The World Health Organization’s suppression of an independent report that critically examined both the strengths and weaknesses of Italy’s COVID-19 pandemic response – sets a dangerous precedent that compromises the international organization’s credibility  at a time when WHO’s independence has been questioned – and the Italian national pandemic response is under intense scrutiny as well, longtime WHO observers in Italy are saying. 

The controversy revolves around the WHO report – “An unprecedented challenge – Italy’s first response to COVID-19” – which a senior WHO official, Ranieri Guerra attempted to censor and revise – before the publication was removed entirely by WHO’s European Regional Office from its official online link, just a day after being published in mid-May.   

Guerra, WHO Assistant Director General of Strategic Initiatives, is a former high-ranking official in Italy’s Ministry of Health,  who served as director of the Ministry’s Prevention department between 2014 and 2017.  

As head of the Prevention team, Guerra should have taken the lead in the updating of Italy’s 2006 national pandemic preparedness plan – as per a 2013 European Commission request to EU member states. But the plan was never updated, critics say.  

A series of Health Policy Watch interviews with knowledgeable insiders suggest that Guerra sought the removal of the WHO report – largely to protect himself from claims that he and other senior officials had failed to update Italy’s pandemic preparedness plan in the period he served in the national government.  

WHO has explained the report’s disappearance saying that it had contained “factual inaccuracies” that needed to be remedied.  But the report was painstakingly researched and executed by a large and experienced team of experts, under the direction of a senior figure in WHO’s Venice office, Francesco Zambon.

A series of email exchanges between Guerra and Zambon as well as a new email disclosure, from Zambon to WHO’s European Regional Director, Hans Kluge that was obtained by Health Policy Watch, underline that the controversy swirling around the report was quintessentially political. Guerra even admitted in one email to Zambon that the report’s factual content was solid – but it needed to be alterered or removed because it would embarrass the Italian government. 

Critics say that Guerra was in fact acting to protect himself and other Italian government figures for alleged shortcomings in updating preparedness plans in the years just before the COVID-19 pandemic erupted. 

It is the narrative around those facts that Guerra sought to blur, they say, leading to the mysterious and disquieting removal of An unprecedented challenge, from the WHO website, on May 14, only a day after it had been published.  

The concern about the report’s suppression is all the more relevant today – insofar as a number of highly sensitive WHO-led investigations are underway to evaluate the global pandemic response, as well as performance of China and other countries worldwide.  

Wonders one longtime WHO observer: “If this is the situation with a European country with middling powers, what will be the outcome in the future when the Chinese role in the pandemic will have to be assessed?”

Updated Pandemic Plan Could Have Saved 10,000 Lives 

An adequate pandemic plan, and its implementation at the regional level, could have saved 10,000 Italian lives among the 65,000 deaths recorded as of 14th December, according to one report of on Italian bio-emergency expert, Pier Paolo Lunelli. 

No such plan was in place when the mysterious coronavirus got its foothold in northern Italy in early 2020.  And the WHO report describes the early days of hospital response in unflinching terms, stating:  

“Unprepared for such a flood of severely ill patients, the initial reaction of the hospitals was improvised, chaotic and creative.” 

In a series of emails on 11 May, recently aired on the investigative news programme, RAI Report of Italy’s public TV channel, Rai3, Guerra demanded that the references to chaos and improvisation be deleted. 

He also ordered Zambon to amend a reference to the 2006 national pandemic response plan, so as to say that had been  “updated” in 2016 – a revision that Zambon refused to make – because it was untrue.   

In late May, just after the WHO account had been withdrawn from the WHO publications data base and officials were debating what to do next, Zambon sent an email to Hans Kluge, director of WHO’s Regional Office  protesting Guerra’s censorship moves – which he said had been politically motivated – and accompanied by threats against him of “dismissal” from his job.  

In Zambon’s email of May 27 to Kluge, Zambon warned that the pressures being applied by Guerra to modify the report could backfire – compromising WHO’s “independence and transparency.” 

“If a second revised version is issued with tailored ‘depurations’ of the text, consequences to the already compromised image – on this very point – of WHO will be, I am afraid, inevitable,” stated Zambon, who is Coordinator of WHO’s Venice-based European Office for Investment for Health and Development. 

Instead of being amended, the report was simply buried by WHO.  But the Italian public and media, still restlessly sifting through the events that led up to the nation’s pandemic debacle, won’t let it die.  

Was Guerra Protecting WHO’s Reputation – Or His Own?

By seeking the removal of the references to Italy’s lack of preparedness in the pre-pandemic period, Guerra was protecting himself from criticisim over his own performance during the years in which he would have been responsible for updating those same plans, Zambon also suggested to Kluge.

“On 11 May, before seeing the sentence about the lack of a pandemic plan (which is a mere fact) Guerra emailed me saying that the publication is fantastic….” said Zambon. 

“Then he saw the sentence about the pandemic plan (first sentence 2.1 chapter), he first intimated me to remove it (email proving that) and then calling saying that if I had not removed it, he was already on the doorstep of the DG, saying that I was putting WHO under attack.”  

Already in May, Italian television was beginning to investigate the matter – and one TV report was “fully devoted to Guerra on the pandemic plan, as he was director of prevention at the MoH 2014-2017 – a second episode of the documentary further elaborated the point by showing that the text of the pandemic plan has not been updated since 2006,” Zambon informed Kluge. 

“As Guerra is a WHO advisor in Rome, should there be legal/administrative investigations on him, implications for the organization might be severe,” he further warned. 

Since May, the mysterious chain of events leading up to the report’s suppression have been the focus of further investigation by RAI Report, led by director Sigfrido Ranucci and lead reporter Giulio Valesini. 

The narrative illustrates how Guerra’s censorship efforts not only blurred the record over critical moments in pandemic response – it also breached the traditional “separation of powers” that has traditionally existed between WHO’s international staff – and their former roles and careers in national governments.   

Appointment of High Level Officials From National Governments – A Common Practice

Guerra’s move from a high level position in Italy’s Ministry of Health to WHO headquarters in Geneva in 2017, was not at all unusual.  

There is a long tradition of WHO Director Generals recruiting high-ranking WHO officials from countries that are major WHO donors or supporters – and Italy is one of those countries in the EU bloc.

There had also been friction between Italy and WHO during the previous WHO administration of Director General Margaret Chan – centering around Rome’s opposition to new WHO guidelines on limiting sugar intake which rankled some of Italy’s powerful food industries. 

And so incoming Dr Tedros Adhanom Ghebreyesus was also keen to repair those bridges – and the appointment of an experienced and high ranking Italian in his administration signaled a turning of the page. Shortly before the report on Italy’s pandemic response was completed, Italy also made a major US$ 10 million voluntary contribution to the WHO. 

Even so, once such high-level appointments are made, the Organization has traditionally maintained a firewall against deeply involving those same officials in WHO reports or activities involving their country of origin. 

“Traditionally, once professional staff or senior staff are recruited internationally in Geneva they are not supposed to be involved with, or reassigned back to their countries of national origin,” notes one longtime observer familiar with WHO’s employment protocols. 

Guerra’s case, however, was unusual. After being recruited by WHO to Geneva office in 2017, he was “seconded” back to Italy’s Ministry of Health in March, 2020. But he also retained his WHO title as an Assistant Director General, and with it, the implicit affiliation with WHO headquarters and senior management.  

That, say insiders, is a clear breach of traditional WHO protocols for its international staff.  

“No ToR for his function to be found in Italy at the MoH,” said one observer close to the situation.  “Whereas it is a common practice  to have Member States second their staff to the WHO as a form of institutional support to the agency – this time it was a WHO staff to seconded to the staff of a national government – and to his country of origin – contrary to common practice.” 

Report’s Repression Has National and International Implications  

The supression of the WHO report on Italy’s pandemic response reverberates on both the national and international level, commented Italy’s Deputy Health Minister Pierpaolo Sileri on an Italian TV programme last Sunday, focusing on the WHO imbroglio.  

Firstly, the involvement of an influential Italian official in censoring a WHO report that was critical of his country – sets a bad precedent for the much broader WHO investigations that are just getting underway  into the global pandemic response and the origins  of the SARS-CoV-2 virus. 

That latter investigation is particularly sensitive as China so far has refused to even allow a visit to the country by the independent WHO committee charged with investigating the SARSCoV-2 virus origins – effectively barring investigators from the place where the first human infection clusters appeared in Wuhan in late 2019. 

Secondly, suppression of the report stands to potentially harm the communities in northern Italy that were the worst hit by the virus – and are still waging a legal battle to get to the roots of why their hospitals and factories remained open – even as infection rates were exploding. 

Just recently, WHO legal officials also have resisted appeals by Italian legal officials to let  Zambon and others involved in preparing the report to testify in an ongoing legal investigation over the government’s  slow and faulty pandemic response.

The legal investigation is centered around the northern Italian town of Bergamo, in the Val Seriana  region. The area, which has very close business and manufacturing ties with China, was one of the first epicenters of the outbreak. 

National government officials were slower to lock down the area than other nearby locales. Rather than shutting Bergamo and neighboring communities down quickly, as per the decisions taken for some other hotspots in northern Italy, the central government’s response in the Val Seriana region was marked by a series of zig-zags that remain unexplained until today.   

After WHO rebuffed a number of subpoenas from local legal officials requesting Zambon and other members of his team to testify in the local investigations, citing a 1947 UN Convention that grants staff of international agencies immunity to many forms of legal proceedings, Italy’s Ministry of Foreign Affairs last week  submitted a formal request to WHO to allow Zambon and others involved to allow them to testify.  

“In view of the excellent collaboration between Italy and the WHO, further strengthened during the Covid19 pandemic, I ask you to consider – in the spirit of Section 22 of the 1947 Convention – the possibility of allowing the WHO officials and experts to comply with the Attorney’s request to appear for interview as persons informed about the facts,” states the Italian MFA letter to WHO’s Dr Tedros delivered in Geneva last week.  

Breaches Of Good Practice Are Institutional – As Well As Individual 

Guerra’s initial attempts to alter the report prior to its publication, were described in detail by the Italian investigative news series Rai Report. A brusque email reportedly sent by Guerra to Zambon on 11 May, and aired on the TV programme over the past two weeks, stated [in Italian]: 

“You need to correct the text immediately: national influenza pandemic preparedness and response plan; Ministry of Health; 2006 (…) And report what is available on the Ministry of Health website (…) last update in December 2016. Don’t mess me up on this one. …I begged you to let me read the draft before printing… damn it…Now I’m blocking everything with Soumya,” it states – a reference to WHO Chief Scientist Soumya Swaminathan. 

“Get me the modified version as soon as you can. It simply can’t come out this way. Please no bullshit. Thank you and excuse the tone, Ranieri.”

In a follow-up mail, also aired by RAI Report, Guerra assured Zambon that “there are no doubts or criticisms about a work that is certainly valuable from the point of view of content,… but I don’t think you fully realize what political issues are overlapping at the moment.” Guerra went on to say that a critical WHO account of Italy’s pandemic response would be perceived as undermining the current Minister of Health, Robert Speranza and thus not be “doing the country a good service” – particularly in light of the fact that Italy had just given WHO a major voluntary donation amoungt to €10 million.

But the intrusion of politics and related breaches of practices in technical activities are not Guerra’s alone, informed observers point out. An institutional pattern of conflicts that has also emerged out of the narrative.  

Whether it was Kluge or WHO Director General Dr Tedros himself who made the decision to pull the WHO report on Italy’s response – after it had already been formally approved and issued – Zambon’s job is also now on the line, sources say. This is despite his longtime tenure in WHO and six years of “outstanding” performance evaluations. 

He has reportedly been obliged to engage a lawyer in Italy as well as one in Geneva – as well as placing a case before the WHO Ombudsperson. 

Zambon Warns Of Harm to WHO’s Reputation – Impacts on Other Investigations 

In his lengthy email of 27 May, Zambon also warned Kluge about the potential reputational and organizational impacts of Guerra’s attempts to censor the report and interfere in its final publication.

“Dear Hans, I received your message yesterday and understood that Guerra is “negotiating” with counterparts in Italy about the Italy report,” reads the email from Zambon to Kluge. 

“I am puzzled he was given this role as a) he disassociated himself from the report and b) I am the coordinator of the report,” said Zambon. The moves were compromising WHO’s independence and transparency, he added: 

“WHO independence. – This is an independent review.  I cannot see how this could be written together, nor reviewed by the involved parties such as the MOH, Italy’s National Health Institute  (Istituto Superiore di Sanità, ISS) as suggested. 

“WHO transparency.  Publication was disseminated to 15,000 contacts.  If a second revised version is issued with tailored ‘depurations’ of the text, consequences to the already compromised image – on this very point – of WHO will be, I am afraid, inevitable. 

Zambon added:  “The independent review of WHO, decided at WHA [the World Health Assembly] on how WHO reacted to COVID will certainly include products produced by WHO, and cleared by HQ. 

“Being this publication the only one with China reporting on MSs’ [member states} response of one of the hardest hit countries, it will certainly not go unnoticed,” added Zambon.  

He concluded noting that WHO has  “strict procedures for clearance of published products. All approvals were obtained, including HQ clearance.”

But more than that, “A large team of experts worked literally days and nights with one motivation, making sure that what happened in Italy is not repeated in those countries behind in time in the epidemic curve. The report contains important messages, extrapolated from facts on what worked (many things) and the blind spots of the system. No accusatory tone at all is used in the publication. Furthermore it contains a wealth of subnational practices with the unique regional profiles…. 

“I find it difficult to understand how an ad hoc created diplomatic incident (with a specific purpose as mentioned above) can withhold what could surely be of benefit to a large number of MSs {member states],” Zambon concludes. 

After Withdrawing Report – WHO Issues Video Praising Italy’s Response  

WHO did not stop with the withdrawal of a painstakingly detailed and substantive report. In late September the Organization also posted a video on Italy’s pandemic response, which contained nothing but praise. No mention was made of the delayed response to the initial clusters of outbreak in Bergamo –  or the failure to update the 2006 preparedness plan.  Rather,  events were framed as entirely unexpected and unavoidable: “We woke up like in a bad dream” one official, Flavia Riccardo, is quoted in the video as saying.

On Monday, WHO”s European office published a press statement about the report, stating the following: 

“On 13 May 2020, the WHO Regional Office for Europe published a document titled “An unprecedented challenge: Italy’s first response to COVID-19.”

“The document, written by experts based at the WHO European Office for Investment for Health and Development, in Venice, Italy, focused on the Government of Italy’s pandemic response. It was intended for use by other countries who might wish to learn from Italy’s early experience fighting COVID-19.

“Following publication, factual inaccuracies were found in the text and the WHO Regional Office for Europe removed the document from the website, with the intent to correct errors and republish it. By the time corrections were made, WHO had established a new global mechanism – called the “Intra-action Review” – as a standard tool for countries to evaluate their responses and share lessons learned. The original document (“An unprecedented challenge”) was therefore never republished.

“At no time did the Italian government ask WHO to remove the document.”

Asked about the announcement at the Monday WHO press briefing, WHO referred reporters to WHO’s European Regional Office for further comment. 

Image Credits: WHO, An Unprecedented Challenge .