Lacking Resources & Authority, WHO Was Too Slow To Act Against COVID-19 – Says Independent Review Panel Emergency Response 19/01/2021 • Kerry Cullinan, Raisa Santos & Madeleine Hoecklin Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Helen Clark, former Prime Minister of New Zealand and co-chair of the Independent Panel review of the COVID-19 pandemic response The World Health Organization’s (WHO) response to COVID-19 was too slow, hampered by an antiquated pandemic alert system, lack of resources and a lack of authority with member states, according to an interim report by the Independent Panel on Pandemic Preparedness and Response, presented to the WHO’s Executive Board meeting on Tuesday. It took the WHO an entire month from the time an alarm was sounded in Wuhan to declare a public health emergency. And it’s alert and response system “seems to come from an earlier analogue era and needs to be brought into the digital age,” panel co-chair Helen Clark, the former Prime Minister of New Zealand told a media briefing. She added: “Modern information systems pick up signals of potential diseases by sifting through hundreds of thousands of data points daily, outpacing formal country reporting and outpacing the procedures and protocols of the International Health Regulations.” But the human deliberations of WHO also slowed down responses. Although the WHO Emergency Committee was convened on 22 January 2020, WHO only declared a “public health emergency of international concern” on 30 January, and first used the word “pandemic” on 11 March. “Even when WHO declared a Public Health Emergency of International Concern on 30 January – the loudest alarm possible under the International Health Regulations – many countries took minimal action to prevent the spread internally and internationally,” Clark said in the briefing. The brand-new report, mandated by the World Health Assembly in May, when the world was reeling from the initial impacts of the pandemic – was presented at the EB during a second day of the exhaustive EB review of the COVID-19 pandemic. EB members also heard a report from yet another review committee, examining the International Health Regulations framework that governs countries’ obligations to monitor, report and respond to emergencies, which found compliance wanting, due partly to a “lack of teeth” in the IHR’s legal enforcement mechanisms. “The absence of a dedicated national entity with sufficient authority and a clear mandate to take ownership and leadership is considered a significant limitation to effective implementation of the IHR at national and subnational levels,” said Professor Lothar Wieler, President of the Robert Koch Institute in Berlin, in a statement. “The IHR are your instrument, our instrument, of international public health law. Making them work requires giving WHO the tools and the resources it needs to better prepare and protect humanity against public health risks, through an effective, coordinated, multisectoral and evidence-based public health response,” said Wieler, speaking to WHO member states. Lessons about the past are more relevant than ever today, Clark stressed. Since 1 January, the world is recording almost 12,500 daily deaths and 682,000 new cases, and countries need to urgently implement “basic measures like testing, contact tracing, isolation, physical distancing, and wearing masks,” which are even more pressing as new and reportedly more infectious variants of SARS-CoV2 are detected. Not Laying Blame on WHO – But … Former Liberian President Ellen Johnson Sirleaf, co-chair, of the Independent Panel’s review of the COVID19 pandemic response, at a media briefing. Co-chair Ellen Johnson Sirleaf, former President of Liberia, stressed that the panel was not trying to blame the WHO: “The world is more reliant on an effective WHO than ever before. But while member states turn to the WHO for leadership, they have kept it underpowered and under-resourced to do the job expected of it.” She added: “Member states are looking to the WHO for leadership, coordination and guidance, but are not equipping it with the authority or access to the funding needed to provide this. WHO has no powers to enforce anything or investigate anything of its own volition within a country. “When it comes to a potential new disease threat, all WHO can do is ask and hope to be invited in. The panel is asking whether this is enough.” At the same time, the report makes a number of damning observations about how member states had failed to act on “numerous evaluations, panels and commissions which have issued many recommendations for strengthening preparedness and response” of WHO. And the Panel also criticised the sometimes overly technical nature of WHO’s advice to countries, saying that it had issued over 330 reports to states, which may have confused them about what their priorities should be. Panel Criticism of China – Receive Rocky Reception From Beijing China’s representative to the Executive Board at the 148th session on Tuesday. The panel report also criticises China, stressing that “public health measures could have been applied more forcefully by local and national health authorities in China in January.” “It is also clear to the Panel that there was evidence of cases in a number of countries by the end of January 2020. Public health containment measures should have been implemented immediately in any country with a likely case. They were not.” Clark would not comment further on China, saying that the panel would have a more detailed report on the chronology of events at a later stage. The final report is due to be presented to the World Health Assembly in May. However, in a later EB debate, China protested about the way that its response had been characterised, saying that it was being unfairly “judged” for early days when authorities were still grappling with “understanding the unknown”. “On January 23 2020, when only four countries outside China reported seven cases, China pressed the pause button in Wuhan, a city with a population of over 10 million, which was not taken lightly. But we did it. And we made huge sacrifices for global fight against the virus that has gone way beyond the traditional public health measures. “We urge the international community to look at China’s anti-epidemic efforts from a rational and scientific perspective. “These extraordinary and forceful public health measures are mass contributions that China made to the world. China suggests that the review committee …should further improve the report and make scientific, objective, fair, comprehensive and balanced assessments on both prevention and response.” Incentives For International Cooperation Are Too Weak Well beyond the WHO or China, however, the panel made it clear that responsibility is shared globally, while the incentives fostering international cooperation between states remain too weak. “Our panel report does identify a series of critical early failings in global and national responses to COVID-19. There had been a failure to prepare adequately for a pandemic threat despite years of warnings that better preparation was necessary,” said Clark at a subsequent afternoon briefing with the EB members themselves on the report’s findings. “Preparedness methods which were being used did not appear to predict how well individual countries would be able to control COVID-19. Perhaps because they couldn’t capture what seems to be a critical dimension of pandemic control: the mix of government effectiveness, concern and leadership, capacity to work with communities, and being able to be guided by science,” said Clark. “The panel notes with deep concern that the failure to enact fundamental change despite the warnings issued has left the world dangerously exposed, as the COVID-19 pandemic proves,” according to the report, which added that there has been “a wholesale failure to take seriously the existential risk posed by the pandemic’s threat to humanity and its place in the future of the planet”. Adds the report: “the incentives for cooperation are too weak to ensure the effective engagement of states with the international system in a disciplined, transparent, accountable and timely manner” despite the fact that the pandemic offers “a once-in-a-generation opportunity for member states to recognize the common benefit of a suitably reinforced suite of tools to enable robust pandemic alert and outbreak containment functions.” Major weaknesses in the Global Supply Chain Other problems flagged by the panel include “major weaknesses in the global supply chain,” while the critical funding gap hampering the Access to COVID-19 Tools Accelerator (ACT-A) platform might result in a “two-tier world, divided between countries where COVID-19 is relatively controlled, and those where COVID-19 adds to the overall burden of disease as yet another ongoing, endemic disease”. “The effective flow and access of new diagnostics, therapeutics, and vaccines to the populations most in need, based on equitable public health criteria, must be the central plank of international co-operative efforts,” the report notes. Vaccine Rollout Also Criticized by Panellists Related to that, the unequal pattern of vaccine rollout also came in for sharp criticism by the panel’s leaders at the EB session: “The panel is discouraged and frankly disappointed by the unequal vaccine rollout. Tens of millions of vaccines are already available in some of the wealthiest countries, but based on current plans, vaccines will not be widely available across the African continent until 2022 or even 2023,” said Sirleaf. “It is unacceptable for wealthy countries to be able to vaccinate 100% of their population, while poorer countries may do with only 20%. It is no exaggeration to say that we are at risk of creating a vaccine distribution system grounded in inequity. We cannot let this happen. “This is a unique opportunity, born out of the gravity of this crisis, to reset the system. Real change in global and national health systems will benefit every country and every citizen,” Sirleaf added. EB Members Frame Reviews As Buildup to WHA Resolution Strengthening Emergency Response Garett Grigsby, director of the Office of Global Affairs, US Department of Health and Human Services Despite resistance from China, member states in Europe, the Americas and elsewhere framed the findings of the three reports as useful inputs to a planned resolution to strengthen WHO’s Emergency Response mechanisms, that will go before the World Health Assembly in May. “It is our duty to provide the WHO and the broader international system with the tools to do its work effectively, efficiently, independently and transparently,” said Garett Grigsby, director of the Office of Global Affairs at the United States Department of Health and Human Services, speaking at Tuesday’s EB session. “We must rise to the occasion, even as we combat the pandemic and resurrect our economies,” said Grigsby. “That is why we need to be sure that the recommendations put forward will be given thoughtful consideration, and any additional funding requests for WHO will be justified and directed at areas where strengthening is necessary, such as pandemic preparedness and response. The United States will work with other member states to strengthen the WHO to make it fit for purpose.” Grigsby also said that the United States was joining the European Union and a wide range of other member states to advance a resolution for the World Health Assembly strengthening WHO’s Emergency Response. The statement represented the first sign of other substantive shifts in policy that can be expected from the White House after President-elect Joe Biden is inaugurated in Washington, DC on Wednesday. Biden is expected to work rapidly to restore the previously close relationship between WHO and Washington – which was shattered by the maverick policies of outgoing Donald Trump – who leaves the White House in disgrace after igniting the emotions of rioters who charged the Capitol on 6 January in a failed attempt to violently overturn the election results. WHO Reaction – We All Have To Learn Lessons “We all have lessons to learn from the pandemic, every member state and the Secretariat….We are committed to accountability and we will continue to learn, to change, and to listen,” said Dr Tedros Adhanom Ghebreyesus, responding to the report at the EB’s afternoon session. While the report remains an interim one, countries should act immediately on some of the lessons learned, the Independent Panel Co-chairs underlined: “We are building the necessary evidence base required for the comprehensive, impartial and independent review of the international health response to COVID-19 with which we were tasked,” Clark told delegates. “While our evidence gathering continues, the progress report before you now does have an unequivocal message that course correction of the handling of the pandemic is needed now. “The panel does strongly recommend that all countries immediately and consistently adopt and implement those public health measures which will reduce the spread and the impact of COVID-19. Simply put, we must do all we can to stop the pandemic now.” Image Credits: WHO. 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