Pandemic failure or convenient scapegoat: How did WHO get here? By Thomas Gaulkin • July 9, 2020 • thebulletin.org/2020/07/pandemic-failure-or-convenient-scapegoat-how-did-who-get-here n April 7, the number of reported A week later, Trump declared a freeze on US deaths in the United States due to funding for WHO, pending a White House in- COVID-19 reached 12,757—sur- vestigation into its handling of the outbreak. O On May 18—as COVID-19 deaths in the passing the CDC’s median estimate of 12,469 deaths from the 2009 Swine Flu pandemic, United States neared 100,000—the president during Barack Obama’s administration. addressed a letter to WHO’s director gener- al, Tedros Adhanom Ghebreyesus. It included That same day, the US president began attack- a four-page-long bullet list of complaints and closed with an ultimatum: “Commit to major ing the World Health Organization for failing substantive improvements within the next 30 to contain the coronavirus pandemic. days” or the funding freeze will become per- manent. Trump didn’t wait that long. On May 29, he announced the United States was “ter- minating” its relationship with WHO and “re- directing those funds to other worldwide and deserving urgent global public health needs. The world needs answers from China on the virus.” On July 7, the Trump administration formally notified the UN that the United vestigation gets underway (if that ever hap- States would withdraw from the WHO. pens), the questions of how the pandemic began and why it wasn’t quashed in infancy But Trump is not alone in raising questions may take years to answer. Still, it’s already about WHO’s response to the novel corona- clear that the developed world—with all of its virus. The organization’s governing body, the advanced medical and communications tech- World Health Assembly, passed a resolution on nologies and national and international gover- COVID-19 in May requiring an “evaluation” nance structures—undeniably and miserably of WHO’s performance “at the earliest ap- failed to stop a lethal disease from infecting propriate moment.” A preliminary report re- the globe and exacting enormous human and leased in mid-May by the WHO Health Emer- financial costs. gencies Programme Independent Oversight and Advisory Committee noted that while the WHO had the job of being the world’s alarm programme had demonstrated its effectiveness system for the coronavirus outbreak. But by responding to 174 “acute events” world- WHO was established as and remains an or- wide in May alone, the COVID-19 pandemic ganization whose members are sovereign na- “has tested WHO as never before,” particular- ly in the implementation of the International Health Regulations that define how the orga- nization and its member states should respond to outbreaks. Other WHO members and leading biosecuri- ty experts have called for a more thorough and immediate forensic investigation of the pan- demic’s origins. WHO officials have said such an investigation (which would require access to Chinese sites and records) would be danger- ous at this time. “It’s like basically taking the fire engines away from the fire, and asking it to go for routine maintenance when desperately needed to put out a flame,” the WHO Direc- tor-General’s special envoy on COVID-19, David Nabarro, told CBS news. WHO announced on July 7 that it will send a team of experts to China to begin prepara- tions for a mission to identify how the novel coronavirus made the jump to humans—but did not specify a time frame for that mission. The 1897 International Sanitary Conference in Venice was featured on the cover of L’Illustrazione Italiana. The conference No matter when an independent forensic in- introduced new regulations related to plague. 2 Bulletin of the Atomic Scientists tions; its ability to act directly when diseases concerns about the impact of disease (par- threaten is limited by its members’ willingness ticularly cholera) on travel and trade led to or unwillingness to cooperate—and, more fun- multilateral negotiation of the International damentally, by the mandate and resources for Sanitary Conventions. First proposed in 1851 intervention that its member states authorize. and supplemented periodically until 1938, the What does it actually mean, then, when the conventions initially embodied the efforts of most powerful of WHO members, the United a small group of (mainly European) states to States of America, sternly turns around and simplify onerous and country-specific quaran- points the finger of blame at WHO—and, in tine rules (see sidebar below) that kept their no small regard, at itself ? trading ships literally at bay. The rules target- ed a specific set of diseases—mainly cholera, The origins of international yellow fever, and plague—to prevent them health regulation from reaching European borders from the east The earliest modern attempts to coordinate and disrupting trade. international responses to disease also reflect- ed the specific interests of the most influen- “It was not cooperation in the spirit of finding tial countries. Beginning in the 19th-century, global solutions to global problems,” Universi- Sidebar: Vinegar, oilskins, and iron tongs From The scientific background of the read it without touching it. Letters Another article (616) provided International Sanitary Conferences, from the unfortunate sick or sus- that a surgeon clad in oilskin gar- 1851-1938 by Norman Howard-Jones, Former Director, Division of Editorial pect passengers confined to a laz- ments could operate with special and Reference Services, WHO. aret (quarantine station) had to be long-handled instruments provid- thrown for a distance of ten paces, ed that he carried with him a bra- It is of interest to cite some of the retrieved with long tongs, plunged zier for burning aromatic herbs. It procedures that were in force, as into vinegar, and then passed was firmly believed that low spirits described by Papon in 1800. On through the flame and smoke of predisposed to epidemic diseas- disembarking, the Master of an ignited gunpowder.” es, and Papon cites with apparent infected or suspected ship was approbation the case of a doctor required to stand before an iron Very similar precautions were who was “very careful” to drink a grille, swear on oath to tell the prescribed in regulations promul- few glasses of wine from time to truth, and then throw the ship’s gated in 1835 by the French Min- time when attending a potential- bill of health into a basin of vine- ister of Commerce. Article 614 ly dangerous patient. “He did not gar. An official would then plunge stated that where there was need get drunk,” says Papon, “but he the bill beneath the surface with for surgical intervention, a surgical became merry.” For the involun- the aid of iron tongs and, when student should be “invited” to be tary inmate of a lazaret, the visit it was judged to have been well incarcerated with the patient— of a half-tipsy doctor clad from soaked, remove it by the same students presumably being more head to foot in oilskins and bear- means, lay it on the end of a plank, expendable than doctors. ing long-handled instruments and and thus present it to the ‘con- a portable brazier was probably servateur de la santé,’ who would […] less than reassuring. thebulletin.org 3 ty of Freiburg historian Thomas Zimmer told Both the Paris Office and League of Nations the Bulletin. “The spirit was ‘we need to pro- health operations were folded into WHO at tect our own borders.’” its founding in 1948, and the WHA voted to consolidate the 13 separate conventions as a But diplomatic coordination around the Inter- single set of International Sanitary Regula- national Sanitary Conventions paved the way tions in 1951. Revised and renamed in 1969 for the World Health Organization, as the first as the International Health Regulations, they international health organizations emerged continued to pertain only to a short list of ep- in part to provide a permanent venue for im- idemic diseases—like cholera, yellow fever, plementing the conventions. The Pan Amer- plague, and smallpox (eradicated by the late ican Sanitary Bureau—which, as the Pan 1970s in one of WHO’s least-disputed tri- American Health Organization (PAHO) now umphs)—through the turn of the millennium. doubles as the WHO’s regional office for the Americas—was established in 1903 to ease It took nearly five decades for the internation- trade between the United States and Latin al regulations to be revised to more compre- America; the Paris-based Office International hensively address the planet’s vulnerability to d’Hygiene Publique was driven by European contagious diseases—including influenza and interests at its creation in 1907, but eventually coronavirus, the two viruses that have caused took over as the global steward of the Interna- the deadliest pandemic outbreaks of the past tional Sanitary Conventions. One of the more century. successful activities of the ill-fated League of Nations was its Health Organization, which The Magna Carta of health coordinated sharing of national health infor- The World Health Organization was con- mation, research, and prevention of disease, ceived in the wake of World War II “to pro- and set the stage for the creation of the WHO. mote and protect the health of all peoples” amid a wave of idealism about the role inter- national institutions could play in creating a peaceful planet. The United States played a pivotal role: Then-US surgeon general Thom- as Parran presided over the 1946 Internation- al Health Conference that drafted the WHO constitution. He dubbed it the “magna carta of health.” One defining feature of the WHO constitu- tion that distinguishes it from other specialized agencies under the United Nations umbrella is the World Health Assembly (WHA).