May 2, 2020


Attacked by Trump, underfunded by the world: Can the WHO survive the coronavirus?: Covid-19 will not be beaten without international co-operation. But with insular nationalism on the rise, where does the organisation go from here? (Ngaire Woods, May 1, 2020, The Prospect)

The WHO simply has to be trusted by governments to be effective. If a government hides information or refuses to take its advice, the WHO cannot send in an enforcement army. "Cosiness" with its member governments is not an optional indulgence, but hard-wired into the structure.

Consider why a government would notify the WHO of any outbreak of disease in the first place, knowing it could face costly and immediate cut-off from other countries, affecting travel and trade. This is why the WHO promises to oppose knee-jerk travel and trade restrictions against a country reporting disease, something it has been attacked for in the coronavirus context. But to do otherwise would be to encourage countries not to report, choking off the stream of information on which all hopes of a rational, cross-border approach to public health depend.

Things could have been far worse if China had regarded the WHO as hostile. As it was, Beijing first reported a cluster of cases of pneumonia in Wuhan on 31st December 2019. (Incidentally, and inconveniently for those who want to blame the coronavirus crisis on a WHO/Beijing stitch-up against the world, the Chinese government has since disciplined local officials for hiding the scale of infection prior to this.) The WHO was then quick to act. The next day, on 1st January 2020, as the head of China's centre for disease control briefed his counterpart in the United States, the WHO set up an Incident Management Support Team, putting its organisation on emergency footing.

After the initial reporting is out of the way, the WHO also needs the trust of governments so that countries share virus information. In February 2007, the world saw what happens when that trust wasn't there. During an international outbreak of swine flu, Indonesia stopped sharing H5N1 samples with the WHO, claiming--incorrectly--that the organisation was passing them on to pharmaceutical companies to make vaccines for which Indonesia would then have to pay very high prices. Without such samples, the WHO was hamstrung in what it could do for the immediately affected country--and the world beyond.

By contrast, in the current crisis, on 9th January the Chinese health authorities and the WHO announced the discovery of a novel coronavirus, known as 2019-nCoV, and over the weekend of 11th-12th January, the Chinese authorities shared the full sequence of the coronavirus genome. Consequently, by 16th January German researchers in Berlin had already developed a new lab test for the virus, soon followed by companies in South Korea. In both nations, preparations for rolling out large-scale testing for the virus began immediately, permitting these countries to follow WHO advice which was to prioritise testing in order to "intensify case finding, contact tracing, monitoring, quarantine of contact, and isolation of cases."

Other countries did not follow the WHO advice, and there was little the organisation could do. In the UK and the US, weeks went by without the adequate development and rollout of testing. Both were forced to limit testing severely as the virus spread. In the US, by 12th February the Centres for Disease Control and Prevention had to admit that its tests were not only inadequate in supply but defective. Even in late March, Public Health England was struggling to deliver enough tests, leaving thousands of health workers untested.

If the WHO were in the business of criticising governments it would have no shortage of governments to choose from. But it would not enhance global co-operation by playing "critic-in-chief." It can only function by understanding its role, which is to be entrusted by governments with the role of "adviser-in-chief"--a status that necessarily constrains the way it works.

Critics argue that the WHO was too slow to sound the full alarm bell on coronavirus. But the bitter experience of the WHO highlights how fraught that call can be. In 2010, the organisation was castigated for labelling swine flu a pandemic. That virus turned out not to be as dangerous as it feared. Five years later it was much more careful when Ebola broke out, and this time it was pilloried for not calling an international emergency faster.

As we are witnessing with the Sars-CoV2 virus, scientists do not quickly form a consensus on the epidemiology or likely trajectory of a virus. Debates are now raging about whether Covid-19 will die out or mutate into a more (or less) lethal form, about whether human beings will develop immunity to it, and if so, for how long.

Even where a sufficient weight of expertise settles into a consensus, the WHO is not automatically free to act on it. It cannot declare a "Public Health Emergency of International Concern" (PHEIC) without convening an Emergency Committee of experts to review the evidence and make a call, a restriction governments have imposed. The WHO convened such a committee on 22nd-23rd January and it failed to reach a consensus. Fortunately, it did not let matters rest. Instead, it despatched a senior delegation to China to gather more data and to call a second meeting of the Emergency Committee at which the experts gave approval to declare a PHEIC on 30th January.

The declaration of a PHEIC signals to the world that there is an ongoing epidemic or disease outbreak that is a serious risk to several countries, demanding a concerted response. It gives the WHO a mandate to act. The next step is for the WHO to escalate and declare a pandemic--which triggers direct action by individual governments. For an organisation that relies on goodwill and contributions from its members to be able to do anything effective, this can be a fraught call. If it calls a pandemic too early, it can lead to countries automatically triggering their pandemic preparedness plans. If the WHO turns out to have been wrong, governments may have committed to unnecessary expenditure. Worse, if there is a rushed recourse to off-the-shelf plans, they may not be appropriate to the specific virus, and especially where that virus is new, as with Sars-CoV2. that we react seriously and maturely to all threats, even if some of them fall short of the current outbreak. 

Posted by at May 2, 2020 8:19 AM