Wednesday, 15 April 2020

How the WHO managed to hang itself out to dry

The global medical body stuck with advice that its own members ignored for so long that it made itself an easy target for White House anger.
Nick HossackColumnist
Last week, the president of the World Health Organisation (WHO) listed a string of achievements to mark the 100 days since the coronavirus outbreak. Less than a week later, the Trump administration has withdrawn its funding, citing mismanagement and cover-ups.
As a United Nations body, the WHO is naturally positioned to lead the world’s fight against the invisible enemy, but there is one glaring fact that gets to the root of why the US is withdrawing funding: WHO still recommends against countries imposing travel bans.
President Donald Trump arrives for a coronavirus taskforce meeting in the White House. Abaca
Since early January, WHO has published travel advice to member countries. Its latest is from February 29, and states:
"WHO continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks".
A quick look through the Wikipedia list of countries adopting travel bans, it seems the whole globe is restricting movement across borders to help contain the virus.
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There are at least three explanations why countries have not adopted WHO’s advice.
One is that WHO is correct and member countries are wrong. This explanation seems unlikely. In Australia’s case, medical advisers and ministers have constantly cited the early travel bans on China, South Korea, Italy and Spain as factors containing infection rates.
While WHO may have aligned its travel advice with that of Beijing, even China is now imposing travel restrictions.
A second possible explanation is that WHO has changed its advice on travel restrictions but is tardy in publishing new guidance. That would appear too big an oversight in the midst of a serious threat to human life.
A third explanation is that WHO executives knew that by changing travel guidance, they risked playing into the hands of Donald Trump and senior Republicans who accuse the UN body of China bias.
A central tenet in scientific disciplines is that when facts and information change, scientists should commensurately be prepared to change their conclusions. The concept was made famous by economist John Maynard Keynes, but applies to all fields.

Advice unchanged

Where WHO is vulnerable is that as new information about the coronavirus emerged or was confirmed, the agency did not substantially alter its advice with respect to travel restrictions, but instead kept its advice aligned with China’s determination to keep open international travel and prevent being isolated.
In late December 2019, WHO was informed by Chinese authorities of a new virus with unknown pathologies, but it was found that investigations suggested no evidence of human-to-human transmission.
On January 5, WHO published a "Disease outbreak news", detailing what was known about the virus. On the critical issue of human transmission, the statement said "preliminary" information from China indicated no evidence of significant transmission.
Yet, despite the preliminary nature of the information, WHO issued very definitive travel advice: "WHO advises against the application of any travel or trade restriction on China based on the current information available on this event."
Five days later, in a formal travel advisory, WHO maintained there was no significant evidence of human transmission and noted an absence of reported cases outside China.
But the statement acknowledged the new coronavirus was in the same family of respiratory diseases as Severe Acute Respiratory Syndrome (SARS). Once again, the advice was definitive, in a bolded headline it advised: "International traffic: no restrictions recommended".

First death

Within four days, important developments emerged. On January 12, China reported its first death. Thailand reported the first diagnosed infection outside mainland China, in a recent traveller from Wuhan. And two technical employees from WHO gave a press conference revealing that there "may" have been "limited" human-to-human transmission from the coronavirus.
So, by mid-January, WHO had at least some evidence the infection was deadly, had transferred between humans, and had spread from travel.
It took WHO 10 days to update its travel advisory, publishing on January 24. In its update, it was noted that coronavirus had appeared in several other countries and the UN body advised that countries take steps to limit exportation and importation of the disease. The day before, January 23, the Chinese central government imposed a lockdown in Wuhan and other cities in Hubei province.
Yet, amazingly, WHO still advised against the application of any restrictions of international traffic.
Over the next three travel updates, up to the end of February, WHO continued to advise against travel restrictions, even as evidence mounted over the potential worldwide catastrophe that may result from the coronavirus.
And that remains the position today. As the infections increased, deaths mounted, WHO’s travel advice remained essentially unmoved.
But none of WHO’s member countries has actually taken that advice.
The problem WHO now has is there is no new information that would provide an objective basis to change its travel advice, so changing it at this late stage will raise suspicions that it was arbitrary all along and designed to benefit China’s commercial interests. In other words, it was China biased.
The UN body is now caught between looking irrelevant because its members have ignored its travel advice, or changing its advice, and helping to justify Trump’s decision to defund it. Not a great situation in the middle of a humanitarian crisis.
An irony is that while WHO may have aligned its travel advice with that of Beijing, even China is now imposing travel restrictions. The UN health agency is on its own and without US money.

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