Shortly after his inauguration, President Donald Trump took a set of thick, black permanent markers and signed a sweeping set of executive orders that took aim at everything from immigration and gender to TikTok and climate change. One of his first moves was to withdraw the US from the World Health Organization (WHO), the United Nations’ global health agency responsible for safeguarding and promoting health around the world since 1948.

The US is one of the WHO’s biggest funders, so any shortage of financial and political support will likely have major ramifications for global health efforts like eliminating malaria, improving access to high-quality health care, and reducing maternal mortality. While that may not directly matter to rich countries like the US that have the means to address their own health challenges, one of the WHO’s most important jobs is to help coordinate the international response to pandemics and outbreaks — events that can threaten everyone, regardless of borders, as we learned during Covid-19.

To Trump and his supporters, the WHO’s perceived failure on that job is one of the biggest reasons why the US should withdraw. Chief among Trump’s complaints are the WHO’s mishandling of the Covid-19 pandemic and other global health crises, its failure to reform, and its inability to demonstrate independence from powerful but authoritarian WHO member states, namely China.

Trump’s decision has engendered plenty of criticism, including from experts who argue that the US could suffer if it loses access to vital WHO data on outbreaks. Still, the WHO is far from perfect, and even before Trump, scientists, think tanks, and government bodies have been pointing out the WHO’s myriad problems, from the lack of term limits for senior leadership to its massive budget for headquarters staff who are paid additional stipends (around $5,000 to $7,000 per month) to cover the cost of living in Geneva, one of the world’s most expensive cities.

I’ve seen the inefficiencies and mismanagement first hand: In my almost 10-year career as a global health epidemiologist, I have interacted with the WHO on many occasions, including, at times, coordinating with them to respond to disease outbreaks in Africa. Like Trump, my biggest complaint is that the organization has shown it is loath to reflect on and address its deficiencies — deficiencies that matter hugely when it has been given the monumental responsibility of safeguarding the world’s health. There has always been some intangible and unspoken sense that the WHO cannot be wrong and cannot be questioned, even after it was clear that it bungled certain aspects of the Covid-19 pandemic.

But while the WHO is far from perfect, many of its flaws are symptoms of more fundamental challenges that go beyond how it is governed. Balancing the need to respond to international health threats while respecting national sovereignty means cooperation is a fine line — and it’s one that’s becoming harder for the agency to walk.

For the WHO to survive, it needs to improve. And for the US to have the best chances of protecting itself from future global health emergencies — especially as the Trump administration also works to dismantle the United States Agency for International Development, another key player in global health and development — it still needs the WHO. But it needs a better one.

What Trump gets right — and wrong — about WHO

In his executive order, Trump reiterated many of the same issues he raised five years ago when he first threatened to withdraw from the WHO.

One of Trump’s biggest complaints was that the agency was too slow to alert the world of an emerging health threat in China and to move to contain its spread. Local newspapers had been reporting that a mysterious illness was spreading around Wuhan as early as November 17, 2019, a fact backed up by genetic analysis.

But Chinese health authorities didn’t alert the WHO — which the country was required to do under a legal framework called the International Health Regulations — to a spate of patients with an unknown pneumonia-like disease until December 31. By then, valuable time to contain the disease had been lost, though it is Beijing, not WHO, that is largely at fault for this lag.

Still, while the WHO has limited if any power to compel China or any other country to act, the body should have been more proactive in November and December.

“WHO has country offices, WHO has relationships with Ministries of Health. I would argue they certainly should have been aware this was happening,” said Ashish Jha, the dean of Brown University’s School of Public Health and the White House Covid-19 response coordinator during the Biden administration. “It was showing up in a lot of media, social media, and they should have pushed the government to say, what is this? What is going on here, and why don’t we know more about it?”

Within five days of learning about the unusual cases in China, the WHO had alerted its member states. But the WHO’s Director-General Tedros Adhanom Ghebreyesus traveled to China and, instead of confronting the government about its obfuscation, heralded Beijing’s response to the outbreak. And then the WHO consistently parrotted inaccurate information from the Chinese government — namely that the virus was not spreading from person to person — to the rest of the world for weeks.

© Vox