A collective global gasp was heard when President Trump announced his intention to defund the World Health Organization. There is no shortage of opinions about the inherent risk to global health if the United States withdraws from the WHO. Yet, the potential implications of such a move on the global stage may not be immediately apparent at the domestic and local level.
We would like to bring the lens closer to home to examine what that means for the Americas, and Michigan, at this critical moment.
The WHO divides the world into six regions to improve and protect people’s health across the Americas. The Region of the Americas is composed of 52 countries including the United States. PAHO, or the Pan American Health Organization, predates the WHO and is now both the health authority of the inter-American system and the regional health office for the WHO. During the nearly 120 years since its inception, PAHO and its member countries in the Americas have achieved the eradication of polio and smallpox as well as the elimination of endemic transmission of measles and rubella. Life expectancy in the region has gained nearly three decades and there have been significant declines in maternal and infant morbidity and mortality. Defunding and departing from the WHO could place these advancements in jeopardy.
To achieve its mission, PAHO promotes long-term partnerships to stimulate innovation, research, and policy change related to public health for all people across the Americas. Many of these important partnerships have included academic and research institutions who work as part of a collaborative network to address public health concerns. Turning our backs on the WHO means turning our backs on the collaborations among scientists and health care providers that could lead to important advancements against emerging infections and viruses such as COVID-19.
The University of Michigan played a special role in developing the first polio vaccine in 1954, but it is the WHO that has helped distribute the vaccine globally. Beginning in the late 1990s the WHO Regional Office for Europe and PAHO have taken a leading role in surveillance prevention recommendations for the West Nile Virus. When the virus appeared in New York City in 1999 and began to spread across the United States, the U.S. Centers for Disease Control benefitted from what was learned a few years before by the WHO European office.
West Nile Virus is the leading cause of mosquito-borne disease in the continental United States. In Michigan, outbreaks of the virus have occurred every summer since 2002. In 2002, Michigan had the second highest number of cases of West Nile Virus in the nation — with 644 cases and 21 deaths. In 2012 cases rose to their highest level since 2003 with 10 deaths in Wayne County alone.
Many people in Michigan receive a flu vaccine annually, yet never realize that components of the vaccine each year are selected based on information from the flu season in the Southern hemisphere (during our summer) which is shared through meetings convened by the WHO and its partners. Most recently, the WHO has helped bring together more than 150 countries to participate in COVID-19 vaccine development. The United States has chosen not to be involved in this endeavor, despite its status as the country with the most COVID-19 cases globally. This leaves Americans particularly vulnerable to emerging infections and viruses. Emerging infectious diseases know no borders.
The U-M School of Nursing is one of only 17 nursing schools in the Americas to hold the designation of a PAHO/WHO Collaborating Center for Research and Clinical Training in Health Promotion Nursing. This trusted and valued partnership among nurses, midwives, other health professionals and policy experts from across the region allows us to learn from each other and improve the health and well-being of citizens throughout the region, including in the United States. It is this mutual learning that helps educate and prepare the healthcare providers serving on the front lines of the COVID-19 pandemic. Withdrawing from the WHO would negatively affect the collaboration of these institutions and thwart the innovation and research that has helped improve the health of people across the Americas.
There are currently multiple activities underway in education, research, service and advocacy through partnerships established by U-M’s connections through the collaborating center. A few examples of this include an analysis of maternal mortality in Nicaragua; providing technical review of antenatal care curriculum for the WHO African region; and working with PAHO representatives from Guyana and Bolivia to identify best practices for maternity waiting homes in the region. We also support the development of nursing and midwifery in the Americas and participate with partners to promote universal health care in the region. U-M students and faculty are an integral part of these endeavors, moving the science forward and becoming informed citizens of the world. Our mission in global education is strengthened by these collaborations with our colleagues at WHO.
The work of PAHO is supported by contributions from member states, participating states and associate members. Currently, most of the non-payment to PAHO – approximately 67 percent of funds – are attributable to the United States. While Collaborating Centers receive no financial remuneration for services and consultations rendered, these funds support the work of PAHO’s dedicated staff to strengthen health sector capacity, provide surveillance during outbreaks of communicable disease and improve health for the most vulnerable among us. The defunding of WHO by our government directly impacts important work to improve health and access to care in the Americas.
As we celebrate 2020 as the International Year of the Nurse and the Year of the Midwife — designated by the WHO to honor the 200th anniversary of Florence Nightingale’s birth and highlight the vital role of nurses and midwives in providing healthcare – we feel the toll the pandemic lays upon health workers around the world.
Nurses have been at the forefront of the COVID-19 pandemic. It is estimated over 450,000 health care workers have been infected with COVID-19 and as of June 1, more than 600 nurses have died from the virus. Countries in the Americas are facing some of the worst outbreaks of COVID-19 in the world. This is not the time to turn our backs on our neighbors in the north and south. Working collaboratively strengthens. We are at a critical moment in history. It is time to show solidarity with the world.
The authors are with the University of Michigan, School of Nursing. Jody Lori PhD, RN, CNM, is director of the PAHO/WHO Collaborating Center; Megan Eagle RN, MS, MPH, FNP-BC, is deputy director of the PAHO/WHO Collaborating Center; Michelle Munro-Kramer PhD, CNM, FNP-BC, is director in the Office of Global Affairs; Nancy Lockhart, MSN, RN is project manager, Office of Global Affairs; Beste Windes, MBA is program manager, Office of Global Affairs.