Senate Foreign Relations Committee questions State Department, USAID, and HHS on COVID-19 and U.S. International Pandemic Preparedness, Prevention, and Response

On Thursday, 18 June 2020, the Senate Foreign Relations Committee convened a hearing on COVID-19 and U.S. International Pandemic Preparedness, Prevention, and Response. The witnesses called to provide testimony included: 1) James L. Richardson, Director, Office of Foreign Assistance, U.S. Department of State, 2) Chis Milligan, Counselor, U.S. Agency for International Development, and Garrett Grigsby, Director, Office of Global Affairs, U.S. Department of Health and Human Services. Among the topics broached at the hearing were the World Health Organization’s (WHO) response to COVID-19, the United States’ relationship to WHO, US engagement with the,Coalition for Epidemic Preparedness Innovations (CEPI), and Senator Jim Risch’s (R – Idaho) bill, the Global Health Security and Diplomacy Act – S. 3829 – introduced in the US Senate on 28 May 2020. Senator Risch’s bill, co-sponsored by Chris Murphy (D – Conn.) and Ben Cardin (D-Md.) calls for the establishment of a Trust Fund for Global Health Security to be housed at the World Bank; the bill would authorize the US to contribute $3 billion (USD) to this Global Health Security Trust Fund between 2021 to 2025. The bill calls for the appointment of a Coordinator of United States Government Activities to Advance Global Health Security and Diplomacy overseas (housed within the State Department.

In his opening remarks, Senator Risch applauded the role of the WHO as the guardian of the International Health Regulations (IHR) and commended its efforts in combating polio and eradicating polio. However, Senator Risch noted that the WHO”s response to fast-moving emergencies such as Ebola and COVID-19 had exposed certain structural weaknesses. Risch advised the Committee that the purpose of the hearing on the COVID-19 response was not to demean, criticize, or condemn the WHO, but to conduct a fair analysis of the response. Risch provided a brief overview of his bill S. 3829 which he noted was a work in progress. Risch stated that his bill would provide an international financing mechanism that would re-energize action under the global health security agenda and create a single accountable entity at the State Department to lead diplomatic efforts and coordinate global health security assistance overseas.

In his opening remarks, Ranking Member, Senator Robert Mendendez (D – NJ) castigated the administration by noting that rather than leveraging US leadership and contributions to the WHO, President Donald Trump abruptly announced that the US would simply pull out of WHO which would not only threaten the United States’ ability to confront COVID-19, it would risk decades of progress on global initiatives including combating Ebola and polio. Senator Menendez noted that while the White House engaged in divisive rhetoric, the rest of the world moved on ahead. He contrasted President Xi Jinping’s announcement of committing $2 billion in the COVID-19 response at the World Health Assembly (WHA) in May 2020 with Secretary Alex Azar’s attack of WHO and China at the WHA. Menendez drew attention to the non-participation of the United States in the European Union’s global pledging marathon for COVID-19 in May 2020 which raised $8 billion dollars. Senator Menendez stated, “Is this what the Administration means by America first? Well if this EU consortium comes up with a vaccine before we do, it will mean America last. This approach is not only isolationist, short-sighted and foolish, it endangers American lives.” In closing, Menendez pushed back at proposals to create a financing facility at the World Bank on Global Health Security which would channel all the money the United States is currently withholding from WHO.

Following the testimony of Richardson, Milligan, and Grigsby, the Committee posed the following observations and questions.

Senator Risch noted that in his conversation with WHO Director-General Dr. Tedros Adhanom Ghebreyesus and his team, the WHO was defensive one respect, noting that the WHO is not a “sovereign entity” and did not have the power to tell a sovereign entity what to do. Risch remarked that the WHO was taken back by the rapid emergence of COVID-19.

In his response, Mr. Garrett Grigsby acknowledged that the WHO did not have a police force or a standing army to enforce the obligations of the International Health Regulations. Grigsby remarked that rather than “calling China out”, the leadership of WHO praised China for their actions in the COVID-19 response. Grigsby declared, “We’ve been in this movie before” alluding to SARS. Grigsby remarked that in contrast to the COVID-19 response, WHO was bolder during the “SARS situation” in 2003 and called the leadership of China out.

In a fiery exchange with Grigsby, Ranking Member, Senator Menendez quoted Grigsby’s testimony that “WHO’s praise of China exacerbated the pandemic because it did not pressure China to be more transparent”. Menendez countered that “President Trump himself praised China’s response multiple times – in speeches, public statements, and tweets. Quite explicitly in one tweet on January 24th, ‘China has been working very hard to contain the coronavirus. The United States greatly appreciates the efforts on transparency. It will all work out well, in particular, on behalf of the American people, I want to thank President Xi.’ On February 6th, at the WHO Executive Board meeting, Ambassador Bremberg who represented the United States, was similarly effusive saying, ‘We deeply appreciate all that China is doing on behalf of its own people and the world’.”

“Was the WHO’s praise of China the fatal flaw which necessitated the US withdrawal from the WHO and if so, why did the US make similar statements in praise and support for China at the same time if this was detrimental to the global pandemic response?” Menendez queried.

Grigsby responded that early on in the COVID-19 response, the United States received information that China was being cooperative. Grigsby noted that, “[w]hat happened was that we received more information later, and as that information changed, the tone changed.” Grigsby briefly described the WHO negotiations on resolution WHA 73.1 on the COVID-19 response which called upon an independent review of WHO’s handling of COVID-19. In his description of the WHO, Grigsby glossed over the WHO negotiations on the COVID-19 resolution, he glossed over the fact that the United States disassociated itself from language referring to sexual and reproductive health and rights TRIPS flexibilities. As reported in Le Monde, during the negotiations, the United States was unsuccessful in its 11th hour attempt to water down the resolution’s references to TRIPS flexibilities.

Senator Menendez asked Grigsby how the United States expected to reform the WHO, including ensuring better compliance with the International Health Regulations, if it had “relinquished its seat at the table.”

Grigsby responded, “The United States is a member of the World Health Organization. The President has announced that relationship is being terminated.”

Menendez interjected, “If I’ve said if I’m terminating my relationship with you, why should I listen to you? Can you explain that to me? If you tell me you are terminating your relationship with me, why should I listen to you about anything you want to do with an organization that I no longer am going to have a relationship with.”

Grigsby countered: “Why don’t I tell you about what we’re actually doing.”

Menendez retorted, “No, why don’t you answer my question?”

Grigsby continued, “I am doing that, Sir. As you know the United States has the presidency of the G7 this year. This provides us the opportunity to speak with health ministries. In fact, since early on in the pandemic, Secretary Azar has had once a week telephone conversations with all health ministers of the G7. As the situation with COVID-19 became more apparent, there was a focus on reform of the WHO…It’s in the interest of the United States whether or not we are a member – to have a WHO that performs better.”

Menendez interjected, “I appreciate your lengthy answer which is a non-answer as far as I am concerned. The reality is you have not made it clear to me how you are going to effect change at the WHO when you’ve terminated your relationship.

Let me ask you one final question. If we create a new global trust fund at the World Bank as I understand it from reading Senator Risch’s bill, would we just be going it alone? The rest of the world, they may be seeking change at the WHO, but they are behind the WHO. So help me understand why other countries would support a new mechanism at the World Bank. Wouldn’t just this create a parallel mechanism to the World Health Organization?”

Grigsby responded noting that his team had just received the text of Risch’s bill a few days before the hearing and would study it in greater detail.