The question of whether to call Covid-19 a pandemic goes to the heart of the World Health Organization’s internal conflicts.
The World Health Organization still isn’t ready to call the coronavirus a pandemic. This says more about the WHO than it does about Covid-19.
“That word is scary, and it’s used in movies, [but] that word is not a proxy for a deadly apocalyptic virus,” Jennifer Nuzzo from Johns Hopkins University Center for Health Security said in a recent briefing. On the basic WHO definition — the worldwide spread of a new disease — Nuzzo and many others think Covid-19 fits the bill. So why not say so?
The question goes to the heart of why the WHO, which has played a major role in the postwar era in disease fighting and prevention, has been, to put it mildly, a frustrating actor in this crisis. The technical answer is that the WHO identifies a pandemic by various phases and doesn’t believe that Covid-19 has hit all the markers yet. But that’s not quite the whole story.
The bigger problem is that conflicting incentives and roles complicate how the WHO approaches major health crises. This threatens to undermine its credibility. Coronavirus is the ultimate test of an organization whose weaknesses — a painfully slow bureaucracy and a hypersensitivity to the political needs of member states — have never fully been addressed. These failings were apparent during the WHO’s much criticized response to the 2014-2016 Ebola crisis.
A sprawling, but distinctly hierarchical organization within the United Nations family, much of the tone is set at the top, a role occupied by the Ethiopian Director General Tedros Adhanom Ghebreyesus. Often just called Dr. Tedros (he has a Ph.D. in community health and a degree in the immunology of infectious diseases), the WHO chief has walked a tightrope, trying to lead the global health-care response, keep communication channels open with China and avoid unnecessary panic. The problem, it seems, is that the latter two aims are often in conflict with the first.
As my Bloomberg Opinion colleague Adam Minter has noted, the WHO was undeniably late to declare a health emergency (it initially mislabeled the risk from the virus as “moderate”) and too sympathetic to China’s wish to avoid the inevitable economic disruption. “The WHO doesn’t recommend and actually opposes any restrictions for travel and trade or other measures against China,” Tedros said as the scale of the outbreak was becoming clearer. “If anyone is thinking about taking measures, it’s going to be wrong.”
By contrast, the U.S. Centers for Disease Control and Prevention took on an equally big beast as China’s President Xi Jinping, when it contradicted Donald Trump’s assurances that Americans had nothing to worry about from the virus and told Americans to prepare.
While WHO officials have been working to control the spread of the virus, its chief has seemed more focused on controlling the narrative. He has called on countries to push back against the “infodemic” of fake news, which he said was equally dangerous. He told the WHO’s executive board in early February that the organization was working with Google “to make sure people searching for information about the new coronavirus see WHO information at the top of their search results.”
In an article for the South China Morning Post recently, Tedros called for a strategy to “debunk pseudoscience and strengthen trust in everything from vaccination to public institutions. Misinformation thrives where trust in the authorities is weak.” No irony was presumably intended.
Speaking on Monday, Tedros again brushed aside the question of when the WHO would declare a pandemic. Using the word would just spark more fear, he said. “This is not the time to focus on what word we use. That will not prevent a single infection today or save a single life today.”
Tedros’s refrain that “this is a time for facts, not fear” would be fine, except the WHO hasn’t always seemed to follow its own guidance for evidenced-based decisions. On Jan. 31, the Lancet medical journal published a report by three doctors in Hong Kong with modelling that estimated a higher infection rate than was being reported. They inferred that “epidemics are already growing exponentially in multiple major cities in China” and that “preparedness plans and mitigations interventions should be readied for quick deployment globally.” That was a month ago.
It’s true that in the age of social media, panics can spread at thumb-speed. Stampedes of any kind are terrifying. And it can be economically ruinous if supply chains and industries are disrupted. It’s just that when a ship is taking on water, the priority must be to convey the best information available and make timely calls for action. It’s shouldn’t be the job of the world’s doctor to seek to control the economic fallout if lives are at risk.
Mostly, the measures taken by governments, companies, schools and families — from canceling the Tokyo marathon to the self-isolation of those who’ve been in exposed areas — are highly rational. It’s also rational to expect this outbreak to get much worse.
If the virus is as bad as some of the base-case scenarios, it may affect most of us one way or another. While people have been relaxed about a seemingly low mortality rate, a case fatality rate of even 2% would be approaching that of the 1918 flu epidemic. “Even 1% would pose burdens on health systems across the world,” Johns Hopkins’ Nuzzo told her audience.
Having been accused of crying wolf in the past, the WHO may be overcompensating this time. But if (as one hopes) containment prevails, then nobody would blame the WHO for pressing for more information and earlier responses for health authorities and the public.
The WHO’s funding is part of the problem. The fact that most of the member country’s contributions are earmarked for specific health programs allows donors to dictate priorities, with just 20 contributors funding 75% of the program budget (which was $4.42 billion in 2018-2019, lower than that of many major hospitals). China is a major donor.
It may be, as some suggest, that the WHO’s functions should be split or focused solely on setting health standards. Another proposal after the Ebola fiasco was that it become more decentralized. Some of these debates need revisiting.
Tedros may utter the P word soon, telling everyone what they already know; or decide he was right not to if the outbreak abates. However the coronavirus plays out, other epidemics are sure to follow and the WHO, with its deep expertise and ties to national health care systems, will have a central role in coordinating responses. The world just needs to be confident of its priorities. (This column was updated to clarify the comparison to the 1918 flu epidemic.)
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Raphael is Bloomberg Opinion columnist and is reached at [email protected]