IHP news 568 : "Getting on with the job" - International Health ...

IHP news 568 : “Getting on with the job”
( 17 April 2020)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the
Institute of Tropical Medicine in Antwerp, Belgium.

Pour la version française de la newsletter: vous trouvez une traduction française (voir pdf en haut et en bas de cette
newsletter).

Dear Colleagues,

This week’s intro is by Sophie Vusha, IHP editorial member from Kenya. She gives her take on the
Covid-19 preparedness & response so far in her country. Meanwhile, after the merry resurrection of
Boris Johnson last week on Easter, we hope you are all set for tomorrow’s big ‘One World: Together
At Home’ (virtual) concert curated by Lady Gaga! At the very least, this big party should manage to
lift the spirits of the billions currently in lockdown. And who knows, perhaps Lady Gaga and dr.
Tedros could sing a new version of “Shallow” together for the occasion ?

(PS: IHP was sort of on holidays this week, so this newsletter will be more in steno-style than usual.)

“Monday 13th marked a month since the Kenyan government announced the first case of COVID-19.
With “only” 208 cases, 40 recoveries and 9 deaths, one can almost feel the collective sigh of relief, that
earlier modelling projections of 10,000 cases (by the end of the first month) have not (yet?)
materialized. The health cabinet secretary has nevertheless warned Kenyans against celebrating
prematurely as work remains to be done on community testing and contact tracing. In addition to this,
regions in more rural parts of Kenya are seeing rises in the numbers of new cases.

To combat the pandemic, the government initially implemented measures that were similar to those
in other countries: social distancing, asking people to wash their hands and stay at home, self-
quarantine for those who had travelled abroad (for 14 days). While these measures seemed
appropriate at the time, they also caused a myriad of problems for the average person. Kenya, like
many other LMICs, is a country where a majority of the people in the urban areas live in slums, with
many also working as daily wage labourers. This has led to some defying the restrictions and going
about their businesses as normal, justifying this with reasons such as the need to generate income to
feed themselves, pay their rent and fend for their families.

In spite of these measures, the number of cases in Kenya kept rising. As a result, stricter measures were
imposed, first with a curfew on March 27, followed by restricted movement in the four counties with
the most cases: Nairobi, Mombasa, Kilifi and Kwale. Unfortunately, this has not happened without the
violation of human rights, with law enforcing police clashing with citizens who were adamant about
to earn their daily bread. Eventually order was restored to some parts of the country, however in
others, people continue to play a cat and mouse game with the authorities.

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Meanwhile, the economy has been hit hard, with everyone feeling the effects. To cushion the blow, the
President has proposed tax interventions which include a 100-percent tax relief for low-income-earning
persons, a reduction in the top Pay-As-You-Earn (PAYE) rate, and other changes such as cash transfers,
credit relief, lower VAT, and a corporate tax cut. The bill is currently waiting to be passed in parliament.
He also rewarded artists with 100 million shillings, for which he was criticised for recognising the so
called “wrong people” instead of health workers who are the COVID-19 soldiers. The more important
question, however, is: where are the Kenyan billionaires? Where are the politicians?

Of course, the bigger elephant in the room is the preparedness of the (weak) health system for tackling
the pandemic including, obviously, the availability of personal protective equipment (PPE). While the
shortage of PPE is a global problem, it is more pronounced in sub-Saharan countries and Kenya is not
exempt. In spite of this, health workers continue to do their best, which can perhaps be explained by
health staff’s resilience to instability and daily disruptions. The government is also working hard to find
solutions. It is encouraging local entrepreneurs and industries to show their prowess in making the
required PPE, and has been successful in increasing the number of masks being procured. As an aside,
the first local functioning ventilator has just been made by Kenyatta university students, surely a sign
of the country's potential and a confirmation of the maxim “necessity is the mother of invention”. Even
though there are still doubts about the efficacy of wearing masks in public, the ministry of health early
on advised the use of masks in public areas which is probably a good thing, certainly in settings where
social distancing is not really an option. A ‘silver lining’ amidst the big Covid-19 mess for people who
are living the most precarious lives?

The country will eventually adjust to the “new normal”, however the combination of the potential
impact of Covid-19 on an already overstressed health system and the consequences of neglecting of
other diseases and health services, is a “time bomb” waiting to explode. With people stuck at home,
some in difficult circumstances, mental health is another post COVID-19 worry.

In sum, it is still not fully clear what to expect and how prepared we are exactly. “

Sophie Vusha

Enjoy your reading.

Kristof Decoster

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Highlights of the week

Ebola DRC setback

WHO - WHO Director-General’s Statement on IHR Emergency Committee on Ebola
Virus Disease in the Democratic Republic of the Congo
https://www.who.int/news-room/detail/14-04-2020-who-director-general-s-statement-on-ihr-
emergency-committee-on-ebola-virus-disease-in-the-democratic-republic-of-the-congo

“The International Health Regulations Emergency Committee for Ebola in the Democratic Republic of
the Congo (DRC) met today, and has advised me that in its view the Ebola outbreak in the DRC
continues to constitute a Public Health Emergency of International Concern. I have accepted that
advice. Tremendous progress has been made containing this outbreak in very difficult circumstances.
Up until Friday, 54 days had passed without a confirmed case being reported, and 40 days had
passed since the last person known to have Ebola tested negative and was discharged from
treatment. Since Friday, three new cases have been confirmed - two in people who died in the
community, and one person who was in contact with one of them. The source of their infection is still
under investigation. It is likely that additional cases will be identified. Flare-ups are expected at the
tail-end of Ebola outbreaks. … … The Committee noted that armed groups are active in the area
where these cases were identified, a lack of funding is constraining the response, and the COVID-
19 pandemic is adding more challenges to an already complex operation….”

Link from last week: Stat - New Ebola case dashes hopes that the 2-year-old DRC outbreak was over

More analysis: New Humanitarian - As coronavirus spreads in Congo, Ebola resurfaces

“ As the spread of coronavirus accelerates across the country, health authorities now have to juggle
both responses — while also treating those affected by the world’s worst measles epidemic, an
outbreak of cholera, and the victims of Congo’s many ongoing conflict…”

Over to the gigantic Covid-19 section then. This week organized like this:

 (1) Covid-19 news from the WB/IMF Spring meetings & G20
 (2) Key news updates & WHO messages
 (3) Funding & other new initiatives
 (4) Science
 (5) Analysis
 (6) Covid-19 resources
 (7) Final Covid-19 snippets
 (8) Covid-19 “collateral damage”

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IMF/WB Spring meeting & G20 Covid-19 news
This week, virtual IMF/WB Spring meetings took place (ending today, 17 April), as well as – more or
less in coordination – a virtual G20 meeting by Ministers of Finance & central bank governors (15
April). All with only one focus: the Covid-19 response.

Bretton Woods Project - Spring Meetings amid COVID-19 crisis: Will this change
everything?
https://www.brettonwoodsproject.org/2020/04/spring-meetings-amid-covid-19-crisis-will-this-
change-everything/

(critical) Analysis ahead of the (virtual) Spring meetings of WB/IMF. Recommended.

G20 Finance Ministers and Central Bank Governors Meeting 15 April 2020
[Virtual] (Communiqué)
https://g20.org/en/media/Documents/G20_FMCBG_Communiqu%C3%A9_EN.pdf

Via the Guardian: “ G20 finance ministers have agreed to suspend poorer countries’ debt payments
from 1 May until the end of the year, as they prepare for increased spending on healthcare systems
during the coronavirus pandemic. That’s according to a communiqué issued earlier today. The G20
said that it will be time-bound (so not quite a jubilee) and it also said that private creditors should
match the terms. “

It’s a first step, but clearly doesn’t go as far as needed. Do compare for example with the broad-
based action across six areas favoured by Section 27: Call for a coordinated equitable and human
rights based global response to Covid-19 (and neatly summarized by Eric Friedman here )

On the bright side, it appears the Chinese will play along. (see below for more on that)

Coverage in Reuters - G20 countries agree debt freeze for world's poorest countries

Some reactions on the outcome of the G20 meeting:

 • Joint statement IMF/WB :

“We strongly welcome the decision of the G20 to respond to our call to allow the poorest countries of
the world that request forbearance to suspend repayment of official bilateral credit on May 1st. This
is a powerful, fast-acting initiative that will do much to safeguard the lives and livelihoods of millions
of the most vulnerable people. The World Bank Group and IMF will move quickly to respond to the
G20’s request for us to support this action by working closely with these countries in ways that make
the best use of this vital lifeline. We championed this debt initiative, and we're committed to taking
all possible steps to support the poor.”

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• Politico - Africa to G20: Debt relief deal to ease coronavirus crisis not enough

“Africa wants the G20 to go further in helping the world’s poorest countries survive the coronavirus
crisis despite the group agreeing to suspend debt payments until the end of the year, officials said. ….
faced with a recession and rising fiscal deficits, many African capitals feel the current deal does not
stretch far enough. Ngozi Okonjo-Iweala, one of four special envoys to the African Union to solicit
G20 support in dealing with the coronavirus, said Africa would need additional help in order to
guarantee the livelihoods of millions of people. The International Monetary Fund on Wednesday
said sub-Saharan Africa’s gross domestic product would shrink this year by 1.6 percent due to the
effects of the coronavirus, low oil prices and poor commodity prices. “It’s a good opening for
discussion. My belief is that until the end of this year will not be adequate. We need a two-year
time scale,” she said referring to the moratorium on Africa's debt. “I think that is what will give
African countries the breathing room to be able to deal with the enormous consequences of the
pandemic.”

 • Jubilee Debt - G20 suspends debt payments, more action needed

They warn of future debt crises if debt is not cancelled outright. And legislation needs to be passed
to ensure private sector complies with voluntary debt payment suspension.

“The suspension of debt payments to private creditors is only voluntary. The UK and New York can
make sure it happens by introducing emergency legislation to prevent any lender suing a country for
stopping debt payments during the current crisis. Otherwise, the real beneficiaries of today’s deal
could be rich speculators who keep being paid thanks to debt suspensions by other lenders.”

See also Oxfam – “G20 debt moratorium is a first step, must go further and multilaterals and private
creditors must follow suit”.

For a similar stance, see also Save the Children (but ahead of the meeting)- Commercial creditors
'must sign up to global debt deal' - or forgo Covid-19 help

“Save the Children says banks, commodity traders and asset management firms should not extract
money from poorest countries.”

“Ashing said in an open letter to the G20 that commercial creditors, such as banks, commodity
traders and asset management firms, accounted for almost half the $62bn (£42.2bn) debt
payments due to be made by the world’s 75 lowest-income countries in 2020. G20 governments
are expected to suspend debt payments for six months in a virtual meeting on 15 April, but Ashing
said this did not go far enough. Allowing commercial creditors an exemption from any debt-relief
initiative would be the “financial equivalent of pouring water into a bucket with large holes”, he
said. “

PS: some seem to have committed also – see Reuters: Private creditors will join the debt relief effort
on a voluntary basis, said the International Institute of Finance, which represents 450 banks, hedge
funds and other global financial firms. …. A French finance ministry official on Tuesday said private
creditors had agreed to roll over or refinance $8 billion of the debt of the poorest countries, on top
of the roughly $12 billion in debt payments to be suspended by bilateral creditors.”

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• Nick Dearden (Global Justice Now): in a tweet

“The #G20 #Covid19 plan is well short of real debt cancellation. It’s actually a delay in payments for
this year, with interest continuing to accrue. It kicks the problem down the road.”

Other links, analysis, advocacy & reads from this week ahead of the G20 meeting

 • FT - G20 nations close in on debt deal for poor countries -

Analysis ahead of the 15 April meeting: “The G20 group is planning to offer lower income countries
a moratorium on bilateral government loan repayments as part of an “action plan” to tackle the
coronavirus pandemic and stave off an emerging markets debt crisis, a senior G20 official said. The
initiative, due to be finalised at a finance ministers’ meeting this week, would see a freeze on
sovereign debt repayments for six or nine months, or possibly through to 2021, in line with an appeal
last month from the IMF and World Bank. Wealthy nations and multilateral institutions would use
the period of the moratorium to draw up “very clear criteria, country-by-country of what exactly is
going to happen.

“.. Those concerns initially focused on China, the biggest bilateral lender to the IDA countries.
Beijing has granted debt relief to creditor countries in the past, but has preferred to do so on a
bespoke basis rather than as part of any co-ordinated effort. China has so far appeared reluctant to
change that approach. Its foreign ministry said last week it was willing to talk to low-income
countries individually about their debt challenges, while noting that past repayment problems had
been resolved bilaterally. That stance may have changed ahead of this week’s meetings. The G20
official dismissed speculation that there were differences between G20 members, particularly
China, saying that while there were “some details that we are working through, certainly there’s a
very clear commitment, including China”. … .. Odile Renaud Basso, chair of the Paris Club, a group
of 22 big creditor nations, said any decision should be taken by all creditors together and that China
was “participating very constructively” with the G20 negotiations.”

 • Reuters - Top creditors to suspend poorest countries' debt payments: France

Also published ahead of the G20 meeting, with some more info on the amounts of money involved:

“Some 76 countries, of which 40 are in sub-Sahara Africa, were eligible to have debt payments
worth a combined $20 billion suspended, out of a total of $32 billion the countries were to spend
on debt servicing this year. “We have obtained a debt moratorium at the level of bilateral creditors
and private creditors for a total of $20 billion,” Bruno Le Maire told journalists. … … The government
creditors, including not only the Paris Club group of creditors, but also China and other members of
the Group of 20 economic powers, are to suspend $12 billion under the agreement, which remains
to be finalised on Wednesday. …”

 6

FT - Only victory in Africa can end the pandemic everywhere
World leaders call for an urgent debt moratorium and unprecedented health and economic aid
packages

On this op-ed, via HPW - World Leaders Call For WHO To Lead “Pan-African” COVID-19 Response
Mechanism

“… some 18 African and European world leaders called on the WHO to lead a “pan-African” COVID-
19 response, in a letter published on Wednesday by the European Council, the heads of state of
members of the European Union. “We must support a pan-African scientific and political
mechanism that will coordinate African expertise with the global response led by the World Health
Organization, and ensure a fair allocation of tests, treatments and vaccines as they become
available”, said the 18 country and regional leaders. The authors of the letter include Giuseppe
Conte, Prime Minister of Italy; Paul Kagame, President of Rwanda; Ursula von der Leyen, President of
the European Commission; Angela Merkel, Chancellor of Germany; Charles Michel, President of the
European Council; Cyril Ramaphosa, President of South Africa; and Felix Tshisekedi, President of
Democratic Republic of Congo, among others. With the WHO at the forefront, a “joint action plan”
will be developed in collaboration with numerous organizations, including the World Bank, the
ADB, Global Fund, Gavi and Unitaid. The letter also called for an “immediate moratorium on all
bilateral and multilateral debt payments” as well as a $100 billion economic stimulus package to
give the African continent fiscal space to respond to COVID-19….”

Eurodad - Six things you should know about Covid-19 and debt for developing
countries
https://eurodad.org/covid19-debt-FAQ

Neat analysis (updated as of 16 April). (PS: Eurodad is part of the Debt Jubilee group).

Guardian - 'Great Lockdown' to rival Great Depression with 3% hit to global
economy, says IMF
https://www.theguardian.com/business/2020/apr/14/great-lockdown-coronavirus-to-rival-great-
depression-with-3-hit-to-global-economy-says-imf

“Latest World Economic Outlook describes shock of coronavirus pandemic as ‘like no other’”

“It is very likely that this year the global economy will experience its worst recession since the Great
Depression, surpassing that seen during the global financial crisis a decade ago. ‘The Great
Lockdown’, as one might call it, is projected to shrink global growth dramatically.”…”

Guardian - IMF Executive Board Approves Immediate Debt Relief for 25 Countries
https://www.imf.org/en/News/Articles/2020/04/13/pr20151-imf-executive-board-approves-
immediate-debt-relief-for-25-countries

 7

(13 April) “The IMF’s Executive Board approved immediate debt service relief to 25 of the IMF’s
member countries under the IMF’s revamped Catastrophe Containment and Relief Trust (CCRT) as
part of the Fund’s response to help address the impact of the COVID-19 pandemic.” “About $215
million of the total will be used for grants to the first 25 countries over the next six months, with
extensions possible up to two years.”

Guardian - Pressure grows for developing world debt relief over coronavirus
https://www.theguardian.com/business/2020/apr/12/pressure-grows-for-developing-world-debt-
relief-over-coronavirus

From earlier this week. “More than 60 poorer countries are spending more paying creditors than
on health – study.”

“Calls for a comprehensive package of debt relief to help poor countries cope with the coronavirus
pandemic have intensified after research showed that more than 60 countries are spending more
on paying their creditors than they are on health. Before a series of key meetings this week, the
Jubilee Debt Campaign said it was vital to relieve the mounting financial pressure on poor countries
by cancelling their debt payments this year. The JDC said that among the 121 low and middle-income
countries for which 2019 data was available an average of 10.7% of government revenue was spent
on public health systems, compared with 12.2% on external debt payments. Of the 121 countries, 64
were spending more on debt servicing than on public health….”

Guardian - Coronavirus chaos could strengthen China's debt hold on struggling
nations
https://www.theguardian.com/world/2020/apr/12/coronavirus-chaos-could-strengthen-chinas-
debt-hold-on-struggling-nations

“Beijing could either take control of other countries’ assets or forgive debt to boost its soft power,
experts say, as economic fallout widens.”

But see also an ODI blog (by Y Chen) - Countries facing Covid-19 debt need flexible financing: lessons
from China

“…China’s past approach as a rising lender and development partner has been one of flexibility and
leniency in periods of difficulty….”

FT - US holds off on IMF plan to boost emerging economies’ finances
https://www.ft.com/content/9cb75566-bfd2-4f25-81f7-55780ebdaa3d

From earlier this week. “… The Trump administration is resisting urgent appeals from European
and African leaders for the IMF to create additional reserve assets to help low-income emerging
economies cope with the coronavirus pandemic, creating a fresh division in the global response to
the crisis. The expansion of the IMF’s “special drawing rights” has arisen as a point of friction in
multilateral discussions ahead of the IMF and World Bank spring meetings, which are being held

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online this week. A new allocation of SDRs would offer a liquidity boost to many countries facing a
sudden depletion of foreign exchange reserves. The move is seen by many governments as a key
complement to a debt relief package to support struggling emerging economies that the G20 —
including the US — is expected to endorse as early as Wednesday. But the US, the IMF’s largest
shareholder, has held off on backing the measure, casting doubt on whether that part of the
multilateral response to the pandemic will get off the ground….”

On this, see also The G20 missed an opportunity to expand financial resources for vulnerable
countries (via “special drawing rights”)

Devex - As Trump attacks WHO, World Bank looks for shareholder support
https://www.devex.com/news/as-trump-attacks-who-world-bank-looks-for-shareholder-support-
96994

“At this week's Spring Meetings, the World Bank's shareholders — including the U.S. government —
will send an important signal about the level of financial ambition they want the institution to
bring to the global COVID-19 response and recovery effort.”

Analysis ahead of the meeting today, Friday. “While the World Bank and International Monetary
Fund’s Spring Meetings have been drastically scaled back, the stakes for this week’s gathering of the
institutions’ shareholders are as high as they have ever been. The World Bank Group Development
Committee — composed of finance ministers from the bank’s member countries — is set to meet
Friday in hopes of reaching a consensus on the role that the world’s most influential multilateral
development bank will play in responding to the multifaceted global crisis brought about by
the COVID-19 pandemic. The message that ministers deliver will be crucial in determining the scale
and speed of the bank’s financial response, experts have said. U.S. President Donald Trump’s attack
on the World Health Organization has stoked fears of a breakdown in international leadership and
support for the multilateral system, while advocates for a strong and sustained World Bank
response to the pandemic hope that the institution will be spared from those political battles.”

“… The World Bank has already announced plans to deploy up to $160 billion over the next 15
months to help countries respond to the immediate health crisis brought on by COVID-19 and to the
economic fallout that is already materializing…. Some experts have said the World Bank and its
peer MDBs have significantly more financial “firepower” that they could bring to bear on behalf of
crisis management and recovery plans in their client countries — if the banks’ shareholders instill
confidence in their leaders that they will see continued support in the months ahead. According to
an analysis from the Center for Global Development, the MDBs collectively have the legal authority
to lend over $1 trillion, though their current lending practices are much more conservative. Whether
they are willing to leverage their balance sheets more aggressively will depend significantly on the
message they get from their shareholders — including this week at the Spring Meetings, Morris
said. “That’s a key thing to be looking for: What level of ambition do the governance actors, these
finance ministers, define for these institutions, and what kind of assurances do they provide going
forward?” he said.”

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Covid-19 key updates & WHO messages
In this section, we provide key updates (in addition to the abovementioned IMF/WB & G20
meetings), with a focus on WHO messaging, but also going beyond that.

As you can imagine, a big part of the week was focused on Trump’s attack on WHO (and the WHO
response to this). And plenty of discussion on the respective ‘timelines’ (in January), provided by
WHO, Trump & media.

Before you start: a quick global update via Cidrap News (April 16) - European nations revisit COVID-
19 actions as cases climb in Asia;

More than 2.1 million cases so far, and more than 144000 deaths. (via JH)

IPW - WHO Director General “Regrets” Trump Decision To Suspend Organization’s
Funding; UN, European Union, China and Others Decry US Move
https://www.healthpolicy-watch.org/who-un-eu-country-leaders-protest-suspension-of-us-funding-
to-who/

We suggest you start by reading this article in full. Great overview of what happened the past
week, with Tedros & other WHO staff’s views at the Wednesday media briefing.

“The European Union, China, and Norway Wednesday joined UN Secretary General Antonio
Guterres in decrying United States President Donald Trump’s decision to suspend US funding to the
World Health Organization – at a critical moment in the international agency’s coordination of the
global COVID-19 response….”

Tedros emphasized the need for a united front in the face of the pandemic. “When we are divided,
the coronavirus exploits the cracks between us”.

Excerpts: “Trump announced Tuesday night that the US administration would suspend WHO’s
funding for a “term of 60-90 days” pending an investigation into the agency’s handling of the
coronavirus pandemic. However, it’s unclear whether his decision can really be implemented
without being approved by the US Congress, which approves allocations to the agency. …”

“…In Wednesday’s WHO briefing, the head of WHO’s Emergency Team as well as WHO’s Legal
Counsel, sought to set the record straight around some of the criticism that Trump and his
Administration have recently levied….”

Taiwan still objects: “…. In a rebuttal of the WHO statements, Taiwan’s Mission to the United
Nations in Geneva issued a statement on Wednesday evening, saying that UN and World Health
Assembly decisions recognizing the goverment in Beijing as the representative of China, should not
imply Taiwan’s complete from consultations and decision-making mechanisms of the global health
body. The official called upon WHO to invite Taiwan to this year’s upcoming World Health Assembly
meeting of member states as an “observer.”

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See also Stat News - WHO’s Tedros, expressing ‘regret’ over Trump move to cut funding, says his
focus is on ‘saving lives’

Full briefing - WHO Director-General's opening remarks at the media briefing on COVID-19 - 15 April
2020

We quite liked Tedros’ diplomatic view, here, and his key message: “WHO is getting on with the
job.”

Guardian - 'Crime against humanity': Trump condemned for WHO funding freeze
https://www.theguardian.com/world/2020/apr/15/against-humanity-trump-condemned-for-who-
funding-freeze

Overview with some of the main reactions by world leaders & the global health community. “Timing
of move during Covid-19 crisis is deplored by UN chief and experts who say it will cost lives”

More high-profile reactions here (Guardian) - Health experts condemn Trump's halting of funding to
WHO

“Gates Foundation and Wellcome heads among those dismayed by ‘dangerous and short-sighted’
action amid coronavirus pandemic”

Excerpt: “…Experts fear that the work of the WHO in fighting disease and improving health and
healthcare systems around the world could be jeopardised. At issue is not just the response to the
current pandemic, and major programmes such as polio eradication which receives substantial
funds from the US, but the collaboration between scientists and doctors at institutions around the
world, who will hesitate to pool their knowledge and expertise if they think there may be political
consequences. “The WHO is a place where anxieties and concerns can be discussed without the sense
that you are going to be somehow called out,” said David Nabarro, professor of global health at
Imperial College London who worked at the highest levels of WHO for many years. “The challenge for
the director general of WHO is always to maintain the core values of public health even when this
goes against some of the political priorities of elected leaders. It is not unusual for there to be some
form of conflict. The challenge is to try to create an environment where the opportunity for people to
share is maintained and they are not having to look over their shoulder in fear that they are going to
fall foul of the political priorities of leaders.””

Some more analysis of Trump’s decision
Guardian Analysis: Trump turns against WHO to mask his own stark failings on Covid-19 crisis

FT Editorial - The WHO should be bolstered, not crippled (recommended)

Stat News - Trump announces a formal freeze on WHO funding, pending an investigation

NYT – Trump Cuts U.S. Funding to the World Health Organization During a Global Pandemic

 11

Quote: “…Trump announced he would cease American funding to the WHO while a review is
conducted to determine its role in “severely mismanaging and covering up the spread of the
coronavirus.” The withdrawal represents a substantial hit to the United Nations’ agency for
international public health: The U.S. contributed $400 million, the most of any country, to the
organization’s $6 billion 2018-2019 budget. According to Axios, the Trump administration is
considering two potential plans to defund the program: By asking Congress to rescind federal
budget funds for the WHO — as the administration did when it cut $285 million in U.N. funding in
2017 — or by re-allocating it to other international organizations….”

UN Secretary General –“Now is not that time”

“It is my belief that the World Health Organization must be supported, as it is absolutely critical to
the world’s efforts to win the war against COVID-19. This virus is unprecedented in our lifetime and
requires an unprecedented response. Obviously, in such conditions, it is possible that the same facts
have had different readings by different entities. Once we have finally turned the page on this
epidemic, there must be a time to look back fully to understand how such a disease emerged and
spread its devastation so quickly across the globe, and how all those involved reacted to the crisis.
The lessons learned will be essential to effectively address similar challenges, as they may arise in the
future. But now is not that time.”

Adam Kamradt Scott (the Conversation) –Explainer: what Donald Trump’s funding cuts to WHO
mean for the world

Excerpts: “The US contributes more than US$400 million to the WHO per year, though it is already
US$200 million in arrears. It is the organisation’s largest donor and gives about 10 times what China
does per year. If enacted, these funding cuts may cause the WHO to go bankrupt in the middle of a
pandemic. That might mean the WHO has to fire staff, even as they are trying to help low- and
middle-income countries save lives. It will also mean the WHO is less able to coordinate international
efforts around issues like vaccine research, procurement of personal protective equipment for health
workers and providing technical assistance and experts to help countries fight the pandemic. … …

“More broadly, if the US extends these cuts for other global health initiatives coordinated by the
WHO, it will likely cause people in low income countries to lose access to vital medicines and health
services. Lives will be lost. … … For decades, the world has looked to the US to provide leadership on
global health issues. Due to Trump’s attempt to shift blame from his administration’s failures to
prepare the US for the arrival of COVID-19, he has now signalled the US is no longer prepared to
provide that leadership role.”

Cidrap News -WHO to review impact of US funding withdrawal
https://www.cidrap.umn.edu/news-perspective/2020/04/global-covid-19-total-tops-2-million-who-
responds-us-funding-freeze
“Tedros said he is reviewing the impact on the US funding withdrawal on its work and will work
with partners to fill any financial gaps to prevent interruptions in its work. He also pushed back on
accusations that the WHO is biased toward China. "Our commitment to public health, science and
to serving all the people of the world without fear or favor remains absolute," he said. … He also said
that, after the pandemic, member states and independent groups will review the WHO's response to
ensure transparency and accountability, a process that is built into its usual processes. "No doubt,

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areas for improvement will be identified and there will be lessons for all of us to learn," Tedros said.
"But for now, our focus—my focus—is on stopping this virus and saving lives."

Devex - Congress considers action in response to Trump WHO funding freeze
https://www.devex.com/news/congress-considers-action-in-response-to-trump-who-funding-
freeze-97007

“Congressional Democrats are exploring how they might respond to protect the World Health
Organization from the funding freeze President Donald Trump announced Tuesday, though they
will likely face opposition from Republicans who have traditionally been reliable advocates for
foreign aid. Some new details about what the halt in funding will look like emerged Wednesday —
it will last for 60 days as the administration conducts a review of WHO, which is likely to be led by
the State Department, several global health experts told Devex. There are still questions about how
much funding this pause will apply to, but the U.S. is the agency’s biggest donor, providing more than
15% of its $4.84 billion 2020-2021 budget, according to Stephen Morrison, the director of the Global
Health Policy Center at the Center for Strategic and International Studies. It is unclear if WHO would
be able to make up that budget shortfall and it would be felt far beyond the COVID-19 response —
impacting other emergencies along with ongoing programs addressing diseases including polio
and malaria, he said. The administration will have to engage in some level of discussion with
Congress if it decides to move forward with the freeze, but it does have “wide latitude” on spending
and reprogramming funding, Morrison said….”

Guardian - G7 backing for WHO leaves Trump isolated at virtual summit
https://www.theguardian.com/world/2020/apr/16/g7-backing-for-who-leaves-trump-isolated-at-
virtual-summit

“Donald Trump found himself isolated among western leaders at a virtual G7 summit, as they
expressed strong support for the World Health Organization after the US’s suspension of its
funding….”

FT - Gates Foundation opposes Trump’s WHO funding freeze
https://www.ft.com/content/1f4b6d9c-71b7-49bc-a3d1-01bf2d3e5db7

“Body to donate an additional $150m to fund fight against coronavirus pandemic”

“The Gates Foundation is more than doubling its donation to the fight against the coronavirus
pandemic, making new grants of $150m to partners to create vaccines, drugs and diagnostics and
to help countries in south Asia and Africa cope with the crisis. The philanthropic organisation also
called for more global co-operation after US President Donald Trump on Tuesday said he
would suspend payments to the WHO temporarily. Mark Suzman, chief executive of the Bill &
Melinda Gates Foundation, said it opposes the US decision to suspend funding to the World Health
Organization. If the US withdraws permanently, the Gates Foundation would be the largest donor
to the body charged with co-ordinating global action against the pandemic. …””…It’s latest
commitment brings its total contribution up to $255m, which will be split between funding the
development of vaccines, diagnostics and treatments. “ “… Mr Suzman said philanthropy cannot be
used to supplant contributions from the public and private sectors. He called on companies and

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governments across the world to co-operate more, including funding organisations such as the
Coalition for Epidemic Preparedness Innovations, a group funded by governments and non-
governmental organisations launched at the World Economic Forum in Davos in 2017, which has yet
to meet its funding target for the development of vaccines. “

For more on the Gates Foundation & Covid-19, see (Gates Foundation) Twenty years in the
making: The foundation’s response to COVID-19

HPW- African Health Leaders, Scientists Protest United States Decision To
Suspend Funding To WHO During COVID-19 Emergency
https://www.healthpolicy-watch.org/scientists-african-health-voices-protest-united-states-decision-
to-suspend-funding/

“The impacts on Africa of United States President Trump’s decision to withhold funding to the
WHO will be ‘quite significant’ as the US is the “number one contributor” of the WHO African
Region budget, said Matshidiso Moeti, WHO Regional Director for Africa, at a joint press
conference hosted by the WHO and the World Economic Forum today. If Trump’s decision from
Tuesday were endorsed by the US Congress, it would affect Africa’s longstanding attempts to
eradicate polio, as well as other priority programs that address communicable diseases such as
HIV, malaria, and work on strengthening Africa’s health systems, she said. “We are hoping that
this decision will be re-thought because the USA is an important strategic partner…In the USA, there
are important players for WHO’s policy-making, strategy making and we value this relationship with
the USA”. So far, the African Region has only received a third of the promised $151 million
contribution from the USA for the current 2020-21 budget period, she added, and money needs to
keep on coming for COVID-19 preparedness plans as well as other disease control activities to
continue….”

“We will need about $300 million for the next six months in order to support what [African]
countries are doing,” said Moeti.

Some more links on the US/China/WHO/Taiwan tension from this week (see also
the Analysis section)

 • NPR - 'We Alerted The World' To Coronavirus On Jan. 5, WHO Says In Response To U.S.

Must-read, on the WHO timeline of things. With the views of M Ryan, Van Kerkhove, …

 • Early this week, via the Guardian:

“In Asia, China weighed in on a growing row between the World Health Organization and Taiwan,
accusing Taiwan’s government of “unscrupulously using the virus to seek independence”.”

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• Guardian - Trump fans flames of Chinese lab coronavirus theory during daily briefing

 (more on this theory in the Analysis section)

Some more links on China’s (murky) “early response”

AP - China didn’t warn public of likely pandemic for 6 key days
AP;

In-depth investigation of what happened in China between January 14 and January 20.
Recommended.

Daily Mail - How China muzzled its Bat Woman: Beijing authorities hushed up the findings of a
scientist who unlocked the genetic make-up of the coronavirus within days of the outbreak - which is
vital for tests and vaccines

FT - Hunt for origin of coronavirus raises new US-China tensions
https://www.ft.com/content/aa5f37ab-4d67-494c-9434-3b044524c4fe

“American officials press China to share data from Wuhan about earliest cases of disease”

“… US officials are pressing for China to share more data about the disease from the period before
December 31, the day the authorities reported to the World Health Organization a cluster of cases of
pneumonia in Wuhan. But a senior Trump administration official said access to Wuhan had been
restricted since the coronavirus outbreak. “[W]e would appreciate the opportunity to work directly
with their virology labs in Wuhan to share whatever research they have, since they’ve known
about it and have been fighting it for at least a month longer than our scientists here in the US,”
the official said. … … Western scientists who have analysed the genetic code of the new virus say it
is extremely unlikely to have been made by genetic engineering in a laboratory, as some conspiracy
theorists have suggested. But they cannot rule out the possibility that it escaped accidentally from
a lab at the Wuhan Institute of Virology or the Wuhan Center for Disease Control and Prevention,
which were studying animal coronaviruses. Bruce Aylward, the WHO assistant director-general who
led a joint coronavirus mission to China comprising 12 WHO scientists and 13 Chinese scientists in
February, told the FT last month that a WHO team would need to return to Wuhan if they were to
determine how the virus started….”

WHO - COVID-19 Strategy update 13 April 2020
https://www.who.int/publications-detail/covid-19-strategy-update-13-april-2020

“This strategic preparedness and response plan outlines the public health measures that the
international community stands ready to provide to support all countries to prepare for and respond
to COVID-19. The document takes what we have learned so far about the virus and translates that

 15

knowledge into strategic action that can guide the efforts of all national and international partners
when developing context-specific national and regional operational plans.”

“It translates knowledge accumulated since the publication of the Strategic Preparedness and
Response Plan (SPRP) on 3 February 2020, into additional practical guidance for whole-of-
government and whole-of-society strategic action that can be adapted according to specific national
and subnational situations and capacities. This strategy update provides guidance for countries
preparing for a phased transition from widespread transmission to a steady state of low-level or
no transmission. This update also highlights the coordinated support that is required from the
international community to meet the challenge of COVID-19.”

Coverage via: the Guardian

“Countries that ease restrictions imposed to fight the spread of the coronavirus should wait at
least two weeks to evaluate the impact of such changes before easing again, the World Health
Organization (WHO) said on Wednesday. In its latest strategy update, the UN agency said the world
stands at a “pivotal juncture” in the pandemic and that “speed, scale, and equity must be our
guiding principles” when deciding what measures are necessary. Every country should implement
public health measures to maintain a sustainable state of low-level or no transmission and prepare
its surge capacity to react rapidly to control any spread, the WHO said. Some of the countries
hardest hit by the virus are now considering lifting lockdowns and beginning the transition toward
a resumption of normal life. “To reduce the risk of new outbreaks, measures should be lifted in a
phased, step-wise manner based on an assessment of the epidemiological risks and socioeconomic
benefits of lifting restrictions on different workplaces, educational institutions, and social activities
…” the WHO said. “Ideally there would be a minimum of two weeks (corresponding to the incubation
period of Covid-19) between each phase of the transition, to allow sufficient time to understand the
risk of new outbreaks and to respond appropriately,” it added.;..”

More coverage via UN News - Testing, tracing, and when to lift restrictions: WHO’s latest advice

“The Director-General of the World Health Organization (WHO), outlined his agency’s latest advice to
countries on Monday in a statement, stressing that a mix of social distancing, testing, contact
tracing and isolation, will be crucial to further curb the spread of the new coronavirus already
devastating much of the globe.”

“In its updated guidance, WHO is expected to summarize those findings and chart the way forward
with a new, six-point set of criteria for countries to consider as they weigh whether to lift
restrictions already imposed against COVID-19. …” Check out the six criteria. Controlled
transmission, access to medical services, minimized risk to settings such as nursing homes,
prevention measures at workplaces and other essential locations, and management of imported
infection risks.

PS: “From their headquarters across the globe, funds, agencies and treaty bodies of the UN system
– especially those related to health, law and development – are contributing their expertise to the
Organization’s robust policy guidance. In a recent statement, he Director-General of the UN-related
International Development Law Organization (IDLO), Jan Beagle, emphasized that justice and the
rule of law should serve as enablers of countries’ responses to COVID-19. She noted that effective
legal frameworks allow for carefully tailored Government actions, including emergency decrees that
protect people from infection and disease while respecting their civil, political, economic and social

 16

rights. The rule of law can also be a lifeline for society’s most vulnerable in times of crisis, when
restrictions on freedom of movement, scarce resources and feelings of stress, anxiety and alienation
can exacerbate exclusion, discrimination and social fissures. “

Or see Cidrap News - WHO urges nations to go slowly in easing COVID-19 steps

PS: Tedros also noted that stay-at-home measures may not be practical for poor countries.

PS: Tedros also detailed a new United Nations supply chain task force that will scale up purchase
and distribution of PPE, lab tests, and oxygen to countries that need it most, but said the initial cost
estimate for storing and moving the supplies is $280 million.

PS: While there has been a "welcome slowing" of COVID-19 cases in European countries hardest hit
by the pandemic, such as Spain and Italy, Tedros said the virus is spreading to rural areas in Africa.

Guardian - WHO warns of 'deadly resurgence' if coronavirus controls lifted too soon

WHO - Public statement for collaboration on COVID-19 vaccine development
https://www.who.int/news-room/detail/13-04-2020-public-statement-for-collaboration-on-covid-
19-vaccine-development

Statement from an international group of scientists, doctors, funders, and manufacturers who have
formed a collaboration, coordinated by the WHO, to help speed the availability of a vaccine.

(13 April) “…Under WHO’s coordination, a group of experts with diverse backgrounds is working
towards the development of vaccines against COVID-19. The group makes a call to everyone to
follow recommendations to prevent the transmission of the COVID-19 virus and protect the health of
individuals. The group also thanks everyone for putting their trust in the scientific community….” “We
will continue efforts to strengthen the unprecedented worldwide collaboration, cooperation and
sharing of data already underway….”

HPW – WHO Softens Position on Masks
https://www.healthpolicy-watch.org/who-director-general-says-he-hopes-us-funding-will-continue-
amidst-spate-of-white-house-attacks/

“As mask use in the general population has gained momentum in various countries, including not
only Asia, but the USA, eastern Europe and Israel, the WHO officials at the briefing expressed a
more positive line on the practice, saying that they could support public use of masks as part of a
comprehensive strategy. Previously, WHO’s Emergencies team had said mask use in the general
population was unnecessary, except among people who are symptomatically ill, or caring for other
sick household members. “The WHO will support countries who wish to implement a more broad
based strategy of mask use “as long as it’s part of a comprehensive strategy”, said Ryan….”

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Guardian - Coronavirus pandemic exacerbates inequalities for women, UN warns
https://www.theguardian.com/world/2020/apr/11/un-coronavirus-pandemic-gender-inequalities-
women

From late last week. “Limited gains made in the past decades’ toward gender equality ‘are at risk
of being rolled back’, UN policy brief said.”

“A global economy in freefall, 1.52 billion students stuck at home, dramatic swells in domestic
violence reports and healthcare systems overwhelmed by a single disease all portend vicious side-
effects for women during the Covid-19 pandemic, the United Nations warns. “There is no single
society where we’ve achieved equality between men and women, and so this pandemic is being
layered on top of existing inequalities, and it’s exacerbating those inequalities,” Nahla Valji, the
UN’s senior gender adviser to the executive office of the secretary general, told the Guardian. … The
current public health emergency will probably mean a disproportionate economic impact for
women, who often work in service industries hit hard by Covid-19. They also tend to take on the
bulk of unpaid family care at home, a burden that has become even more all-consuming amid
physical distancing and self-isolation. And, even as women represent 70% of the global health
workforce, the critical resources they need to stay well – reproductive health services, maternal
care – may fall by the wayside as the world’s hospitals go into crisis mode. That, in turn, could lead
to more maternal mortalities, young pregnancies and sexually transmitted diseases, according to a
UN policy brief published on Thursday.”

Guardian - Declare abortion a public health issue during pandemic, WHO urged
https://www.theguardian.com/global-development/2020/apr/10/declare-abortion-a-public-health-
issue-during-pandemic-who-urged

“Charities press World Health Organization to ensure women can get contraception and safe
abortions during crisis.”

VOA - UN Official Says Coronavirus is Worsening Repression and Inequality
VOA;

“UN High Commissioner for Human Rights Michele Bachelet warned the coronavirus pandemic is
likely to widen existing inequalities around the world if left unchecked, with the poor, the disabled,
the homeless, minorities, women and elderly among others most at risk. At a virtual meeting, the
human rights chief also had stern criticism for governments that she said are using health
emergency measures to justify repression and expand their powers. UN High Commissioner for
Human Rights Michele Bachelet said civil and political rights are being threatened by governments
that are abusing the emergency measures they are taking to respond to this public health crisis. She
said an emergency situation is not a blank check to disregard human rights obligations.”

 18

UNAIDS condemns misuse and abuse of emergency powers to target marginalized
and vulnerable populations
https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/april/20
200409_laws-covid19

Press statement (9 April). “UNAIDS is deeply concerned by reports that the COVID-19 epidemic is
being used as an excuse to target marginalized and vulnerable populations, restrict civil society
space and increase police powers. In particular, UNAIDS is extremely concerned by reports of new
laws that restrict rights and freedoms and target criminalized groups in a manner that will harm
the rights and health of people living with or vulnerable to HIV….”

Stat News - Democrats scramble to turn the 2020 election into a referendum on
Trump’s coronavirus response
https://www.statnews.com/2020/04/10/democrats-2020-health-platform-trump-coronavirus/

No doubt this plays at the background of Trump’s WHO attack.

Nature News – China is tightening its grip on coronavirus research
https://www.nature.com/articles/d41586-020-01108-y

“Some scientists welcome government vetting because it could stop poor-quality COVID-19 papers
being published – others fear it is an attempt to control information.

“China’s government has started asserting tight control over COVID-19 research findings. Over the
past two months, it appears to have quietly introduced policies that require scientists to get
approval to publish — or publicize — their results, according to documents seen by Nature and
some researchers. This fits with media reports that at least two Chinese universities have posted
notices online stating that research on the virus’s origins needs to be approved by the university’s
academic committee and the Ministry of Science and Technology (MOST) or Ministry of Education
(MOE) before being submitted for publication. Scientists in China say the changes are probably a
response to poor-quality studies on the virus, which have been posted online and reported widely —
and several welcome them. But some academics have suggested that the policies are part of
China’s attempt to control information about the start of the outbreak….”

Guardian - China clamping down on coronavirus research, deleted pages suggest
https://www.theguardian.com/world/2020/apr/11/china-clamping-down-on-coronavirus-research-
deleted-pages-suggest

News from early this week. “Move is likely to be part of attempt to control the narrative
surrounding the pandemic.”

“China is cracking down on publication of academic research about the origins of the novel
coronavirus, in what is likely to be part of a wider attempt to control the narrative surrounding the

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pandemic, documents published online by Chinese universities appear to show. Two websites for
leading Chinese universities appear to have recently published and then removed pages that
reference a new policy requiring academic papers dealing with Covid-19 to undergo extra vetting
before they are submitted for publication.”

NYT – A New Front for Nationalism: The Global Battle Against a Virus
https://www.nytimes.com/2020/04/10/business/coronavirus-vaccine-nationalism.html

“Every country needs the same lifesaving tools. But a zero-sum mind-set among world leaders is
jeopardizing access for all.

“Now, just as the world requires collaboration to defeat the coronavirus — scientists joining forces
across borders to create vaccines, and manufacturers coordinating to deliver critical supplies —
national interests are winning out. This time, the contest is over far more than which countries will
make iPads or even advanced jets. This is a battle for supremacy over products that may determine
who lives and who dies. At least 69 countries have banned or restricted the export of protective
equipment, medical devices or medicines, according to the Global Trade Alert project at the
University of St. Gallen in Switzerland. The World Health Organization is warning that protectionism
could limit the global availability of vaccines.”

Devex - USAID ships COVID-19 supplies from Dubai to Oregon
https://www.devex.com/news/usaid-ships-covid-19-supplies-from-dubai-to-oregon-96997

“For the first time since Hurricane Katrina struck the southern U.S. in 2005, the U.S. Agency for
International Development is deploying its overseas disaster relief supplies — generally intended
for international crises — to support domestic response efforts. The shipment follows an “urgent
request” from USAID to its implementing partners for PPE and other medical equipment that might
be used in the U.S. government’s response to COVID-19….”

CBS - World Health Organization urges China to close controversial "wet
markets"

https://www.cbsnews.com/live-updates/coronavirus-pandemic-covid-19-latest-news-2020-04-
14/#post-update-1a630370

“Dr. David Nabarro, the World Health Organization Special Envoy on COVID-19, urged countries
around the world — and specifically China — to close wet markets….”

But it’s more complicated than it seems, totally “banning wet markets” – see Vox - The coronavirus
likely came from China’s wet markets. They’re reopening anyway. In-depth analysis of what ‘wet
markets’ involve, and different varieties.

And see Tedros clarifying WHO’s position (16 April) here: “Reports in some media on WHO’s view
on the re-opening of wet markets in China are not correct. The World Health Organization's
position remains that all sectors affected by COVID-19—including food markets—in China and
around the world need to ensure strong regulatory systems, high standards of cleanliness, hygiene

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