President Donald Trump’s move to officially withdraw the U.S. from the World Health Organisation will rob the body of a leading provider of funding, treatments and personnel, and leave China in a position to fill the void.

The exit will not leave the WHO in an immediate crisis, thanks to a rise in private philanthropic contributions from such sources as the Bill & Melinda Gates Foundation, which ranks second only to Washington.

Still, its disease-fighting efforts in developing nations could be hindered if the move interferes with American personnel support or relationships with U.S. pharmaceutical companies, with potential consequences for its ability to combat the coronavirus outbreak and future pandemics.

The United Nations body has helped to coordinate international cooperation on tackling the coronavirus, including collecting case reports and developing vaccines and treatments, and has encouraged sharing of big data and free access to patent information. But some observers worry this approach may be difficult to maintain if China takes the lead as the U.S. steps back.

Beijing is the second-largest contributor to the UN budget, behind the U.S., and is a vital source of funds for a body whose finances have been squeezed as many member states fail to pay their share. Its sway in personnel matters is growing, Chinese Officials lead four of the United Nations’ 15 Specialised Agencies.

Some of these bodies have made organisational and policy decisions that appear to reflect Beijing’s priorities. The International Civil Aviation Organisation has refused to let Taiwan participate in meetings since Liu Fang’s 2015 appointment as Secretary General.

Zhao Houlin, Head of the International Telecommunication Union, was previously involved in developing telecom standards for the Chinese government and has in his current post encouraged members to get on board with Beijing’s Belt & Road Infrastructure Initiative.

China is “aiming to ‘Sinify’ the UN with its overwhelmingly deep pockets and wealth of talent,” said an alarmed diplomatic insider in Geneva.

Washington had been highly active in the WHO, drafting strategic proposals and sending medical staff to disease-hit areas. The Centres for Disease Control and Prevention and many other American organisations are involved in the body’s global response network. During the Ebola outbreak in West Africa that began in 2014, the Obama administration dispatched 3,000 troops and thousands of health care workers to the region.

And American pharmaceutical companies have lent significant support to the WHO’s work. In the 1980s, Merck partnered with the organisation to distribute treatments for tropical diseases caused by parasites, such as river blindness, for free in emerging countries.

With the U.S. leaving, it will be up to other major contributors such as Japan and Europe to pick up the slack.

The WHO was established in 1948 amid a push for international cooperation in health and hygiene believed to be driven by joint efforts by European nations to fight cholera and plague outbreaks in the 19th century, along with the deadly influenza pandemic of 1918.

Political manoeuvring has been present in the organisation since the beginning, with the Soviet Union, for example, seeking to strengthen its influence in a body whose creation was spearheaded by the U.S. and the U.K. Yet even members who were in direct conflict cooperated in this context, leading to successes including the eradication of smallpox and broader access to AIDS treatment.

But this has broken down amid the mounting tensions between the U.S. and China. The Trump administration cited distrust of Chinese influence in its decision to withdraw from the WHO.

Author: Kiyoshi Ando & Rintaro Hosokawa