February 1, 2021
Rejoining the World Health Organization (WHO): Reform and
Related Issues
The Biden Administration is working to restore U.S.
WHO Outbreak Response: Challenges
involvement in the World Health Organization (WHO). On
January 20, 2021, President Joe Biden sent a letter to
WHO Dual Role
United Nation (U.N.) Secretary-General Antόnio Guterres
Allegations by the Trump Administration that WHO’s
indicating that the United States would remain a member of
initial recommendations for and responses to COVID-19
WHO. The letter retracted a July 6, 2020, decision by the
were unduly influenced by China highlights the dual role of
Trump Administration to withdraw the United States from
WHO: to be the international authority on global health and
WHO effective July 6, 2021. The withdrawal determination
to balance relationships with and among Member States. In
followed assertions by the Trump Administration that
the early months of the pandemic, WHO seemed caught
WHO failed “to independently investigate” reports
between this duality. On the one hand, for example, the
conflicting with Chinese government’s accounts of the
organization appeared to acknowledge on January 15, 2020,
pandemic and repeated “grossly inaccurate” or
findings by China that “there is no clear evidence of
“misleading” claims made by Chinese authorities about
sustained human-to-human transmission...” On the other
Coronavirus Disease 2019 (COVID-19). On January 21,
hand, WHO seemed to recognize contradictory information
2021, U.S. officials announced a resumption of regular
from other sources by tweeting on the same day that “we
engagement with WHO and an end to the drawdown of
cannot exclude the possibility of limited human-to-human
U.S. staff seconded to WHO. The White House also issued
transmission.”
a directive, which among other things, directed the
Assistant to the President for National Security Affairs to
Questions about possible motives shaping WHO actions
make recommendations for reforming and strengthening
were raised during past health events and led to related
WHO.
reforms. During the 2005 H5N1 bird flu outbreak, for
example, several low- and middle-income (LMIC)
The unprecedented attempt to withdraw the United States
countries accused WHO of enabling pharmaceutical
from WHO raised questions about congressional authority
companies to profit off virus samples they shared for free
to inform the withdrawal process. It also reignited calls for
with WHO collaborating centers. The concerns ultimately
reforming WHO, some of which conflated shortcomings of
led to the development of the Pandemic Influenza
WHO with limitations of the International Health
Preparedness Framework in 2011, which includes terms for
Regulations [IHR (2005)]—the rules governing responses
sharing and using influenza virus samples, including a
by WHO and Member States to public health emergencies
payment scheme for participating pharmaceutical
of international concern (PHEIC).
manufacturers. The agreement only applies to influenza
WHO Background and Structure
viruses, and not to coronaviruses like SARS-CoV-2, which
causes COVID-19 illness.
Established in 1948, WHO is a member-driven U.N.
specialized agency that directs and coordinates global
In 2010, the Parliamentary Assembly of the Council of
health efforts within the U.N. system. Duties include:

Europe (Parliamentary Assembly) asserted that the
engaging international partners on global health;
pharmaceutical industry had influenced WHO to
 shaping the international health research agenda;
characterize the 2009 H1N1 swine flu outbreak as a
 establishing norms and standards;
pandemic. Then-Director-General Chan convened a
 articulating evidence-based health policy;
committee to review the functioning of IHR (2005) and

WHO’s response to the 2009 H1N1 pandemic flu. The
providing technical support to countries; and
committee found “no evidence of malfeasance,” but
 monitoring and assessing global health trends.
identified “systemic difficulties” and “shortcomings,” and
The World Health Assembly (WHA)—comprised of all
issued a number of policy and program recommendations.
U.N. Member States—authorizes funding for and
WHO and its governing bodies instituted some reforms in
implementation of WHO programs. The WHA also vote on
response to the recommendations. For example, WHO
amendments to IHR (2005). The WHO Director-General,
revised its ethics rules to manage potential conflicts or
requests funds for and leads implementation of WHO
concerns. It also now publishes the names and affiliations
programs, which are carried out by the Secretariat. For
of all members of Emergency Committees, which, among
more information on WHO, see CRS In Focus IF10289,
other things, recommend whether to declare a PHEIC to the
World Health Organization (WHO): Background and
WHO Director-General.
Issues, by Tiaji Salaam-Blyther.
https://crsreports.congress.gov

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Rejoining the World Health Organization (WHO): Reform and Related Issues
Lack of Investigative Authority
rationale for such measures. Given the role international
Following the aforementioned 2011 complaints from the
travel has played in the global spread of COVID-19,
Parliamentary Assembly, a WHO special committee
Member States may consider revising travel-related
recommended that the World Health Assembly consider the
language in IHR (2005).
lack of legal consequences for violating IHR (2005).
Though periodically discussed at WHA meetings, Member
Outlook
States have yet to provide WHO authority to enforce IHR
Congressional views on WHO’s initial responses to the
(2005). Absent such authority, China is unlikely to face
COVID-19 pandemic have been mixed. Whereas there
repercussions from WHO if it is found to have violated IHR
appeared to be congressional consensus around assessing
(2005). Additionally, no enforcement authority prevents
the WHO response, Members seemed to disagree on
WHO from compelling any country to take action after
whether to make an investigation of WHO’s initial response
declaring a PHEIC. Following debate about the WHO
a precondition for providing WHO financial support or
response to the COVID-19 pandemic, WHA directed the
maintaining U.S. membership. Some Members argued for
WHO Director-General to establish an Independent Panel
withholding U.S. contributions to WHO, while others
for Pandemic Preparedness and Response to assess the
advocated for continuing financial support, particularly
WHO and international response to the COVID-19
during the pandemic. In the 116th Congress, Members
pandemic. The Panel concluded, among other things, that
proposed a range of legislation on this issue, although none
most countries failed to sufficiently prepare for the
were enacted. Congressional debates regarding U.S.
pandemic following the PHEIC declaration.
engagement with WHO have continued in the 117th
Congress, with legislation introduced to prohibit U.S.
A lack of enforcement authority also inhibits WHO from
contributions to WHO (H.R. 419 and H.R. 374). Given
investigating a possible PHEIC within a country without its
continued congressional interest in WHO and U.S.
consent. Article 11 of IHR (2005) requires WHO to discuss
membership in the organization, observers debate the extent
outbreak-related information it receives from non-official
to which Congress might influence U.S. engagement with
sources with the source country or directly collect evidence.
WHO.
WHO may struggle to confirm the information should a
country delay or prevent WHO from conducting on-site
Congressional Funding Authority
inspections, as China did during both the SARS outbreak
Congress generally does not appropriate funding directly to
and COVID-19 pandemic. On the other hand, Article 9
WHO; instead, it appropriates a lump sum for accounts in
permits the WHO to share information regarding a PHEIC
annual State-Foreign Operations appropriations bills, while
with the public “if other information about the same event
the executive branch determines how the funds are
has already become publicly available.” Some might argue
allocated. Congressional consideration of U.S. membership
that information regarding the outbreak was already
in WHO included debates about whether Congress should
“publicly available” through Chinese media sources,
use its funding authority to inform U.S. membership
thereby fulfilling the aforementioned IHR (2005) condition
decisions. For example, some Members supported draft
for WHO to publicize information that contradicted
language that prohibited any funds from being used to
assertions by China that there was no sustained human-to-
withdraw from WHO. Others supported language that
human transmission of the virus.
directed the Administration to withhold funding from WHO
until the WHO Director-General resigned. Given continued
Funding Constraints for Pandemic Response
debate about the WHO response to the COVID-19
The Independent Panel for Pandemic Preparedness and
pandemic, it remains to be seen whether Congress
Response found that limited resources and weak incentives
continues to provide the executive branch flexibility in
to cooperate with WHO has “underpowered” WHO from
allocating funding or consider more prescriptive legislative
fulfilling expected duties. Through WHA, countries have
measures.
voted over several years to authorize new implementation
and coordination authorities to WHO, especially in
Congressional Role in the WHO Withdrawal
relationship to pandemic response. For example, WHA
Process
authorized the establishment of a Contingency Fund for
Congress authorized U.S. participation in WHO through a
Emergencies (CFE) in 2015. Member States and donor
1948 joint resolution, which also included terms for
contributions, however, have not reached the $100 million
withdrawing from the organization (since WHO lacks
endowment goal. Insufficient standing funds have required
withdrawal language in its constitution). That 1948
WHO to seek financial support for each health emergency,
resolution does not specify whether the Administration
impacting the timing and scope of aid provided.
shall consult with Congress before making a withdrawal
decision. The 117th Congress might consider specifying its
Free Travel and Trade Priorities in IHR (2005)
views on the matter. For more information on rules
The United States was the first country to announce that it
governing U.S. membership in WHO, see CRS Report
would limit the arrival of passengers from China to control
R46575, U.S. Withdrawal from the World Health
the spread of COVID-19. Several countries and WHO
Organization: Process and Implications, coordinated by
criticized this decision. IHR (2005) emphasizes limiting
Tiaji Salaam-Blyther.
interruption to travel and trade. Article 28 obligates any
country that implements measures that “significantly
Tiaji Salaam-Blyther, Specialist in Global Health
interfere with international traffic” to inform WHO, within
48 hours of their implementation and to provide the health
IF11750
https://crsreports.congress.gov

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Rejoining the World Health Organization (WHO): Reform and Related Issues


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https://crsreports.congress.gov | IF11750 · VERSION 1 · NEW

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