How did China and WHO fail to control Covid-19? Pandemic probe panel blames 'lost opportunities' in early stages
Public health measures could have been applied 'more forcefully' by local and national health authorities in China in January, suggest experts
Criticizing Beijing’s response to the pandemic, an independent panel has said that China should have acted faster and more forcefully to restrict the initial outbreak of Covid-19 in the city of Wuhan. A close reading of the chronology of the earliest events in the emergence indicates that there were “lost opportunities” to apply “basic public health measures” at the earliest opportunity, notes the report.
“What is clear to the panel is that public health measures could have been applied more forcefully by local and national health authorities in China in January,” states the second report of the independent panel for pandemic preparedness and response. It adds, “The initial chronology of the early phase of the outbreak suggests that there was potential for early signs to have been acted on more rapidly, with an escalation of response tied more immediately to the emerging information about the spread of the virus.”
The investigators are also critical of the World Health Organization or WHO’s response to the pandemic and questioned the delay in declaring a global emergency by the agency. “The emergency committee established under the International Health Regulations (IHR), 2005, was convened on January 22, 2020. It is not clear why the committee did not meet until the third week of January, nor is it clear why it was unable to agree on the declaration of a public health emergency of international concern when it was first convened,” they write.
While a public health emergency of international concern was declared on January 30, 2020, the panel says that based on the evidence considered thus far, the extent of the response to that in countries around the world fell short of what should have been expected.
The committee is continuing to consider what actions could have been taken including by WHO and regional, national and local actors, that may have resulted in more forceful country action, in particular in the period from the beginning of February 2020 until early March. “One question is whether it would have helped if WHO had used the word pandemic earlier than it did. Although the term pandemic is neither used nor defined in the IHR (2005), its use does serve to focus attention on the gravity of a health event. It was not until March 11 that WHO used the term,” they explain.
The virus was first detected in Wuhan in December 2019. According to the authors, there was evidence of cases in several countries by the end of January 2020. “Public health containment measures should have been implemented immediately in any country with a likely case. They were not. According to the information analyzed by the panel, the reality is that only a minority of countries took full advantage of the information available to them to respond to the evidence of an emerging epidemic,” the findings reveal.
The researchers emphasize that the earliest evidence of the success of measures taken against SARS-CoV-2 could have been shared more widely and proactively, and action should have been taken more rapidly to employ the most successful containment measures in all places where cases appeared.
“The panel has noted that when WHO conducted a technical briefing at its Executive Board session on February 4, 2020, it reported that there had been over
12000 confirmed cases in China but only 176 cases in the rest of the world — definitive evidence of human-to-human transmission, and also a clear signal to all countries with even a handful of cases that they needed to act quickly to contain the spread. In far too many countries, this signal was ignored,” state observations.
The committee, which calls for a “global reset", will submit another report to the 74th World Health Assembly scheduled for May 2021.
What else does the analysis say?
Pandemic response has deepened inequalities
Inequalities both within and between nations have worsened as vulnerable and marginalized people in many countries have been left without access to healthcare, not only to treat Covid-19 but also because health systems have been overwhelmed, shutting many out of basic care and services, caution experts. They highlight the gap between countries in the level of access to diagnostics, therapeutics and essential supplies.
“We cannot allow a principle to be established that it is acceptable for high-income countries to be able to vaccinate 100% of their populations while poorer countries must make do with only 20% coverage. Covid-19 did not start in the poorest countries, but they are suffering the greatest collateral damage, and they need enhanced solidarity and support from the international community,” emphasizes the team.
Global pandemic alert system is not fit for purpose
Critical elements of the system are slow, cumbersome and indecisive, warns the committee. The panel has been advised that an increasing majority of alerts concerning outbreaks come to WHO via news or social media and is aware that platforms to collate epidemic intelligence from open and non-traditional sources have been created. “Overall, the procedures and protocols attached to the operation of the IHR, including those leading up to the declaration of a public health emergency of international concern, seem to come from an earlier analog era and need to be brought into the digital Age,” they recommend.
The study also calls for a system of distributed information, fed by people in local clinics and laboratories, and supported by real-time data gathering and decision making tools, to enable reaction at the speed required — which is days, not weeks — to confront epidemic risk. This technical updating must be accompanied by a “political step-change in the willingness of countries to hold themselves accountable for taking all necessary actions” as soon as an alert is issued, emphasize authors.
WHO has been 'underpowered to do the job' expected of it
The investigators note that they have been ‘struck’ that the power of WHO to validate reports of disease outbreaks for their pandemic potential and to be able to deploy support and containment resources to local areas is gravely limited. They observed that the incentives for cooperation are “too weak” to ensure the effective engagement of states with the international system in a disciplined, transparent, accountable and timely manner.
Failure to take seriously the already known risks posed by pandemic threat
Previous pandemic crises have prompted numerous evaluations, panels and commissions that have issued many recommendations for strengthening preparedness and response. The team observes that too many of those were not acted on during the ongoing Covid-19 pandemic. “There has been a wholesale failure to take seriously the existential risk posed by pandemic threat to humanity and its place in the future of the planet. The collective reaction has amounted to wishful thinking instead of farsighted risk assessment and action,” write investigators.
Stating that the crisis shows how quickly a new virus can sweep away decades of hard-won progress and investment in the future, the panel believes that for the international community to fail again to heed calls for preparedness against the pandemic threat “would be unconscionable".