WHO failings

The WHO has almost 200 member countries.

On 22nd Jan the WHO Director-General convened an Emergency Committee (EC) to assess whether the outbreak constituted a Public Health Emergency of International Concern (PHEIC). The member states on various committees make decisions and the Executive (including the DG) take action on those decisions.

So, at this meeting the 15 independent members (and 6 advisors) from around the world could not reach consensus on whether to call a PHEIC, the highest level of WHO alert. The opinions/votes of individual member countries are not known (secrecy provisions); it is understood that some felt that a PHEIC call was too extreme and would have preferred an alert that was not as major. But that’s not in their menu, and perhaps that’s a problem? Or perhaps they wanted to institute PHEIC, but some member states were under pressure from their governments? We’ll never know, and that lack of transparency is an issue.
The EC asked to be reconvened in 10 days.

On the 30th January the DG reconvened the EC. This was two days after the first reports of limited human-to-human transmission were reported outside China. This time, the EC members reached consensus and decided to declare the outbreak a PHEIC.

As soon as this happened, member countries started to implement their own action plans.

Immediately, many countries starting restricting travel from China, and some airlines stopped flying there. At this stage, WHO was against this approach: “Travel restrictions can cause more harm than good by hindering info-sharing, medical supply chains and harming economies. The WHO recommends introducing screening at official border crossings. It has warned that closing borders could accelerate the spread of the virus, with travellers entering countries unofficially.”

Unfortunately, screening at border crossings would not have worked. Due to the move to just-in-time ordering, western countries didn’t have enough tests (or PPE). Hospitals would not have coped with the influx of patients and many sick people would have had to be quarantined. (Countries, such as Singapore and Hong Kong, that were hit by SARS back in 2002-4 were well-prepared and knew what a pandemic would mean, but other countries were caught flat-footed.) Six weeks later, we also know that many infected people are asymptomatic for quite some time (like Patient 0 in Italy), so the screening would not have caught all carriers in any case.

 

From 16th to 24th Feb: The WHO-China Joint mission, which included experts from Canada, Germany, Japan, Nigeria, Republic of Korea, Russia, Singapore and the US (CDC, NIH) spent time in Beijing and also travelled to Wuhan and two other cities. They spoke with health officials, scientists and health workers in health facilities (maintaining physical distancing). The report of the joint mission can be found here: www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf From the report:

The COVID-19 virus is a new pathogen that is highly contagious, can spread quickly, and must be considered capable of causing enormous health, economic and societal impacts in any setting. It is not SARS and it is not influenza. Building scenarios and strategies only on the basis of well-known pathogens risks failing to exploit all possible measures to slow transmission of the COVID-19 virus, reduce disease and save lives.

and

Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society.

Given the damage that can be caused by uncontrolled, community-level transmission of this virus, such an approach is warranted to save lives and to gain the weeks and months needed for the testing of therapeutics and vaccine development.

These are strong words; about as strong as it gets. Was this report read, understood, and acted on in all countries?

By 24th Feb, Italy had 219 cases and 5 deaths. Canada had 11 cases.

Singapore, South Korea, Hong Kong and Taiwan had already implemented strong (though varying) responses.

In the US, on the 25th, all US Senators were briefed on the virus by the Department of Health and Human Services, Department of Homeland Security, Centers for Disease Control and Prevention, National Institutes of Health and the State Department.

So yes, there are some problems. Having just one level of major alert–the PHEIC–is possibly an issue. Once declared, actions countries are likely to take in response are bound to cause major disruption. There would always be blow-back, and representatives or member countries would want not want to be seen to be crying wolf. The decision-making process requires consensus, which is always difficult when there are only two binary options–call the alert or don’t. No middle ground. Even a single member country with a representative on the Emergency Committee could block the alert. And we would never know which country/ies chose to do that, so there is no accountability. It’s too opaque. It’s a less than ideal process.
It will be up to member states to make these changes and let’s hope they do.

 

h/t Sonerous