“A global pandemic requires a world effort to end it—none of us will be safe until everyone is safe.” - Ursula von der Leyen, president of the European Commission
“I am still hopeful that the health of our citizens will be a high priority at some point.” - Dr. Nyachira, public hospital doctor, Obstetrics and Gynecology, University of Nairobi
Founded on April 7, 1948, the World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health and comprised of 194 member states. The WHO’s mandate is “the attainment by all peoples of the highest level of health.” While it plays a pivotal role in coordinating the global health response to pandemics, the WHO has no enforcement authority. Instead, it is primarily an advisory and coordinating organization.
Since the 1950 effective date of the WHO, April 7th of each year is celebrated as World Health Day—a celebration that aims to create awareness of a specific health theme that highlights a priority area of concern for the WHO. The theme of this year’s campaign is “to build a fairer, healthier world.” As the crisis of the COVID-19 pandemic lessens in some parts of the developed world, this Germ Gems post reflects on some of lessons we’ve learned and why this year’s campaign is critically important for the ultimate victory over the pandemic.
Lesson 1. Heed the warning. In 2005, the WHO initiated an international health emergency alarm system for a “public health emergency of international concern” (PHEIC) to signal when a pandemic might be imminent. Since then, the WHO has declared six PHEICs: 2009 H1N1 (swine flu); 2014 resurgence of polio in Afghanistan, Pakistan, and Nigeria; 2014 Ebola virus infections in West Africa; 2016 Zika virus infections spreading in the Americas; 2019 Ebola outbreak in the Democratic Republic of the Congo; and on January 30, 2020, COVID-19 originating in China. COVID-19, however, had already reached pandemic proportions, that is, it had spread globally, by the time the WHO declared a PHEIC on January 30. Nonetheless, the WHO did not classify COVID-19 as a pandemic until March 11, 2020.
Admittedly, the WHO was slow in classifying COVID-19 a pandemic. But WHO’s 194 Member States also failed to move swiftly and in a coordinated manner following the PHEIC declaration in January 2020. Instead, each individual country’s response to the COVID-19 health emergency was chaotic and hindered by political infighting. And it certainly didn’t help that our previous administration referred to the pandemic as a “hoax” and pulled out of the WHO on July 8, 2020.
The WHO is severely hampered by having no enforcement authority to pressure governments to comply with its recommendations. According to Joanne Liu, a former president of Médecins Sans Frontières (aka Doctors without Borders), “The real question is, what would it take for people to do something when a declaration happens?”
I am encouraged by the fact that the U.S. rejoined the WHO in January 2021. And I believe it was also a step in the right direction in restoring the WHO’s partnership with another pillar of global health, the Center for Disease Control and Prevention.
Lesson 2. Be prepared. Human history is replete with epidemics and pandemics (more than 180 are recorded), and like COVID-19, many started as zoonotic infections (i.e., infections that were transmitted from animals to humans). In the April 1, 2021 issue of the New England Journal of Medicine, the article “Emerging Infectious Diseases—Learning from the Past and Looking to the Future,” highlights many of the remarkable gains in public health over the past century. But it also makes clear that “Emerging Infectious Diseases” are coming at us fast and furious. While nobody can predict when, where, and what the next pandemic will be, we can be certain of one thing: there will be others.
The emergence of COVID-19 in Wuhan China in December 2019 was followed by a discombobulated global response. We have now seen the dramatic consequences of our unpreparedness. There have been close to 13 million cases and more than half a million deaths globally, and counting. Perhaps we’ve finally learned our lesson—including the crucial need for all governments to work with the WHO on a “convergence of nations on pandemic preparedness.”
Lesson 3. Inequity is a public health problem. There have been impressive gains in public health in the past half-century. Nonetheless, many challenges remain, some of which are magnified by the COVID-19 pandemic. Here are a few of the pertinent facts and figures:
For the first time in 20 years, global poverty levels are predicted to rise and hinder the progress towards the Sustainable Development Goals;
Up to 60% of people living in some developing countries lack essential health services coverage;
More than 1 billion people living in informal settlements or slums are facing increased challenges in preventing infection and transmission of SARS-CoV-2;
The Asia-Pacific region as a whole accounts for nearly 82.5 million or 32% of the world’s international migrants;
5.9 million children in the Asia-Pacific Region are at risk of not returning back to school due to the disruption to education and the economic impact of the pandemic; and
52% of the Asia-Pacific population remains unconnected to the internet.
The COVID-19 pandemic has made painfully clear that social determinants of health, such poverty and racism, are as important as underlying medical conditions as risk factors for developing severe COVID-19. Reporting from Kenya in an article, “Some Nations Could Wait Years for Covid 19 Shots. That’s Bad for Everyone,” New York Times correspondents Abdi Latif Dahir and Benjamin Mueller describe the desperate circumstances throughout much of Africa, as people await vaccines supplied by the COVID-19 Vaccine Global Access Facility (COVAX).
The WHO, the Global Alliance for Vaccines, and the Coalition for Epidemic Preparedness Innovations lead the COVAX effort. This is a ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. Nonetheless, 30 nations have as yet failed to start vaccinating against COVID-19. And even though global vaccination is recognized as essential to ending the pandemic, this fact hasn’t prompted the unity required to deliver vaccines to all countries.
With repaired relations between the U.S. government and the WHO, and strong leadership at the helms of each of these organizations, I’m optimistic that a new era of solidarity between peoples is dawning. But as Margaret Chan, former Director-General of WHO (and now the head of the School of Public Health at China’s top-ranked university, Tsinghua University), stated recently, “The most important lesson of all is that complacency kills. It is not a lack of learning that the world is struggling to bring the COVID-19 pandemic to an end. We do not lack solutions; we lack action to implement them. Now is the time to act.”
Who should lead global health research and development (R&D)? No doubt, the world would be better served by a well-funded WHO with greater authority over its 194 member states. But the chances of this happening anytime soon seem slim. In my opinion, an additional challenge faced by the WHO is that its scope is too broad—it tries to do too much for too many. While working on this Germ Gems post, I read an exciting proposal that surfaced recently that would help lighten the agenda of the WHO by moving responsibility for global health R&D to a newly created international entity.
The proposal by Drs. Nicole Lurie, Gerald Keusch, and Victor Dzau, three formidable leaders in global health, is published in the March 27, 2021 issue of The Lancet, “Urgent lessons from COVID-19: the world needs a standing, coordinated system and sustainable financing for global research and development.” The authors review the gaps that exist in mounting a coordinated global health response to pandemics and also the incredible scientific advances that surfaced during the COVID-19 pandemic, most notably, the development of several highly safe and effective vaccines in astonishing record time. As they point out, the concept of a biomedical ecosystem emerged almost two decades ago, driven by the interests of the pharmaceutical industry to expedite the translation of science into breakthrough therapies by enabling “all of us in the biomedical community to work together more effectively than ever before.”
It is time to seize the momentum spurred by COVID-19. The R&D ecosystem that Drs. Lurie, Keusch and Dzau have conceived would help ensure global equitable access to new products, thereby promoting the WHO’s 2021 campaign for a “fairer, healthier world."