More than 13 years before a new and deadly coronavirus began to spread across China, a Hong Kong-born doctor with a Canadian passport met Hu Jintao, then the president of China. Mr. Hu told Margaret Chan that Beijing was interested in her as a potential director-general of the World Health Organization.
Never before had a Chinese person led a major United Nations organization. Two years before Beijing would play host to the Olympics, the top seat at the WHO was a prize for a country seeking influence at the pinnacles of the global establishment. Dr. Chan, a physician who completed her medical studies at the University of Western Ontario before going on to serve as Hong Kong’s Director of Health, fit the image of a globetrotting leader of Chinese ethnicity.
In late 2006, she won a resounding victory after a leadership campaign heavily backed by China, which included Mr. Hu writing a personal letter of recommendation. Shortly after her victory, she met Mr. Hu in Beijing, where the Chinese president promised to support the WHO and strengthen co-operation with the organization.
Dr. Chan went on to lead the WHO for a decade, a time in which she reshaped the organization and nurtured its relationship with China, a connection that has come under intense scrutiny in the midst of the COVID-19 pandemic. Loudest among the critics has been U.S. President Donald Trump, who pulled funding from the organization and accused it of bending to Chinese dictates to “mislead the world” about the threat of the virus. The WHO has shown “an alarming lack of independence,” Mr. Trump has said.
Dr. Chan is no longer at the WHO, and her defenders and former colleagues call her a woman of integrity who showed no bias toward China.
But her long-standing role in shaping the WHO and its posture toward China has nonetheless made her a central player in the direction of an organization that has drawn worldwide questions about its praise for China and its willingness to repeat, unquestioned, early Chinese reassurances about the limited dangers of a coronavirus that has become the most acute international health crisis in a century.
In the months since the coronavirus began its spread from Wuhan, Dr. Chan, who is now dean of the Vanke School of Public Health at Tsinghua University in Beijing and president of the Global Health Forum of the Chinese-backed Boao Forum for Asia, has offered effusive praise of the Chinese response.
“China has done a very good job of showing responsibility to the international community,” she said in a March interview with Phoenix Television, a partly private network backed by Chinese state television.
“At the most urgent time, the Chinese government has successfully exerted its system’s advantages and mobilized the nation to maintain the safety of the people’s lives,” she wrote in a column for Global Times, a nationalist tabloid run by the Communist Party.
“This COVID-19 pandemic has given Chinese universities and Chinese scientists the chance to showcase their advancement and achievements in science,” she told a conference in late May organized by the China Association for Science and Technology.
She declined an interview request from The Globe and Mail.
But it was under Dr. Chan that WHO staff were told to call Taiwan a “province of China.” She helped to deepen the World Health Organization’s embrace of Chinese traditional medicine, whose use of folk wisdom and ingredients from exotic animals is considered by Western science to be largely unproven. She also aligned the WHO with the Belt and Road Initiative, Beijing’s effort to extend the reach of its diplomatic sway and corporate investments.
Dr. Chan, like the WHO today, was criticized for being too obeisant to individual countries and failing to show international leadership.
After the 2013 Ebola outbreak in West Africa, which killed more than 11,000 people, an independent review panel pointed to the lengthy delay in declaring a public-health emergency of international concern. Such a declaration is a red-flag warning about a serious health problem, but it was not made until August, 2014, nine months after the beginning of the Ebola outbreak. (The WHO was similarly criticized for a much shorter delay this year in declaring the new coronavirus a public-health emergency of international concern.)
“Independent and courageous decision-making by the director-general and the WHO secretariat is necessary with respect to such a declaration. This was absent in the early months of the Ebola crisis,” found the panel, which was constituted in part by Dr. Chan herself to examine shortcomings.
Dr. Chan “made it very clear that the WHO is just a technical agency. Basically, she deferred to the influence of the member states,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, a New York-based think tank.
But, he added, ”under Margaret Chan, were there any institutional changes that made it more China-friendly? I can’t see much there.”
In fact, those who worked with Dr. Chan at the WHO, even her foremost former rival, offered little criticism of her interactions with China.
Michael O’Leary was the WHO’s chief representative in Beijing from 2009 to 2013, a role that placed him in the room with Dr. Chan during her meetings with China’s top leadership, including President Xi Jinping.
”I never saw anything that looked like inappropriate pressure or relationships on either side. I just saw a good working relationship, basically,” Dr. O’Leary said. During his time, WHO priorities in China included tobacco control, health-system reform and health care delivery for marginalized populations, including drug users and others with HIV.
He agreed with Dr. Chan’s approach, which relied on an apolitical position and quiet diplomacy. For the WHO, “their job is not to investigate and publicly name and shame countries for doing things,” Dr. O’Leary said. The “WHO is not the global policeman for health. It’s a technical agency to support countries.”
The WHO has in the past acted more decisively, particularly under Gro Harlem Brundtland, the former prime minister of Norway, who was unafraid of standing up to other world leaders. Ms. Brundtland was director-general of the WHO from 1998 to 2003, and famously tongue-lashed China for covering up the initial outbreak of SARS.
Dr. Chan embodied a very different leadership style. Her personal philosophy, as she described it to Steven Hoffman, professor of global health, law and political science at York University, is that “she sees the director-general as a servant of member states. And legally, she is right,” he said. “The challenge, though, is that if that leadership and that vision doesn’t come from the director-general, who is it going to come from?”
He complimented Dr. Chan both for helping to better integrate China into global health governance, as well as for making changes to the WHO’s emergencies program, by elevating its importance, assigning it more resources and developing surge capacity for times of need. Those changes mean that the WHO in the current pandemic “has performed better than the WHO has ever performed in an emergency,” said Prof. Hoffman, who worked as a project manager for the organization under Dr. Chan.
But, he said, none of that changes problems to the current configuration of the WHO, which can “advise but never direct; guide but never govern; lead but never advocate; evaluate but never judge. It’s this whole impossible situation they’re faced with.”
Julio Frenk, the former dean of the Harvard T.H. Chan School of Public Health, was among the authors of the independent panel report that criticized the WHO under Dr. Chan for its Ebola response.
But if there is fault to be found in the broader leadership style shown by both Dr. Chan and her successor, Dr. Tedros Adhanom Ghebreyesus, it lies primarily in the structure of the WHO itself, said Dr. Frenk, who lost out to Dr. Chan for the position of director-general in 2006. In an interconnected world where both diseases and cures “are no longer within the control of any single nation-state,” the WHO is an international body without a dedicated ability to enforce health measures.
“The issue with the WHO is that the member states deliberately keep it weak. The member states are very reluctant to share their sovereignty, which is what you require to mobilize effective international collective action to deal with common threats,” he said.
That’s unlike other organizations, such as the International Civil Aviation Organization. If that body had the same limited powers as the WHO, “airplanes would be crashing all the time,” Dr. Frenk said.
“The way we keep airplanes safe is by making sure everyone follows the same rules,” he said. “We need to give the same power to the WHO.”
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