Covid-19 has exposed global deficiencies in the response to dangerous infectious diseases and the international system will need to be strengthened to raise alerts and deal with future outbreaks, according to Helen Clark, co-head of an international panel investigating the pandemic.
Despite the novel coronavirus emerging in a world with rapid communication services, it was notable how slow the global response to the outbreak was after it was first detected in China, said Clark, a former prime minister of New Zealand and one-time head of the United Nations Development Programme.
“Every day counts if you are trying to stop an infectious disease of unknown origin,” she said in an interview with the South China Morning Post. “There just doesn’t seem to be enough happening quickly enough, from the time of first awareness of the cluster onwards, and here we are.
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“The WHO didn’t have all the information it needed, and – let’s be fair here, we are still discovering things about Covid-19 every day, we are on a very steep learning curve – but all the more reason, I would think, for applying a precautionary principle. If it smells bad, it may well be bad,” she said, referring to the early days of the pandemic.
The Independent Panel for Pandemic Preparedness and Response, headed by Clark and Nobel Peace Laureate and former president of Liberia, Ellen Johnson Sirleaf, released an interim report last month stating that the World Health Organization lacked the authority to do the job expected of it. It added that the international alert system for health emergencies was outmoded in today’s data-driven world and that a global reset was needed for pandemic preparation.
Such critiques have been made before but the panel, which comprises 13 prominent diplomats, former leaders and health experts, including China’s top Covid-19 scientist Zhong Nanshan, hopes this time they will stick.
The reasoning is compelling. On January 30, 2020, WHO director general Tedros Adhanom Ghebreyesus declared Covid-19 a public health emergency of international concern. One year on, there have been more than 100 million infections, more than 2 million related deaths and the sharpest economic contraction since the Great Depression in the 1930s.
But the panel’s initial findings have been criticised by Beijing. In particular, its finding that China’s authorities could have applied health measures more forcefully in January last year stands in contrast to China’s own portrayal of its response as a global model.
The panel’s report must be “improved”, said Sun Yang, a member of China’s National Health Commission and the country’s representative to the WHO executive board meeting in Geneva last month.
Clark said countries could give their feedback to the panel but “in the end we are going to be guided by the evidence and what we can establish as fact, and then we can look for the gaps in response – and we think there are gaps”.
Clark pointed out there were several days between the identification of the first cluster of cases in the Chinese city of Wuhan towards the end of December and when an alert was put out by the local government, and then a further gap until the WHO received information from Beijing on January 3.
She noted that disease alerts were already going out on other forums, such as the ProMed online outbreak monitoring system, which picked up Wuhan’s December 31 alert and blasted it through its global network via email.
“The reality is that the signals were picked up by ProMed, by others … but then you need to have a system that will act on it, at national level, at global level and at every other country level,” Clark said.
The panel is also investigating why a public health emergency of international concern was not declared earlier in January by the WHO. The New York Times reported that China lobbied other governments against declaring such an emergency, citing unnamed diplomats and health officials.
But a significant problem, Clark said, was that even when the all-important signal was sent it “didn’t trigger a frenzy of activity” by countries scrambling to prepare for the virus.
“February is like a blank space in a lot of the world, because that’s when the world is sitting and watching the measures in Wuhan almost as if it couldn’t happen to it,” she said.
One subject at the fore of the panel’s work is the WHO’s power to check into reports of disease outbreaks and deploy support to local areas, which the report says is “gravely limited”. The UN body is dependent on member states for such access, a legal limitation on its ability to deal with health emergencies.
“If it were accepted [by member states] that the WHO needs access and needs information then it becomes much more transparent whether it is cooperated with, at the moment it’s behind a bit of a curtain,” Clark said.
Outside observers have long called for such reforms, but also question how feasible they may be to achieve.
Lawrence Gostin, director of the WHO Collaborating Centre on National & Global Health Law at Georgetown University in Washington, said member states would push back against “any perceived interference with sovereignty”.
“But the world has suffered unimaginably from this pandemic. The crisis should lead to an opportunity to strengthen WHO and the international health regulations,” Gostin said. He added such powers to independently verify reports mattered as China was “misinforming” the WHO about the extent of the early novel coronavirus outbreak.
David Fidler, an adjunct senior fellow for Global Health at the Council on Foreign Relations in New York, said it was unlikely the member states would elect to give WHO powers to enter countries without sovereign permission to independently investigate outbreaks.
“I also do not believe countries, especially China, will agree to allow local and subnational medical and health facilities to report information directly to a WHO-operated surveillance network to produce a faster, more comprehensive global ‘early warning’ system,” he said.
Creating an improved system – whether at the WHO or within the global reset on preparedness that the panel calls for from the “local community right through to the highest international levels” – would require countries to work together, Clark said.
“It’s unfortunate that [the pandemic] has happened at a time when the multilateral system has been struggling and the level of tension between major powers has been high. None of that helps,” she said.
The current critical test is how countries handle the global vaccine roll-out and provide inoculation support to poorer countries, according to the panel.
For Clark, it is using these tools and public health measures to get control of this virus that is the most pressing work.
“Rewriting international conventions and the powers of the WHO – this is quite urgent,” she said. “But nothing is more urgent than curbing transmission.”
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This article Coronavirus: after Wuhan, it’s time for global response reset, says Covid-19 probe chief first appeared on South China Morning Post