Gravediggers in protective suits
Gravediggers in protective suits carry the coffin of a COVID-19 victim as relatives and friends stand at a distance in the section of a cemetery reserved for coronavirus victims in Kolpino, outside St. Petersburg, Russia. A WHO report has found crucial flaws in the global response in early 2020 to the COVID-19 outbreak. Image Credit: AP

Geneva: A new global system should be set up to respond faster to disease outbreaks, which could ensure that no future virus causes a pandemic as devastating as COVID-19, an independent World Health Organisation review panel said on Wednesday.

The experts found crucial flaws in the global response in early 2020 - including a delay in declaring an emergency, a failure to impose travel restrictions and an entire “lost month” when countries neglected to respond to warnings - that let the virus quickly spread into a catastrophic pandemic.

To address those problems, the WHO should be given the power to send investigators swiftly to chase down new disease outbreaks, and to publish their full findings without delay.

“It is critical to have an empowered WHO,” panel co-chair and former New Zealand Prime Minister Helen Clark told reporters on the launch of the report “COVID-19: Make It the Last Pandemic”.

Co-chair Ellen Johnson Sirleaf, a former president of Liberia, said: “We are calling for a new surveillance and alert system that is based on transparency and allows WHO to publish information immediately.” Health ministers will debate the findings at the WHO’s annual assembly opening on May 24. Diplomats say the European Union is driving reform efforts at the UN agency that will take time.

“We look forward to working with our member states to discuss the recommendations of this panel and the other committees to build a stronger WHO and a healthier, safer, fairer future for all of us,” WHO Director-General Tedros Adhanom Ghebreysus said.

Lost month

Looking back at the early days of the pandemic, the experts noted that Chinese doctors had reported cases of unusual pneumonia in December 2019. The WHO picked up reports from the Taiwan Centres for Disease Control and others.

But when the WHO’s Emergency Committee met on Jan. 22, it stopped short of declaring an international health emergency.

That declaration did not come until eight days later, costing crucial time.

The committee, acting under the WHO’s International Health Regulations, also declined to endorse international travel restrictions, which would have slowed the spread of the virus.

The experts said those guidelines need to be changed.

Governments, meanwhile, failed to grasp that the emergency declaration was WHO’s “loudest possible alarm”, the experts said.

“It is glaringly obvious to the Panel that February 2020 was a lost month, when steps could and should have been taken to curtail the epidemic and forestall the pandemic.” Instead of preparing their hospitals for COVID-19 patients, many countries engaged in a “winner takes all” scramble for protective equipment and medicines, it said.

The panel did not lay specific blame on China for its actions in the early days of the pandemic, or on WHO head Tedros, accused by the United States under then-President Donald Trump of being too deferential to Beijing.

Lawrence Gostin of the O’Neill Institute for national and global health law at Georgetown Law in Washington, D.C., called the failure to point fingers a weakness of the report.

“The report does not single out any government, agency, or actor for their actions or inactions in impeding the response “hurting the ability of WHO to adapt for the future,” he said.

“In particular, despite marked delays in China’s reporting of a novel outbreak in Wuhan and its impeding WHO in finding the pandemics origins, the (panel) did not seek to hold the government accountable.”

Here are the report’s main findings:

World’s pandemic preparedness

The report said the world “dodged a bullet” with the 2003 SARS epidemic but then, despite alarms sounding following outbreaks of bird flu, Ebola, Zika and MERS, “ignored warnings which resulted in a massive failure”.

It said the pandemic threat was not considered with the same level of concern as war, terrorism, nuclear disaster or global economic instability.

The panel said national preparedness was “vastly underfunded”, despite clear evidence of the benefits when an epidemic occurs. It said health systems and their workers were not ready for a prolonged crisis.

Findings on outbreak response

The report said that under the World Health Organization’s current set-up, information was treated at a “slow”, methodical pace.

It said the Wuhan outbreak was “likely” to have met the criteria for a Public Health Emergency of International Concern (PHEIC) - the WHO’s highest alarm level - at its January 22, 2020 emergency meeting.

And when WHO finally did declare a PHEIC on January 30, it said it was “not followed by forceful and immediate emergency responses in most countries” and did not trigger an “urgent, coordinated, worldwide response”.

The global reaction was characterised by “some early and rapid action, but also by delay, hesitation, and denial”, the report said. The net result was that the outbreak turned into an epidemic, and then a pandemic.

February 2020 was “a lost month”, with many countries only taking action once the term pandemic was finally used on March 11.

Findings on COVID-19 handling

The report called the pandemic “a catastrophe at every level”.

Countries reacted with strategies of either aggressive containment, suppression or mitigation; or no discernable strategy at all.

Poor strategic choices and lack of coordination created a “toxic cocktail” which turned the pandemic into “catastrophic human crisis”.

The countries with the worst outcomes “devalued science, denied the potential impact of the pandemic, delayed comprehensive action”, the report said.

The denial of science, compounded by leadership failures, eroded public trust in health measures.

Recommendations to end pandemic

The report said high-income countries should provide the 92 poorest territories in the Covax scheme with at least one billion vaccine doses by September 1, and more than two billion by mid-2022.

The G7 should immediately pay 60 percent of the $19 billion required to fund vaccines, diagnostics and therapeutics via the WHO’s Access to Covid Tools Accelerator in 2021, with other G20 nations and others providing the rest.

The WHO and the World Trade Organization should convene vaccine-producing countries and manufacturers for an agreement on voluntary licensing and technology transfer for Covid-19 vaccine production.

If this results in no action within three months, intellectual property rights should be waived immediately, the report said.

The panel said vaccine production capacity should be built immediately in lower- and middle-income countries.

The world needs infrastructure to produce at least five billion booster doses annually, the experts said.

Preventing future outbreaks

The panel called for a Global Health Threats Council, endorsed by a UN General Assembly resolution, and a pandemic treaty.

The G20 should create an International Pandemic Financing Facility with $5-10 billion per year for preparedness, and the ability to disburse up to $100 billion at short notice.

A platform should be set up to produce vaccines, diagnostics, therapeutics and supplies and secure their rapid, equitable delivery as global common goods.

Public research and development funding should include a commitment to technology transfer and voluntary licensing.

Countries should appoint national pandemic coordinators and conduct annual simulation exercises, the report said.

WHO reform proposals

The WHO should be restructured by May 2022, the panel said. It needs greater control over how its money is spent, while the director-general needs greater authority, under a seven-year single term in office.

Currently, the UN health agency’s chief can serve up to two five-year terms.

Rather than waiting for overwhelming evidence, future PHEIC declarations should be done early as a precaution.

A new global surveillance system must be set up by October, including animal and environmental health monitoring. The alert system must be faster and the definition of a suspected outbreak with pandemic potential needs redefining.

The WHO should have the authority to publish information immediately on outbreaks without the prior approval of concerned countries, and to dispatch expert missions immediately.