just asking questions

Why Trump Deserves More Blame for the U.S. Coronavirus Crisis Than the WHO or China

From left, WHO officials Dr. Maria D Van Kerkhove, Director-General Tedros Adhanom Ghebreyesus, Professor Didier Houssin, and Dr. Michael Ryan on January 23, after an emergency committee meeting over the novel coronavirus. Photo: Pierre Albouy/AFP via Getty Images

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The United States now claims nearly one-third of the world’s COVID-19 cases, making it the center of the coronavirus pandemic. Instead of leaning on the World Health Organization for support, last week President Trump announced that he would be halting the U.N. agency’s funding, accusing it of bungling its early response to the coronavirus. “This is lunacy. Truly,” responded Jeremy Konyndyk, a policy fellow at the Center for Global Development who previously served as the director of USAID’s Office of U.S. Foreign Disaster Assistance, where he coordinated the country’s humanitarian responses to the 2014 Ebola outbreak in West Africa, the 2015 earthquake in Nepal, and the war in Syria. He also served on a WHO advisory group to rethink the agency’s responses to outbreaks and emergencies. Over the past few months, he has emerged as a leading critic of the Trump administration’s handling of the coronavirus pandemic. Intelligencer spoke to Konyndyk about Trump’s WHO announcement, the reemergence of a theory that the virus may have leaked from a laboratory in Wuhan, and what he thinks is the biggest global health concern on the horizon.

Can you outline your frustrations with the Trump administration’s pause on WHO funding?
First off, the decision to pause funding to the organization that is coordinating the global fight against a pandemic in the middle of a pandemic is hugely damaging. If they do move forward with fully cutting off funding, that doesn’t just disrupt COVID response; it disrupts a lot of different things the U.S. government relies on WHO to do, like polio eradication, or cholera in Yemen, or extinguishing the Ebola outbreak in eastern Congo. The fact that the U.S. didn’t need to deploy a massive Ebola response effort in eastern Congo, like we did to West Africa in 2014, is a direct outflow of our investment in WHO’s emergency capacity. If we undermine those investments, then that just puts more work on our plate.

My second big frustration with halting funding is that the stated reasons for it are wrong. I broke this down in an op-ed last week with Thomas Bollynky. The administration has accused WHO of a few things. It’s accused them of being too close to China; it’s accused them of being complicit in a Chinese cover-up of the initial information on the virus, and in so doing, delaying the world’s ability to respond; and it’s accused them of making the wrong call on travel bans. To the extent that there is a rhyme or reason to the accusations, those are them. Secretary Pompeo went on Fox News a few days ago and said that the WHO should have been investigating China and investigating the origins of this. That just fundamentally misunderstands the WHO’s role and fundamentally mischaracterizes what WHO actually did.

Okay, describe WHO’s actions as you see them.
Let’s start with what they actually did. WHO received initial notice from China on December 31. By the 5th of January, WHO put out a notice about a reported pneumonia of unknown cause and a cluster of cases requiring hospitalization. At that point, they didn’t have much more to go on than what the affected country gave them. That is by design. What people don’t understand, and what the U.S. government is willfully ignoring, is what WHO can and cannot do is governed by something called the International Health Regulations. That is a binding international agreement amongst WHO member states that lays out the requirements for providing notice to WHO and the authorities that WHO has when there is a novel outbreak like this. When WHO gets a report from the Chinese government, WHO doesn’t really have the latitude to say, “We don’t believe you.” That’s how member states want it, and you can imagine why. If the U.S. were providing outbreak information to WHO, the U.S. would not take kindly if WHO said, “We don’t believe you.”

The information WHO received from China, we now know, was somewhat misleading and incomplete. The thing that has gotten WHO in hot water the most seems to be a tweet from January 14, where they said, “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission.” Right there, you’ve got that hedged in two ways. It’s characterized as “preliminary investigations” — it’s not drawing a final conclusion; it’s sharing an initial impression. And it’s saying “no clear evidence,” which does not mean it’s not happening. It means there’s an absence of evidence, rather than evidence of absence. There was a press conference later that same day about the discovery of a case in Thailand, and WHO was more forward-leaning in that press conference and noted that there was the potential for human-to-human transmission. Bear in mind, this is all within about two weeks of the world even coming to understand that this virus even existed. On the 20th and 21st of January, China agreed to let WHO personnel go to Wuhan to assess the situation there. That mission came back and confirmed that there was human-to-human transmission occurring. To go from “based on preliminary information we don’t have evidence” to “It is happening, we do have evidence” in a week is not unreasonable.

On the 23rd of January, they convened the emergency WHO committee, and the report that came out of that meeting laid out a picture of the virus that holds up pretty well even now: a virus that was transmitting from human to human, that had a basic reproduction number of somewhere between 1.4 to 2.5, which would make it more transmissible than the flu, and that had a case fatality rate of about 4 percent, which is similar to what we’ve seen in other countries. That right there is enough to be scary. That is the four-alarm fire.

So you believe the organization’s actions hold up well?
On the merits, did the WHO warn the world at the time? I think you have to say they did. Whatever the initial garbles that they got from China, by the 23rd of January, they had put out a pretty accurate picture of this virus to the world. At a point when this really had not hit the rest of the world, the world knew the basic picture of this virus and they knew it via the WHO. The notion that WHO failed to tell the world that it was transmitting human to human, or failed to tell the world how dangerous it was, is just absurd. It totally ignores what they were actually saying in January.

Another thing that the administration gets wrong is the accusation by the president and Secretary Pompeo that WHO should have somehow investigated China. WHO has no power to investigate a member state! Zero. There is no authority or mechanism that WHO member states have given them to unilaterally launch an investigation. It’s crazy.

Then there’s the fourth point. Fundamentally, this is not about what WHO did or did not do. It’s not about what WHO did or did not say. What it’s about is turning WHO into a political scapegoat to distract from this administration’s failures to prepare. WHO’s own information, WHO’s level of alarm, WHO’s characterization of the risk, were always well out ahead of the Trump administration. At a time when the U.S. government was still saying the risk to the American public was low, WHO was saying that this absolutely had pandemic potential.

Trump’s motives aside, is there legitimacy to the core complaint that WHO has been uncritical, at least publicly, of China? 
WHO is not critical of any of its member states in public. Ever. Has WHO been deferential to China? Yes. Is that unique to China? Not at all. The U.S. is the epicenter of the global epidemic now on an enormous scale, we have screwed up our domestic response badly. Has WHO publicly criticized us for that? Of course not.

During the Ebola epidemic in eastern Congo, the Congolese government made huge missteps. It politicized that outbreak. The president used it as a pretense to cancel elections in several opposition held areas with no public health basis whatsoever. WHO did not support that decision, but they didn’t criticize it publicly. If they are not going to criticize the Democratic Republic of Congo, which is hardly a powerful member state on the order of China or the United States, I think that tells you this is not unique to China. It’s just absurd.

I think what the administration also gets wrong is if you’re afraid that China is instrumentalizing an international organization, you don’t respond by abandoning that organization. You’re just conceding the playing field to China. You respond by engaging further. The point of the multilateral system is a place for all states to engage regardless of politics. If you’re worried that China has too much influence, the solution is not to abandon your own influence.

Do you see the reemergence of the origin question as part of this same scapegoat offense? 
Absolutely. It’s an attempt to change the subject. The administration is clearly grasping for anything it can to distract from its own poor performance. If they can blame this on WHO, or if they can blame this on a lab accident in China, that somehow alleviates them of their responsibility. That is very clearly the play.

The lab thing is a useful target for them because it can’t be disproven. We will probably never know with 100 percent certainty whether this was a natural spillover or a lab spillover. But what we can say is, the fact that you can’t disprove one or the other doesn’t mean that they are equally plausible. The natural spillover is drastically more plausible than a lab spillover scenario. If you look at the ledger on each side, what you have on the ledger of the natural spillover scenario, is basically every significant global outbreak has been a natural spillover. Natural spillovers happen all of the time. Biology points to a natural event. It points to — though we don’t know for sure — the virus probably jumped from bats to another intermediate animal before jumping to humans.

What do you make of the actual hypothesis that the virus escaped from a lab?
On the lab side of the scenario, you basically have no affirmative evidence linking it to a lab origin. What you have is a lot of speculation based on the proximity of the lab to the market and based on a few incomplete allegations of poor safety practices at one of the labs in Wuhan. That is not a lot to go on. There is no indication that this virus was in that lab, which was working on other bat coronaviruses. There is no indication that this one was there. The fact that we knew that they had other coronaviruses and we didn’t know that they had this one feels notable. There was an interview with an American scientist who had done work with the Wuhan lab where she said if they had this virus, they probably would have published about it pretty rapidly. If you find this kind of a novel coronavirus, you would want the world to know about it. The fact that they did not do that raises questions about the viability of the lab spillover scenario.

You can look at this through a biology lens and you can look at this through a political lens. If you look at the biology, basically everything about the biology says that the likelier scenario is that this was a natural origin, not a lab spillover. If you look at this through the politics, yes, the Chinese government is being opaque about what was going on in that lab, and they have not wanted to share that with the outside world. But at the same time, the U.S. government is obviously doing everything it can to spin this up as a story. The National Security Council is reportedly pushing the intelligence community very hard to try and find anything that would suggest that the lab was the origin. We have the administration trying to put the story out into the ecosystem, pushing it through favorable media outlets and personalities on the basis of very little. If they had something stronger, we would see it. They wouldn’t be sitting on it.

I do think one sign of how precarious the theory is, is the fact that Trump is not pushing it publicly. If anybody would be pushing a theory on thin evidence, it would be Trump.
Totally. It’s very reminiscent of how the Bush administration handled the WMD intel prior to the Iraq War. The evidence was not definitive in either direction. The Iraqi government was acting suspiciously, not being transparent, not sharing everything that they had. But we didn’t have affirmative evidence to say they were still running their weapons programs. You had an administration that was very motivated to make the case that Iraq was doing so and pushing the intelligence community to cherry-pick whatever information they could to make that case on the thinnest of grounds. You see a very parallel dynamic here. You have an administration, or at least figures in the administration, who really want the intelligence to give them a particular outcome and they disregard any evidence that runs against that outcome. They capitalize on the opacity of the Chinese government, just as the Bush administration capitalized on the opacity of the Iraqi government and used it to spin that as indicative of a cover-up. We know from Iraq, the lack of transparency was not because they were covering up a weapons program. I don’t think we should make the same mistake here that we did there.

Iraq having weapons is very different from proof of an accident in China. We’re not going to war over it. So what purpose does it serve? 
Again, there’s the biological layer and a political layer. The political layer here is that the U.S. would really, really like to be able to blame China for its own problems. The end point is different. It’s not like we’re going to launch a war with China over this like we did with Iraq. From the administration’s point of view, they know they’ve got a disaster at home. They don’t want to own that disaster. They want to be able to shift that responsibility from them to someone else. If they can say, “Look, this whole global crisis flowed from poor safety practices in a lab in China,” then that’s a way for them to escape their own responsibility for their own failure to prepare. If they can create enough confusion, it will buy them some political breathing room. That’s the play.

Shifting away from China, what parts of the world are you particularly worried about that aren’t getting coverage right now? 
The biggest outstanding question mark is how this disease is going to behave in the developing world. In one sense, the vulnerability in the developing world is huge. If a country like the U.S. is struggling to get tests, ventilators, and PPE, it’s going to be 100 times harder in the developing world. They can’t compete with the U.S. Of course, hospital capacity is much weaker in the developing world. They have very few intensive-care beds, very few ventilators, and underlying health conditions tend to be pretty poor as well.

The other side of the ledger, this is what creates some uncertainty, is the demographic profile in much of the developing world is very different. The highest-risk portion of the population is people 65 and above. In Italy, that’s about 20 percent of the population. In sub-Saharan Africa, that’s about 3 percent. What we don’t know is how that dramatic difference in demographics will affect the risk. It could be offset by other underlying health problems, it could mean that hospitals, as weak as they are, may not be overwhelmed simply because the demographic profile of people overwhelming hospitals in wealthier countries is a much smaller share of the population in the developing world. There are a lot of questions. If it spreads far and wide there, it does have the ability to be quite devastating.

What about developed countries that have taken a more relaxed approach to distancing, like Sweden or Japan? 
At this point, neither of those gambles seem to be paying off all that well. No one knows with full certainty what the best game plan is. We know that if this disease gets out of hand, it can overrun hospitals. Sweden is gambling that they can keep it from getting out of hand. That’s certainly not the gamble I would take.

You’ve been concerned about Russia. What’s happening there? 
What concerns me about Russia is that you have a population that skews older, a lot of underlying chronic health vulnerabilities, and a government that is opaque and puts a premium on control. That’s concerning. The government of Russia is going to want to project that they are in control of this situation whether or not they, in fact, are. They’re going to want to project that to their own people and they’re going to want to project that to the world. What we know from China, Italy, and the U.S., is that if you do let it get out of control, at a certain point, that becomes impossible to hide. That’s what to watch for in Russia. If we don’t see that happening, it would suggest that Russia is somehow keeping it under control.

What else are you concerned about globally? 
One of my biggest fears is the global competition we’re going to see when a vaccine is available. The competition scrum that we’re seeing right now on PPE availability, test kit supplies, things like that, is a fraction of the competition we’re going to see for those first doses of vaccine. When and if a vaccine is proven effective, it then needs to be manufactured at scale, and it’s not like 7 billion doses are immediately going to drop from the sky. The competition over those first tens of millions or hundreds of millions of doses is going to be intense. I’m really nervous that if there is not more work put in now to prenegotiate and prearrange how those vaccines will be distributed, we’re going to see an ugly global competition happen.

This interview has been lightly edited and condensed for clarity.

America’s Coronavirus Crisis is On Trump, Not WHO or China