In the midst of the global coronavirus disease 2019 (COVID-19) pandemic that has sickened and killed people on every continent except Antarctica, President Trump announced his decision to withdraw funds from the World Health Organization (WHO). This decision, made by a high-income country, could have deadly implications for low- and middle-income countries.
Previous pandemics have demonstrated that a strong, coordinated global response is key in mitigating their devastating social and economic consequences. Although the WHO has faced some criticism for its missteps in its response to the COVID-19 pandemic, historically, the agency has served as a leader in the coordination of global influenza pandemic response efforts. It led the World Influenza Center and the Expert Committee on Influenza, offering guidance and technical assistance for the development of vaccines and antiviral drugs.
Since the devastation of the 1918 flu pandemic, which killed an estimated 50 million people, widespread concern about global influenza pandemics gradually waned over the course of the 20th century. Preparedness for global influenza pandemics was relegated down from the global stage to the domestic level. By the late 1990s, because of a lack of funding, the WHO influenza office was downsized to just 1 person.
This was a big problem for lower- and middle-income countries, which had significantly less global economic and political clout than wealthier nations. The US and Great Britain were able to use their economic power to obtain advance purchase agreements with pharmaceutical manufacturers, allowing them to preemptively purchase vaccines and other pandemic preparedness tools. In contrast, because of their lack of economic power, lower- and middle-income countries could not follow suit and were effectively blocked from an adequate supply of vaccines.
These inequities were brought to the forefront by the 2004 H5N1 outbreak and the 2009 H1N1 pandemic. High-income countries preemptively placed large vaccine orders, buying out much of the pharmaceutical companies’ inventories before the WHO and low- and middle-income countries could access them. Even low- and middle-income countries that had contributed the viral strains upon which vaccines were based could not acquire vaccines.
Fighting back, Indonesia, supported by other low- and middle-income countries, restricted access to its viral strains of the H5N1 flu in 2007 until the issue of disproportionate vaccine access was addressed. These countries did this by halting their viral strain donations to the WHO and to nations that intended to manufacture and trade vaccines made from the donated strains. In response, the WHO implemented the Pandemic Influenza Preparedness Framework, stipulating that countries supplying virus materials must have access to the vaccines and the antiviral drugs they helped produce. This laid the groundwork through which lower- and middle-income countries could afford access to the global supply of influenza vaccines and antiviral drugs.
The influenza crises in the early 2000s demonstrated some of the concerns associated with national responses to global pandemics, including a lack of equitable access to pandemic preparedness resources. In lessons learned from the 2004 and 2009 pandemics, public health officials emphasized the need to strengthen global governance and coordination mechanisms to improve influenza preparedness internationally. Unfortunately, because of ongoing geopolitical friction and unilateral national responses, this has not been realized in the initial response to COVID-19.
Numerous high-income countries, including the US, have implemented protectionist policies that have restricted the export of medical equipment. These policies will be detrimental to economically disadvantaged countries that must import medical supplies to address the COVID-19 pandemic.
In addition to the increase in protectionist policies, the Trump administration’s withdrawal of funds to the WHO may further exacerbate the effect of the COVID-19 pandemic on the global community. The US contributes more than $400 million per year to the WHO, accounting for approximately 20% of the WHO’s budget. A disruption of funds of this magnitude could have considerable global consequences during a pandemic, with low- and middle-income countries and historically marginalized communities bearing the brunt.
When faced with public health emergencies such as COVID-19, the world is only as strong as its weakest link. Protectionist policies and withdrawals from global governing bodies will only serve to exacerbate the effects of the pandemic on all countries and communities across the entire world. With scientists forecasting an increase in pandemic frequency, it is imperative that pandemic responses are rooted in global coordination, collaboration, equity, and human rights.
Open Access: This is an open access article distributed under the terms of the CC-BY License.
Corresponding Author: Austin Frakt, PhD, Partnered Evidence-Based Policy Resource Center, Veterans Health Administration, John F. Kennedy Federal Building, 15 Sudbury St, Boston, MA 02203 (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.
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Ndugga N, Frakt A. Protectionist Policies and Withdrawal From Global Coordinating Bodies Undermine Efforts to Fight Pandemics. JAMA Health Forum. 2020;1(6):e200800. doi:10.1001/jamahealthforum.2020.0800