Empty Seat, Absent Nation:

The World Health Organization and America's Participation

The gavel came down on the 78th World Health Assembly last month, with delegates from 193 nations gathering for nine days to compare notes on the world’s most pressing health concerns. However, one seat was empty. For the first time since the World Health Organization was founded in 1948, the United States was not at the table.

It’s a table I’ve sat at numerous times. For two years, I served as the Assistant Director-General of the World Health Organization, the top-ranking American in the organization which convenes the Assembly.

The Assembly is much more than a bureaucratic gathering. It is where collaboration mixes with national agendas. The world’s health leaders hash out strategies on everything from HIV/AIDS to malaria, from equitable access to care in the poorest nations to fighting counterfeit medicines across the globe. At its core, it is driven by the reality that diseases do not respect borders and that not only is it our moral duty to improve the human condition by advancing health care everywhere, but it is also in our own interest to nip diseases in the bud before they can make their way here. Maintaining a global monitoring system to track deadly outbreaks, and pooling the brain power of the world’s leading researchers to solve emerging health issues is critical to stemming the tide of another, as yet, unknown ravaging disease.

The decision for the United States to stay home was a serious policy catastrophe. Our absence left a vacuum, and China likely gloated at the opportunity to fill it. They sent a 180-person delegation to Geneva. That was not mere participation – it was a naked flex of power. By building relationship with those nations where deadly outbreaks originate, we are letting them shape the early response to global health threats. And that risks the lives of Americans. This approach does not square with our strong rhetoric about China and simply allows them to shape global health security. Since the assembly in May, the WHO convened its fourth meeting of the International Health Regulations (IHR) to discuss the mpox outbreak. Recommendations were put forth regarding the recent strain variant that has caused concern. However, the President’s executive order says that the United States will not negotiate any amendments to the IHR.

I’d be the first to tell you that the World Health Organization isn’t perfect. It has flaws and many times operates with a model from the 1950s whereby resolutions to improve health are voted upon once a year. Yet in a world moving at tweet-speed, we need to remain engaged in the dialogue and do more than just writing the huge $1.3billion check payable to WHO. We need to provide our perspective and experience on health issues to improve the system from within, not as a bystander. At this year’s assembly the WHO signed the Pandemic Agreement that addresses a broad array of global health actions to prevent, prepare and respond to future pandemics. The United States was not a signatory.

We cannot afford to hand over influence like this on the global health stage. To protect America’s interests, we must be present at these international meetings. I understand how political the World Health Organization can be, after all it is a UN agency! I’ve been in the room when tempers rose. I remember one negotiation where the United States delegation walked out. Yet, they returned later when the political temperature dropped, and diplomacy prevailed. There’s always a bit of theater involved. But there is one fact that is indisputable: you can’t put on a show if the lead actors are missing.

Our experts from the CDC, NIH, remnants of USAID, and others have dedicated their lives to protecting health and preventing suffering. Their voices share incredible knowledge and they safeguard our nation’s interests.

This isn’t about politics. It’s about protecting the health and well-being of the American people which is something the President , along with Secretary of Health and Human Services have, appropriately so, made a top priority. But commitment means showing up and if we are not in our chair at these WHO gatherings then we are handing the microphone and influence over to others, most notably China.

Global health leadership is ours to reclaim but only if we act. The world is watching. And so are the American people.

Howard A. Zucker, MD: Former Assistant Director General of the World Health Organization, Former Deputy Director for Global Health at the Centers for Disease Control & Prevention and Co-Creator/Host of Docology Podcast.