Is the WHO Too Soft on Russia?

In May, as Russia was tentatively emerging from a nationwide lockdown and clocking up near-record numbers of new infections, Russian officials began mounting an aggressive public campaign to present Moscow’s handling of the coronavirus as faultless. 

Central to that was boasting about the country’s low number of fatalities compared with Europe, the U.S. and elsewhere. 

“Mortality rates are 7.5 times lower in Russia than the world as a whole,” Deputy Prime Minister Tatiana Golikova told a state TV channel, basing her assessment on the daily tally of infections and fatalities published by the country’s new pandemic task force.

Other statistics were already pointing to a different picture. Figures quietly published by the country’s national statistics agency, Rosstat, as well as early research into excess mortality were showing a potentially dramatic undercount of coronavirus-related fatalities in Russia — a discrepancy which has only grown wider and been supported by more evidence as the pandemic has continued.

But just as officials were criticizing the Western media outlets that had reported concerns, and EU embassies were — according to one EU diplomat — privately expressing little confidence in the official numbers, Moscow won an unexpected and authoritative endorsement.

“We — the World Health Organization — have no complaints about the statistics being provided by Russia,” said Dr. Melita Vujnovic, head of the WHO’s office in Russia.

It’s a position the WHO and Vujnovic have stuck to over the last six months, even as signs mount that Russia could be missing vast numbers of coronavirus fatalities by not including deaths where another potential cause is present. 

“No major concerns have been conveyed about the Russian methodology” for counting deaths, Vujnovic told The Moscow Times in an interview Monday, conducted over Zoom.

In conversations with The Moscow Times, Russian and international health experts have raised fresh concerns over the WHO’s public stance, saying the defense of questionable statistics and overly pro-government comments demonstrates Russia’s influence over the body and highlights its underlying organizational weaknesses.

After Vujnovic delivered a similar message supporting Russia’s count in an interview with the Echo Moskvy radio station last week, Russia’s state-run TASS news agency ran an article headlined: “WHO said it has no questions about Russian data on coronavirus mortality.”

The authorities have seized on the WHO’s public support for their approach — which has extended beyond the counting methodology to praising regional healthcare facilities.

In September, after touring hospitals in Russia’s regions, Vujnovic told TASS: “I really wanted to see other countries have the same number of medical staff, such hygiene and such equipment.” 

“I am not saying there are no issues or that there are no remote places where something is in critical condition. However, looking at the general picture, the equipment is very good. There are problems everywhere, but in general you can be proud of your healthcare system compared to others.”

Within weeks a second wave had exposed the fragilities of Russia’s regional healthcare system, and desperate medics were lambasting authorities for not having used the summer to better prepare.

Critics are questioning the WHO’s professionalism and motives.

“When the WHO says it trusts the Russian statistics, they either show that they are completely unprofessional and unqualified to understand data, or that something else is at play,” said independent data analyst Boris Ovchinnikov, who has published widely on flaws in Russia’s coronavirus statistics.

“In the medical and demographic community in Russia, WHO statements are discussed a lot. We don’t trust them and no one takes them seriously anymore,” said Alexey Raksha, a former government demographer who was fired from his job at Rosstat after publicly questioning the numbers.

Endemic problem

Charges of influence from autocratic regimes are nothing new for the WHO. Loud criticism that it was too friendly toward Beijing threatened to overshadow the body’s role as the global authoritative voice on combatting the pandemic early on. 

Experts say the same dynamics — the WHO’s need to be diplomatic and not seem too critical of its members, coupled with a weak organizational and financial structure which leaves it dependent on the generosity of its donors — are also at play in its relations with Russia. 

“When the WHO indirectly supports Russia’s talking points, it is a cost to the credibility and reputation of the organization,” said J. Stephen Morrison, a former staffer in U.S. President Bill Clinton’s administration and now director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS).

“The problem with the WHO is an endemic problem: It is a member state organization, and all its offices exist at the will of the member states. WHO personnel at a public level have to be exceedingly deferential, and it constrains them. It limits their autonomy to speak truth to power and to be critical.”

Part of that structural weakness is financial. Around 20% of the WHO’s income comes from mandatory contributions based on the size of a country’s economy, with the rest made up by voluntary top-ups from governments, foundations and the private sector for specific WHO programs and initiatives.

While U.S. President Donald Trump’s high-profile attacks on the WHO for being too close to Beijing were criticized publicly by America’s allies and rivals alike, there is acceptance among Western countries that the WHO needs reform. 

But experts say Russia is now lining up to block any attempts to give the body more teeth and an ability to intervene, criticize and lead from a position of strength. Instead, Russia appears to want to ensure that any change would increase its influence over the WHO even further.

Growing influence

Relations between Moscow and the WHO have not always been so cordial, Mikko Vienonen, the WHO’s former special representative in Moscow who led the expansion of the office from the late 1990s until mid-2000s, told The Moscow Times.

He said the fall of the Soviet Union left many European states as developing countries and led to the establishment of small offices in former Communist countries including Poland, Lithuania and Latvia.

“And we felt having a WHO office in Russia would be useful for both us and Russia,” Vienonen said.  

“But in 1998, when it came to the discussion with Russian officials, they would ask, ‘does the WHO have an office in London, Paris or Washington, D.C.? No? So we don’t need it here either.’” 

The economic collapse later that year gave the WHO the opportunity to push then-Russian President Boris Yeltsin to agree to a Russian office, should the situation deteriorate further. It was opened a year later.

Once in Moscow, Vienonen said he never had difficulty “saying what I thought.” 

“Sometimes we argued, but people accepted it. In general it was a good relationship with the Russians,” he said. 

Asked about his experience working with Russian data, he said: “The HIV statistics were the only ones that I had my questions with — it was a sensitive topic.” 

As Russia’s economy improved through the 2000s, and coffers swelled, health improved and life expectancy increased, the balance between Russia and the WHO began to shift. By 2013, it had become — in the WHO’s words —  “more equitable.”

“Russia is increasingly asserting its role in development, financial, environmental and security matters,” a 2014 WHO country strategy document for Russia outlined. From being a recipient of WHO aid, Russia was now “becoming an influential donor country.”

Experts fear that dynamic has pushed the balance decisively in Moscow’s favor. 

Today, Russia contributes around $35 million a year to the WHO — almost two-thirds of which is voluntary.

And while that may be small in terms of the WHO’s sprawling global programs — in 2019, Russia was only the 22nd largest donor and covered 1% of the WHO’s total budget — Russia’s investments have been strategic and reputation enhancing. 

Chief among them is its decade-long commitment to finance and host the WHO’s European Office for the Prevention and Control of Non-communicable Diseases (NCDs) in Moscow — a key part of WHO operations across 53 European countries.

“There’s no doubt Russia’s status has really increased over the years, and not just because of the increase in donations,” said Larisa Popovich, Director of the Institute for Health Economics at Moscow’s Higher School of Economics.

In addition to the cash, “Russia has placed experts in key positions on tuberculosis and non-communicable diseases,” said Judy Twigg, a professor of political science at Virginia Commonwealth University and expert on Russia’s healthcare system.  

“These investments have been a key part of Russia’s strategy of building global health leadership, even pre-Trump,” she added. 

The closeness of the Russia-WHO relationship has undoubtedly helped secure some key health successes, experts say. 

“It is obviously not all bad that Russia’s role is increasing,” said CSIS’s Morrison. “With fighting tuberculosis, they have actually gotten much better with the help of the WHO.” 

Since 2012, tuberculosis morbidity in Russia has decreased by more than 30% and mortality by more than 48%.

‘Weak organization’

But there are fears Russia’s growing ambitions in the global healthcare space — and increasing clout within the WHO — could railroad attempts to fix the WHO’s structural shortfalls, thrust into the spotlight by the pandemic.

Over the summer, French and German officials began lobbying to push through a package of reforms to better equip and fund the organization, giving the WHO more teeth, autonomy and impact in global health policy and practice, Reuters reported. 

“The WHO is a weak organization, and there is a public misalignment of expectations as to what it is capable of, versus what it can do with its authority,” Morrison said. 

“But Russia, unsurprisingly, is against reforming the WHO.”

In a speech to the UN, Russian President Vladimir Putin voiced his support for some kind of WHO reform. But Russia’s ideas appear to differ from the West’s — focusing on giving the WHO more cash, but not power or autonomy.

Russia’s G20 sherpa said last week the WHO was wrong-footed at the start of the pandemic, “simply because it was underfunded.” And Putin’s idea is that extra funding must come with higher accountability to individual countries, a Russian embassy official told Politico earlier this year. 

“The WHO needs to become more powerful. Right now it is too reliant on its members, it is very vulnerable,” said Vienonen. “But I dont think countries want to give away their autonomy.”

No reform efforts will get off the ground without consensus among WHO members. And Putin’s position highlights how tricky that will be — especially any reform that has Western fingerprints on it at a time when the Kremlin is skeptical of ceding power to multinational bodies.

Russia also has form for shutting down attempts at WHO reform. In the wake of the 9/11 attacks, the BRIC countries — Brazil, Russia, India and China — pushed back against U.S. attempts to beef up the organization’s ability to protect against bioterrorism threats, The Guardian reported. 

In a move that hinted at Russia’s desire to play down the WHO’s responsibilities, the country welcomed the organization’s decision in April to reverse an earlier appeal to allow aid organizations to cross the Iraq crossing into Syria to help combat the coronavirus pandemic. 

Reacting to the decision, Louis Charbonneau, U.N. director at Human Rights Watch said “The WHO should stand firm and not cave in to pressure from big powers. This is about saving lives, not avoiding criticism.”

No choice

The current structural and financial vulnerabilities, experts say, is what lies behind the WHO adopting soft public stances and being ultra-cautious over possibly spooking national authorities — be it in Beijing, Moscow or elsewhere. 

In the 2014 Ebola outbreak, for instance, the body took months to announce a public health emergency for fear of upsetting “three very small west African countries,” Charles Clift, a former WHO employee told The Atlantic.

“I would give mercy to Dr. Vujnovic,” said Vienonen. “She might have wanted to encourage Russia. No country has been perfect when handling the pandemic. It’s a bit like with children, you can’t be scolding them the whole time.

Vujnovic is also aware of the boundaries. When asked how she responds to the charge that the WHO is “too soft” on Russia, she told The Moscow Times: “The WHO has been very much looking into its constitution and to what we are allowed and not allowed to do, and we have very strict protocols on that.” 

“We are not here to say ‘do this or that’ or ‘respond to this or that.’ We are here to support all countries in the world to respond to this unprecedented challenge … We are not encouraging any country to do anything differently. That’s not our mandate.”

Experts admit that fulfilling that mandate often requires public tact and diplomacy. 

“The WHO doesn't have a goal to critique other countries. They are there to give advice, not critique,” said Popovich from the Higher School of Economics.

However some feel the lack of criticism has gone beyond diplomatic niceties and is harming the WHO. 

“Representatives have to keep good relations with governments. When you have good relations you can get your point across,” said Vasily Vlassov, an epidemiologist at the Higher School of Economics who was a consultant on the WHO’s European Advisory Committee on Health Research for 10 years.

“But the WHO in Russia is really pushing that strategy to the max. Sometimes it has been borderline embarrassing,” he said.