Months after its initial outbreak, the world continues to struggle with the novel coronavirus disease (COVID-19). Beyond its status as a public health crisis, the pandemic has affected millions of lives and has had a profound political, social, and economic impact. When it comes to global health, the World Health Organization (WHO) is the most widely acknowledged international authority and the major coordinator of international efforts to contain communicable diseases. However, the organization is now under close scrutiny as the media and governments of some Member States have accused the WHO of responding to the unprecedented crisis in a disappointing way.

Pedro Villarreal, a scholar at the Max Planck Institute for Comparative Public Law and International Law, uses the term “international public authority” to explain the constraining effects of non-binding instruments under international law as opposed to binding legal rules. According to Villareal, two forms of legitimacy justify the WHO’s international public authority in the field of global health. One is technocratic legitimacy, which leads states to follow the WHO’s recommendations and guidelines based on the assumption that they are more likely to be technically accurate. The other is political legitimacy, which in the case of WHO decision making refers to transparency and accountability of the WHO in its decision-making process. The WHO’s handling of the COVID-19 pandemic has weakened both its political legitimacy and its technocratic legitimacy, calling into question its international public authority.

The political legitimacy of WHO lies in its transparency and neutrality. This transparency and neutrality has recently been subject to serious doubt, however, in light of the WHO’s apparent deference to China in its handling of the COVID-19 pandemic. Numerous sources reported the Wuhan local government and Beijing’s initial denial and coverup of the emergence of the novel coronavirus. Due to the centralized governance system that imposes pressure upon local governments to maintain social stability, the Wuhan government resorted to secrecy for political concerns that delayed the necessary domestic and global responses in taking early measures.

The criticism leveled against the WHO was linked to how China initially behaved when faced with the unexpected circumstances of dealing with the sudden outbreak of a novel coronavirus. Initially, the WHO recognized human-to-human transmission of the coronavirus on January 24, 2020. It, however, stopped short of declaring a Public Health Emergency of International Concern (PHEIC) over the coronavirus outbreak after the meeting of the IHR Emergency Committee.  Director-General Tedros of the WHO then traveled to Beijing on January 28, 2020 to meet President Xi and discuss the coronavirus outbreak. On this trip, Director-General Tedros commended China for setting “a new standard for outbreak control” and stated that China “bought the world time, even though those steps have come at greater cost to China itself.”

The media has characterized Tedros’ praise of China’s response to the outbreak as “effusive,” despite China’s initial coverups as well as some of the extreme measures the nation later took to contain the virus. Tedros reportedly denied in an interview that the WHO was deferential to the Chinese government and “said China’s actions don’t contradict WHO standards and have slowed the virus’s spread” and “they are reducing the vulnerability of the other countries.”

There are certainly political concerns that the Director-General must take into consideration when dealing with the initial outbreak of a global pandemic. Observers recognize that praising China, which had first-hand information of the coronavirus, might have been viewed by the WHO as a tool for encouraging its cooperation and information-sharing to help the WHO better study the coronavirus and tackle the pandemic as it spread across the globe. After all, the current scientific consensus is that COVID-19 originated in China and that, as early as January, the Chinese government had valuable information that could have helped contain the virus’ spread, making it an important ally for the WHO in its efforts to contain COVID-19.  Some also believe that the WHO could not afford to alienate China due to China’s leadership, political influence, and financial contributions to the organization. Others point to the fact that China donated $20 million to the WHO in the midst of the coronavirus outbreak—at time when it was likely suffer from its own problems of shortage of resources and supplies—as evidence of China’s attempt to further wield clout over the organization.

Critics have argued that the WHO could have declared a PHEIC earlier than it did, allowing other nations to better prepare before the outbreak warranted extreme measures. Counterfactual as those claims are, the WHO’s weak response to China’s mishandling of the initial outbreak probably, as a commentator claimed, “has laundered China’s image at the expense of the WHO’s credibility.” China has undoubtedly become a political and economic juggernaut, and therefore the WHO’s desire to maintain a positive relationship with China is understandable. Nonetheless, its salient deference has inevitbaly cast doubt on its international authority.

Beyond harming its political legitimacy, the WHO’s response to the COVID-19 pandemic also harmed its technocratic legitimacy. Insofar as the WHO’s international public authority is legitimate because it reflects the work of medical experts, an overlooked glitch during the pandemic threatens to undermine that authority.

The official Weibo (or “Micro Blog”, the Chinese equivalent of Twitter) of the World Health Organization stated the following on March 9, 2020:

Since the outbreak of coronavirus disease (COVID-19) in 2019, the World Health Organization (WHO) has been committed to providing the public with information on how to identify, prevent and manage the disease, and answering questions of public concern. The content is published on the WHO website in six official UN languages. WHO regional and country offices also translate the content into local languages for promotion.

As the scientific evidence related to the epidemic continues to update and new questions are constantly raised by the public, the WHO regularly updates the relevant guidelines on various platforms, including social media and the frequently asked questions column on the WHO website.

On the FAQ page, we list some things that the public should and should not do. Under “What Should I Not Do”, the earlier version suggested that people should not use traditional herbal medicine.

The decision to delete this content was made at the editorial meeting of the WHO headquarters news and risk communication group on 4 March. The reason for this is that the previous language is too broad, without considering that many people will use traditional herbal medicine to alleviate the mild disease caused by 2019 coronavirus disease.

This clarification was in response to the WHO’s English version of COVID-19 FAQ page, which listed the use of traditional medicine as an ineffective treatment for COVID-19. This information, however, was absent from the Chinese version. Eventually, both the Chinese and English versions of the webpage explicitly failed to list traditional medicine as an ineffective treatment for coronavirus.

The WHO immediately became embroiled in the controversy sparked by that post, with critics arguing that the move was nothing more than an attempt at catering to a Chinese audience, where a large population subscribed to the state-sanctioned promotion of traditional herbal medicine.

Mainstream medical experts have not been able to prove the efficacy of traditional herbal medicine or traditional Chinese medicine (TCM), and have categorized TCM as alternative or complementary medicine. In keeping with the medical community’s skepticism of traditional herbal medicine in general, a doctor warned that “herbal remedies—which China is exporting as part of its efforts to combat the coronavirus around the world—pose both direct and indirect risks to patients.” Despite the fact that the Chinese population consumes large quantities of traditional herbal medicine, medical experts outside of China point out that there is still little evidence as to the efficacy of TCM. Moreover, scientific studies that support traditional herbal remedies generally lack scientific rigor due to small sample size and the use of vague terms.

Chinese government officials, on the other hand, tried to promote and push for the use of traditional medicine for treatment and prevention of COVID-19. “We are willing to share the ‘Chinese experience’ and ‘Chinese solution’ of treating COVID-19, and let more countries get to know Chinese medicine, understand Chinese medicine and use Chinese medicine,” Yu Yanhong, deputy head of China’s National Administration of Traditional Chinese Medicine, said at a press conference on March 6, 2020.

Regardless of the true merits of TCM, which is subject to debate and further research, modern medical science finds it hard to reconcile itself with traditional herbal remedies due to absence of solid scientific proof of TCM’s efficacy. Despite the scientific community’s hesitancy to embrace TCM as an effective treatment for COVID-19, however, the WHO apparently did not feel itself so constrained. The clarifying message issued on its Weibo could be read as a subterfuge for previously not including taking traditional herbal medicine as ineffective treatment measure for the COVID-19. Notably, the WHO was critiqued by an editorial on a prominent scientific journal a year ago for endorsing TCM in its official document even when most treatments using TCM have not undergone rigorous randomized control trials. It pointed out that one of the reasons why the Chinese government arduously promotes TCM both domestically and internationally was that TCM was a big business in China’s healthcare industry.

Technocratic legitimacy and political legitimacy seem to be intertwined in the WHO’s handling of the COVID-19 pandemic. For the world’s leading authority over global health issues, the importance of the WHO’s technocratic legitimacy is that “decision-makers consider the scientific nature of some problems to be beyond” political discussions. But if a decision that is supposed to be grounded in scientific evidence is susceptible to political pressure, then the expert-based legitimacy would necessarily be discounted. The deference that the WHO afforded to China went hand in hand with its catering to the Chinese audience who would put up a fight against listing traditional herbal medicine as ineffective treatment measure in its official guidelines. The fact that some even called the time “ripe for clear leadership from the WHO based on science not politics” demonstrates that its prominent technocratic legitimacy has been conceivably undermined.

The weakening of the WHO’s authority is not without consequence. Many countries, including the United States, imposed travel restrictions that medical experts deemed problematic when the WHO warned that application of unnecessary and disproportionate international travel restrictions would only exacerbate the harm. Moreover, the U.S. constantly attacked the organization for how it dealt with China and has decided to withdraw from it, which only further undermines the WHO’s global legitimacy.

The complex political and financial dynamics between the WHO and the world’s major powers necessarily complicate the way in which the organization responds to a situation like the COVID-19 pandemic. But it is essential for the organization to rebuild and enhance its technocratic and political legitimacy so that nations are willing to rely on its recommendations and give credence to its management and coordination efforts. Its ability to maintain its international public authority over global health governance looms large, particularly given the possibility of another pandemic hitting humankind in the future.

Yunpeng (Patrick) Xiong: J.D. 2021, Berkeley Law School and California Law Review Vol. 109 Executive Editor. I owe my gratitude to Professor Katerina Linos, who offered great support and guidance during the seminar on International Organizations, on which this piece is based.