This article is part of the series Governance, in crisis.
Synopsis: This post assesses the World Health Organisation’s (WHO) initial response to the COVID-19 pandemic and identifies three major limitations that precluded a more effective organizational response.
Keywords: COVID-19, pandemic, governance, World Health Organisation (WHO), international institutions
Lawyers have, as tangential responders to the present pandemic crisis, sought to identify the potential effects of the COVID-19 disease on the rights of the marginalised, the affected legal regimes (here and here), and also examined avenues to sue certain States. This post holds to account our seeded belief in international institutions as “harbingers of international happiness” , their politicisation on the one hand, and their failure in fulfilling their stated objectives on the other.
While not all information about COVID-19 has yet been gathered, and there is also misinformation in circulation, certain facts regarding the pandemic have become undeniable through the lapse of time. COVID-19 was first discovered in Wuhan, China, at least at the end of December 2019, perhaps even in November 2019, as a new strain of the coronavirus. The Chinese response, after the initial period of denial, was strict and wide-ranging. The Chinese authorities contacted the WHO Office in China as early as 31 December informing them of a spike in pneumonia cases in Wuhan. The authorities thereafter informed the WHO Country Office and Headquarters, on 3 and 7 January 2020 respectively, that the rise in pneumonia cases was the result of a newer form of coronavirus. Subsequently, China shared the genetic code of the virus with the world on 12 January. The initial communication by China did not notify the WHO of the nature, or the severity of the virus. Further, the discovery of the virus was also not notified within the required time period. Articles 6-7 of the 2005 International Health Regulations (IHR) require notification within 24 hours of the “assessment of public health information”, or “evidence of an unexpected or unusual public health event within its territory” which may constitute a public health emergency of international concern (PHEIC).
Around mid-January, China started imposing strict travel restrictions to and from Hubei Province. The measures progressively got more stringent with the lockdown affecting 56 million people in Hubei, and the authorities conducting door-to-door testing and enforcing isolation upon all symptomatic people.
The WHO’s immediate response
The identification of the virus and its rapid spread required initiative and lead from the WHO in relation to the identification of the symptoms, carriers, and general nature of COVID-19. However, no independent investigation regarding the severity, transmission, or carriers of the virus seems to have been conducted during the early stages. This is, in part, explained by China’s categorical refusal to let the WHO send a team of scientific observers to Hubei.
Regardless, after informing the public of a possible outbreak, the WHO did release its preliminary findings on 10 January based on the information shared by China. The official reports and prescriptions released by China were relied upon and repeated by the WHO in the absence of any institutional investigation, but also perhaps to allay panic that would further bolster prevalent nationalist sentiments through broad trade and travel blockades.
Notably, in its advisory issued on 10 January and through a tweet on 14 January, the WHO highlighted the Chinese claims denying human-to-human transmission. Whereas the assertion denying human transmission has since been retracted, the corollary of such an assertion, i.e. not imposing travel restrictions, was not withdrawn with the same promptness and was reiterated by the Organisation on 30 January 2020. During that period, China had essentially locked down Hubei, closing all entry/exit points from Wuhan to the rest of the Mainland.
At the same time, despite conducting a visit to Wuhan, the WHO Emergency Committee did not declare COVID-19 as a PHEIC in its meeting on 23 January. Such declaration only came at the meeting of the WHO Emergency Committee on 30 January after a visit of the WHO’s Director-General, Dr Adhanom Ghebreyesus, to China on 28 January. The belated and unfortunate timing of the visit prevented any aspiration for coordination, as several States had already initiated independent measures.
A preliminary assessment of the WHO’s response
Following President Trump’s decision to cut the WHO’s funding, in a tweet on 15 April, Dr Adhanom Ghebreyesus said that “[i]n due course, [the] WHO’s performance in tackling the [Covid-19] pandemic will be reviewed by the Member States & the independent bodies. This is part of the usual process to ensure transparency, accountability and recommendations for future outbreak responses.” Burci and Sands recently argued not to evaluate responses by States or international organisations without conclusive evidence.While an in-depth assessment will have to wait till the dust settles, this section will touch upon and examine some of the aspects of the WHO’s response.
COVID-19 put the whole world into a hitherto uncharted field. The response to this serious and potentially irreversible threat to human health required the application of the precautionary principle on behalf of the WHO, through issuance of guidelines and a scientific basis to decision-making. However, the actions of the WHO during the initial weeks after the discovery of the virus seem to echo those of China itself. The report released after the first Emergency Meeting lauded Chinese efforts at the early identification of the virus and decoding and sharing the gene sequencing with other countries despite the manifest delay of two week in such communication.
Three major limitations may be pointed out in reference to the handling of the spread of COVID-19 by the WHO. First, the WHO seems to have ignored its own Outbreak Communication Guidelines. At the outset, the WHO was late in communicating details in relation to the virus and further contributed to misinformation such as lack of human transmission based on limited information and evidence to the contrary. Further, the reports released by the WHO lacked any risk assessments undertaken by the relevant decision-makers or evidence of any public deliberation with experts.
Second, the declaration of COVID-19 as a PHEIC was belated despite Wuhan being an international transportation hub, and notwithstanding evidence of transmission of the virus to more than 15 countries. Article 1 IHR defines PHEIC as “an extraordinary event which is determined, as provided in these Regulations, to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. In the past, the WHO designated the H1N1 flu as PHEIC upon the spread of the infection to three countries, and despite limited information regarding “clinical features, epidemiology, and virology of reported cases”. The designation of COVID-19 as PHEIC only came on 30 January when the virus had already infected more than 7000 people and had spread to 18 countries.
Third, the continued insistence by the WHO not to impose international travel and trade restrictions was maintained despite a severe lockdown within Hubei, and evidence of rapid spread of the virus. The WHO refrained from recommending any entry/exit point restrictions as allowed under Article 18 IHR. The Organisation has previously, during the spread of Ebola, stated that restrictions on international trade and travel can further create onerous burdens on the suffering State, and push such trade and travel to informal crossings thereby possibly increasing the spread. However, restrictions do not necessarily require complete curtailment. The recommendations could have included restricting travel and trade within Hubei/Wuhan, like China later did unilaterally. It could have also emphasised the need of continuing supply of essential services and goods and limiting non-essential travel. Further, entry-and-exit screening, recommended almost two weeks after proof of human-to-human transmission could have been recommended much earlier. Countries that implemented entry-screening during the early stages of the spread, like Taiwan and South Korea, have been more effective in controlling the spread of the virus. Yet, in line with the Chinese Government’s One China Policy, the WHO consistently ignored the recommendations made by Taiwan, most importantly refusing to acknowledge evidence of human transmission shared by Taiwan’s Centers for Disease Control.
The apprehension against imposition of international travel restrictions is understandable considering the potential prejudice it could generate. At the same time, the effects of the accelerated spread of the virus required a more nuanced approach that recommended limited measures rather than treating restrictions on trade and travel as a zero-sum game. Its lack of any reasoning led to two problems. First, it did not dissuade any discriminatory behaviour, as is evident from absolute restrictions imposed by several countries on China rather than application of limited screening. Second, the lack of reasoned guidelines made these restrictions piecemeal, origin-based and centred around panic rather than science, risk and proportionality (Article 43 IHR). Mapping international travel, for instance, could have helped follow up with the initial spread, as the contemporary intensification of global traffic distinguishes this pandemic from the previous ones.
Postscript: The restrained approach of the WHO at the beginning of the crisis arguably allowed the rapid proliferation of COVID-19. The next part of this post shall examine the ever-rising failures of global governance bodies with a focus on the reactions of the international community.
Note: The views expressed in this post are solely those of the authors. They do not necessarily reflect the views of any institution with which they are or have been affiliated. Nor do they necessarily reflect the views of any of their current or former clients.
Photo by Thorkild Tylleskar