WHO more fragile than ever on the eve of its general assembly

Text by: Simon Rozé Follow

The World Health Organization (WHO) is holding its general assembly from May 17 to 21 as it faces the greatest crisis in its history. Attacked and criticized by its member states, it tackles this great event, more fragile than ever, at the worst time.

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It's a story of emails sent on New Years Day. This December 31, 2019, China, via the Wuhan municipal health commission, officially warns WHO of the occurrence of several cases of unidentified pneumonia. A new coronavirus is then identified. Can this emerging disease be transmitted from person to person? Chinese authorities say no. However, Taiwan certifies having alerted the organization the same day on the risk of such a transmission. We will have to wait until January 20, 2020 for the WHO to recognize that this new disease is transmitted well between human beings .

Have three weeks been lost? It turns out that the WHO does not recognize Taiwan as one of its member states, largely because of China's opposition, which would explain why it did not heed this alert. In fact, the relations between Beijing and the organization crystallize most of the criticisms made against it during this pandemic crisis. Is Dr. Tedros Adhanom Ghebreyesus, the head of the organization, under the thumb of the Chinese? "  The WHO really missed everything  ," tweeted Donald Trump on April 7, summarizing many of the grievances against the WHO. “  It is mainly funded by the United States, but yet very focused on China.  If the American president has thus justified his decision to withdraw from the organization , this criticism is nonetheless caricatured.

WHO dependent

"  WHO is an intergovernmental agency: this is the crux of the problem,  " explains Auriane Guilbaud, of the sociological and political research center at Paris 8 University. "  The main tool on which the organization is based, it is the international health regulation adopted by its member states in 1951 and revised since. It stipulates that member states must report public health events that they have spotted on their territory. WHO therefore depends on its Member States and on the reliability of their information.  "

Therefore, was the information provided by the Chinese authorities on this beginning of the epidemic reliable? "  WHO has been a bit misled,  " John MacKenzie told the British daily The Guardian . The advisor to the emergency committee of the organization notes that when China informed the WHO on December 31, its scientists had already sequenced the genome of the virus and already knew that they were dealing with a new coronavirus. However, the Beijing authorities will not officially confirm this until January 7, and the entire genome will not be shared with the international community until January 12. Likewise, John MacKenzie wonders about the assessment communicated by China: 59 cases for the first week of 2020, "  very, very far from what we could expect  ".

In this context, what could WHO do? "  The organization is intergovernmental, it must seek the Member State  ", explains Auriane Guilbaud. WHO has asked China for permission to send a team of scientists to Hubei province, the epicenter of the epidemic. Beijing refused. "  And the WHO has no sanctioning power  ," added the researcher. It was not until February 8 that the Chinese authorities authorized a team of WHO observers to their territory.

Dr. Tedros has never publicly reported on China's reluctance to cooperate. He even did the opposite on January 28 when he met Xi Jinping behind closed doors and praised two days later the Chinese efforts to contain the disease: “  A new model of epidemic control.  However, it was this same January 30 that the WHO declared Covid-19 as a health emergency of international concern . For Auriane Guilbaud, in this sequence, “  the WHO played a role of diplomatic actor to preserve its relations with its member states, including China. It is a pragmatic line, it was necessary to preserve relations  ”.

The example of SARS

In fact, being dependent on its information, the World Health Organization has always spared China during this crisis. However, it has not always played this role. In November 2002, the Chinese government discovered on its soil a new respiratory disease, SARS, and did not inform the WHO. But at the time, under the leadership of its then general manager, Gro Harlem Brundtland, the organization monitored Chinese medical forums and was therefore aware of this atypical pneumonia. With this information in hand, the WHO went to see the Chinese leaders, who officially notified it soon after.

Gro Harlem Brundtland was then not afraid to publicly accuse China of having kept this information for itself, thus preventing the epidemic from being contained "  if the WHO could have intervened earlier and send its teams on the spot  ". Following these statements, Beijing quickly cooperated.

Why hasn't WHO adopted the same line almost twenty years later? Probably because she has lost her aura. In 2003, when the SARS epidemic was spreading in several countries (Hong Kong, Vietnam and Canada), the organization issued for the first time a warning advising against traveling to the affected areas. Although the WHO does not actually have the power to nail planes to the ground, this advice has been followed.

Following this epidemic, the WHO response was generally deemed to be a success. Only 26 countries have been affected by the disease and less than 1,000 people have died. "  Brundtland has done things for which WHO did not have a mandate,  " recalls organization consultant David Fidler. For good reason: it is neither the treatments nor the vaccines that have overcome SARS, but the exchange of information on a global scale, travel restrictions, policies of screening and isolation of the sick.

The missed opportunity

Unfortunately this test will not be transformed. However, there was an opportunity: "  The international health regulations of 1951 were revised following SARS  ", explains Auriane Guilbaud. Others pushed to give more latitude to the WHO, but it was ultimately the reverse line that won. Several countries feared that they would have to face the same restrictions that China had to endure if they ever found themselves in its situation. Thus, on the issue of closing borders, the revised international health regulations now stipulate that "  Member States undertake to prevent the international spread of diseases and to respond to them with proportionate health measures without unnecessary obstacles to travel and trade international  ”. For Auriane Guilbaud, this half-hearted resolution can be explained by two things: “  First of all, States must not feel discriminated against, otherwise they could hesitate to report public health events. Second, they do not want to be ostracized by the international community because all trade with them would have been prohibited.  "

WHO has become inaudible

Thus, for the Ebola epidemic in 2014 as for that of Covid-19, the WHO did not call for the closure of the borders. "  In 2014, some states had closed them,  " recalls Auriane Guilbaud. “  The WHO then criticized them, saying it did more harm than good.  For the Ebola outbreak, the WHO also took several months to declare an emergency. David Fidler believes that this has delayed all the essential international aid, and greatly weakened the leadership of WHO. This lack is glaring today: "Many States no longer follow the recommendations", analyzes Auriane Guilbaud.

Richard Horton, the editor-in-chief of the prestigious medical journal The Lancet goes further: “  The states, and especially the western states did not listen. Rather: they did not try to understand what was happening in China at the start of 2020  ”. We can thus consider that the declaration of a pandemic on March 11 was purely rhetorical to urge the WHO Member States to do more, given that the international health emergency was already forcing them to react.

The organization has indeed always repeated a few simple principles that States must apply: reduce public exposure to the disease, in particular by identifying all the chains of contamination. "  You have to test, test, test,  " continues to hammer Dr. Tedros for several months. It was therefore not listened to since, with the exception of South Korea and Germany , most Western countries stood out for their deficiencies in the matter until a confinement became inevitable - some countries betting even on a putative population immunity against all recommendations.

WHO is also facing an almost complete disappearance of international cooperation in health matters - except on the scientific level. Images of governments requisitioning masks to the detriment of other countries, others wanting to claim the scoop of a possible vaccine ... There are many examples and of course there is the American withdrawal from the organization. This is currently a suspension, but the United States provides 15% of the WHO budget. This will therefore necessarily impact the programs while paradoxically giving more latitude to China - precisely what Washington denounces with this withdrawal. In international epidemic matters, however, is essential: "  Circulating information is essential, and it is a challenge. 194 Member States have to be made to work together and someone is needed to fulfill this role. The WHO is the only health organization with a universal vocation  ”, points out Auriane Guilbaud.

A general meeting under the sign of Covid-19

It is therefore with this weakened role that the World Health Organization will approach its general assembly from May 17 to 21. Usually devoted to governance issues, it risks being entirely dedicated to the Covid-19 pandemic. In addition, "  it should be a virtual assembly  ", anticipates Auriane Guilbaud. “  It's a shame because in normal times, a lot of discussions take place between two doors, it will not be possible. It will still be very interesting to follow, it will be necessary to see how the Member States position themselves in relation to the Director-General, if he is supported.  "

After each epidemic, WHO always carries out an evaluation of past events. Lessons are learned and lead to more or less large-scale measures. The organization now appears more fragile than ever. What will happen tomorrow? Will its member states agree to give it more latitude? “  We are still in the midst of a crisis. These measures will be for later,  ”concludes Auriane Guilbaud.

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