- The rapid spread of the Wuhan coronavirus has put the multilateral heath system to the test.
- Adequeately responding to such pandemics and preserving public health depends on credible action, strong leadership, and responsible behavior by the governments and agencies involved.
- Whether those handling this crisis have learned from previous ones will be seen in the coming weeks, writes Stewart M. Patrick.
- Visit Business Insider's homepage for more stories.
The rapid spread of the Wuhan coronavirus, which the World Health Organization declared a global health emergency last Thursday, is immediately testing the multilateral system's capacity to respond to a pandemic.
As of January 31, the virus had infected a reported 9,720 people in China and around 100 more in 20 other countries and territories, killing at least 213. The deepening health crisis underscores that we live in an epidemiologically interdependent world, in which outbreaks anywhere can hopscotch around the world at jet aircraft speeds.
Preserving global public health depends in large part on three things: timely and credible action by governments where outbreaks occur; firm direction and leadership from the WHO in coordinating international responses; and responsible behavior by other nations that naturally want to protect their own citizens from disease.
Previous pandemics, including of Severe Acute Respiratory Syndrome, or SARS, in 2002 and 2003 and of Ebola in West Africa in 2014, show that these three things cannot be taken for granted. The coming weeks will reveal whether China, other governments and the WHO have learned their lessons from those past pandemics and implemented needed reforms.
China's central government, which of course has primary responsibility for containing the immediate outbreak, seems determined to avoid repeating mistakes made during the outbreak of SARS, a previous coronavirus that ultimately infected more than 8,000 people in 26 countries across five continents.
Although the official figures tallied "only" 800 deaths, it shaved an estimated $100 billion off global GDP. The episode also exposed the mendacity of Chinese authorities, who at first denied and subsequently downplayed the outbreak, allowing it to gather momentum in critical early phases.
China's performance since the coronavirus outbreak has been mixed, however, because old habits die hard, particularly at the provincial level. In the wake of SARS, the ruling Communist Party had established the China Information System for Disease Control and Prevention and warned officials against seeking to cover up any future outbreaks.
Despite this guidance, local officials in the central city of Wuhan and the rest of Hubei province dithered for weeks after detecting the outbreak in early December, placing secrecy ahead of immediate interventions that might have stopped the epidemic in its tracks.
The central government, once it stepped in, has been more decisive. On December 31, consistent with their binding treaty obligations under the WHO's International Health Regulations, Chinese authorities alerted the organization about a string of pneumonia-like cases in the central city of Wuhan. The Chinese government also appointed Premier Li Keqiang as the head of a new task force of the Communist Party's Central Committee, charged with researching the virus and preventing its spread.
The government has since imposed full or partial quarantines and travel restrictions on 16 cities, affecting more than 50 million people; extended the Chinese Lunar New Year to reduce travel; and banned the trade of wild animals, which are suspected of being the source of the disease, throughout the country.
By late January, Wuhan, a city of 11 million, was under effective lockdown, and entry and exit into the rest of Hubei province was restricted. On January 28, China agreed to welcome a team of WHO experts. While some US researchers grumble about delays in sharing epidemiological data, China's overall transparency is far better today than in the past.
The Wuhan coronavirus will also test the WHO and its secretary-general, Tedros Adhanom Ghebreyesus. He assumed his post in 2017 from the beleaguered Margaret Chan, who was widely pilloried for her clumsy response to Ebola.
During that crisis in West Africa, the WHO appeared MIA, failing to designate the accelerating outbreak as a "public health emergency of international concern" until the virus had spread to Nigeria, Africa's most-populous country, and claimed nearly a thousand lives in Guinea, Liberia and Sierra Leone. Chan enraged many by declaring that the WHO was merely a "technical agency," not a "first responder."
A subsequent independent assessment of the WHO's shortcomings essentially agreed that the agency "does not have the capacity or organizational culture to deliver a full emergency public health response." The blame for these shortcomings lay partly with the WHO's member states, which had chronically underfunded it while piling its agenda higher and higher.
Ghebreyesus faces the unenviable task of spearheading the multilateral response to the Wuhan coronavirus, while heading an agency still hamstrung by defective management, governance and financing structures. The silver lining is that China has much stronger response capacities than fragile West African states. This allows the WHO to focus on its role in coordinating, rather than implementing, a coherent global response, while lending its technical expertise in support of Chinese efforts.
On January 30, Ghebreyesus fired the most powerful weapon in the WHO's arsenal, designating the coronavirus a "public health emergency of international concern," only the sixth time the body had done so since the World Health Assembly gave it that power in 2005.
While this step has no legal force, its symbolic and practical impact is considerable, reinforcing the gravity of the crisis and the WHO's authority to mobilize and coordinate the international response. Yet public health experts still express frustration at the binary, "all or nothing" nature of these designations and the time wasted debating whether any particular epidemic has reached this vague threshold. Ghebreyesus has proposed a color-coded classification system to more accurately capture the gradations of global health crises.
The third test for the multilateral system is whether countries besides China take actions that enhance, rather than impede, responses to pandemics, improving global health in the process. Four priorities stand out.
First, countries should avoid draconian trade and travel restrictions unless they are based on solid scientific evidence and principles of public health, as the WHO's International Health Regulations insist. Closing borders and banning travel are tempting options, but they are rarely required and can do more harm than good, while also devastating trade, which depends on global supply chains, including of medicines.
As the WHO declared during the 2014 Ebola crisis, "vigilance, not bans," should be the default setting. This has not stopped a growing number of countries from imposing such restrictions, including the United States, which last Friday banned entry from anyone who had been to China in the past two weeks.
Second, nations must commit to share samples of viruses they isolate, so that scientists worldwide can understand the structure and epidemiology of any disease and quickly develop vaccines. As my colleagues at the Council on Foreign Relations, Thomas Bollyky and David Fidler, note, virus sample sharing is on the decline, coinciding with the 2014 Nagoya Protocol on Access to Genetic Resources, which recognizes a country's sovereignty over genetic resources in its territory. Sovereignty claims over the genetic sequencing of pathogens must not be allowed to trump global public health.
Third, countries should commit to sharing antivirals and other life-saving medical supplies, rather than stockpiling them for purely national use or allowing corporations to profiteer from their scarcity. When such materials are scarce, and an epidemic is raging, as in the H1N1 pandemic of 2009, there is a natural inclination to hoard. To reduce this danger, WHO member states need to begin what will doubtless be arduous negotiations over an international framework to guarantee equitable access to vaccines.
Finally, states must improve their national capacities to respond to epidemics. As of 2018, only one-third of the world's countries had come into self-reported compliance with the legal requirements of the WHO's International Health Regulations. The other two-thirds had health systems unprepared to respond to major disease outbreaks, thus putting the whole world at risk.
Stewart Patrick is the James H. Binger senior fellow at the Council on Foreign Relations and author of "The Sovereignty Wars: Reconciling America with the World" (Brookings Press: 2018). His weekly WPR column appears every Monday.
