Yes, Blame WHO for Its Disastrous Coronavirus Response
A step-by-step reconstruction of events reveals a long series of mistakes and missteps.
Time was when the World Health Organization (WHO) was the least controversial of multilateral bodies. Its parent organization, the United Nations, is idealized by some but vilified by others. The International Monetary Fund inspires riots when it meets. The World Trade Organization has become a political punching bag. And the less said about the U.N. Human Rights Council, the better.
Yet from its founding in 1948 until the first decade of this century, WHO was mainly known for defeating smallpox, fighting polio and tuberculosis, and providing support to poor countries that lacked sufficient health infrastructure. However, under the leadership of Margaret Chan, appointed director-general in 2006, and her successor since 2017, Tedros Adhanom Ghebreyesus, WHO has bounced from scandal to scandal. Widely panned for mishandling the swine flu in 2009 and Ebola in 2014, it has also been embroiled in expenses scandals.
Then came the coronavirus.
Tedros, who previously served as Ethiopia’s health minister and then foreign minister, was elected to head WHO with Chinese behind-the-scenes support, reflecting China’s close relationship with Addis Ababa, which has become China’s bridgehead in Africa. WHO has been accused of acting as China’s accomplice in initially suppressing information about the coronavirus, with Tedros repeatedly lauding China’s “transparency” when Beijing had hid information about the virus’s origins, infectiousness, spread, and deadliness for more than a month. Although WHO’s professional staff have faced some criticism for allowing the organization’s coronavirus response to be dictated from Beijing (particularly in regard to WHO’s exclusion of Taiwan), most of the anti-WHO ire has focused on Tedros himself.
It was Tedros, after all, who on Jan. 11 complemented the director of China’s National Health Commission, Ma Xiaowei—whom Tedros called “brother” in a tweet—for “sharing information [on the genetic sequencing of the coronavirus] in a timely manner,” when in fact Beijing had delayed passing on this lifesaving information for 10 days after Chinese doctors completed the research. When China announced no new cases of the coronavirus between Jan. 5 and Jan. 17—a period when we now know the outbreak in Wuhan was in full swing—WHO took this at face value. Based on the information it received from China, WHO assured the world on Jan. 12 that there was “no clear evidence of human to human transmission.” In reality, a Chinese doctor had already concluded that the new disease was “probably infectious” as early as Dec. 27.
Was WHO complicit in China’s deception, or merely credulous? Only the promised “impartial, independent” investigation commissioned by WHO’s governing body of member-state representatives, the World Health Assembly, can say for sure. But given the influence of China over the body and the dependence of the investigation on evidence supplied by Beijing, the investigation may never shed much light on the matter.
Much of the circumstantial evidence surrounding WHO’s coronavirus response points toward complicity. And that complicity seems to have come from Tedros himself.
Immediately after the first reports on Dec. 31 that something was amiss in Wuhan, Hong Kong and Taiwan started temperature screening at airport arrivals halls and alerted hospitals to be on the lookout for acute respiratory illnesses. Singapore followed suit on Jan. 3. Yet on Jan. 5, WHO reassured the world that such precautions were an overreaction. In an announcement that would be relied on by many countries deciding on their initial public health responses, WHO insisted there was “no evidence of significant human-to-human transmission and no health care worker infections have been reported.”
Whether WHO was merely negligent in obtaining the information, or knew but didn’t want to displease the Chinese by announcing it to the world, will be up to an investigation to find out. But WHO already knew at this point that Wuhan hospitals were isolating patients and that Chinese doctors were taking full precautions against possible infection. After all, that was what Chinese newspapers were already reporting (and may help explain the supposed lack of infections among health care workers). When a WHO team eventually conducted site visits to ground zero in Wuhan on Jan. 20 and 21, they found that at least 16 health care workers had been infected. Not publicly reported at the time, one of them was the whistleblowing doctor Li Wenliang, who later died of the illness.
Had Tedros been reading the news from the BBC, he would have known as early as Jan. 3 that Chinese authorities had punished eight doctors for “publishing or forwarding false information on the internet without verification.” That supposed false information, as described by the BBC, included warnings on Chinese social media that the emerging Wuhan pneumonia resembled the 2002-2003 outbreak of SARS. In addition to the description of the new disease, the punishment of doctors for sharing information should have rung alarm bells at WHO about China’s vaunted transparency. Instead, the report and incident went unnoted.
On Jan. 22, the Chinese Centers for Disease Control finally admitted that the novel coronavirus was “highly infectious”—though it maintained, again minimizing the danger, not as virulent as SARS. By then, it had already spread from Hubei province to 12 other Chinese districts, plus Japan, South Korea, Taiwan, and Thailand. And those were just the confirmed cases that had been reported to WHO. By Jan. 24, it had also been reported in Hong Kong, Macao, Vietnam, Singapore, and the United States. Yet on that same day, WHO reaffirmed its advice “against the application of any restrictions of international traffic.”
Strangely, although WHO recommended that China “conduct exit screening at international airports and ports in the affected areas,” it did not recommend entry screening by other countries receiving passengers from China. It recommended temperature checks upon departure from China, but remained oddly vague about entry checks, warning that they “may miss travelers incubating the disease or travelers concealing fever during travel and may require substantial investments.” Yet in the very next sentence, WHO admitted that “the majority of exported cases were detected through entry screening.” Reading between the lines, WHO’s message was: Don’t do anything. Let China handle this.
That message was taken up by other countries. For example, Australia’s chief medical officer, Brendan Murphy, explicitly cited WHO advice when he concluded that “they will stop exits from China which is a more effective way” to fight the virus than “banning direct flights from China.” The latter, WHO advice had led him to believe, was “not a public health measure.” In the United States, the Washington Post published an op-ed chastising the United States and other countries for undermining global health cooperation by pandering to public demands for action.
On Jan. 30, WHO’s Emergency Committee reluctantly declared the coronavirus outbreak a “Public Health Emergency of International Concern.” That the declaration was reluctant can clearly be read between the lines of the statement, in which WHO emphasized that the declaration “should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency.” WHO recommended that other countries “put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures.”
But once again, WHO recommended against “any travel or trade restriction,” implying that such actions could “promote stigma or discrimination.” But this time it went even further, reminding countries that “interfere with international traffic” that they must “send to WHO the public health rationale and justification within 48 hours of their implementation.” When the United States banned noncitizens from entering the country from China on Jan. 31, academic critics and a WHO spokesperson duly condemned the restrictions as “counterproductive” and likely to cause “social disruption.” When Australia and Singapore followed the United States’ lead, a Chinese Foreign Ministry spokesperson said the United States had “unceasingly manufactured and spread panic.”
On Feb. 3, Tedros reiterated WHO’s advice against restricting travel from China. He said that if “it weren’t for China, the number of cases outside China would have been very much higher,” again implying that other countries should rely on China to control the outward spread of coronavirus, instead of imposing restrictions of their own. The next day, Tedros called on countries to reverse their travel restrictions, which he claimed “can have the effect of increasing fear and stigma, with little public health benefit.”
Many countries followed WHO’s guidance, including many poor ones with insufficient public health infrastructure and dependent on the support of international organizations such as WHO. Pakistan, an ally of China which had suspended flights from various Chinese cities on Jan. 31, reinstated flights on Feb. 3, only to suspend them again on March 21. Ethiopia continued flights to and from China despite the pleas of other East African countries desperate to prevent the introduction of the virus into Africa via Addis Ababa’s airport, the continent’s main gateway to China.
As late as Feb. 26, Tedros gave a speech in which, beggaring belief, he claimed that “we are not witnessing sustained and intensive community transmission of this virus, and we are not witnessing large-scale severe disease or death.” On the same day, his own organization reported 81,109 confirmed coronavirus cases in 38 countries and Taiwan, including 2,762 recorded deaths, and a risk assessment of “high” for the entire world. Yet once again, on Feb. 29, WHO confirmed that it “continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks.”
In a bizarre case of self-contradiction, WHO reasoned that “restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions,” even as one of its chief epidemiologists, Bruce Aylward, praised China for its “bold approach to the rapid spread of this new respiratory pathogen” that had “changed the course of what was a rapidly escalating, and continues to be, deadly epidemic.” WHO’s odd message seemed to be that China was right to lock down its population, but other countries shouldn’t dare lock out China.
Of course, China now has some of the world’s tightest travel restrictions on international travel, barring entry by nearly all foreigners (including those with residence permits) since March 28. Perhaps in a nod to WHO guidance that such restrictions should “be short in duration, and be reconsidered regularly as the situation evolves,” China characterized its move as a “temporary measure” that “will be calibrated in light of the evolving situation.” As of late May, the situation still hasn’t evolved sufficiently for China to lift its global travel ban. There’s been no word from Tedros or WHO about the appropriateness of China excluding the world now that China itself is relatively virus-free—the reverse of the situation at the beginning of the pandemic.
U.S. President Donald Trump and his supporters aren’t alone in thinking that “the World Health Organization has been curiously insistent on praising China,” as Trump wrote in a May 18 letter to Tedros that threatened to permanently cut U.S. funding and withdraw from the organization. More than 110 countries have now demanded an investigation into WHO’s handling of the coronavirus crisis. Time will tell just how impartial and independent that investigation turns out to be. The World Health Assembly’s official resolution establishing the investigation, tellingly, does not mention China, which may be why China ultimately agreed to co-sponsor it. The resolution also suggests that the investigation might take advantage of “existing mechanisms, as appropriate.” Translation: Don’t be surprised if WHO ends up evaluating itself. And be even less surprised if that evaluation ultimately pins no blame for the coronavirus pandemic on WHO—or on China.