World Health Organization's response to the COVID-19 pandemic

The World Health Organization is a leading organization involved in the global coordination for mitigating the COVID-19 pandemic. On 5 January 2020, WHO notified the world about "pneumonia of unknown cause" from China and subsequently followed up with investigating the disease.[1] On 20 January, WHO confirmed human-to-human transmission of the disease.[2] On 30 January, WHO declared the outbreak a Public Health Emergency of International Concern and warned all countries to prepare.[3] On 11 March, WHO said that the outbreak constituted a pandemic.[4] WHO has spearheaded several initiatives like COVID-19 Solidarity Response Fund for fundraising for the pandemic and Solidarity Trial for investigating potential treatment options for the disease.[5][6] In responding to the outbreak, WHO has had to deal with political conflicts between member states, in particular between the United States and China.[7][8][9]

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COVID-19 pandemic
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Timeline

December 2019
  • On 30 December 2019, WHO obtained a Chinese report about seven or more cases of atypical pneumonia.[7]
  • On 31 December 2019, authorities in China reported a cluster of cases of pneumonia of unknown cause.[1] Taiwan's CDC emailed WHO a few hours later, restating the earlier Chinese report and requesting more information.[7]

January 2020
  • On 1 January 2020, WHO set up the Incident Management Support Team for dealing with the disease outbreak on an emergency basis.[10]
  • On 5 January 2020, WHO notified all member states about the new outbreak of an unknown pneumonia virus in Hubei province of China.[11]
  • On 10 January, WHO issued a comprehensive package of guidance to countries on how to test for potential cases.[11] By this date, WHO warned of the risk of human-to-human transmission.[12][3]
  • On 12 January, Chinese scientists shared the genetic sequence of the new virus,[13] and WHO asked a German team to design a test.[14]
  • On 13 January, WHO confirmed the first case of the disease outside of China, in Thailand.[15]
  • On 14 January, Maria Van Kerkhove of WHO told in a press briefing that "it is possible that there is limited human-to-human transmission, potentially among families, but it is very clear right now that we have no sustained human-to-human transmission"[16] [17][18]WHO recommended countries to take precautions due to the human-to-human transmission during earlier SARS and MERS outbreaks.[12][3] On the same day, WHO's Twitter account reported that "preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission".[19]
  • On 20 January, WHO tweeted that it was "now very clear from the latest information that there is at least some human-to-human transmission" that has occurred, given that healthcare workers had been infected.[2]
  • On 22 January, WHO issued a statement stating that the data "suggests that human-to-human transmission is taking place in Wuhan", and called for more investigation.[20]
  • On 22 January, an emergency committee was convened to assess whether the outbreak constituted a public health emergency of international concern (PHEIC). The committee could not reach a consensus.[21]
  • On 27 January, WHO assessed the risk of the outbreak to be "high at the global level".[22]
  • On 30 January, the emergency committee reconvened, and advised that the outbreak constituted a PHEIC. WHO warned that "all countries should be prepared for containment".[3][23]

February 2020
  • On 3 February, World Health Organization chief Tedros Adhanom Ghebreyesus said there was no need to "unnecessarily interfere with international travel and trade" in trying to control COVID-19. He said, "We call on all countries to implement decisions that are evidence-based and consistent." At the time, China was "facing increasing international isolation due to restrictions on flights to and from the country, and bans on travellers from China" according to Reuters.[24][25][26] WHO's long-standing policy is that travel restrictions are generally ineffective and can be counter-productive.[27]
  • On 12 February, a Research and Innovation Forum was convened by WHO, which included researchers and funders, to fund priority research for stopping the outbreak and preventing future outbreaks.[28]
  • From 16–24 February, the WHO–China Joint Mission travelled to China and created a report about the evolution of the outbreak in China.[29]

March 2020
  • On 3 March 2020, WHO released a Strategic Preparedness and Response Plan to help protect those countries with weaker health systems.[30]
  • On 9 March, WHO and ICAO published a reminder statement to caution against the breach of the 2005 International Health Regulations.
  • On 11 March, WHO confirmed coronavirus disease 2019 as a pandemic. The DGWHO called on governments to change its course by taking "urgent and aggressive action".[4]
  • On 13 March, WHO launched COVID-19 Solidarity Response Fund to support their work in containing the 2019-20 coronavirus pandemic.[31]
  • On 18 March, WHO launched Solidarity Trial, an international clinical trial to find an effective treatment for coronavirus disease.[32]

April 2020
  • On 3 April, WHO announced that it will work together with UNICEF on COVID-19 response through Solidarity Response Fund.
  • By 7 April WHO had accepted two diagnostic tests for procurement under the Emergency Use Listing procedure (EUL) for use during the COVID-19 pandemic, in order to increase access to quality-assured, accurate tests for the disease.[33]
  • 9 April marks the 100th day since WHO was notified of the first cases of 'pneumonia of unknown cause' in China. The Director General told that WHO will release an updated strategy for fighting the pandemic. WHO launched the UN COVID-19 Supply Chain Task Force to scale up the supply of life saving products for COVID-19.[34]
  • On 23 April, WHO accidentally posted draft reports of results from COVID-19 trials in China, which were then removed from the website.[35] Financial Times published an article on the findings,[36] and Gilead Sciences released a statement saying that "the study investigators did not provide permission for the publication of the results. Furthermore, we believe the post included inappropriate characterizations of the study." Gilead indicated that there were plans to publish the data in a peer-reviewed outlet.[37]
  • On 24 April, WHO released a scientific brief arguing against immunity passports due to insufficient evidence.[38] They also launched Access to COVID-19 tools accelerator, a collaboration to accelerate the development and production of vaccines, diagnostics and therapeutics for COVID-19.[39]
  • On 30 April, the third meeting of the Emergency Committee convened by the WHO Director-General, agreed that the pandemic still constitutes a PHEIC.[40]

May 2020
  • On 18-19 May, the 73th World Health Assembly was held online. Australia and the EU tabled a seven-page motion which was supported by over 120 delegations.[41] The Australian delegation hardened the tone of the original European text, to include the qualifiers "impartial, independent and comprehensive evaluation",[42] to the text of OP9.10 "as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19", "using existing mechanisms (including an IHR Review Committee and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme)". The motion was supported by China but not by the United States, [43] and passed by the WHA with unanimity. The final motion calls for the review to be coordinated by the WHO itself.[42]

June 2020
  • On 5 June, the World Health Organization recommended mask-wearing for members of the public, a change from their previous recommendations, on the basis of increased evidence. The organization still had reservations, though, and cautioned that mask use by the general public was still "not yet supported by high quality or direct scientific evidence".[44]

Initiatives

WHO releases daily situation reports and holds press conferences for updating the media about the pandemic.[45] WHO has shipped more than two million items of personal protective equipment and one million diagnostic test kits to over 120 countries.[46] WHO has launched multilingual e-learning courses about various aspects of COVID-19, including for preparedness and response.[47][48] By April 2020, WHO's Solidarity Response Fund had gathered more than US$140 million from more than 200,000 individuals and organizations.[49]

Safe Hands Challenge, a campaign launched by WHO urges everyone to wash their hands regularly saw participation from celebrities.[50] WHO has active presence on all social media channels, where they work to counter misinformation.[49] In order to counter myths related to COVID-19, WHO has created resources for the public.[51] WHO has partnered with Lady Gaga, who will perform a TV concert for fundraising for health workers. By 7 April, she raised US$35 million for the cause.[52]

People

Tedros Adhanom Ghebreyesus, WHO's Director-General, has been leading the organization's efforts to contain the coronavirus pandemic.[45] Along with Tedros, Michael J. Ryan, executive director of WHO's Health Emergencies Programme and Maria Van Kerkhove, technical lead of COVID-19 Response, appear in press conferences at WHO Headquarters in Geneva.[53] The WHO–China Joint Mission in February 2020 was headed by Bruce Aylward of WHO and Wannian Liang of China's National Health Commission.[29]

Reception

WHO's handling of the epidemic has come under criticism amidst what has been described as the agency's "diplomatic balancing act" between "China and China's critics", as ongoing tension between China and the United States creates challenges in controlling the virus.[54] Critics charge the organization with being "too close to Beijing".[14] Initial concerns included the observation that while WHO relies upon data provided and filtered by member states, China has had a "historical aversion to transparency and sensitivity to international criticism".[55]

In response to the criticisms, Director-General Tedros has stated that China "doesn't need to be asked to be praised. China has done many good things to slow down the virus. The whole world can judge. There is no spinning here,"[56] and further stating that "I know there is a lot of pressure on WHO when we appreciate what China is doing but because of pressure we should not fail to tell the truth, we don't say anything to appease anyone. It's because it's the truth."[57] Some observers have said WHO is unable to risk antagonizing the Chinese government, as otherwise the agency would not have been able to stay informed on the domestic state of the outbreak and influence response measures there, after which there would have "likely have been a raft of articles criticizing WHO for needlessly offending China at a time of crisis and hamstringing its own ability to operate."[57] Through this, experts such as Dr. David Nabarro have defended this strategy in order "to ensure Beijing's co-operation in mounting an effective global response to the outbreak".[58] Osman Dar, director of the One Health Project at the Chatham House Centre on Global Health Security defended WHO's conduct, stating that the same pressure was one "that UN organisations have always had from the advanced economies."[54]

African leaders expressed support for WHO amid the pandemic, with the African Union saying the organization had done "good work" and Nigerian President Muhammadu Buhari calling for "global solidarity".[59]

The Deputy Prime Minister and Finance Minister of Japan, Tarō Asō, said that some people have called WHO the "China Health Organization", because of what he described as its close ties to Beijing.[60]

On 14 April 2020, United States President Donald Trump announced that the United States would halt funding to WHO while reviewing its role in "severely mismanaging and covering up the spread of the coronavirus."[61] A week earlier, at a press briefing, Trump had criticized WHO for "missing the call" on the coronavirus pandemic and had threatened to withhold U.S. funding to the organization; on the same day, he also tweeted a complaint that China benefits disproportionately from WHO, saying that "WHO really blew it."[62] The U.S. Congress had already allocated about $122 million to WHO for 2020, and Trump had previously proposed in the White House's 2021 budget request to reduce WHO funding to $58 million.[63] The announcement by President Trump drew widespread condemnation from world leaders and health experts, and came amid constant criticism of his failure to prepare for the outbreak in the United States, the country with the highest official number of confirmed cases of infection as of April 15, 2020.[64][12] WHO called the decision "regrettable" and stated that the organization first alerted the world on 5 January when a cluster of 41 cases of atypical pneumonia was singled out from the millions of similar cases that occur every year.[65] American law professor Lawrence O. Gostin said that Trump's decision was "the prime example of why we are in this mess": the World Health Organization is hesitant to cause any offense for fear of losing funding.[66]

In April 2020, the Sydney Morning Herald reported that while the Australian government valued the World Health Organization and planned to continue contributing funds, they had "lost faith" in the organization's global headquarters. The Australian government planned to push for WHO to be given greater power, similar to UN weapons inspectors, to reduce reliance on individual country's governments. The Australian government also planned to push for a review of the global handling of the outbreak, including WHO.[67]

In May 2020, German newspaper Der Spiegel reported that China's paramount leader Xi Jinping had asked WHO Director-General Tedros Adhanom Ghebreyesus, in a 21 January phone call, to hold off on issuing a global warning or reporting human-to-human transmission.[68] WHO denied that Ghebreyesus and Xi had spoken on that date and added that the two had never spoken by phone.[69] WHO also noted that China had already confirmed human-to-human transmission on 20 January.[69]

On 19 May 2020, Donald Trump re-affirmed his criticism concerning WHO's management of COVID-19 in a letter to Director-General Tedros Adhanom. The letter presented a selective history of the pandemic, ignored WHO's clear warnings, and falsely claimed that WHO ignored warnings from Taiwan that the virus could be transmitted between humans.[70][71] The Lancet rebutted the claim that WHO had ignored a December 2019 report by the journal, stating its first reports were published on 24 January.[72] Trump threatened to withdraw the United States from WHO if the organization did not "commit to major substantive improvements within the next 30 days."[70] After 11 days, on May 29, Trump announced plans to cut ties between the United States and WHO,[73][74] though it was unclear whether he had the authority to do so.[75]

An Associated Press report said that some WHO officials had internal discussions of an alleged delay by the Chinese government regarding the release of data at an early stage of the pandemic.[76]

Taiwan

The Taiwanese government protested WHO's "very high" risk rating for Taiwan in February 2020, at which time Taiwan had a very small number of cases compared to China.[77] Taiwanese officials and some analysts have said that the exclusion of Taiwan from WHO, on the basis of pressure from China, has increased the risk of Taiwan missing disease-related updates.[78] WHO has responded that Taiwan has been given access to all coronavirus data and information, and said that Taiwanese experts were "involved in all of our consultations ... so they're fully engaged and fully aware of all of the developments in the expert networks."[78] China had previously allowed Taiwan to be an observer at the World Health Assembly, before relations deteriorated in 2016.[79] The Taiwanese government and US President Donald Trump have said that Taiwan sent an email to WHO on 31 December warning of human-to-human transmission, a claim that The Guardian and fact-checking websites have rated as false.[80][81][82][83][84]

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