MESSAGE
| DATE | 2020-08-30 |
| FROM | Ruben Safir
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| SUBJECT | Subject: [Hangout - NYLXS] WHO failure
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wsj.com
How Coronavirus Overpowered the World Health Organization
Betsy McKay and Drew Hinshaw
23-29 minutes
GENEVA—Sylvie Briand landed in China looking for answers. Nearly a month
had passed since word of a mysterious pneumonia had emerged. It was now
late January and the World Health Organization was struggling to learn
more about it.
They met with President Xi Jinping. They had a phone call with local WHO
staff just back from the Wuhan epicenter, quarantined after one
developed a cough. Dr. Briand, the agency’s director of global
infectious hazard preparedness, drew up a list of questions for Chinese
health officials.
By the time the WHO received answers, the Covid-19 pandemic was
stumbling into emergency rooms on three continents. Its spread around
the world had already begun on Jan. 30 when the WHO declared a global
public-health emergency, its one and only level of alert.
The announcement was a dud. Few countries paid enough attention.
Over the next weeks, the WHO warned nations the virus was headed their
way. “Now is the moment for all countries to be preparing themselves,”
Director-General Tedros Adhanom Ghebreyesus declared on Feb. 4, when the
WHO reported more than 20,600 cases in 25 countries.
The WHO’S Tedros Adhanom Ghebreyesus, center, with Michael Ryan, head of
the health emergencies program, and Sylvie Briand, director of global
infectious hazard preparedness, on Feb. 5.
Photo: Salvatore Di Nolfi/Keystone/Associated Press
But that same day, the WHO also asked nations not to close
borders—following its standard protocol, as such restrictions might
discourage governments from reporting outbreaks. Within weeks, the virus
landed on the agency’s doorstep, turning Geneva into a hot spot. By
March, Dr. Briand, a physician, was quarantined in her own apartment,
tending to her husband and teenage son, who had become infected at school.
“Very frustrating,” she said. “Everybody realized, we are not talking
about theoretical threats.”
The WHO spent years and hundreds of millions of dollars honing a
globe-spanning system of defenses against a pandemic it knew would come.
But the virus moved faster than the United Nations agency, exposing
flaws in its design and operation that bogged down its response when the
world needed to take action.
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THE COVID STORM
The Wall Street Journal is examining the causes of the Covid-19
catastrophe and the bungled response that followed. Get alerts for each
new installment, along with our daily coronavirus briefing.
The WHO relied on an honor system to stop a viral cataclysm. Its member
states had agreed to improve their ability to contain infectious disease
epidemics and to report any outbreaks that might spread beyond their
borders. International law requires them to do both.
Time and again, countries big and small have failed to do so. The WHO,
which isn’t a regulatory agency, lacks the authority to force
information from the very governments that finance its programs and
elect its leaders. It can’t parachute disease-fighting teams to an
outbreak unless a government invites it. And years of painstakingly
worded treaties, high-level visits and cutting-edge disease
surveillance—all meant to encourage good-faith cooperation—have only
bitten around the edges of the problem.
“It doesn’t have a mandate to investigate,” said J. Stephen Morrison,
director of the global health policy center at the Center for Strategic
and International Studies in Washington. “It can’t demand entry into a
country because they think something bad is happening.”
Nearly 200 countries were counting on an agency whose budget—roughly
$2.4 billion in 2020—is less than a sixth of the Maryland Department of
Health’s. Its donors, largely Western governments, earmark most of that
money for causes other than pandemic preparedness.
In 2018 and 2019, about 8% of the WHO’s budget went to activities
related to pandemic preparedness. Nearly three times that amount was
budgeted for eradicating polio, a top priority for the WHO’s two largest
contributors: the U.S. and the Bill & Melinda Gates Foundation. Its
headquarters’ staff numbers 2,500, spread across a range of diseases.
Medical staff transfer patients in Wuhan on Jan. 17.
Photo: Getty Images
To write its recommendations, the WHO solicits outside experts, which
can be a slow process. It took those experts more than four months to
agree that widespread mask-wearing helps, and that people who are
talking, shouting or singing can expel the virus through tiny particles
that linger in the air. In that time, about half a million people died.
The agency’s actions in the Covid-19 pandemic are now a subject of an
international review, with nearly all member states calling for an
accounting of early missteps.
A review of the WHO’s initial response to the pandemic, based on
interviews with current and former WHO staff, public-health experts
advising it and officials who work with it, suggests that the agency’s
bureaucratic structure, diplomatic protocol and funding were no match
for a pandemic as widespread and fast-moving as Covid-19.
In particular, The Wall Street Journal found:
* China appears to have violated international law requiring governments
to swiftly inform the WHO and keep it in the loop about an alarming
infectious-disease cluster. Those laws were written so that governments
could break them with impunity—there are no clear consequences for
violations.
* The WHO lost a critical week waiting for an advisory panel to
recommend a global public-health emergency, because some of its members
were overly hopeful that the new disease wasn’t easily transmissible
from one person to another.
* The institution overestimated how prepared some wealthy countries
were, while focusing on developing countries, where much of its ordinary
assistance is directed.
“Retrospectively, it’s always easy to reinterpret the facts,” said Dr.
Briand. “I was in the middle of the storm myself….It was like driving at
400 kilometers per hour. You don’t see the landscape when you are at
this speed.”
The U.S. intends to withdraw from the organization next year. President
Trump has said the agency responded too slowly to the pandemic and
wasn’t tough enough on China. Democratic presidential candidate Joe
Biden has pledged to keep the U.S. in the WHO.
Public-health leaders say the WHO plays a critical role in global
health, leading responses to epidemics and setting health policies and
standards for the world. It coordinates a multinational effort every
year to pick the exact strains that go into the seasonal flu vaccine,
and has provided public guidance and advice on Covid-19 when many
governments were silent.
“We sounded the alarm early and we sounded it often,” Dr. Tedros
repeated during thrice-weekly news conferences.
It is up against a particularly contagious pathogen that has flummoxed
some of the world’s best-resourced health agencies. Many institutions
were slow to realize that the new coronavirus was spreading before its
victims showed symptoms, helping it slip through fever checkpoints at
the borders the WHO encouraged to stay open.
Frightening news
The world’s public-health agency was born weak, created in 1948 over
U.S. and U.K. reluctance. For decades, it was legally barred from
responding to diseases that it learned about from the news. Countries
were required to report outbreaks of only four diseases to the WHO:
yellow fever, plague, cholera and smallpox, which was eradicated in 1980.
A measles vaccination campaign led by the WHO in India, 1974.
Photo: nik wheeler/Sygma/Getty Images
In early 2003, the WHO confronted some frightening news. A strange new
pneumonia was spreading from China to other countries.
The WHO immediately issued global alerts and the agency’s chief, Gro
Harlem Brundtland, publicly scolded China for not reporting the new
disease, called severe acute respiratory syndrome, before it jumped borders.
SARS convinced governments to retool the WHO. The next year, delegates
arrived in the Geneva palace where the League of Nations once met to
resolve a centuries-old paradox: Countries don’t report outbreaks,
because they fear—correctly—their neighbors will respond by blocking
travel and trade.
As months rolled on, it became clear that governments were reluctant to
allow the U.N. to scold, shame or investigate them. An early draft
included blunt language allowing the WHO to call out countries that
don’t share information on a potential outbreak, said Gian Luca Burci,
then a WHO senior legal officer: “Everybody pushed back. No sovereign
country wants to have this.”
China wanted an exemption from immediately reporting SARS outbreaks. The
U.S. argued it couldn’t compel its 50 states to cooperate with the
treaty. Iran blocked American proposals to make the WHO focus on
bioterrorism. Cuba had an hourslong list of objections.
Around 3:15 a.m. on the last day, exhausted delegates ran out of time.
The treaty they approved, called the International Health Regulations,
imagined that each country would quickly and honestly report, then
contain, any alarming outbreaks. In return, the treaty discouraged
restrictions on travel and trade. There would be no consequences for
reporting an outbreak—yet no way to punish a country for hiding one.
The treaty’s key chokepoint: Before declaring a “public health emergency
of international concern,” or PHEIC, the WHO’s director-general would
consult a multinational emergency committee and give the country in
question a chance to argue against such a declaration. Delegates agreed
this could give some future virus a head start but decided it was more
important to discourage the WHO from making any unilateral announcements
that could hurt their economies.
WHO instructors train new health workers in Liberia during the Ebola
epidemic in 2014.
Photo: John Moore/Getty Images
Over the next few years, emergency committees struggled over how to
determine whether an outbreak was a PHEIC. It took months to declare
emergencies for two deadly Ebola epidemics. Yet the WHO declared one
when a few hundred polio cases imperiled an eradication push.
Early warning
Just before dawn on Dec. 31, reports started streaming in on a
multimillion-dollar early-warning system, which scans the internet for
keywords. The reports were translations of health notices from officials
in the city of Wuhan to hospitals that had been leaked to Chinese media.
“The South China Seafood Market in our city has seen patients with
pneumonia of unknown cause one after another,” read one.
“Whether or not it is SARS has not yet been clarified, and citizens need
not panic,” read another.
A short notice in Chinese soon followed on the website of the Wuhan
Municipal Health Commission, reporting 27 cases. “The investigation so
far has found no obvious person-to-person transmission,” read the
notice, which has since been deleted. Another sentence suggested the
opposite: “Avoid closed public places and crowded places with poor air
circulation.”
The WHO’s electronic system receives hundreds of notices daily. Still,
“every time we see a cluster of unexplained pneumonia, especially in
China, it always catches our attention,” Dr. Briand said. Anything
beyond five cases was cause for alarm.
Following protocol, the WHO formally requested verification from Chinese
health officials. By now it was Jan. 1.
On Jan. 3, representatives of China’s National Health Commission arrived
at the WHO office in Beijing. The NHC acknowledged a cluster of
pneumonia cases, but didn’t confirm that the new pathogen was a
coronavirus, a fact Chinese officials already knew. That same day, the
NHC issued an internal notice ordering laboratories to hand over or
destroy testing samples and forbade anyone from publishing unauthorized
research on the virus.
China’s failure to notify the WHO of the cluster of illnesses is a
violation of the International Health Regulations, said Lawrence Gostin,
professor of global health law at Georgetown University who has advised
the WHO on international health regulation matters. “Once a government
knows that there is a novel virus that fits within the criteria, which
China did, it’s obliged to report rapidly,” he said.
China also flouted the IHR by not disclosing all key information it had
to the WHO, said David Fidler, an expert on global health and
international law at the Council on Foreign Relations. The regulations
call for member states to provide the WHO with “timely, accurate and
sufficiently detailed public health information available to it on the
notified event.”
When asked for comment, the National Health Commission pointed to a
Chinese government white paper that said China reported the new virus
“in an open, transparent, and responsible manner and in accordance with
the law.”
The WHO said it’s up to member states to decide whether a country has
complied with international health law, and that the coming review will
address those issues.
In Geneva, the WHO’s emergency response team had been meeting since Jan.
1, searching for evidence the disease was spreading between people,
infecting more than those who had been at the seafood market where the
early cases originated. The agency’s infectious disease experts were
convinced it was.
The WHO’s Maria van Kerkhove on Jan. 29.
Photo: Martial Trezzini/Keystone/Associated Press
“Whenever you hear of a cluster of atypical pneumonia you think
respiratory and you think human-to-human transmission,” Maria van
Kerkhove, a specialist in Middle East respiratory syndrome and now the
WHO’s technical lead for the Covid-19 response, said in a May briefing.
“It’s not if—it’s just what is the extent?”
While Chinese scientists had sequenced the genome and posted it
publicly, the government was less forthcoming about how patients might
be catching the virus. WHO scientists pored over data they did get, and
consulted with experts from national health agencies, including the CDC,
which has 33 staff detailed to the WHO.
Then a 61-year-old woman was hospitalized in Thailand on Jan. 13. She
had been in Wuhan, but not at the seafood market. That was strong
evidence that the virus was spreading from human to human.
The next day, Dr. van Kerkhove told reporters: “It’s certainly possible
that there is limited human-to-human transmission.” MERS and SARS, both
coronaviruses, were transmissible among people in close quarters.
Epidemiological investigations were under way, she said.
Emergency declaration
Six days later, China acknowledged that there was human-to-human
transmission. Dr. Tedros convened an emergency committee to determine
whether to declare a global public-health emergency.
On Jan. 22, a committee of 15 scientists haggled for hours over Chinese
data and a handful of cases in other countries. Clearly, the virus was
spreading between people in China, though there was no evidence of that
in other countries. The question now: Was it mainly spreading from very
sick people in hospitals and homes—or more widely?
The committee met over two days, but was split. They mostly agreed on
one point: The information from China “was a little too imprecise to
very clearly state that it was time” to recommend an emergency
declaration, the committee chair, Didier Houssin, said in a news
briefing after the meeting ended.
Meanwhile, a team of five WHO staff had just toured Wuhan. Case counts
would likely increase, potentially into thousands, reported the team,
which had begun to understand a crucial phenomenon: Many cases were
mild. They asked if China needed the WHO’s help. Then one member
developed a cough, and the team was quarantined.
With so many unanswered questions, Dr. Tedros decided to go to China
with a small entourage. They rushed on a weekend to get visas and catch
a flight to Beijing.
On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with
Mr. Xi. Dr. Briand was overtaken by the enormous room and the formality
and protocol.
Leaning across three wooden coffee tables, Dr. Tedros pressed for
cooperation. In the absence of information, countries might react out of
fear and restrict travel to China, he repeated several times throughout
the trip.
Mr. Xi agreed to allow a WHO-led international team of experts to visit.
It took until mid-February to make arrangements and get the team there.
Dr. Tedros and Xi Jinping at the Great Hall of the People in Beijing,
Jan. 28.
Photo: Naohiko Hatta/Press Pool
China also agreed to provide more data, and Dr. Tedros departed, leaving
Dr. Briand behind with a list of mysteries to solve. How contagious was
the virus? How much were children or pregnant women at risk? How were
cases linked? This was vital information needed to assess the global
risk, Dr. Briand said.
Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it
was clear there was human-to-human transmission in other countries. When
it met on Jan. 30, the committee got the information the WHO had been
seeking. This time the committee recommended and Dr. Tedros declared a
global public-health emergency.
The emergency was the sixth the WHO had ever declared. The announcement
was the biggest cannon in its arsenal.
In the weeks to come, Germany’s Angela Merkel remained focused on
repairing a faltering border-control agreement with Turkey.
President Trump and New York Gov. Andrew Cuomo both assured constituents
their health systems would perform well.
The U.K.’s chief medical officer described the WHO’s advice as largely
directed at poor and middle-income countries.
As for keeping borders open, by then many governments had already closed
them to visitors from China.
The WHO shifted focus to the developing world, where it believed
Covid-19 would exact the heaviest toll. To its surprise, cases shot up
just across the border, in northern Italy.
A WHO doctor visits a lab in Ghana where samples of Covid-19 are tested.
Photo: Nana Kofi Acquah/Blink Media/WHO
Hospitals there overflowed with desperately ill patients. Soon, the
virus tore through a nursing home in Kirkland, Wash., and ravaged New
York City.
To date there have been 24 million cases world-wide, nearly a quarter of
those in the U.S. More than 822,000 people have died.
Lessons learned
If there were one thing the WHO might have done differently, it would be
to offer wealthier countries the type of assistance with public-health
interventions that the WHO provides the developing world, Michael Ryan,
head of the WHO’s health emergencies program, said in a media briefing
last month.
An intensive care unit at a Wuhan hospital, Feb. 6.
Photo: /Associated Press
Going forward, an independent committee will review parts of the
International Health Regulations, Dr. Tedros said Thursday. The
committee will advise him on whether changes “may be necessary to ensure
this powerful tool of international law is as effective as possible,” he
said.
“The pandemic has been an acid test for many countries and organizations
as well as for the International Health Regulations,” he said.
Many global-health experts, including Dr. Tedros, say the WHO’s warning
system of declaring a global public-health emergency needs to change.
Some want to see a warning system more like a traffic light—with
color-coded alarms for outbreaks, based on how worried the public should
be. A flare-up of polio or Ebola isn’t the same as a rapidly spreading
new respiratory virus. One afflicts a region; Covid-19 swept the world.
Emergency committees need clearer criteria for declaring a global
public-health emergency and should publicly explain their thinking,
according to a recent study in the BMJ Global Health, which found past
decisions inconsistent.
The WHO should have more powers to intervene in countries to head off a
health crisis, said Jimmy Kolker, a former U.S. ambassador and former
assistant secretary for global affairs at the U.S. Department of Health
and Human Services. He also said that the WHO’s health emergencies unit
should report to the director-general and not member states, and its
budget should be protected so it doesn’t have to compete with other
programs for money.
Implementing many of those ideas would require herding diplomats back
for another monthslong slog of treaty revisions. If and when such talks
begin, new governments will likely be in place, and political priorities
will float elsewhere, said Adam Kamradt-Scott, a global health security
scholar at the University of Sydney who sat through the last round.
“Unfortunately, I’m very cynical about this,” he said. “We are living
through cycles of panic and neglect. We’ve been through all of this before.”
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