The World Health Organization should be overhauled and given more authority to investigate global disease threats, according to an independent review that found COVID-19 mushroomed into a pandemic amid a myriad of failures, gaps and delays in the international response.
While stopping short of assigning blame to any particular factor, the report released Wednesday by a panel co-chaired by former New Zealand Prime Minister Helen Clark linked the severity of the global outbreak to deficiencies across governments, the WHO and other multilateral organizations, as well as regulations that guide official actions.
The panel also called for an agreement to waive vaccine patents, limited terms for WHO leaders and an oversight body and legally binding treaty to bolster the prevention and response to future pandemics.
The international system, the panel said, remains unfit to avoid another disease spiraling into one that matches COVID-19, which threatens to cost the world economy $22 trillion by 2025.
“The situation we find ourselves in today could have been prevented,” former Liberian President Ellen Johnson Sirleaf, the panel’s other co-chair, told reporters over Zoom Monday. “It is due to a myriad of failures, gaps and delays in preparedness and response.”
In the first weeks of the pandemic, the WHO could have warned countries to assume that the SARS-CoV-2 virus was spreading among people as a precaution, according to the panel, which was established a year ago at the request of the World Health Assembly, WHO’s decision-making body.
The WHO also could have declared the outbreak in Wuhan, China, a public health emergency of international concern — the highest level of global alert — earlier, by at least Jan. 22, Clark said.
The role of the WHO and its director-general have been contentious from the early days of the pandemic as governments sought to understand how the virus emerged and was allowed to spread unchecked.
WHO Director-General Tedros Adhanom Ghebreyesus said Wednesday he looks forward to discussing the recommendations with member-states “to build a stronger WHO and a healthier, safer, fairer future for all of us.”
The 73-year-old United Nations agency came under blistering criticism from former U.S. President Donald Trump, who claimed it had coddled China, allowing it to conceal the origin of the virus and threatened to withhold funding.
The WHO represents 194 member-states, which collectively decide how strong and well-funded it wants the organization to be, said Joanne Liu, a former international president of Doctors Without Borders who was one of 11 members of the independent panel.
“We can blame China for losing a few days, and we can blame WHO for losing maybe a week before calling the public health emergency of international concern, but basically 90% of the countries around the globe sat on their hands for four-to-six weeks,” Liu said in an interview over Zoom. “The reality is, it’s on them.”
The WHO was hindered by its regulations, which aren’t conducive to taking a precautionary approach, according to Clark. The “slow and deliberate pace” with which information is treated under the International Health Regulations and the alert system used were out of step with a fast-moving respiratory pathogen and the swift availability of information through digital tools and social media, the panel found.
The WHO should have the power to investigate outbreaks speedily, with guaranteed rights of access and with the ability to publish information without waiting for a member state’s approval, Clark said.
“Sensitivities about sovereignty cannot delay alerting the world to the threat of a new pathogen with pandemic potential,” she told Monday’s media briefing.
The elevation of the COVID-19 threat to WHO’s highest level of alert on Jan. 30, 2020, failed to trigger an urgent, coordinated, worldwide response, the panel found. It called for disease surveillance and alert systems to be overhauled to function at “near-instantaneous speed” to detect and verify signals of potential outbreaks.
Most countries failed to heed the warning, choosing to “wait and see,” rather than take firmer measures that could have contained the virus, Clark said, adding that February was “a month of lost opportunity.”
“For some, it wasn’t until hospital ICU beds started to fill that more action was taken — and by then it was too late,” she said. “There were also countries which devalued science, denied the severity of COVID-19, delayed responding, and sowed distrust among their citizens — with deadly consequences.”
Although missed opportunities and failures to act characterized much of the early response to COVID-19, the panel found areas in which early action was taken to good effect: the rapid containment of the virus by some countries, including South Korea, Vietnam and New Zealand, and the unprecedented speed at which the virus genome was sequenced and vaccines were developed.
“Science delivered when the world needed it most, and the world benefited wherever there was open sharing of data and knowledge,” according to Johnson Sirleaf.
The Harvard-educated former banker said the WHO and the World Trade Organization should help broker an agreement among major vaccine-producing countries and manufacturers on voluntary licensing and transfer of vaccine technology to third parties.
“If actions do not occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately,” Johnson Sirleaf said.
While manufacturing needs to be scaled up urgently, the panel called on wealthy countries with adequate vaccine coverage to commit to providing at least 1 billion doses no later than Sept. 1 to 92 countries that lack adequate supplies, and to increase that to a total of 2 billion by mid-2021.
The panel also called for:
- The creation of a Global Health Threats Council that will maintain political commitment to pandemic preparedness and response, and hold actors accountable.
- A Pandemic Framework Convention within six months to address gaps in international regulations, and to clarify responsibilities between states and international organizations.
- A special high-level session of the United Nations General Assembly to agree on a political declaration on transforming pandemic preparedness and response.
- Strengthening of the authority and financing of the WHO, including by developing a new funding model to end earmarked funds and to increase member-state fees.
- An international pandemic-financing facility capable of disbursing $5 billion to $10 billion a year for preparedness and $50 billion to $100 billion in the event of a crisis.
- A single, seven-year term for the WHO director-general and regional directors.
“COVID-19 is the 21st century’s Chernobyl moment — not because a disease outbreak is like a nuclear accident, but because it has shown so clearly the gravity of the threat to our health and well-being,” the report said. “It has caused a crisis so deep and wide that presidents, prime ministers and heads of international and regional bodies must now urgently accept their responsibility to transform the way in which the world prepares for and responds to global health threats.”
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