WHO still struggling to manage pandemic response
GENEVA » When the World Health Organization declared the coronavirus a pandemic one year ago Thursday, it did so only after weeks of resisting the term and maintaining that the highly infectious virus could still be stopped.
A year later, the U.N. agency is still struggling to keep on top of the evolving science of COVID-19, to persuade countries to abandon their nationalistic tendencies and help get vaccines where they’re needed most.
The agency made some costly missteps along the way: It advised people against wearing masks for months and asserted that COVID-19 wasn’t widely spread in the air. It also declined to publicly call out countries — particularly China — for mistakes that senior WHO officials grumbled about privately.
That created some tricky politics that challenged WHO’s credibility and wedged it between two world powers, setting off vociferous Trump administration criticism that the agency is only now emerging from.
President
Joe
Biden’s support for WHO may provide some much-needed breathing space, but the organization still faces a monumental task ahead as it tries to project some moral authority amid a universal scramble for vaccines that is leaving billions of people unprotected.
“WHO has been a bit behind, being cautious rather than precautionary,” said Gian Luca Burci, a former WHO legal counsel now at Geneva’s Graduate Institute. “At times of panic, of a crisis and so on, maybe being more out on a limb — taking a risk — would have been better.”
First warning
WHO waved its first big warning flag on Jan. 30, 2020, by calling the outbreak an international health emergency. But many countries ignored or overlooked the warning.
Only when WHO Director-General Tedros Adhanom Ghebreyesus declared a “pandemic” six weeks later, on March 11, 2020, did most governments take action, experts said. By then, it was too late, and the virus had reached every continent except Antarctica.
A year appears later, WHO still hamstrung. A
WHO-led team that traveled to China in January to investigate the origins of COVID-19 was criticized for failing to dismiss China’s fringe theory that the virus might be spread via tainted frozen seafood.
That came after WHO repeatedly lauded China last year for its speedy, transparent response — even though recordings of private meetings obtained by The Associated Press showed that top officials were frustrated at the country’s lack of cooperation.
“Everybody has been wondering why WHO was so praising of China back in January” 2020, Burci said, adding that the praise
has come back “to haunt WHO big-time.”
Mask failure
Some experts say WHO’s blunders came at a high price, and it remains too reliant on iron-clad science instead of taking calculated risks to keep people safer — whether on strategies like mask-wearing or whether COVID-19 is often spread through the air.
“Without a doubt, WHO’s failure to endorse masks earlier cost lives,” said Dr. Trish Greenhalgh, a professor of primary care health sciences at Oxford University who sits on several WHO expert committees. Not until June did WHO advise people to regularly wear masks, long after other health agencies and numerous countries did so.
Greenhalgh said she was less interested in asking WHO to atone for past errors than revising its policies going forward. In October, she wrote to the head of a key WHO committee on infection control, raising concerns about the lack of expertise among some members. She never received a response.
“This scandal is not just in the past. It’s in the present and escalating into the future,” Greenhalgh said.
Raymond Tellier, an associate professor at Canada’s McGill University who specializes in coronaviruses, said WHO’s continued reluctance to acknowledge how often COVID-19 is spread in the air could prove more dangerous with the arrival of new virus variants first identified in Britain and South Africa that are even more transmissible.
“If WHO’s recommendations are not strong enough, we could see the pandemic go on much longer,” he said.
Vaccine fairness
With several licensed vaccines, WHO is now working to ensure that people in the world’s poorest countries receive doses through the COVAX initiative, which is aimed at ensuring poor countries get COVID-19 vaccines.
But COVAX has only a fraction of the 2 billion vaccines it is hoping to deliver by the end of the year. Some countries that have waited months for shots have grown impatient, opting to sign their own private deals for quicker vaccine access.
WHO chief Tedros has responded largely by appealing to countries to act in “solidarity,” warning that the world is on the brink of a “catastrophic moral failure” if vaccines are not distributed fairly. Although he has asked rich countries to share their doses immediately with developing countries and to not strike new deals that would jeopardize the vaccine supply for poorer countries, none have obliged.
“WHO is trying to lead by moral authority, but repeating ‘solidarity’ over and over when it’s being ignored by countries acting in their own self-interest shows they are not recognizing reality,” said Amanda Glassman, executive vice president of the Center for Global Development. “It’s time to call things out for the way they are.”
Nearly a year after California Gov. Gavin Newsom ordered the nation’s first statewide shutdown because of the coronavirus, masks remain mandated, indoor dining and other activities are significantly limited, and Disneyland remains closed.
By contrast, Florida has no statewide restrictions. Republican Gov. Ron DeSantis has prohibited municipalities from fining people who refuse to wear masks. And Disney World has been open since July.
Despite their differing approaches, California and Florida have experienced almost identical outcomes in COVID-19 case rates.
How have two states that took such divergent tacks arrived at similar points?
“This is going to be an important question that we have to ask ourselves: What public health measures actually were the most impactful, and which ones had negligible effect or backfired by driving behavior underground?” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Though research has found that mask mandates and limits on group activities such as indoor dining can help slow the spread of the coronavirus, states with greater governmentimposed restrictions have not always fared better than those without them.
California and Florida both have a COVID-19 case rate of around 8,900 per 100,000 residents since the pandemic began, according to the federal Centers for Disease Control and Prevention. And both rank in the middle among states for COVID-19 death rates — Florida was 27th as of Friday; California was 28th.
Two approaches
Connecticut and South
Dakota are another example. Both rank among the 10 worst states for COVID-19 death rates. Yet Connecticut Gov. Ned Lamont, a Democrat, imposed numerous statewide restrictions over the past year after an early surge in deaths, while South Dakota Gov. Kristi Noem, a Republican, issued no mandates as virus deaths soared in the fall.
While Lamont ordered quarantines for certain out-of-state visitors, Noem launched a $5 million tourism advertising campaign
and welcomed people to a massive motorcycle rally, which some health experts said spread the coronavirus throughout the Midwest.
Both contend their approach is the best.
“Even in a pandemic, public health policy needs to take into account people’s economic and social wellbeing,” Noem said during a recent conservative convention.
Lamont recently announced that he is lifting capacity limits at retail stores, restaurants and other facilities,
effective March 19. But bars that don’t serve food will remain closed and a mask mandate will continue.
“This is not Texas. This is not Mississippi. This is Connecticut,” Lamont said, referencing other states that recently lifted mask mandates.
“We’re finding what works is wearing the mask, social distancing and vaccinations,” he said.
Stringent or lax
As new COVID-19 cases decrease nationally, governors in more than half the states have taken actions during past two weeks to end or ease coronavirus restrictions, according to an Associated Press tally. Some capacity limits ended Friday in Maryland and Oklahoma. Michigan, Minnesota, New Jersey, New York and Wyoming are relaxing restrictions in the coming week.
In almost all cases, governors have lauded their approach to the pandemic, while critics have accused them of being too stringent or too lax.
California’s slow reopening is expected to gain steam in April. But Republicans in California are helping organize a recall effort against Newsom that has drawn nearly 2 million petition signatures from people frustrated over his longlasting limits on businesses, church gatherings and people’s activities. He also faces intense pressure over public school closures and the glacial pace of getting them reopened.
Newsom asserted that California has been a leader in combating the virus while delivering his State of the State address this past week from Dodger Stadium, where the empty seats roughly equaled the state’s 55,000 COVID-19 deaths.
“From the earliest days of this pandemic, California trusted in science and data, and we met the moment,” Newsom said.
He added: “We’re not going to change course just because of a few naysayers and doomsayers.”
Best strategy?
In his own State of the State address, DeSantis asserted that Florida was in better shape than others because its businesses and schools are open. Florida’s unemployment rate ranked below the national average, and significantly lower than California’s, at the start of this year.
“While so many other states kept locking people down over these many months, Florida lifted people up,” DeSantis said.
Determining which approach is best is more complicated than just looking at statewide policies and overall case rates.
Like Florida, Missouri had no statewide mask mandate, ended business restrictions last June and has a cumulative COVID-19 death rate similar to California’s. In the absence of statewide orders, many of the largest cities in Florida and Missouri imposed their own mask requirements and business restrictions. In Missouri, that meant about half the population was still subject to mask mandates.
Republican Gov. Mike Parson has touted “a balanced approach” to the pandemic that left many public health decisions up to local officials and allowed Missouri’s economy “to come back strong.” New COVID-19 cases and unemployment are both low, and consumer spending has returned to pre-pandemic levels, Parson said this past week.
State health director Randall Williams believes residents heeded Parson’s call to voluntarily mask up when Missouri’s coronavirus cases spiked last fall to some of the highest levels nationally.
Individual choices
Public health experts said individual choices could help explain the similar outcomes among some states with loose or strict orders from the governor.
Some people voluntarily were “being more vigilant in states where the guidelines are more relaxed,” said Thomas Tsai, an assistant professor at the Harvard T.H. Chan School of Public Health. Yet in states with more government mandates, “people generally in public were wearing masks and following the guidelines, but in private they were letting down their guard and less vigilant,” he said.
Imposing strict measures, like forbidding families from visiting grandparents and friends from gathering, is like taking an abstinence-only approach to combating drug use and sexually transmitted disease, said Adalja, of Johns Hopkins University.
Some will comply. But other “people are going to do those activities, anyway,” he said.