News in Focus

The world this week News in focus FABRICE COFFRINI/REUTERS FABRICE WHO director-general Tedros Adhanom Ghebreyesus is reviewing how the world responded to the early days of the COVID-19 pandemic. WHY DID THE WORLD’S PANDEMIC WARNING SYSTEM FAIL FOR COVID? Nearly one year ago, the World Health Organization sounded the alarm about the coronavirus, but its message was ignored.

By Amy Maxmen is that so many countries ignored it. Two new any changes would occur. Some of the propos- preliminary investigations — one from the als include modifying the PHEIC alarm to have he World Health Organization (WHO) WHO and another from an independent panel colour-coded warning levels, and gettingcoun- sounded its highest alarm on 30 Janu- responsible for assessing the organization — tries to sign a new pandemic treaty. ary 2020 — it declared a ‘public health attempt to unravel why. The thorniest problem for the WHO, how- emergency of international concern’, “The biggest issue to me is that for six to ever, is how to persuade countries to heed its or PHEIC, signalling that a pandemic eight weeks after the PHEIC declaration, warnings. Liu says: “The real question is, what Tmight be imminent. But few countries heeded countries, except for in Asia, sat on their would it take for people to do something when the WHO’s call for testing, tracing and social hands,” says Joanne Liu, a former president a declaration happens?” distancing to curb the coronavirus. By mid- of Médecins Sans Frontiérs (also known as The PHEIC alarm originated in 2005, when March, the virus had spread around the world. Doctors without Borders), who serves on the the WHO overhauled its decades-old regula- Now, health officials and researchers are eval- independent panel. tions about international health emergencies: uating why the organization’s warning system World health officials evaluated potential 196 countries and territories agreed to alert failed and how to overhaul it. improvements to the system during the WHO’s the organization when outbreaks emerged, Many say the organization should have executive board meeting, held on 18–26 Jan- and gave it the power to declare a PHEIC. The declared a PHEIC about a week earlier than it uary. Talks will continue in advance of the WHO can sound this alarm if it deems an emer- did. But the largest failing, researchers agree, annual World Health Assembly in May, when gency extraordinary, if the emergency poses

News in focus a risk to countries outside where it originated But governments around the world ignored The WHO therefore relies on diplomacy, and if it requires an international response — those calls. For example, the United States did which often boils down to praising or shaming meaning, in some cases, that it could have not roll out testing across the country until countries. But the WHO’s appetite for criticism pandemic potential. late February, and it banned some travel from is limited by its reliance on donations from its With each PHEIC, the WHO advises govern- China, where the virus was first discovered. member countries and on countries openly ments on how to deal with the emergency. For Countries seem to agree that to improve the offering access and information — which could example, last January, WHO director-general world’s ability to respond to pandemics, the be withheld if leaders felt insulted. A case in Tedros Adhanom Ghebreyesus said of the WHO should be transformed and bolstered. point is that the WHO spent weeks gently COVID-19 outbreak, “It is still possible to Speaking as a representative of the United persuading China to permit an international interrupt virus spread, provided that countries States, Anthony Fauci, director of the US team of scientists to visit Wuhan after the out- put in place strong measures to detect disease National Institute of Allergy and Infectious break was reported there. On the financing early, isolate and treat cases, trace contacts Diseases, told the WHO on 21 January that the front, researchers say that a larger, reliable and promote social-distancing measures.” country will reverse its withdrawal from the budget for the WHO would give the organization greater autonomy because it wouldn’t What’s in a name? “The real question is, what be dependent on fundraising amid a disaster. Liu admits that the term PHEIC isn’t as sexy To address communication concerns, Tedros as an emotive word, such as ‘pandemic’ or would it take for people has suggested adding a gradient of warnings to ‘emergency’. But researchers and health offi- to do something when a the PHEIC, coded by colour. The colours could cials chose it partly because they wanted to declaration happens?” separate emergencies that might evolve into a avoid panic while encouraging world leaders pandemic from those that are serious but won’t to act according to WHO advice, says Gian affect nations across the globe. Countries with Luca Burci, an international law specialist at organization, initiated by former president outbreaks might more willingly share informa- the Graduate Institute of International and Donald Trump, and will “work constructively tion if there were a low-grade alarm that was Development Studies in Geneva, Switzerland. with partners to strengthen and importantly less likely to result in disruptions to people’s Burci helped to revise the regulations in 2005. reform the WHO”. livelihoods or the economy. In hindsight, that reasoning seems to be One change to strengthen the WHO could be Reforms won’t come until the World Health flawed. Several reports note that politicians a new treaty on pandemics, proposed by the Assembly in May — at the earliest. The possi- and the public mainly ignored the PHEIC decla- president of the European Council, Charles bility of solutions being delayed or forgotten ration and Tedros’s corresponding recommen- Michel. On 20 January, Tedros said he would fills Liu with dread, because she recalls dozens dations in January 2020, but started listening assemble a working group to explore this p. of panels assessing failures in the response to when the organization used the unofficial term Still, the WHO probably wouldn’t have the the Ebola outbreak in West Africa in 2014–16. ‘pandemic’ to describe COVID-19 in March, ability to penalize countries that don’t com- “Less than 10% of the recommendations were once the disease was spreading on multiple ply with the treaty. “There’s no silver bullet followed up on,” she says. “We have an amazing continents. Unlike the PHEIC, ‘pandemic’ is not here since you’re dealing with a community talent to outrage ourselves about a situation, a defined declaration, and countries haven’t of nations, all of whom guard their sovereignty but when it comes time to deliver any change, agreed to take any actions once it’s used. very closely,” says Steven Solomon, principal there is very little traction, and people go back Despite the disproportionate response to legal officer at the WHO. to doing whatever they had done before.” the word pandemic, many scholars argue that changing the name of the WHO’s highest alarm wouldn’t be useful. “I don’t care for the term PHEIC,” says Alexandra Phelan, a global-health lawyer at Georgetown University in Washing- ton DC, “but I worry that if we get too into the FAST-SPREADING COVID words, we miss the point that countries need to act appropriately when there is a declaration.” VARIANT CAN ELUDE Global-health scholars question why a PHEIC for COVID-19 wasn’t declared sooner. On 22 IMMUNE RESPONSES January 2020, Tedros convened a closed-door meeting of virologists, public-health research- Early studies find that a variant of the virus identified ers and certain government representatives — as the PHEIC process dictates. They decided in South Africa could compromise immunity. that a warning wasn’t warranted, but a week later, the committee flipped its position. The By Ewen Callaway some of the results could portend a reduction delay might have cost the world time to con- in the effectiveness of COVID-19 vaccines. tain the virus. vidence is growing that some corona- But the picture is murky, Altmann and Still, a one-week lag in declaring a global virus variants could evade immune other scientists emphasize. The studies — emergency isn’t even the most concerning responses triggered by vaccines and which examined the blood of small numbers action that took place in the early days of the previous infections. Researchers are of people who had recovered from COVID‑19 COVID-19 pandemic, critics say. When Tedros trying to make sense of a tsunami of or received a vaccine — probed only their declared the PHEIC, he advised governments Elaboratory studies released last week that raise antibodies’ capacity to ‘neutralize’ variants to move fast with public-health measures concerns about some emerging variants and in laboratory tests, and not the wider effects of including tests and social distancing. He also mutations. other components of their immune response. asked them to resist bans on travel and trade “Some of the data I’ve seen have really scared Neither do the studies indicate whether because, historically, they had been of limited me,” says Daniel Altmann, an immunologist the changes in antibody activity make any utility and are potentially harmful. at Imperial College London, who worries that difference to the real-world effectiveness of