state fees be increased to two-thirds of the WHO base programme budget, with no earmarking.12 The UK—already the second-biggest state donor to the WHO—has pledged £340 million in new non-earmarked contributions over four years, intended to help strengthen and reform the organisation.13

7.Political independence: The WHO operates in a highly political realm, and the Director-General, who is directly elected by member states, inevitably comes under political pressure.14 The IPPPR noted that global health is “a politically charged domain and it is vital that WHO as an institution is strong enough to be able to perform with maximum independence”. It recommended that the Director-General and regional directors should be limited to a single term, extended from five to seven years. This would strengthen their authority and independence, as they would not need to stand for re-election.15 Health experts have also called for reform to ensure that deliberations on declaring a public health emergency of international concern (PHEIC) are public, to make the process more transparent.16

8.Warning systems: Many countries failed to take action when the WHO declared a PHEIC—its highest level of alert—doing little until it used the term “pandemic”, which has no formal standing.17 To address this, the UK Government has called for strengthened early warning systems for pandemics,18 while the WHO Director-General has backed proposals for the creation of an intermediate alert below PHEIC.19 However, we heard evidence that these steps would make little difference. The challenge is not in gathering information about diseases, but getting governments to take action, and a lower tier of alert would likely also be ignored.20 To encourage governments to follow the WHO’s recommendations, the organisation instead needs to build trust with member states.21

9.Another pandemic could wreak just as much havoc on the global economy and have just as devastating an effect on global health outcomes as war, famine or environmental disaster. The temptation for world leaders will be to ignore the risks of a future pandemic until it is too late. We recommend that the Government takes steps to ensure that every G7 and G20 meeting includes an agenda item on mitigating pandemic risks.

China and the WHO

10.This Committee has repeatedly warned of the Chinese government’s creeping capture of multilateral organisations and the reticence of some to stand up to the challenge to the agreed international norms of conduct.22 Beijing aims to gain influence and control over these bodies and in some cases to undermine the fundamental principles on which they are founded. Meanwhile, China’s large and growing global sway means that multilateral bodies have little choice but to find a way to work with it. The risks of this influence are shown by the WHO’s shortcomings in responding to the pandemic. The organisation’s efforts to build a closer relationship with Beijing, declaring an “intensified strategic partnership”23 in 2017, may have led to “blind spots” that hindered its response to covid-19.24

11.Beijing has repeatedly undermined efforts to investigate the origins of the pandemic. It has delayed efforts to investigate, limited access to data and key sites, and retaliated against Australia after the prime minister called for a robust investigation.25 In July 2021, Beijing triggered stronger criticism from the WHO when it rejected a proposed second stage of the international inquiry into the origins of covid-19.26 The Director-General criticised the “premature push” to rule out the theory that the virus came from a lab, and the failure to share data from the start of the pandemic.27 When we asked then-Foreign Secretary Dominic Raab why the Government had not done more to press for a full investigation, he said that the UK was building a coalition to put pressure on Beijing—a task made more difficult by how much China was doing to “support many countries”. He warned that if the investigation appears to be politicised against China, it could lose international support.28

12.The risks of Chinese influence at the WHO are illustrated by the case of Taiwan. The island is excluded from the World Health Assembly—the WHO’s decision-making forum—by China, which claims Taiwan as its territory.29 Taiwan has criticised this decision, accusing the WHO of “capitulat[ing] to the political interests of a certain member”.30 Taiwan has claimed that the WHO failed to act after Taiwanese officials reported concerns about human-to-human transmission on 31 December 2019.31 More than two weeks later, the WHO was still repeating China’s position that there was no clear evidence of human-to-human transmission.32 The issue has drawn more attention because of Taiwan’s successful response to covid-19. It has largely avoided harsh lockdowns while keeping cases low, thanks to a data-driven policy of testing, tracing and isolation.33 The UK is lobbying the WHO to allow Taiwan to return,34 and joined with other G7 countries this year to express its support.35 The Minister responsible for global health security was not aware of the UK’s position on this issue when she appeared before us.36 However, she confirmed in later correspondence that the UK supported Taiwan’s participation in international organisations such as the World Health Assembly.37

13.The pandemic has exposed shortcomings in the multilateral health system. The WHO lacks adequate funds, power and independence. It has done hugely important work in a difficult situation, facing intense pressure from many sides. However, it performed less effectively than under the leadership of Gro Harlem Brundtland and fell short on demanding transparency from Beijing, particularly in the early months, leading to costly delays in the international response. Far from being a reason to abandon the WHO, the pandemic should be a wake-up call that prompts reform to give the WHO the powers it needs to respond more effectively to future outbreaks. No country should be able to impede it effectively performing its role of protecting global health. As the second-largest donor to the WHO, the UK is in a strong position to influence this process, build a coalition of member states, and press for the necessary reforms. These should include greater transparency and accountability across its work. We recommend that the Government endorses the recommendations of the Independent Panel (IPPPR), including for greater powers to independently investigate outbreaks, an increase in member state fees, and greater independence for the WHO’s leadership. For each, the Government should assess the chances of success, and explain the efforts the UK is making to promote it, if any.

14.To be more effective and independent, the WHO needs more reliable sources of funding, based on predictable fees from member states, rather than earmarked voluntary donations. We welcome the UK’s commitment to increase its core funding to the organisation. This should be accompanied by greater efforts to bring together other countries in support of increasing non-earmarked core contributions. We recommend that the Government campaigns for an increase in member state fees ahead of next year’s World Health Assembly.

15.The WHO needs support to withstand political pressure from certain member states. There should be no space for doubt about the independence of the WHO’s leadership, particularly given the organisation’s important work during the pandemic. Working in a highly political environment and facing targeted attempts at influence by Beijing and other governments, the Director-General should be insulated from the need to campaign for re-election. Making key deliberations public would help to remove any scope for undue influence. We recommend that the FCDO should support proposals to give the Director-General and other senior officials a single, non-renewable term, and to publish deliberations on declaring a public health emergency.

16.Without a full and transparent investigation into the origins of covid-19, we are at greater risk of a disastrous new outbreak. By impeding efforts to trace the origins of the virus, Beijing is endangering its own population along with the rest of the world. Even with a full investigation, the limited access to data and to key sites in China in the early days of the pandemic makes any investigation more difficult—this must be addressed for any future outbreaks. The Government should work with other countries to increase the WHO’s powers to independently access countries where an outbreak has been reported, mirroring the work of the International Atomic Energy Agency (IAEA)—including through reform of the International Health Regulations, if necessary. The Government should build a partnership of nations to investigate the virus’ origins and should make clear what measures it will take to support countries that are facing intimidation from Beijing over their backing for an independent investigation.

17.Taiwan’s impressive response to covid-19 illustrates that its exclusion from WHO forums risks harming global health security, making it harder to exchange information with Taiwan and learn from its experiences. In a deeply interconnected world, where the next pandemic could emerge from any region, we cannot afford to arbitrarily remove key partners from global health forums. We were disappointed that the Minister responsible for global health security was not aware of the UK’s position on this topic, which suggests that the issue may not be getting the attention it deserves within the FCDO. We recommend that the Government builds on the momentum of the joint G7 statement supporting Taiwan’s participation in the WHO with a renewed push for its attendance at the 2022 World Health Assembly.

European health networks

18.European health networks are one of the UK’s key forums for international cooperation on health security. At the end of the Brexit transition period, the UK left the European Centre for Disease Prevention and Control (ECDC)—the EU agency responsible for monitoring infectious diseases—and its Early Warning Response System, which alerts members to outbreaks. The UK can request access to the system on a case-by-case basis, and this was granted in the context of covid-19.38 Jeremy Hunt argued that the UK should be part of the ECDC, warning that decreased coordination in these areas would “increase the risk of a pandemic taking hold, or of a less effective response when a pandemic does take hold.”39 We were told that the Early Warning Response System is important for sharing data on outbreaks that would not meet the criteria for notification to the WHO.40 When we asked Minister Morton for her view, she did not appear to be aware of the issue.41

19.We are concerned that the UK’s reduced access to European health networks could undermine the UK and European response to future disease outbreaks. We recommend that the Government builds structured permanent cooperation with the European Centre for Disease Prevention and Control (ECDC). In its response to this report, the FCDO should set out its assessment of how its new ad hoc access to the Early Warning Response System affects global health security; whether and on what terms it sought to retain membership of the ECDC during EU exit negotiations; and when the current access in the context of the pandemic will lapse.