International Health Response

Funded by mandatory dues paid by its 194 member states and voluntary contributions from private organizations (see Figure 2), the WHO has been criticized for its deference to Beijing and increasing Chinese influence over the institution (Council of Foreign Relations, 2020). The fact that the virus began in China, a country known for control and suppression of information, was a disadvantage when it comes to preventing the spread of Covid-19. China notified the WHO about the outbreak in late December, but the agency was only able to send a team to Wuhan in late January. They met with President Xi Jinping and presented a list of questions to the Chinese health officials, but by the time the WHO received answers, the virus had already travelled around the world (see Figure 3). We can suspect the answers downplayed the outbreak as the WHO communicated in its Jan. 14 press briefing that “there was risk of human transmission,” and in its Jan.23 report that there was “growing evidence the disease spread between humans” (Jha, 2020). It was not until Jan. 30 that the WHO declared the virus outbreak PHEIC, or Public Health Emergency of International Concern.

The fact that the WHO does not have any power over countries limits its effectiveness to prevent pandemics. The agency depended on China for access and information, which came in late, so when PHEIC was finally declared, outbreaks were already present in over 30 cities across 26 countries (see Figure 3). What is more, on that same day and following its standard protocol, “WHO asked nations not to close borders” fearing that such restrictions might discourage states from reporting new outbreaks (McKay & Hinshaw, 2020). When the situation worsened globally and countries stopped international travel, the disease was already present within their borders, and the WHO has no authority to dictate what states should do in their territory. It also does not have a mandate to investigate or “authority to force information from the very governments that finance its programs and elect its leaders” (ibid). This is a major structural problem in global health governance which impaired the WHO’s response.

Besides acting too late and lacking the ability to gather data fast, WHO bureaucratic structure and lack of funding also contributed to its failure to handle the virus. In 2018-2019, only 8% of the WHO’s budget went to activities related to pandemic preparedness, which demonstrates that it is not a top priority (McKay & Hinshaw). The WHO does not even have enough experts who could write its recommendations and often relies on outside experts, which can be a very slow process. For example, it took over 4 months for WHO to agree that wearing masks slowed the spread of Covid-19, and in that time, about half a million people died (ibid). The WHO was also criticized for its undue praise of China’s early response to the virus, despite the fact that China has impaired the WHO’s response by failing to share timely and accurate information (Jha, 2020; Gostin et al., 2020). All of these issues combined resulted in the fact that the WHO did not do enough at the onset of the problem which rapidly reached global dimensions.

Figure 3. Travel from China around the world before January 31, 2020.

Pandemics do not occur randomly. They are a result of interactions between people, other animal species and the environment. More than forty new infectious diseases in humans have emerged in the past few decades according to the graph in figure 4.

In the current world where 5.4 billion people are urban dwellers, emerging infectious diseases are less likely to burn out in rural areas, and would probably reach more integrated hubs of commercial traffic which have limited public health systems (Bollyky & Patrick Stewart, 2020). The International Health Regulations (IHR) of 2005 created by the WHO provide an overarching legal framework that defines the rights and obligations of countries’ in handling public health emergencies that have the potential to cross borders (World Health Organization). Pandemic preparedness is for the global public good, and infectious diseases such as COVID-19 do not know national borders when circulating unabated.

The IHR can be broadened to prevent future pandemics from occurring by helping to understand and recognize the great division that exists between the biological aspects of disease, and the social, environmental and political factors (Wilcox & Gubler 2005). Given the potential threats stemming from the movement of animals and livestock, and food production and distribution, national health information systems need to be able to ‘speak to’ other sectors in terms of data exchange. This includes being able to capture local specificities and connect with affected communities and actors, an aspect of core capacity-building that is not explicitly covered in the IHR (2005) (Kluge et al. 2018).

Bringing land use into public health policy research would be a step in the right direction. Since pandemics are rare events, the task of making accurate predictions will remain difficult. However, preventing a pandemic from happening would be a low cost approach in comparison to suffering from one. For example, the United States had spent $5 billion fighting Ebola in West Africa (McNeil, 2019). However, with projects such as PREDICT, the USAID’s Emerging Pandemic Threats program, we can strengthen global surveillance and laboratory diagnostic capabilities for both known and newly discovered viruses, while costing much less than suffering from the effects of a pandemic (UC Davis School of Veterinary Medicine). In addition, if the World Health Organization can invest in programs that monitor trade, by mapping trade routes and investigating the vectors that carry infectious diseases, this would be helpful in preventing future pandemics from taking place (Patz et al. 2004) .