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How to reinforce WHO and make COVID-19 the last pandemic

WHO Director-General Dr Tedros Adhanom Ghebreyesus, credit: WHO

The international panel of experts which was tasked to review the WHO-coordinated international health response to COVID-19 presented its report on Wednesday.

The report follows a resolution adopted in May last year by the  World Health Assembly, the decision-making body of WHO, expressing support for WHOs role in coordinating the response to the pandemic. However, calls for an external investigation of the response were replaced by a request to WHO’s Director-General to initiate an evaluation of lessons learned at his own timing.

At the same assembly, WHO was also requested to identify the zoonotic source of the virus and the route of introduction to the human population. After many delays, an international group visited China in January 2021 and presented its report in April. That report was not conclusive and left all options on the table as regards the source of the virus, according to Dr Tedros, the WHO Director-General.

The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Ellen Johnson Sirleaf and Helen Clark, started its work in September 2020 and has spent the last eight months reviewing evidence of the spread, actions and responses to the COVID-19 pandemic.

In contrast the previous report, the IPPPR claims that is has produced a definitive account of what happened and why it happened and analysed how a pandemic can be prevented from happening again. “COVID-19 remains a global disaster. Worse, it was a preventable disaster,” the report summarises its findings.

The Independent Panel found weak links at every point in the chain of preparedness and response. Preparation was inconsistent and underfunded. The alert system was too slow—and too meek. The World Health Organization was under-powered. The response has exacerbated inequalities. Global political leadership was absent.

As regards the chain of events and the specific role and performance of WHO, the panel identified 13 “defining moments” when a change in direction could have made a difference. What appears to be missing is an analysis of the late decision by WHO to declare the outbreak of the coronavirus a pandemic.

During “the month following the declaration of the Public Health Emergency of International Concern (PHEIC) on 30 January 2020, too many countries took a ‘wait and see’ approach rather than enacting an aggressive containment strategy that could have forestalled the global pandemic,” according to the Panel.

What about WHO? Dr Tedros warned repeatedly during that period that the world had a window of opportunity, though steadily narrowing, to prepare and to prevent widespread community transmission. WHO did issue advice but it was not always specific, such as proposing travel restrictions and quarantines of travellers from China and other affected countries.

Only on 11 March did WHO made the assessment that COVID-19 can be characterized as a pandemic. The WHO Director-General has defended himself against allegations that WHO did not act in time to alert the world. “From the beginning, WHO has acted quickly and decisively to respond and to warn the world. We sounded the alarm early, and we sounded it often.”

The Panel explains that, “We alternate between the paralyzing anxiety of indecision, when faced with something truly unpredictable, and the temptation to impose our old models on the new events, whether they fit well or not. This pandemic has seen plenty of evidence of both reactions. “

“It is tempting to assert that it is ‘obvious’ what should have been done at each stage in the past, based on the knowledge we have gained now,” the Panel writes.

To make COVID-19 the last pandemic (the title of the report), the Panel has issued a number of recommendations that will remedy the shortcomings and failures during the current pandemic.

Among others, pandemic preparedness and response should be elevated to the highest level of political leadership by the establishment of a high-level Global Health Threats Council led by Heads of State. A Pandemic Framework Convention should be adopted within the next 6 months to strengthen the independence, authority and financing of WHO.

The financial independence of WHO should be based on fully unearmarked resources, and on an increase in Member States’ fees to two-thirds of the WHO base programme budget. WHO should establish a new global system for surveillance, based on full transparency by all parties, using state-of-the-art digital tools.

Referring indirectly to the information flow from China to the WHO, the Panel recommends that the World Health Assembly should give “WHO both the explicit authority to publish information about outbreaks with pandemic potential immediately without requiring the prior approval of national governments.”

As a lesson learned from the other report on the source of COVID-19, the Panel recommends that WHO should have the power to investigate pathogens with pandemic potential with short-notice access to relevant sites, provision of samples, and standing multi-entry visas for international epidemic experts to outbreak locations, according to the Panel.

Dr Tedros explained at a press conference on Friday (14 May) that all recommendations will be discussed with the Member States at the World Health Assembly at the end of this month.

M. Apelblat
The Brussels Times