Tedros, Taiwan, and Trump: What They Tell Us About China’s Growing Clout in Global Health

In one of my recent blog posts on the World Health Organization (WHO) director general (DG) election, I discussed how the new election procedure has reduced the advantage larger states have in influencing election outcomes. Still, since health is a “highly politicized” topic, competition for the job involves deal-making and horse-trading that allow a complex set of factors (e.g., geopolitical considerations) to decide who will be the final winner. In this process, major powers can exert significant influence in part because they have more non-health-related bargaining chips than smaller nations to use in the negotiations. This might explain why days before the WHO election Dr. David Nabarro was campaigning in Beijing, busy meeting with Chinese health and foreign affairs officials, giving interviews to local media, and delivering a speech at the prestigious Tsinghua University. China at the time was very likely debating whether to throw its support behind him or Dr. Tedros Adhanom, former Ethiopian minister of health and minister of foreign affairs. As early as March, Dr. Tedros was invited to visit China where he delivered a keynote speech at Peking University.

The political entity that felt left out of the party was Taiwan, which viewed formal participation at the World Health Assembly (the WHO’s executive body) as a critical step in its quest for international recognition. Under President Ma Ying-jeou, who served in that capacity between 2008 and 2016, Taiwan was able to participate as an observer under the title “Chinese Taipei.” The invitation arrived at the last minute last year, apparently as a warning sign from mainland China against the newly elected pro-independence President Tsai Ing-wen. This year, China was convinced that Tsai’s government had no intention of following the so-called “1992 Consensus,” which dictates that both Taiwan and mainland China are inalienable parts of a single entity, though each side has a different interpretation of what that entity is. Under pressure from China, the WHO secretariat did not issue an invitation to Taiwan. Dismayed and disappointed, Taiwan lobbied eleven of its twenty-one diplomatic allies to raise a motion calling for Taiwan’s inclusion at the WHA. The motion was deleted from the agenda when the WHA met on May 22, dashing any hopes that Taiwan could secure representation at the meeting. Interestingly, in its WHA bid Taiwan was advised to lobby its allies to vote for Nabarro, who was believed to be “nicer to Taiwan.” This kind of wishful thinking only did a disservice to Nabarro’s campaign: while both candidates sought to befriend China, Tedros now seemed to be a more favorable choice to China. Like Margaret Chan, the current WHO DG, Tedros was keenly aware of the importance of the Taiwan issue in WHO’s relationship with China. The day after his electoral victory, he reiterated his adherence to the “One China” principle (read: WHO will not invite Taiwan for formal participation without China’s approval).

What about the United States, the largest funder of the WHO? As my colleague Laurie Garrett observed, Tedros was the favorite candidate of the Obama administration, but was not the Trump administration’s first choice. This is in part because Tedros’s focus on universal health coverage ran counter to U.S. Secretary of Health and Human Services Tom Price’s interest in global health security. But the U.S. preference was not echoed by developing countries, which voted overwhelmingly in favor of Tedros. While the WHA was in session, the Trump administration unveiled its proposed budget, which would cut the annual global health budget by about 26 percent. The massive cut in global health funding would not only pose existential challenges to specific global health programs, including those related to family planning, malaria, and HIV/AIDS, but also risk fulfillment for WHO’s overall budget, exacerbating the international agency’s funding crisis.

By contrast, China’s top health official bragged that 2017 would bring a “bumper crop” for its global health engagement: in January, it signed a MOU with the WHO for cooperation on the One Belt, One Road initiative; in March, it opened the Global Health Drug Discovery Institute, a partnership with the Gates Foundation that focuses on early drug discovery to fight HIV, tuberculosis, and malaria; in April, it co-chaired the China-Africa Health Ministers Conference, committing itself to “multilateralism and a rules-based global health governance mechanism”; in May, President Xi Jinping hosted the Belt and Road Forum for International Cooperation, during which he pledged 60 billion RMB ($8.8 billion) to developing countries and international organizations participating in the initiative to launch more projects to improve people’s well-being worldwide; in July, China will host the BRICS Health Ministers Conference; and in August, a high-level forum will be held in Beijing to discuss global health cooperation. With China’s rapid advancement in global health and U.S. retreat from this area, we will see a WHO increasingly looking toward China for leadership.