WSJ Part 3
Frightening news
The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980
In early 2003, the WHO confronted some frightening news. A strange new pneumonia was spreading from China to other countries.
The WHO immediately issued global alerts and the agency’s chief, Gro Harlem Brundtland, publicly scolded China for not reporting the new disease, called severe acute respiratory syndrome, before it jumped borders.
SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.
As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them. An early draft included blunt language allowing the WHO to call out countries that don’t share information on a potential outbreak, said Gian Luca Burci, then a WHO senior legal officer: “Everybody pushed back. No sovereign country wants to have this.”
China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.
Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks. In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.
The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration. Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies
Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics. Yet the WHO declared one when a few hundred polio cases imperiled an eradication push.
Early warning
Just before dawn on Dec. 31, reports started streaming in on a multimillion-dollar early-warning system, which scans the internet for keywords. The reports were translations of health notices from officials in the city of Wuhan to hospitals that had been leaked to Chinese media.
“The South China Seafood Market in our city has seen patients with pneumonia of unknown cause one after another,” read one.
“Whether or not it is SARS has not yet been clarified, and citizens need not panic,” read another.
A short notice in Chinese soon followed on the website of the Wuhan Municipal Health Commission, reporting 27 cases. “The investigation so far has found no obvious person-to-person transmission,” read the notice, which has since been deleted. Another sentence suggested the opposite: “Avoid closed public places and crowded places with poor air circulation.”
The WHO’s electronic system receives hundreds of notices daily. Still, “every time we see a cluster of unexplained pneumonia, especially in China, it always catches our attention,” Dr. Briand said. Anything beyond five cases was cause for alarm.
Following protocol, the WHO formally requested verification from Chinese health officials. By now it was Jan. 1.
On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew. That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.
China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations, said Lawrence Gostin, professor of global health law at Georgetown University who has advised the WHO on international health regulation matters. “Once a government knows that there is a novel virus that fits within the criteria, which China did, it’s obliged to report rapidly,” he said.
China also flouted the IHR by not disclosing all key information it had to the WHO, said David Fidler, an expert on global health and international law at the Council on Foreign Relations. The regulations call for member states to provide the WHO with “timely, accurate and sufficiently detailed public health information available to it on the notified event.”
When asked for comment, the National Health Commission pointed to a Chinese government white paper that said China reported the new virus “in an open, transparent, and responsible manner and in accordance with the law.”
The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.
In Geneva, the WHO’s emergency response team had been meeting since Jan. 1, searching for evidence the disease was spreading between people, infecting more than those who had been at the seafood market where the early cases originated. The agency’s infectious disease experts were convinced it was.
“Whenever you hear of a cluster of atypical pneumonia you think respiratory and you think human-to-human transmission,” Maria van Kerkhove, a specialist in Middle East respiratory syndrome and now the WHO’s technical lead for the Covid-19 response, said in a May briefing. “It’s not if—it’s just what is the extent?”
While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus. WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.
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