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The World Health Organization is supposed to coordinate the global response to epidemics. But the U.N. agency cannot force countries to play by international rules.
For weeks, the World Health Organization resisted declaring the coronavirus outbreak a pandemic, fearing that doing so would incite panic across the globe.
But facing the cameras on Wednesday, the agency’s director general, Dr. Tedros Adhanom Ghebreyesus, did just that, asking for global unity to “change the course of this pandemic.”
It was a symbolic moment that underscored the standing of the W.H.O. as the world’s leading public health agency. But it also reflected the W.H.O.’s underlying weakness as an organization that by international treaty is supposed to lead and coordinate the global fight against coronavirus — yet that has, in many ways, been marginalized.
Global solidarity has been noticeably absent in the fight to stop an outbreak that has already killed more than 4,300 people and spread to more than 110 countries. No one seems to be in charge. There doesn’t seem to be a plan.
Except there is one. The problem is that relatively few countries are paying much attention to it.
[Bagpipe music] There are moments that seem bizarre, moments of fear … … preparation and moments of emptiness. These are scenes from the world living with coronavirus. It has spread across cultures, languages and even out to sea. And despite these global differences, a number of shared experiences have emerged. There is grief over the dead. In Iran, hospital staff mourn a doctor’s death from the virus. In China, a quarantined building collapses, and a firefighter breaks down after pulling bodies from the rubble. In Italy, a man mourns the death of his sister. To try and save lives, authorities take precautions. They disinfect public areas and screen populations. “This is just crazy. Around the world, people are afraid and on edge. “Unbelievable.” In Northern Ireland, routine construction work at an Apple Store is mistaken for virus-related activity. In Japan, tempers flare when a man sneezes on a train. One Italian takes the fear and adds humor. This is a circle to keep people at a safe distance. In fact, lots of people use humor to cope with the uncertainty or the stigma of being sick. In Australia, a run on toilet paper leads to lessons in self-defense. “He’s going to show you how to deal with people stealing your toilet paper.” There is also defiance, a conviction that life must go on despite the virus. Across rooftops in China, quarantined neighbors socialize. From a rooftop in Italy, a theater group performs poetry for an area where movement is restricted. On a quarantined cruise ship, there’s songwriting to pass the time. In an apartment in China, too. But perhaps some of the most striking moments from the pandemic are those where little happens: the empty streets. “Unbelievable. No traffic.” The quiet airports. The places of worship without worshippers. Stores without goods. This is how it is across the globe as we prepare, grieve and wait for the next chapter of the coronavirus.
The coronavirus has touched a diverse collection of countries and cultures, but a number of shared experiences have emerged — from grieving the dead to writing songs.CreditCredit...Carlos Lemos/EPA, via Shutterstock
Fifteen years ago, the World Health Organization undertook a major revision of the International Health Regulations, the global framework for responding to outbreaks. The revision was intended to correct flaws in the global response to the 2003 SARS outbreak, which killed hundreds of people and pushed advanced health care systems to the breaking point.
The basic idea was that the W.H.O. would serve as a central coordinating body. Countries would notify the agency about outbreaks and share information to help scientists address an epidemic at the global level. The W.H.O. would coordinate efforts on containment, declare emergencies and make recommendations. The revised regulation is legally binding and has been signed by 196 countries, including the United States.
But dozens of countries are flouting the international regulations and snubbing their obligations. Some have failed to report outbreaks to the organization, as required. Others have instituted international travel restrictions, against the advice of the W.H.O., and without notifying global health officials.
“One of the biggest challenges we face is that too many affected countries are still not sharing data with W.H.O.,” Dr. Tedros said last month. He has also blamed some countries — he has refused to specify which ones — for failing to take the outbreak seriously enough.
As part of the United Nations, the W.H.O. is broadly influential yet hampered by budget and political pressures. It lacks meaningful enforcement authority, creating a telling power imbalance. It is often accused of kowtowing to its donors — from powerful players like the United States and China to private funders like the Gates Foundation.
These contradictions contributed to the agency’s much-criticized response to the Ebola outbreak in West Africa and led some scholars to question the need for such a weak institution. But Rebecca Katz, a scholar at Georgetown University, said such criticism misses a fundamental point.
“If there wasn’t a W.H.O., you’d have to invent it,” said Dr. Katz, who has studied health regulations for more than a decade. “They are in a bit of a tough spot because you know you have international law but then you also know that every nation is sovereign,” she said.
This time, some former critics credit the W.H.O. for doing a better job, declaring a global emergency much quicker than it did during the SARS and Ebola outbreaks, consistently sharing information with the public and convening more than 300 scientists and research funders to help develop tests, vaccines and medicines.
Even so, the agency is also marginalized in many ways.
The most obvious examples are the global flouting of international travel restrictions. More than 70 countries have instituted the restrictions, according to the W.H.O., including the United States, where President Trump announced on Wednesday night restrictions to travel from the European continent.
Yet in four advisories it has issued since early January, the W.H.O. has consistently advised against them, cautioning that limits on international movement during public health emergencies are unlikely to stop the pathogen’s spread.
The rules do not apply to domestic travel restrictions or to decisions made by private airlines, but the W.H.O. has repeatedly warned that international bans can block needed resources, or delay aid and technical support. Such restrictions are justified only at the beginning of an outbreak to buy nations time to prepare, the agency said. Beyond that, they are more likely to cause significant economic and social harm.
Meanwhile, only 45 of the more than 70 countries that have adopted international travel restrictions have fulfilled the requirement to report their actions to the agency, a spokesman said.
Restricting travel “is a good political placebo. It’s going to make people feel safe,” said Clare Wenham at the London School of Economics, a scholar who has studied the health regulations for more than a decade. “Why are we not learning that this doesn’t work?” Dr. Wenham asked about travel restrictions.
W.H.O. itself has sent out mixed signals in recent weeks. In a report it issued this week, the agency said that some travel restrictions “may have delayed the importation of new cases.” But W.H.O. did not change its fundamental opposition to international restrictions or revise its travel advisory.
Then there is the unwillingness of some countries to lift a ban on the export of protective equipment, complicating the broader fight against the disease. France and Germany have put limits on exports of such gear.
“We can understand that governments have a primary responsibility to their own health workers,” said Michael Ryan, who heads the W.H.O.’s health emergencies program.
He urged nations to stop hoarding gear and called for solidarity across the globe.
“The life of a health worker in one country is certainly as valued as the life of a health worker in another,” Dr. Ryan said on Monday.
The national governments that signed onto the international regulation also left themselves a loophole, which they are exploiting now.
The loophole was the product of hours of negotiations in Geneva, where the revisions were finalized in 2005, according to Gian Luca Burci, who served as the agency’s legal counsel for 11 years. Mr. Burci said negotiators stayed up until 5 a.m. before agreeing on a trade-off that balanced “public health considerations and the retention of the ultimate political power.”
Countries were reluctant to cede total control to an international agency. They drafted a provision that gave them the right to take health measures that they believed would have similar or better results than W.H.O. recommendations — on the premise that these measures were scientifically grounded and for the common good.
“States gave themselves a ‘get-out-of-jail-free’ card,” Mr. Burci said.
Under the rules, countries are obligated to report to the health agency within 48 hours any measures that they take beyond the collective guidelines, as well as report the rationale behind their actions. Many countries have failed to do so during the coronavirus outbreak, and the W.H.O. can do little about it.
In some cases, W.H.O. officials learned of travel shutdowns only after they happened, from reports in the media.
“What do we really mean if nobody is following W.H.O.’s recommendation with impunity,” Mr. Burci asked.
Because they have no power to enforce international regulations, W.H.O. officials have to walk a diplomatic tightrope. In a statement, a W.H.O. spokesman said that the agency “cannot compel countries to change measures they have implemented.”
Last month, Dr. Tedros sent two letters, which have not been made public, reminding nations about their obligations. His staff has collated media reports on the flurry of travel restrictions and is chasing after countries to obtain their rationale.
Agency officials have resisted naming and shaming countries that breach the rules and have largely dodged media questions on the subject.
“The W.H.O. doesn’t interact in public debate or criticize our member states in public,” Dr. Ryan said on Wednesday when asked which countries had failed to rise to the occasion.
“You know who you are,” Dr. Ryan said.
Part of that hesitation comes down to money, said Ashish Jha, a director of Harvard Global Health Institute. The organization has said that it needs $675 million to fund its response to the coronavirus outbreaks. As of this week, nations have pledged to donate about $300 million.
“W.H.O. is at the mercy of its member states,” Dr. Jha said. “Countries don’t have to listen.”
Even as the agency struggles to nudge member states to comply with the regulations, the coronavirus pandemic poses major questions for the future. One pressing question is on how the world will cope if an outbreak develops in countries with underdeveloped health care systems.
Two-thirds of the world’s countries lack the necessary laboratories and surveillance systems to detect outbreaks and comply with international regulations. The Group of 7 has pledged to help poorer nations but has not always followed through.
The world is not ready for “a fast-moving, virulent respiratory pathogen pandemic,” a W.H.O. report said last year.
Dr. Katz, the Georgetown scholar, said stronger international regulations would help prepare for such an outbreak.
“This is what we have. This is the agreement we have. This is the organization we have,” she said.