Tag Archives: Trump

U.S. withdrawal from W.H.O.

A few days before Christmas, the Financial Times reported that the Trump transition team will pull the United States out of the World Health Organization (W.H.O.)—on day one. This is not the first time Trump has made this threat, and all indications are that he will make good on the promise. The U.S. withdrawal from W.H.O., while challenging, may also present an opportunity.  Never let a crisis go to waste.

The Financial Times report about the U.S. withdrawal generated significant heat in social media. However, the actual level of threat (and the opportunity it offers) needs to be put into perspective. We can assume that the Director General, Dr Tedros Adhanom Ghebreyesus, started planning for the possibility of a U.S. withdrawal prior to the November presidential election. Once the result was known, W.H.O. would have looked at it’s options in earnest, and in 12 days time, W.H.O. will be able to respond positively and proactively. At least, this is the hope. And if the new Trump administration doesn’t withdraw, the plans can be quietly shelved.

A significant loss of funding will necessitate reform. Because a multilateral agency like W.H.O. is not a commercial entity it does not have the same singular focus: make money. U.N. Agencies simultaneously pursue diverse (sometimes unaligned) positive outcomes. The sustainable development goals are a hallmark of this tension: economic growth, sustainable cities and communities, responsible consumption, climate action,… save the planet. Thus, any reforms required by substantial changes in funding must navigate a complex web of member states’ competing priorities and interests. These complexities include balancing the divergent needs of countries that vary on economic, political, social, economic, demographic, and geographic profiles. There are, nonetheless, strategic lessons to be learned from past crises in large complex organisations. Know your core business (even if it is a portfolio of activities), focus on delivering that, do it efficiently.

A good place to start is by acknowledging that W.H.O. is not a bastion of lean and efficient administration. Even the most ardent defenders of W.H.O. are under no illusions that it is an organisation with structural problems. There are, for instance, critical thematic overlaps in the organisation’s activities. These overlaps occur between W.H.O. departments, and between W.H.O. and other multilateral agencies and international non-government organisations (INGOs). The overlaps create significant inefficiencies in the delivery of global health. Given the health threats we face, a less entrenched, more agile agency would benefit the world. And the U.S. withdrawal could provide that opportunity.

The U.S. provides about 20% of total revenue. As such, the Director General should not let the opportunity for reform afforded by the U.S. withdrawal go to waste. A budget black hole is a perfect reason for institutional reform. Something has to go, if you no longer have the money to do all the activities you were doing before. Some reform will be short, sharp and unpleasant—dictated by the exigencies of circumstance, and some can be more gradual. If the planning process has been done properly, as W.H.O. prepared for the Trump presidency, it should all be strategic.

Focus reform on staff numbers and practice, and programmatic inefficiencies and overlaps. Engage in a strategic redundancy exercise. Renegotiate Staff Association rules that protect poor work practices—W.H.O. staff are international civil servants, not recipients of sinecures. Identify core current business and core future business, and focus effort there. Leave other agencies and INGOs to look after non-core business. Regardless of the reform outcome, W.H.O. can use its substantial convening power to ensure that the coverage of key health areas is not lost but redistributed and shared—this will prevent fragmentation. The funding crisis should also be used as a clarion call for member state financial support and for member state support of the institutional reform process. The loss of U.S. funding is also a political opportunity to push back against member states adopting purely transactional relationships with W.H.O.. Draw a line in the sand. Send the message, “You will not bully us”, and any countries’ efforts to destroy global health will be resisted.

In 2011 U.N.E.S.C.O. faced a funding shortfall following the granting of full membership to Palestine. The organisation went through the strategic process of terminating or scaling back low priority programs. They trimmed administrative and operational activities to focus on key deliverable priorities. They sought to diversify funding.

There are risks associated with any institutional reform process. The risks, however, are most obviously associated with a voluntary reform process rather then one forced on the organisation by circumstance—hence, the notion of never letting a crisis go to waste. The biggest internal risk is the alienation of staff by changing long-standing employment practices. The risk is unsought (staff will understand that) and needs to be balanced against the even greater risk of sinking into a sea-of-debt by failing in a broad fiduciary duty to member states and beneficiaries. Staff reforms will require open and transparent engagement with the staff association, which can be enhanced by member states supporting affected nationals. The greatest external risk is a dilution of W.H.O.’s mission and the further fragmentation of global health efforts.

Reforms must be approached judiciously and collaboratively, ensuring that W.H.O.’s core mission and credibility as a global health leader are not compromised. Goodwill (not the U.S.’s) is on W.H.O.’s side. Historically, it has been a massive global good. Is it imperfect? Yes. Does it get things wrong? Sure. Can it be improved? Absolutely. The measure of W.H.O. is not in its failures but in its successes: the eradication of smallpox; the elevation of HIV/AIDS as a global problem; the African Programme for Onchocerciasis Control; the worldwide reduction of infant and child mortality; and the coordination role in the COVID-19 pandemic. None of these successes are W.H.O.’s alone, and that redounds to the ultimate value of the organisation. W.H.O. is the multilateral space that promotes global health. It is the only global health organisation empowered by 194 (err…193) member states to promote global public health, set international health standards, provide leadership on health matters, and coordinate international efforts to prevent and respond to health emergencies.

If the U.S. does withdraw, it is almost impossible to imagine that any alternative organisation could be proposed. A world health organisation by any other name would be similarly exposed to capricious withdrawal by a member state responsible for significant funding. The remaining member states need to double-down on their commitment and support a reform process, or risk a collapse in coordinated global health efforts.

While I am being so generous with my unsolicited advice, I also have a humble suggestion for the speech Dr Tedros should make if the Trump team make good on its promise to withdraw. I was “inspired” by the speech given by the U.K. Prime Minister (Hugh Grant) to the U.S. President (Billy Bob Thornton) in Love Actually.

The United States has been a cornerstone of global health efforts—a key partner since 1948. But let me be clear. The World Health Organization is not a convenience. Nor is it a platform for unilateral decisions and capricious withdrawal. It exists not for the benefit of any single nation but for the collective good of all nations—nations coming together to confront challenges that no country can solve alone.

We have eradicated smallpox. We have led the global fight against malaria and polio. We led the Safe Motherhood Initiative. These achievements are not ours alone but the result of countries uniting for the common good.

For any country to withdraw at this time, in this world of increasing threats, is to risk undoing decades of progress that have saved millions of lives and improved the lives of millions more.

A global partner who turns away in times of shared need is no longer acting as a partner, and while we have valued past support, we will not be bullied into abandoning our values and principles. To withdraw is to selfishly turn one’s back on a shared responsibility, risking decades of progress globally and within the United States.

Diseases and crises do not respect borders.

While the decision by the President will have the greatest impact on the most vulnerable, let me assure you: W.H.O. will remain steadfast in its mission to protect those who need us most. We exist to ensure health for all, especially the most marginalised, and we will not waiver in that responsibility. We have faced crises before, and in crisis lies opportunity. We will adapt, persevere, improve, and deliver life-saving support—not for our survival, but to safeguard the lives and well-being of the world’s most disadvantaged communities—including those communities in the United States.

What the Democrats did wrong

I feel like the guy at the all-you-can-eat buffet who didn’t understand that the prudent consumer treats it as an all-you-should-eat buffet. I am an avid consumer of modern American politics, but you can get too much of a good thing. The most recent Sandwiches on a table the buffetpresidential election was a long, exhausting, roller-coaster ride that crashed at the end. It also has a fair probability of being the most consequential US election since Roosevelt or possibly (hopefully not) Lincoln.

Now the election is over, the dessert trolley has caught my eye. I am fascinated by the public rending of garments and loud wailing as Democrats simultaneously mourn their loss and look for someone to blame.

One of the best characterizations of these empty, futile gestures was The Daily Show comedienne Desi Lydic’s shredding.

Vice President Kamala Harris ran what many regard as an extraordinarily disciplined campaign in an extraordinarily short time. She did this after picking up the reins dropped by an obviously geriatric Joe Biden. Joe mumbled and stumbled through the first three-quarters of the campaign before bowing out. Thank you, Joe!

In the German Federal election held on 6 November 1932, the two best-performing parties were the NSDAP and the SPD. The former outperformed the latter by 15.7 points. I imagine the SPD (the Social Democratic Party) had a postmortem. Why did we do so badly, they ask themselves? And I can’t help but wonder, following the loss to Donald Trump, what advice would the modern American Democratic strategists offer the SPD for their next election. What lessons might some Democrats think they have learned that are worthy of passing on? Here are some thoughts about that conversation.

[Democrat]: Guys, we just lost our own bruising election. We are you, and we have advice. It would help if you broadened your appeal. You lost the working class. And remember, you’re just coming out of the Great Depression, so repeat after me … “It’s the economy stupid!!!” If you’re going to beat the NSDAP, you need to step it up. And for God’s sake, stop with the identity politics.

[SPD]: We hear what you say, but our platform does support workers’ rights and trade unions. We advocated for unemployment benefits and social welfare programs. Our policies focused on dealing with the economic fallout of the Great Depression. We know it’s about the economy(!), and we’re not stupid!

Well, your messaging is obviously all wrong. The voters aren’t hearing you, or they don’t believe you. Sometimes, they need a point of focus, a metaphor for their troubles. Have you thought about demonising a particular group or class of people who you could blame for controlling the economy? Tell them about a group they can hate. Bankers are a good place to start—and if you can link your Bankers to some out-group!

Also, you really need to get some distance from the Marxists.

We hate the Marxists. Our platform is explicitly anti-communist.

Yeah … but the voters aren’t hearing you or don’t believe you. Could you give them a point of focus? Make the abstract real. Have you thought about demonising a particular group or class of people who you could identify with the communists? Create a mental portrait of an evil Bolshevik in their minds … Find an out-group and make that group the hated Bolshevik … A communist out-group—that’s a group everyone can hate.

And jobs! Don’t forget jobs. Why should good, pure German citizens not have greater opportunities to engage in the workforce? Is there a group of people who are not quite your equals, a sort of under-person who you could target, some foreigner who’s stealing your jobs?

Adolf Hitler, the leader of the NSDAP (Nazi Party), had a “go to” group to hate—the Jews . But he had hate to spare. His tent of loathing had a broad canopy: Communists, Slavs, Gays, Roma.… Hitler’s ire had two focigroups for public demonisation and groups who threatened his power.

In September 1930, Hitler’s Nazi Party won only 2.6% of the popular vote. In July 1932, it won 18.3%. In November 1932, it won 37.3% —the first time the Nazis outperformed the Social Democrats. That was also the last free election before Hitler seized power in 1933. Mein Kampf (“My Struggle”) is his political manifesto/autobiography. In it, he introduced the idea of the “Big Lie”, a lie that is so audaciously false that some people will believe it. Fake News!

Let’s return to the original question: what did the Democrats do wrong?

I have heard people did not know who Kamala Harris was. They couldn’t vote for someone they didn’t know. They most certainly did know Donald Trump! He had been their 45th President. Donald Trump was there for all to see. He praised whites and demonised non-whites. He gave government assistance to allies and punished (perceived) enemies. He praised authoritarians, demagogues, and dictators and railed against democratic allies. He argued for the Justice Department to target his enemies. He overstated the threats posed by protesters and suggested that the troops should shoot them. He engineered the loss of reproductive rights. He gave billions of dollars of taxpayers’ money to other billionaires.

He is a racist who says he is the least racist person he knows. A rapist who says that no one loves and respects women more than he does (shudder…). He boasts about his sexual assaults. He is a fraud—“no one knows business better than I do”. An insurrectionist. A notorious liar. As Nancy Pelosi says, if his lips move, he’s lying.

If the electoral choice is between a demagogue and a lawn chair, you vote for the lawn chair. But you didn’t have a lawn chair. You had had a smart, accomplished woman of color, who has worked for the people for most of her adult life.

What lesson should the Democrats learn from their electoral loss? Easy. Over 50% of the American voters in the last election lost their moral compass. They either agree with, don’t care, or are easily duped by a power-hungry, narcissistic, charlatan, showman, and felon.

My advice for the future. Give no quarter. Do not edge to the right—you will not win the descent into hell. Do not forsake your values. Do not forsake the vulnerable. Drag your republic back to where it should be. Call out the demagogue for who he is. Defend every liberty and every right you have—and defend those rights for others. When they take them from you (and they will take them from you), do not accede.

Fighting words(!), but cheap, essentially worthless advice. I am a detached observer only able to consume American politics from a distant armchair. It may affect me—as it will affect the rest of the world—but I have no power to affect it. Nonetheless, I can hardly wait for my next visit to the buffet.