By Shelley Lamare & Deepak Solanki
SOLIDARITY SOLIDARITY SOLIDARITY are the words used by the Director General of the World Health Organisation (WHO) frequently in his speeches (media briefings) to the world. Some days ago United States President Donald Trump declared that US would be holding it’s funding to the WHO to review its warnings about Coronavirus and alleged that the world health agency mismanaged the spread of the Coronavirus. A large number of scientists and health experts have sternly condemned this move of the US President. Here we will analyze the speeches given by WHO Director general in the months of January and February to find out whether ‘the WHO hid anything from the world about the novel virus or withheld any information given to it by the Chinese Government or was it the complacent behavior of the US President that led to the country becoming the hotspot of COVID-19’.
The Director General WHO stated on January 23, 2020, that as per its risk assessment the outbreak is at very high risk in China and a high risk regionally and globally. On this date there were a total of 584 cases in the world, out of which 575 were reported from China and the rest from Japan, The Republic of Korea, Singapore, Thailand, US and Vietnam. Also the DG stated that the reason for them not declaring it a Public Health Emergency should not mean that nations treat this novel virus less seriously. On January 30, the Public Health Emergency of International Concern was declared by WHO. The DG had visited China and also appreciated the way Chinese government detected the outbreak. China had by now isolated the virus, sequenced the genome and shared it with WHO. This was appreciated by WHO. At this point in time however the greater concern for WHO were the countries with weaker health systems. But in retrospection the opposite happened. The virus reached those countries that were well connected by air and where decisive action was not taken during the window of opportunity i.e., month of February 2020.
Although WHO did inform the world about the severity of the outbreak, it also trusted the information given by the Chinese government blindly. John Mackenzie, WHO’s Emergency Committee Advisor told ‘the Guardian (newspaper) that the organization was a little misled about the Wuhan Outbreak’. Others too questioned the numbers and statistics given by the Chinese. This mistrust was found to be true when recently the Chinese government increased the number of deaths reported from Wuhan by 50 percent. ‘China likes to find ways within the global system to give it a leading and benevolent image. The WHO was an uncontroversial place to do it,’ said Rana Mitter, the director of the University of Oxford China Centre. No longer! The extent of the initial cover up is still unclear, but there is no question that at least at the local level, Chinese officials knew about the outbreak of a novel disease for weeks before it was reported to the WHO. During that time, Chinese doctors were prevented from speaking out and whistleblowers shunted out.
By February 4, 2020, 176 cases were reported outside China. At the media briefings from now on the DG emphasized on utilizing the ‘window of opportunity’ because of the small number of cases outside China. WHO Director-General in a speech on February 19, said that they had declared a Public Health Emergency of National Concern (PHEIC) a month ago. Under PHEIC, WHO is directed to constitute a public health risk advisory to other states through the international spread of disease and to potentially require a coordinated international response. WHO also activated the United Nations Crisis Management Team led by Dr Mike Ryan to enable WHO to focus on the health response while other agencies bring their expertise to bear on the wider social, economic and development implications of the outbreak. But were these measures enough? On February 23, the WHO China Joint Mission report was published in which they found that the epidemic peaked and flattened between January 23 and February 2 and has been declining and there was no significant change in the genetic make-up of the virus. The team also said that the measures taken by China had averted significant number of cases. However, by the end of February, the number of cases in China was 78,959 and 2791 deaths, while the number of cases in other countries had soared to 4351 in 49 countries and 67 deaths. Perhaps, WHO did not find it appropriate to call the situation a pandemic because on February 25, WHO declared that China has fewer than 80,0000 cases in a population of 1.4 billion and the rest of the world had 2790 cases with a population of 6.3 billion.
In the entire month of February, we see WHO applauding China for their containment efforts. This was done because of the strict lockdown approach of the Chinese authorities that made WHO believe that China was trying everything to contain the virus. But the damage was done. Now the spread of the virus was seen in many new countries such as Denmark, Estonia, Lithuania, Netherlands and Nigeria. Though WHO had urged countries to be prepared for any kind of outbreak, this call was not enough to contain the virus.
On March 3, WHO said that ‘evidence from China suggests that only 1 percent of the reported cases do not have symptoms and most of the cases develop symptoms within two days’. This piece of information again smacked of China’s attempt to show less number of confirmed cases by not including asymptomatic cases in the tally of the infected. And it was proved correct recently when China shared the data of the asymptomatic cases. Hence we can see that it is not WHO but the Chinese government’s attempts to project stability, concealing the exact nature of the outbreak and US President’s complacent behavior that worsened the health crisis.
Funding and the
Future of WHO
WHO’s funding is based on a mix of assessed and voluntary contributions. Assessed contributions are the dues countries pay in order to be a member of the Organization. The amount each member state must pay is calculated relative to the country’s wealth and population. Assessed contributions have however declined as the overall percentage of WHO’s Budget and account for less than one quarter of the organization’s financing. The largest assessed contributions come from US. It is the global health body’s largest donor contributing more than $400 million every year. The second largest contributor is the Bill and Melinda Gates foundation contributing more than $300 million every year. The graph given below shows the top contributions.
However what is important to note is that these donations are not enough for WHO to work smoothly. It had to ask continuously for emergency funds during the COVID-19 pandemic from different organizations and countries. This time WHO asked for $ 675 million to fund its coronavirus response, through to April. It took precious time to collect this amount; time which could have been better utilized if the funding was better organised. Lawrence Gostin, professor of Global Health at Georgetown Law has stated that WHO needs more funding otherwise it would be a paper tiger and crumble.
The Way Forward
In 2005, WHO drew up a new version of International Health Regulations, a legal document that all countries are bound by. This document gave the power of declaring public health emergency of International concern to WHO, using its own information, over the objection of a single country. But it fell short of giving real powers to WHO if states refused to comply. For all the responsibility vested in the WHO, it has little power. Unlike international bodies such as the WTO or IMF, the WHO has no ability to bind or sanction its members. Richard Horton, the editor of the influential medical journal the Lancet, says, ‘the WHO has been drained of power and resources.’ Hence it is of utmost importance that the long pending demand of health workers of reshaping WHO into an organization that can take action during an emergency and not just give advice needs to be fulfilled if the world wishes to fight the future pandemics in a better and prepared manner. Hence instead of playing the blame game due to different political considerations, US should keep funding the organization and support it.
The issue of transparency and data sharing related to public health are other issues that demand policy maker’s attention. Countries need to come together and frame new rules and regulations on sharing of information regarding any outbreak. There should be penalties and sanctions if countries don’t promptly share information and data related to public health with WHO. Although we are in the middle of the crisis right now, not knowing when its going to end, but whenever the next World Health Assembly meets, reforms in executive powers and increase in funding of WHO should be on the agenda.
(Shelley Lamare is Doctoral Candidate at JNU, Delhi & Deepak Solanki is Doctoral Candidate at JNU, Delhi & taught at Ramanujan College, Delhi University).
