The next time the world faces an outbreak of a fast-spreading and deadly new pathogen, governments must act swiftly and be ready to restrict travel or mandate masks even before anyone knows the extent of the threat, according to a pair of new reports delivered to the World Health Organization.
The studies are intended to address missteps over the past year that led to more than 3.25 million deaths, some $10 trillion in economic losses, and more than 100 million people pushed into extreme poverty.
“Current institutions, public and private, failed to protect people from a devastating pandemic,” concluded one of the reports, released Wednesday, which called the COVID-19 pandemic “the 21st century’s Chernobyl moment.”
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“Without change,” it said, these institutions “will not prevent a future one.”
The reviews, released in advance of this month’s meeting of the WHO’s governing assembly, were written by appointees who donated countless hours in the midst of their own countries’ pandemic fights to interview hundreds of experts, comb through thousands of documents, gather data, and seek counsel from public and private institutions around the world.
Pandemics, the authors concluded, are an existential threat on the order of a chemical or nuclear weapon, and preparing for them must be the responsibility of the highest levels of political leadership rather than only health departments, often among the least powerful of government agencies.
The reviews also called for nations to provide predictable and sustainable financing to the WHO and to their national preparedness systems.
“WHO is underpowered and underfunded by its member states,” Helen Clark, a former prime minister of New Zealand and an author of one of the reports, said at a media conference this week.
Whether the recommendations lead to lasting change is an open question. Clark’s group, the Independent Panel for Pandemic Preparedness and Response, pointedly noted that since the H1N1 pandemic in 2009, there have been 11 high-level commissions and panels that produced more than 16 reports, with the vast majority of recommendations never implemented.
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These reports “sit closed gathering dust in UN basements and government shelves,” said Ellen Johnson Sirleaf, another author of that report, who served as president of Liberia during the Ebola outbreak there in 2014 and 2015.
Under the current international health regulations, “there’s no enforcement mechanism,” said Dr. Lothar H. Wieler, president of the Robert Koch Institute in Berlin, who led the second major review, in which scientists scrutinized how those regulations functioned in the pandemic.
Both reports supported the creation of an international pandemic treaty that would establish consequences if countries failed to live up to their commitments. Those might include quickly sharing samples and sequences of emerging pathogens, providing rapid access to teams deployed by the WHO for early investigation and response, and ensuring equitable distribution of vaccines, medicine, and tests around the world.
Both reviews also noted that early in the coronavirus pandemic, many countries all but ignored the formal warning issued by the WHO, known as a Public Health Emergency of International Concern. Its unfortunate acronym, PHEIC, is often pronounced “fake,” one of the reports noted. (Whether the proposal to change this to “PHEMIC” will prove more stirring remains to be seen.)
The independent panel also concluded that the warning could have been declared at least a week earlier than it was on Jan. 30.
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Even then, “so many countries chose to wait and see,” only taking concerted action once intensive care beds were filled, Clark said.
Her group contends that if its recommendations on political leadership, financing, and surveillance systems had been in place, the coronavirus outbreak would not have become a pandemic. It also said that digital tools, such as those that scrape social media for rumors of new outbreaks, should be better incorporated into official responses.
Notably, the panel did not delve into individual countries’ failures in its report, determining that blame would not be “a very useful approach,” said Dr. Anders Nordström, who helped lead the effort.
The recommendations of panels after global emergencies have sometimes been embraced. The Ebola outbreak of 2014 and 2015 led to the creation of the WHO’s health emergencies program, aimed at boosting the agency’s role in managing health crises as well as providing technical guidance. A report released this month noted that the new program had received “increasingly positive feedback” from countries, donors, and partner agencies as it managed dozens of health and humanitarian emergencies.
The WHO before the Ebola outbreak and after it are “two different agencies basically,” said Dr. Joanne Liu, a former international president of Doctors Without Borders and a member of the independent panel. Liu was one of the WHO’s most trenchant critics during the Ebola response, and she noted a “marked improvement” in how quickly the agency had declared an international emergency this time.
Liu said her biggest fear was that as wealthier countries gained an upper hand on the virus because of vaccines, they would leave low- and middle-income countries behind, with COVID-19 becoming “a neglected pandemic because they are going to be the only ones fighting it — a bit like HIV and TB.”
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To avert that, the panel released a slew of urgent recommendations and called for the world’s entire population to be immunized within a year.
Wealthy countries with a good vaccine pipeline should commit to making at least 1 billion doses available to the poorest countries by September through programs such as COVAX, a global effort to provide vaccines equitably throughout the world, the group said.