Thwarting the next global health catastrophe

Would an empowered World Health Organisation help prevent future pandemics?

Over 15 months after the Covid-19 pandemic began, the first review of how the world responded has just been published. There will be more local and regional reviews I have no doubt, but for now the World Health Organisation’s (WHO) response is the one under the microscope. The headline finding is that the WHO should have declared the new coronavirus outbreak in China an international emergency earlier than 30 January 2020. But the panel said the next month was “lost” as countries failed to take strong measures to halt spread of the novel virus. The independent experts called for bold WHO reforms and revitalising national preparedness plans to prevent another “toxic cocktail”.

“It is critical to have an empowered WHO,” panel co-chair and former New Zealand Prime Minister Helen Clark told reporters on the launch of the report ‘Covid-19: Make it the last pandemic’.

Co-chair Ellen Johnson Sirleaf, a former President of Liberia, said: “We are calling for a new surveillance and alert system that is based on transparency and allows WHO to publish information immediately.”

The SARS-CoV-2 virus, which emerged in the central Chinese city of Wuhan in late 2019, was allowed to evolve into a “catastrophic” pandemic, the report said.

“The situation we find ourselves in today could have been prevented,” said Johnson Sirleaf. “It is due to a myriad of failures, gaps, and delays in preparedness and response.”

Chinese doctors reported cases of unusual pneumonia in December 2019 and informed authorities, while WHO picked up reports from the Taiwan Centres for Disease Control and others, the panel said. But as the coronavirus began spreading across the globe, WHO’s top experts disputed how infectious the virus was, saying it was not as contagious as flu and that people without symptoms only rarely spread the virus. We now know that Sars-CoV-2 transmits even quicker than the flu and that a significant proportion of spread is from people who don’t appear to be sick.

WHO’s emergency committee should have declared an international health emergency at its first meeting on 22 January instead of waiting until 30 January, the report said. That committee did not recommend travel restrictions due to the limitations of WHO’s international health regulations, which need revamping: “If travel restrictions had been imposed more quickly, more widely, again that would have been a serious inhibition on the rapid transmission of the disease and that remains the same today,” it said.

The review was not entirely negative. It highlighted strengths on which to build a more robust system for the future: Health workers have been stalwart in their efforts. Doctors, nurses, midwives, long-term caregivers, community health workers, and other frontline workers, are still working tirelessly to protect people and save lives. It also said country wealth was not a predictor of success. A number of low- and middle-income countries successfully implemented public health measures, which kept illness and death to a minimum.

However, a number of high-income countries did not; vaccines were developed at unprecedented speed; and open data and open science collaboration were central to alert and response. The sharing of the genome sequence of the novel coronavirus on an open platform quickly led to the most rapid creation of diagnostic tests in history. The review also praised the “unstinting” efforts of WHO staff, including our own Dr Mike Ryan.

But the overarching message from the review is that the WHO is underpowered and underfunded and must be reformed to give it the resourcing to be more effective. You can sense a frustration with the traditional WHO approach of diplomacy over frankness, transparency, and accountability. In fact, you can almost smell the fustiness of an organisation that is still firmly embedded in the 1960s from the review.

For example, governments seemed unaware that the emergency declaration was WHO’s “loudest possible alarm” and that it, amazingly, has no authority to declare a pandemic (although it eventually described it that way on 11 March).
Individual countries reacted badly also. Instead of preparing their hospitals for Covid-19 patients, many countries engaged in a “winner takes all” scramble for protective equipment and medicines, the review said. But it did not name these countries.

One of the panels most important recommendations is that a new transparent global system should be set up for probing disease outbreaks, empowering the WHO to deploy investigators at short notice and reveal their findings.
And we must hope the Covid-19 catastrophe becomes a rallying cry to ensure governments invest in public health to prevent emergencies and be ready for the inevitable next pandemic.