The World Health Organization (WHO) helped to coordinate one of the most extensive efforts in history to counter the spread of COVID-19. Former president Donald J. Trump criticized it for being too slow to respond to the pandemic and for being too easy on China, then announced his decision to withdraw from the WHO and freeze its US funding as the novel coronavirus spread. President Joseph R. Biden Jr. reversed that decision, but the organization's troubles remain.
This week as the 75th World Health Assembly of the WHO meets in Geneva, it faces extraordinary pressures from some of the same corporate interests that had been poisoning its reputation even before the Trump administration took aim. An example is a resolution in the US House of Representatives known as "H.Res.896," sponsored by Representative Guy Reschenthaler, a Pennsylvania Republican. Introduced just weeks before Trump's withdrawal and budget freeze, H.Res.896 accused the WHO of "actively targeting major American industries, including agriculture, food and beverage, and pharmacology, with onerous global regulations," in particular the regulation of tobacco.
The Biden administration has given no indication of supporting such a resolution. But the administration does continue to talk about the need to "reform" the organization in a way that could abet industry demands to play a greater role in the formulation of WHO policies—including on tobacco, the major focus of H.Res.896.
What kind of corporate pressures does the administration face on US positions toward the WHO? A careful look at federal lobbying disclosures can shed light.
Tobacco lobbying on the WHO
Disclosure records show that PMI Global Services Inc. (Philip Morris International) and RAI Services Company (linked to RJ Reynolds) are on record as lobbying the US government on its policies toward the WHO in 2020 as the pandemic spread.
The WHO maintains a treaty called the Framework Convention on Tobacco Control, which defines countries' rights and obligations to address harmful use of tobacco. The United States has signed the Convention but never ratified it, so is not a full party. The Convention entered into force in 2005 and makes the WHO a thorn in the side of the tobacco industry.
The lobbyists that PMI and RAI employed refer to H.Res.896, which essentially complains that the WHO refuses to allow input from the tobacco industry in its policy processes and is favoring Chinese tobacco companies over US tobacco companies. The criticism bears similarity to fears of a Chinese takeover of the WHO and encroachment on civil liberties raised by some pundits of late. The resolution praises the US Food and Drug Administration's (FDA) policies toward tobacco and urges that the WHO adopt those instead. The FDA is open to tobacco's newest marketing strategy—"harm reduction" through use of noncombustible or low-nicotine products. The WHO is skeptical of reduced harm from the industry's new products, instead focusing on reduced use of tobacco products.
Nonprofit lobbying on the WHO linked to tobacco
Other groups have also pushed the United States to pursue tobacco industry interests at the WHO. The National Taxpayers Union (NTU) lobbied on "tobacco taxes" at the same time they discussed a meeting of the governing body of the WHO Framework Convention on Tobacco Control in 2018. The disclosures do not reveal its position, but in October 2017, the NTU made its position more transparent. It wrote to the US Acting Secretary of Health and Human Services (HHS) expressing concern about a WHO plan, called a Roadmap, to recommend excise taxes on tobacco, alcohol, and sugar-sweetened beverages. In the letter, the NTU recommended that HHS boycott an upcoming WHO conference on fighting noncommunicable diseases (including obesity, heart disease, and cancer), urging that the US
Publicly repudiate all portions of the Roadmap that overtly or implicitly support tax increases, multinational regulations, or other government-driven policies that undermine democratic fiscal policymaking among nations and economic rights among citizens….
The NTU was part of a Global Plain Packaging Coalition fighting against proposals that countries require plain packaging on tobacco products. In 2018, a letter from this coalition addressed to the director-general of the WHO included NTU's logo and called these proposals for such requirements a violation of human rights.
Lobbyists for the Center for Individual Freedom, some of whose officers used to work for the National Smokers Alliance, also requested in 2018 that President Trump reduce US funding for the WHO by 25 percent.
A complex web
Tobacco interests are not alone in their lobbying activity. The same demands made in H.Res.896 to allow more influence from commercial interests in WHO policies are coming from other industries as well. The apparent conflict between tobacco interests and the WHO is an example of the tension between approaches to public health touting "harm reduction" within a product's composition or nature (i.e., lower nicotine or noncombustible) versus reducing use of products that can harm health through taxes, bans, or marketing restrictions (as under the Framework Convention on Tobacco Control). This tension arises in different forms for other products like alcohol, junk food, and even some chemicals. It often generates roadblocks when designing policy to fight the rise of noncommunicable diseases associated with use of some of these products.
Newly published research shows that lobbying on US positions toward the WHO intensified between 2016 and 2021, as some industries and manufacturers started to team up and together lobby both Congress and across the interagency process in the executive branch. A new coalition formed, Engaging America's Global Leadership (EAGL). It did not include tobacco companies but lobbied concurrently with tobacco-linked interests on US appropriations and other positions. The central push has been to weaken barriers to industry influence currently built into WHO decision-making processes.
Prospects for US leadership on health
Comorbidity during the pandemic shows that it is long past time for the United States to get serious about public health policies to fight tobacco use and noncommunicable diseases. To do so, it must strengthen channels for public health advocates not funded by commercial interests to have a bigger say in US policy toward global health. Taking on industry lobbies to strengthen public health infrastructure is not for the faint of heart.
Congress and the Biden administration have gone out on a limb, taking key steps to narrow loopholes for tobacco marketing affecting kids and other targeted populations. Why not finish the job? While the United States considers participating in a new international treaty to enhance global pandemic preparedness, it may wish to consider ratifying an old one: the Framework Convention on Tobacco Control.
Regardless, it is clear that without making room to elevate public health voices unfettered by commercial interests, the Biden administration will have a hard time forging policy to ensure the strongest possible global response to the next pandemic. President Biden proved his leadership on global health issues, finding common ground with Senator Jesse Helms to restore US funding to the WHO more than 20 years ago. Can he again find a way to do what is necessary now to build a more lasting public health infrastructure, less beholden to commercial interests?