Expert Speak Health Express
Published on May 03, 2020
Although, plentiful has been written about China’s inaction during the early days of the outbreak of this pandemic, there is scant mention of WHO being held accountable for its tardy response which has denied the world the critical time it needed to prepare for the crisis. An early action by the WHO, declaring COVID-19 as a PHEIC (Public Health Emergency of International Concern) followed by promulgation of detailed strategy for its containment and advising governments on policy matters would have saved many innocent lives across the world.
Tardy response to COVID19 pandemic: WHO in dire need of reforms

The first positive case of Coronavirus was detected in Wuhan, China on 17 November 2019, however, it wasn’t until 31 December 2019 that China reported these to the World Health Organisation. The dissemination of this critical information was delayed by almost a month and a half by the Chinese authorities to safeguard vested interests. Further, WHO on its part, took another month to declare COVID-19 a Public Health Emergency of International Concern (PHEIC), in spite of positive cases being reported as early as 20 Jan 2020 from Japan, South Korea and Thailand. By 23 Jan 2020, travel restrictions were already in place in Wuhan; 17 people had reportedly died and more than 570 others had been infected including in Taiwan and the United States. Eventually, PHEIC was declared by WHO on 30 Jan 2020.

If the delayed reporting of COVID-19 cases by China was contemptible, the response by WHO, being the apex-level specialized agency for global health, was indeed deplorable. Considering the contagious nature of the pandemic and the rapidity of its transmission, this avoidable delay has proved detrimental to lives across the globe with disastrous consequences. When dealing with an outbreak, time and timing are of paramount importance; an early warning can exponentially enhance the possibility of containing the contagion.

There is no denial of the fact that the outbreak of the pandemic was in China. However, it is the institutional cover up by the Chinese authorities immediately after the outbreak and the blatant intimidation of doctors, scientists and journalists alike some of whom were its own, that is most appalling. The Chinese Communist Party concealed important information about the spread of the virus and the world paid the price for it with tragically high number of death cases and many more infected. WHO, on the other hand, owing to ulterior motives, failed to flag these relevant concerns internationally. Instead of holding the Chinese government accountable for the avoidable lapses and inept handling of the situation during the intervening period between testing of the first positive case (17 Nov 2019) and reporting the same to WHO (31 Dec 2019), the UN International health body chose to ludicrously commend China for the praiseworthy efforts in containing the outbreak.

It was a fitting moment to build international pressure on China and hold her accountable for the false narrative built around the outbreak of the virus and the ensuing response strategy. But the WHO chose to keep mum. Not only was the WHO in congruence with chronicling of China’s efforts, it also chose to kowtow the inaccurate account put out by China in the public domain by downplaying the threat of coronavirus, taking painfully long to classify it as a PHEIC. This tardy and malfeasance act resulted into preventable misery, denying the world critical time needed to implement measures for the early containment of the pandemic.

WHO’s mandate entails promoting universal healthcare, monitoring public health risks and coordinating responses to public health emergencies. The World Health Assembly, the governing body of WHO, adopted the International Health Regulations (IHR 2005), which is a legally binding instrument with an aim to prevent, protect, control and provide a public health response to the international spread of disease. Article 6 of IHR (2005) mandates that each state party shall notify WHO of all events which may constitute a PHEIC within 24 hours of assessment of public health information. Quite clearly, response by the Chinese government in the extant instance was in breach of IHR regulations with the WHO acting as a mute spectator in spite of its country representative being stationed in Beijing.

WHO has been heavily politicized and is in dire need of specific reforms. The UN Secretary General’s remark in UNSC 2015 during the High-Level Panel convened by his office on the Global Response to Health Crisis rang the alarm bells when he stated that WHO’s inability to reform would result in thousands of deaths in the next pandemic which otherwise can be averted. During the special G20 summit held via video conferencing on 26 March 2020, Indian Prime Minister Narendra Modi shared similar concerns and backed early reforms to the UN agency.

WHO needs a leader with strategic vision and foresight. Dr Tedros Adhanom Ghebreyesus, the current DG of WHO, has been widely criticised for showering praises on China for its political leadership and transparency despite its lackluster performance in dealing with the pandemic. In stark contrast, the handling of SARS outbreak in 2003 strengthened WHO’s image under the leadership of Dr Gro Harlem Brundtland, the fifth DG of WHO.

SARS with its epicenter in South China, was the first infectious disease of the 21st century, with unknown origin and treatment; posing a threat to the health governance framework infecting 8,098 people across 26 countries and claiming 774 lives. While all SARS affected countries self-reported, the only country not doing so was China. With the increased number of new cases, WHO scaled up the investigation in eleven laboratories across ten countries to identify the causative agent of SARS. Ominously, the resistance by the Chinese government was a concern with no data having been shared for almost a month. What was even more appalling was WHO not being granted the permission to examine ground zero in Guangdong, China for gathering epidemiological evidence.

On 2 April 2003, WHO proactively imposed travel restrictions for Hong Kong and Guangdong. It was only on 4 April 2003 that the Chinese government accepted their failure to report cases. WHO took the lead and contributed to the success of containing the spread of SARS by performing real time epidemic surveillance and sharing updated statistics of its severity, advising governments on policies and assessing and coordinating global events.

WHO usually does not criticize its members, but throughout the SARS event, it resorted to strong condemnation of the unsupportive attitude of China and played the role of government evaluator which was a bold act. WHO’s chief representative in Beijing too criticized the Chinese government for being uncooperative and also highlighted that inadequate investments in health by the government had hindered the response mechanism. The Chinese Government was publicly confronted and rebuked by Dr Gro Harlem Brundtland who accused them of delayed involvement during the SARS pandemic. Such was the severity of the backlash that the Chinese Health Minister was forced to resign for concealing the extent of spread of the virus. The Mayor of Beijing, too, was fired for underreporting the virus.

The containment of SARS in just four months of WHO’s involvement despite its unknown origin and pathogen is an epic instance of an efficient global collaboration and is undeniably observed as one of the greatest triumphs since the eradication of smallpox. Strong-willed and decisive leadership as exhibited by WHO during the SARS episode is required even today.

The need for timely action during an outbreak of such severity cannot be overemphasized. An early warning system followed by cogent direction can help save many lives. Even on this account, WHO has failed to keep pace with the technological progress made elsewhere. Bluedot, a Canadian health monitoring firm tracked the spread of COVID-19 using big data analytics and alerted the world on 31 Dec 2019; much before WHO designating it as a PHEIC. Shouldn’t the WHO have acquired this technical expertise beforehand, especially when innocent lives worldwide were at stake? Notwithstanding, WHO should definitely have fared better with its response and containment strategy, particularly when it prides itself in being the international health body with a clear mandate and authority to tackle public health emergencies.

WHO is begging for reforms. Nonetheless, now is not the time to undertake sweeping transformations, for the world needs concerted efforts to defeat this pandemic. Surely though, when the dust settles down, WHO must reinvent itself if such a calamity is to be prevented from re-occurrence. WHO must distance itself from politics and focus on policy provisions and their strict compliance. Newer technologies must be amalgamated with existing processes and decision-making must be driven by evidence based approach, rather than being held hostage by the political and economic interests of totalitarian regimes. It’s time to talk tough!

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Meenakshi Sharma

Meenakshi Sharma

Meenakshi Sharma is a health policy specialist with over 13 years of experience in public health. She has worked extensively in the development sector in ...

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