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Together with a group of Chinese scientists, they had to prepare a joint report on the nature of the virus and its spread in the world’s most populous country. On the first day of the trip, non-Chinese members met to discuss their alleged credentials, topics on which they intended to gather more information by visiting hospitals and research institutions.
It was February 16, more than a week after Uhan’s doctor, who received severe reprimands and accusations from local officials, attempted to warn himself of the virus after trying to warn colleagues of a dangerous new pathogen.
Li Wenliang’s death was sensational news in China, fueling a storm of outrage on social media and resonating with major international repercussions. But the group did not have to investigate whether the alerts were suppressed in Uhan, the epicenter of the virus at the time, in the first days of the outbreak. “It wouldn’t have helped,” Dale Fisher, an infectious disease specialist at the National University of Singapore and a member of the group, said in an interview. – Our task was to collect technical information and inform the rest of the world. From the common demands placed on us, it became clear that we would focus on the future, not the past. “
While such a decision certainly seemed rational to scientists, it also explained why, at a time when WHO is trying to coordinate the response to the worst pandemic in a century, the organization faces an unprecedented political challenge due to concerns based on its relationship with China. The Trump administration has recently tightened its rhetoric towards the organization, threatening to permanently suspend its funding and reconsider the issue of US membership. USA If the WHO is not involved in a radical transformation.
While such demands are similar to efforts to divert attention from the US’s own failures. USA In the fight against coronavirus, the White House is not alone in expressing concern: Australia and Canada have also called for an investigation into the origins of the pandemic and the WHO response.
Recently, the WHO International Governing Council approved plans to conduct an independent analysis of the response to the pandemic, including the role of the organization. Director-General Tedros Adhanom Ghebreyesus, a former Ethiopian health care official and the first non-doctor to hold the position, said he supported the study.
Even when D. Trump threatened the WHO, Chinese President Xi Jinping announced the agency’s base; China, as its economy grows, has dramatically expanded its influence over multilateral agencies. The president promised to spend $ 2 billion over two years to combat the virus, and said China will produce any universally available vaccine as soon as it is developed.
Although the name of the WHO itself is associated with health care and its delivery, the main function of an organization, especially during outbreaks, is to provide information, to find out as much as possible about what is happening at its epicenter and to tell the rest of the world how to respond.
Gro Harlem Brundtland
But critics of the organization are considering that the mission may have been over-tolerated in the first few weeks of the coronavirus pandemic because of the information Beijing wants to send to the world. If this is true, it could be a sign of an even bigger and more widely recognized problem: that WHO has little room for maneuver without the consent of its members.
There is no doubt that the group is doing a great deal of invaluable work. Its long history includes many achievements, from the complete eradication of polio to the successful management of Severe Acute Respiratory Syndrome (SARS) in 2003. During the current crisis, WHO is coordinating efforts to provide guarantees to developing countries and is working with partners, including the European Commission (EC), to discover a vaccine and develop medicines as soon as possible.
No in-depth study of its action on COVID-19 should justify the deficiencies of countries such as the United States and the United Kingdom in preparing for the outbreak. But in a world that will be far more alert than ever to the threat of infectious diseases in the near future, some experts are calling for a review of WHO’s mandates and protocols.
“Respect for the sovereignty of one country and of any other country should not be jeopardized,” said Thomas Bollyky, director of the Global Health Program at the Council on Foreign Relations and a former medical negotiator for the United States government.
Bruce Aylward
“Either WHO will have additional powers to act more aggressively and proactively during outbreaks, or we will have to find some other organization willing to do so,” he said. But it is necessary to take every opportunity to improve the institution’s epidemic management methods before considering something new, he emphasized.
The date of WHO’s establishment almost coincides with the establishment of the United Nations (UN) and the post-war order. Yes, in 1948. The preamble to the Constitution establishes that “the right to the enjoyment of the highest possible level of health is a fundamental right of every human being; The health of all nations is essential to maintain world peace and security. “
Such a bold mission has engaged the agency with a wide range of challenges, from measures to improve maternal health to immunization and assistance to refugees. The organization’s role in its early history was largely consultative, based on its legal basis; WHO is officially a bureaucratic unit of the World Health Assembly. As an exception, smallpox needs to be mentioned here, where the organization played a key role in coordinating efforts to eradicate the devastating disease that has plagued human populations since ancient Egypt.
However, events in the 1990s have exposed the dangers of new and little-known infections in a world experiencing rapid globalization. The 1995 Ebola outbreak in Qiquito, a city in what is now the Democratic Republic of the Congo, has claimed hundreds of lives, 80 percent. their murdered Thanks to the efforts of WHO and other agencies, the virus was brought under control, but the likelihood of even more devastating epidemics was evident, and the agency gradually assumed an increasingly active role. In 2000, she created the Global Outbreak Response and Alert Network (GOARN), a consortium of health authorities to monitor emerging diseases, and soon had the opportunity to be even more aggressive.
When an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in southern China in 2002, the Beijing government from the beginning tried to hide information about the disease and refused to report it to the WHO. The organization only became aware of the outbreak a few months after receiving an email notification of a contagious disease that killed more than 100 people in Guandong province in nearly a week.
At the time, SARS was already at its peak in Hong Kong, from where it spread to Toronto, which eventually recorded the highest number of cases outside Asia.
Margaret Chan
The then WHO Director-General, former Norwegian Prime Minister Gro Harlem Brundtland, criticized China’s actions, according to UN standards, saying that “it certainly would have been useful if international experts and WHO had been able to assist in an earlier stage. ” In addition, it issued the first WHO travel recommendations, calling to postpone the trip to certain parts of China and Toronto.
SARS, which has claimed nearly a thousand lives, has finally become a success story for the public health system, a unique example of how decisive action can stop the spread of a new disease and prevent it from becoming a devastating epidemic. However, efforts in 2005 to give WHO more powers, such as the formal sanction of countries that do not report outbreaks, have failed, and fundamental reforms in this area have failed. Member States simply did not want to give this type of tool to act.
And if WHO was to continue to serve as a global public health oversight body, it had to do so with limited resources. So-called mandatory contributions (bills automatically sent to all members) cover less than 20%. the remaining funds are raised voluntarily from governments and national organizations such as the Bill and Melinda Gates Foundation. The Centers for Disease Control (CDC) in the United States spends much more each year than the Cleveland Clinic.
Another Ebola outbreak, an explosion of infections in West Africa that began in 2014, demonstrated the WHO’s limited powers. The virus has been raging in Liberia, Sierra Leone, and Guinea for more than half a year since WHO declared an outbreak of a “international public health crisis” or PHEIC. Margaret Chan, then WHO Director-General, acknowledged that she was aware of the severity of the epidemic, which had already spread in all its severity, after receiving an email from her deputy, Bruce Aylward, urging the official to prioritize the theme.
WHO’s response has been so slow that World Bank (WB) President Jim Yong Kim has said the world needs a new service specifically dedicated to responses to disease. Finally, the most effective international response was possibly President Barack Obama, who mobilized CDC and the United States Agency for International Development (USAID) to fight the epidemic with the help of thousands of elite troops, and the outbreak. it was gradually controlled. More than 11,000 people died.
Chen recognized that the effort had not yielded the desired results. “We responded, but our response may not have matched the extent of the outbreak,” the official told Bloomberg News at the time.
At least in the early stages of the pandemic, the new coronavirus did not seem unprecedented. The flu-like virus, which originated in a Chinese province and spread to humans, most likely developed in bats and transmitted to humans through other animals, is a script from a textbook, which in part recalls to the contagion film Contagion. Exactly when the virus first appeared is still unclear, but in December, when it had already taken root in Wuhan, China’s response was different from SARS, at least according to the country’s observation.
City officials warned the WHO on New Year’s Eve, informing a group of patients with pneumonia of unknown origin. And the next day, the agency used its emergency response capabilities. “Beijing may not have withheld the information for several weeks, but the local government has clearly come too late in announcing a serious message,” Brundtland wrote in an email.
And China, on January 12, shares information about the sequence of the infectious genome, allowing scientists from other countries to develop their own tests and start researching on the vaccine.
However, China’s transparency was far from sufficient. For a long time in mid-January, just as major Communist Party meetings were held in Wuhan, the city did not report a single case, a level of control that seemed impossible to say the least. Government investigators continued to reiterate that there was no evidence of person-to-person transmission of the virus, although Chinese social media at the time was already full of rumors that some health workers had contracted the mysterious new disease.
On January 14, Maria Van Kerkhove, one of the researchers who heads the WHO crisis response team, said at a press conference in Geneva that the virus could have been transmitted from human to human in “limited extent”, and He noted that such infections would not come as a surprise in light of past experience. associated with other pathogens that cause respiratory diseases. But the same day, the WHO posted on its official Twitter account a message that was less ambiguous, haunting the agency thereafter: “According to preliminary investigations by Chinese authorities, there is no clear evidence that the virus is transmitted. from person to person”.
A group of people outside mainland China who could observe conditions in Wuhan were skeptical of the information received. A couple of infectious disease specialists from Taiwan visited Uhan with an official visit from January 12 to 15; Local authorities assured them that person-to-person transmission of the virus was, at worst, limited. But the fact that there have been cases of “non-wet markets,” the Huanan Market, where a group of coronavirus infections was first identified, “has shown that there is more than one source and that infections in society have already been possible. they are fixed, “said Chuang Yin-Qing, one of the specialists.
Maria Van Kerkhove
“These signs were a serious warning to us that we must be vigilant about the situation in China.” So when we returned from the trip, we offered to look at the situation as if it was already clear that people were infecting each other, ”he said.
No WHO official has publicly raised the possibility that China does not provide a complete picture of the current situation.
The organization appears to have “blindly published information released by China at a time when distance travel needed to be discussed,” said Stephen Morrison, director of the Center for Global Health Policy at the Center for Strategic and International Studies.
WHO officials say they have lobbied China behind closed doors to keep them informed, and that many countries have struggled to provide accurate figures on the number of infections and victims, often simply because hospitals are overcrowded. “Our sole objective is to ensure that the right decisions are made, not to find out who is to blame or not. Sometimes such discussions get very hot, but they are always based on respect,” said Bernhard Schwartlander, chief of staff, at a Interview: According to him, one aspect of the agency’s successful approach to China was that “there has never been a closed door. It is important. The worst for us and diplomatic negotiations is when the door is closed.
When China finally changed its tactics and recognized a coronavirus outbreak in a large-scale crisis, it warned the WHO, at the very least. On January 22, after a panel of approximately 20 senior advisers stopped to decide whether to raise the level of the coronavirus crisis to the highest level of danger, the group discussed what to do in the office of officials at the WHO. According to a source familiar with the situation, a staff member suddenly burst into the cabinet with dramatic news: China isolated Wuhan from the rest of the country, taking the first step towards the complete closure of Hubei province. In a meeting the next day, CEO Tedros Adhanom Ghebreyes said that he was not yet a IGC, but that it was an opportunity. The committee agreed to meet again shortly.
Around that time, the WHO Director-General was due to attend an important meeting. On January 28, he met Xi Jinping in Beijing, accompanied on the trip by Bernhard Schwartlander and Mike Ryan, manager of the emergency program. By the time they visited China, WHO had received one of the first clear and serious reports that the virus was transmitted beyond close contact. However, the news did not come from China, but from Germany, which had begun to monitor the outbreaks of infection (groups) in Munich.
Returning to Switzerland, the WHO group decided to convene senior executives to discuss whether it was time to announce the TMVSK. Speaking to reporters on January 30, after the agency had already made that decision, Tedros Adhanom Ghebreyesus spared no praise for China for his reaction; He stated that his response to the crisis was “wordless” and that he had left Beijing “without any doubt about China’s commitment to a policy of transparency and protection of the peoples of the world.”
Didier Houssin, chairman of the emergency committee, added that the WHO would carefully examine travel restrictions imposed by other countries, which the Xi Jinping government strongly opposed, with the intention of asking them to “reconsider such a decision.” Taiwan, Hong Kong, Australia and New Zealand were soon added to the list of countries that imposed such restrictions, all of which stood out in the successful fight against the pandemic. The experience of the United States, which at the same time introduced relatively weak travel restrictions, in the treatment of the outbreak is completely different.
Tedros Adhanom Ghebreyesus, Xi Jinping
However, China’s commitment to a transparency policy has not provided an opportunity to closely observe its response to the outbreak. It took over a week to negotiate who would be on the team and what their specific actions would be to get the WHO delegation into the country. According to Bernhard Schwartlander, it is generally necessary to convince a country that the WHO will come to help, not control, before sending in a group of experts. All parties are nervous in this context. “
The group, led by B. Aylward, a doctor who issued the WHO Ebola warning in 2014, and Liang Wannnian of the China National Health Commission, stayed in the country for more than a week, visiting research bases. and hospitals, talking to doctors, although only Wuhan was admitted. A small group of experts. Like Tedros Adhanom, they left without applauding for the successful fight against the virus. In their report, the group wrote that “China has demonstrated perhaps the most ambitious, intelligent, and aggressive effort to stop the disease in history,” ultimately protecting the world. The group not only praised the efforts of health professionals and ordinary citizens, but also highlighted China’s top leader.
“Secretary General Xi Jinping personally directed the prevention and control measures,” the report said.
Other countries no longer have to wait for WHO to provide information on the coronavirus. Now they have something to investigate: many of their own cases, especially in the United States, where Trump’s chaotic response has led to the world’s deadliest outbreak. However, some officials ask difficult questions about the agency’s performance. Australian Foreign Minister Marisa Payne announced in April that she shared some of the “United States’ concerns about WHO and that it should be one of the targets rather than the organizer of an international pandemic investigation.” Health Minister Greg Hunt expressed his discontent because “the response of some Geneva officials is, in our opinion, a response that has not helped the world.” after the imposition of measures. “
Tedros Adhanomas Ghebreyesus, Didier Houssin
An independent assessment of the response to the pandemic, including the role of WHO, will be launched “as soon as possible,” said the WHO Director-General. The resolution on the study was approved at a meeting of the World Health Assembly.
The investigation is unlikely to ease tensions with the United States, given that the White House has accused the WHO of not giving the coronavirus crisis a political priority in the run-up to the November presidential election. The country stands out from the rest, no other country has threatened to freeze funds for WHO and has not been so severely criticized, but it can hardly be ignored as the agency’s largest donor to date and a global center for health research. . “We want and seek strong scientific and strategic partnerships with the United States,” said WHO’s Ryan. “We cultivate this relationship.”
Although Democrats, including Democratic presidential candidate Joe Biden, largely defend the WHO, this position can be difficult to maintain if the impression is strengthened, in Washington and among the broader electorate, that it is too close to Beijing. Tedros Adhanom Ghebreyes did nothing to help himself in American politics when he said at a press conference in April that the Taiwanese government, a key American ally with active supporters in both parties and excluded from Chinese action by Chinese pressure, it did not distance itself from the WHO attacks. Against him.
The problems that WHO has recently faced have not deprived it of public support. Despite its limited budget, it offers a wide range of important programs, many in conflict zones and in the world’s poorest countries. Emerging markets “need WHO,” said Amadou Alpha Sallas, director of the Pasteur Institute in Dakar, Senegal. “There is always the possibility of working better, but as in the midst of a storm, they are doing well.”
It is also unclear what an updated WHO or any other organization that would replace it would look like. Australian Prime Minister Scott Morrison proposes to give WHO the power to send expert teams to investigate disease outbreaks without the necessary permission, the way military inspectors operate. The idea and related proposals that WHO should have the power to impose sanctions on member states, such is the power of the World Trade Organization (WTO), would undoubtedly be the most difficult to implement. Even those governments that are most active in advocating for WHO reform may refuse to receive that mandate.
Schwartlander called on member states to proceed with the reforms with caution. “It is an easy time to get angry because you have to give up everything and take a completely different path,” he said. “But the cost of such a change can be huge, as it could lead to a loss of consensus.”
Other proposed reforms are likely to be easier to implement. Health experts have long complained that the agency appoints regional leaders by secret ballot among member states, arguing that such practices may make them feel too committed to the governments that elected them. It may also be possible to restructure the WHO budget to make it less dependent on voluntary contributions and to provide more clarity on future resources.
However, countries seeking to reorganize WHO to save them from the effects of another pandemic may not be looking there. In the context of the current coronavirus crisis, which is still ongoing, the United States, like dozens of other governments, could have looked faster or more decisively in retrospect.
Searching for scapegoats, in Geneva or China, means not understanding the substance, said Marie-Paule Kieny, a former WHO official who is currently the director-general of the French Institute of Scientific Medicine, Inserm. “How long did it take for the United States government to see, understand, and report that there is a problem? She asked. – The Chinese government colluded in the first few weeks, but later “actively shared information, but unfortunately other countries did not take it seriously because they did not expect the infection to reach them.”
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