WHO more fragile than ever on the eve of its general assembly

The World Health Organization (WHO) is holding its general assembly May 17-21 as it faces the greatest crisis in its history. Attacked and criticized by its member states, it is tackling this great event, which is more fragile than ever, at the worst time.

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It’s a story of emails sent on New Years Day. On December 31, 2019, China, through the Wuhan Municipal Health Commission, officially warned WHO of the occurrence of several cases of unidentified pneumonia. A new coronavirus is then identified. Can this emerging disease be transmitted from person to person? Chinese authorities say no. However, Taiwan certifies having alerted the organization the same day about the risk of such a transmission. It will take until January 20, 2020 for the WHO to recognize that this new disease spreads well between humans.

Have three weeks been lost? As it turns out, the WHO doesn’t recognize Taiwan as one of its member states, largely because of China’s opposition, which would explain why it ignored the alert. In fact, relations between Beijing and the organization crystallize most of the criticism leveled against it during this pandemic crisis. Is Dr. Tedros Adhanom Ghebreyesus, the head of the organization, under the thumb of the Chinese? ” WHO really missed it all “, tweeted donald trump on April 7, summarizing many of the grievances against WHO. ” It is mainly funded by the United States, but yet very focused on China. “If the American President has thus justified his decision to withdraw from the organization, this criticism is no less caricatured.

WHO dependent

WHO is an intergovernmental agency: this is the crux of the problem “Explains Auriane Guilbaud, of the sociological and political research center of the University Paris 8.” The main tool on which the organization relies is the international health regulations adopted by its member states in 1951 and revised since. It stipulates that member states must report public health events that they have spotted on their territory. WHO therefore depends on its member states and the reliability of their information.

Therefore, was the information provided by the Chinese authorities on this beginning of the epidemic reliable? ” WHO was a bit misled “John MacKenzie told the British daily The Guardian. The advisor to the organization’s emergency committee notes that when China informed the WHO on December 31, its scientists had already sequenced the genome of the virus and already knew they were dealing with a new coronavirus. However, the Beijing authorities will not officially confirm this until January 7, and the entire genome will not be shared with the international community until January 12. Likewise, John MacKenzie wonders about the assessment communicated by China: 59 cases for the first week of 2020, ” very, very far from what we would expect

In this context, what could WHO do? ” As the organization is intergovernmental, it must request the Member State “Explains Auriane Guilbaud. WHO has asked China for permission to send a team of scientists to Hubei province, the epicenter of the epidemic. Beijing refused. ” And WHO has no sanctioning power Added the researcher. It was not until February 8 that the Chinese authorities authorized a team of WHO observers to their territory.

Dr. Tedros has never publicly voiced China’s reluctance to cooperate. He even did the opposite on January 28 when he met Xi Jinping behind closed doors and praised Chinese efforts two days later to contain the disease: ” A new model for epidemic control. However, it was the same January 30 that the WHO declared Covid-19 as a international health emergency. For Auriane Guilbaud, in this sequence, ” WHO has played a diplomatic role in preserving relations with its member states, including China. It’s a pragmatic line, we had to preserve relationships

The example of SARS

In fact, being dependent on its information, the World Health Organization has always spared China during this crisis. However, it has not always played this role. In November 2002, the Chinese government discovered on its soil a new respiratory disease, SARS, and did not inform the WHO. But at the time, under the leadership of its then chief executive, Gro Harlem Brundtland, the organization monitored Chinese medical forums and was therefore aware of this atypical pneumonia. With that information in hand, WHO went to the Chinese leaders, who officially notified it shortly after.

Gro Harlem Brundtland was not afraid to publicly accuse China of having kept this information for herself, thereby preventing the epidemic from being contained. ” if WHO could have intervened earlier and send its teams there ” Following these statements, Beijing quickly cooperated.

Why didn’t WHO take the same line almost twenty years later? Probably because she has lost her aura. In 2003, when the SARS epidemic was spreading in several countries (Hong Kong, Vietnam and Canada), the organization issued for the first time a warning advising against traveling to the affected areas. Although WHO does not have the power to actually nail down planes, this advice has been followed.

Following this epidemic, the WHO response was generally deemed to be a success. Only 26 countries have been affected by the disease and less than 1,000 people have died. ” Brundtland has done things for which WHO had no mandate Remembers David Fidler, consultant for the organization. The reason is that it is neither the treatments nor the vaccines that have overcome SARS, but the global exchange of information, travel restrictions, policies for screening and isolation of the sick.

The missed opportunity

Unfortunately this test will not be transformed. There was, however, an opportunity: ” International health regulations of 1951 were revised following SARS “Explains Auriane Guilbaud. Others pushed to give more latitude to WHO, but it was ultimately the reverse line that won. Several countries feared that they would have to face the same restrictions that China would have to face if they ever found themselves in its situation. Thus, on the issue of closing borders, the revised international health regulations now stipulate that ” Member States undertake to prevent the international spread of disease and to respond to it with proportionate health measures without unnecessary obstacles to movement and international trade ” For Auriane Guilbaud, this half-hearted resolution can be explained by two things: ” First, states must not feel discriminated against, otherwise they may be reluctant to report public health events. Second, they do not want to be ostracized by the international community because all trade with them would have been prohibited.

WHO has become inaudible

For both the 2014 Ebola epidemic and the Covid-19 epidemic, WHO did not call for the borders to be closed. ” In 2014, some states had closed them “Recalls Auriane Guilbaud. ” The WHO then criticized them, saying it did more harm than good. WHO had also taken several months to declare an emergency for the Ebola outbreak. David Fidler believes that this has further delayed essential international assistance, and greatly weakened the leadership from WHO. This lack is glaring today: “Many states no longer follow the recommendations”, analyzes Auriane Guilbaud.

Richard Horton, the editor of the prestigious medical journal The Lancet go further : ” The states, especially the western states, did not listen. Rather: they did not try to understand what was happening in China at the beginning of the year 2020 ” We can thus consider that the declaration of a pandemic on March 11 was purely rhetorical in pushing WHO member states to do more, given that the international health emergency was already forcing them to respond.

The organization has in fact always repeated a few simple principles that states must apply: reduce public exposure to the disease, in particular by identifying all the chains of contamination. ” You have to test, test, test “, Has been hammering Dr Tedros for several months. It was therefore not listened to, since with the exception of the South Korea and of Germany, most Western countries have distinguished themselves by their deficiencies in this matter until confinement has become inevitable – some countries even bet on a putative population immunity backwards from all recommendations.

WHO is also facing an almost complete disappearance of international cooperation in health matters – except scientifically. Images of governments requisitioning masks to the detriment of other countries, others wanting to arrogate the scoop of a possible vaccine … There is no shortage of examples and there is of course the American withdrawal from the organization. It is currently a suspension, but the United States provides 15% of the WHO budget. This will therefore necessarily impact the programs while paradoxically giving more latitude to China – precisely what Washington denounces with this withdrawal. In international epidemic matters, however, is essential: ” Circulating information is essential, and it is a challenge. 194 member states have to work together and someone has to do this. WHO is the only universal health organization “Recalls Auriane Guilbaud.

A general meeting under the sign of Covid-19

It is therefore with this weakened role that the World Health Organization will approach its general assembly from 17 to 21 May. Usually devoted to governance issues, it risks being entirely dedicated to the Covid-19 pandemic. Furthermore, ” this should be a virtual assembly “, Anticipates Auriane Guilbaud. ” It’s a shame because normally there are a lot of discussions between two doors, it won’t be possible. It will still be very interesting to follow, it will be necessary to see how the Member States position themselves in relation to the Director-General, if he is supported.

After each epidemic, WHO always assesses past events. Lessons are learned and lead to more or less large-scale measures. The organization appears today more fragile than ever. What will happen tomorrow? Will its member states agree to give it more latitude? ” We are still in the midst of a crisis. These measures will be for after “Concludes Auriane Guilbaud.

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