WSJ Part 4
Then a 61-year-old woman was hospitalized in Thailand on Jan. 13. She had been in Wuhan, but not at the seafood market. That was strong evidence that the virus was spreading from human to human.
The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said
Emergency declaration
Six days later, China acknowledged that there was human-to-human transmission. Dr. Tedros convened an emergency committee to determine whether to declare a global public-health emergency.
On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?
The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration, the committee chair, Didier Houssin, said in a news briefing after the meeting ended.
Meanwhile, a team of five WHO staff had just toured Wuhan. Case counts would likely increase, potentially into thousands, reported the team, which had begun to understand a crucial phenomenon: Many cases were mild. They asked if China needed the WHO’s help. Then one member developed a cough, and the team was quarantined
With so many unanswered questions, Dr. Tedros decided to go to China with a small entourage. They rushed on a weekend to get visas and catch a flight to Beijing.
On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi. Dr. Briand was overtaken by the enormous room and the formality and protocol.
Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip.
Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.
China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said.
Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.
The emergency was the sixth the WHO had ever declared. The announcement was the biggest cannon in its arsenal.
In the weeks to come, Germany’s Angela Merkel remained focused on repairing a faltering border-control agreement with Turkey.
President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well.
The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries.
As for keeping borders open, by then many governments had already closed them to visitors from China.
The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.
Hospitals there overflowed with desperately ill patients. Soon, the virus tore through a nursing home in Kirkland, Wash., and ravaged New York City.
To date there have been 24 million cases world-wide, nearly a quarter of those in the U.S. More than 822,000 people have died.
Lessons learned
If there were one thing the WHO might have done differently, it would be to offer wealthier countries the type of assistance with public-health interventions that the WHO provides the developing world, Michael Ryan, head of the WHO’s health emergencies program, said in a media briefing last month.
Going forward, an independent committee will review parts of the International Health Regulations, Dr. Tedros said Thursday. The committee will advise him on whether changes “may be necessary to ensure this powerful tool of international law is as effective as possible,” he said.
“The pandemic has been an acid test for many countries and organizations as well as for the International Health Regulations,” he said.
Many global-health experts, including Dr. Tedros, say the WHO’s warning system of declaring a global public-health emergency needs to change. Some want to see a warning system more like a traffic light—with color-coded alarms for outbreaks, based on how worried the public should be. A flare-up of polio or Ebola isn’t the same as a rapidly spreading new respiratory virus. One afflicts a region; Covid-19 swept the world.
Emergency committees need clearer criteria for declaring a global public-health emergency and should publicly explain their thinking, according to a recent study in the BMJ Global Health, which found past decisions inconsistent.
The WHO should have more powers to intervene in countries to head off a health crisis, said Jimmy Kolker, a former U.S. ambassador and former assistant secretary for global affairs at the U.S. Department of Health and Human Services. He also said that the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.
Implementing many of those ideas would require herding diplomats back for another monthslong slog of treaty revisions. If and when such talks begin, new governments will likely be in place, and political priorities will float elsewhere, said Adam Kamradt-Scott, a global health security scholar at the University of Sydney who sat through the last round.
“Unfortunately, I’m very cynical about this,” he said. “We are living through cycles of panic and neglect. We’ve been through all of this before.”
- BETSY MCKAY
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