H5N1

WHO launches global network to detect and prevent infectious disease threats

A WHO news release: WHO launches global network to detect and prevent infectious disease threats. Excerpt:

WHO and partners are launching a global network to help protect people from infectious disease threats through the power of pathogen genomics. The International Pathogen Surveillance Network (IPSN) will provide a platform to connect countries and regions, improving systems for collecting and analyzing samples, using these data to drive public health decision-making, and sharing that information more broadly.  

Pathogen genomics analyzes the genetic code of viruses, bacteria and other disease-causing organisms to understand how infectious they are, how deadly they are, and how they spread. With this information, scientists and public health officials can identify and track diseases to prevent and respond to outbreaks as part of a broader disease surveillance system, and to develop treatments and vaccines.  

The IPSN, with a Secretariat hosted by the WHO Hub for Pandemic and Epidemic Intelligence, brings together experts worldwide at the cutting-edge of genomics and data analytics, from governments, philanthropic foundations, multilateral organizations, civil society, academia and the private sector. All share a common goal: to detect and respond to disease threats before they become epidemics and pandemics, and to optimize routine disease surveillance.  

The goal of this new network is ambitious, but it can also play a vital role in health security: to give every country access to pathogen genomic sequencing and analytics as part of its public health system,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “As was so clearly demonstrated to us during the COVID-19 pandemic, the world is stronger when it stands together to fight shared health threats.”  

COVID-19 highlighted the critical role pathogen genomics plays in responding to pandemic threats. Without the rapid sequencing of the SARS-COV-2 genome, vaccines would not have been as effective, or have been made available so quickly. New, more transmissible variants of the virus would not have been as quickly identified.  

Genomics lies at the heart of effective epidemic and pandemic preparedness and response, as well as part of the ongoing surveillance of a vast range of diseases, from foodborne diseases and influenza to tuberculosis and HIV. Its use in monitoring the spread of HIV drug resistance, for example, has led to antiretroviral regimes that have saved countless lives.

WHO: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals

A WHO news release: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals. Excerpt:

WHO is releasing the 2023 edition of its annual World Health Statistics report with new figures on the impact of COVID-19 pandemic and the latest statistics on progress towards the health-related Sustainable Development Goals (SDGs).  

The report with data up to 2022 underscores a stagnation of health progress on key health indicators in recent years compared with trends seen during 2000-2015. It also alerts us to the growing threat of noncommunicable diseases (NCDs) and climate change, and calls for a coordinated and strengthened response.  

COVID-19 cost in lost lives and health progress  

The report documents updated statistics on the toll of the pandemic on global health, contributing to the ongoing decline in progress towards the SDGs. During 2020-2021, COVID-19 resulted in a staggering 336.8 million years of life lost globally. This equates to an average of 22 years of life lost for every excess death, abruptly and tragically cutting short the lives of millions of people.  

Since 2000, we saw significant improvements in maternal and child health with deaths falling by one-third and one-half, respectively. The incidence of infectious diseases such as HIV, tuberculosis (TB) and malaria also declined, along with a lowered risk of premature deaths from NCDs and injuries. Together, these contributed to an increase in global life expectancy from 67 years in 2000 to 73 years in 2019.  

However, the pandemic has put many health-related indicators further off-track and contributed to inequalities in access to high-quality health care, routine immunizations and financial protection. As a result, improving trends in malaria and TB have been reversed, and fewer people were treated for neglected tropical diseases (NTDs).  

“The World Health Statistics is WHO’s annual check-up on the state of the world’s health. The report sends a stark message on the threat of noncommunicable diseases, which take an immense and increasing toll on lives, livelihoods, health systems, communities, economies and societies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “The report calls for a substantial increase in investments in health and health systems to get back on track towards the Sustainable Development Goals.”

The truth about decolonising global health worth spreading

A letter in The Lancet: The truth about decolonising global health worth spreading.

With any myth about decolonising global health (as Richard Horton describes it), always question intent, dissent, lament, and discontent. Then, remember the wise words of Frederick Douglass, “power concedes nothing without a demand, it never has and it never will”.  

In the words of Chinua Achebe, we are living in a time when the “lions have their own historians”, and they have finally arrived to take the stage to tell the story of the hunt and the stories of their struggle, their own way, as history has glorified the hunter for too long. Those who stand in the way of this moral conscience are part of the problem, not the solution.  

Decolonising global health is an unconventional movement, told from the point of view of everyday people, and soaked in the struggles of their daily living, the bravery even, of the lions. The process is also so much more than a destination—it is a journey. 

I state this knowing that this movement still has struggles ahead. There is a lot of work to do before anyone or any group can claim to decolonise something as rugged and dynamic or complex as global health. This movement might not bear fruit even in one's lifetime, but at least generations will know that with global health, there was a struggle. We might fail, but at least we struggled to tell our stories, our way. This is the truth about decolonising global health worth spreading.

Reducing the risks of nuclear war to humanity

Via The Lancet: Reducing the risks of nuclear war to humanity.

On Feb 27, 2022, Russia's President Vladimir Putin ordered Russian nuclear forces to be placed on “the special regime of combat duty”. This decision increased the alert status of Russian nuclear forces from a peacetime status to a pre-combat status, creating the legal conditions for any further instruction to launch missiles. Presumably Putin's move is intended to create fear and uncertainty, intensify pressure on Ukraine and the North Atlantic Treaty Organization (NATO) allies and partners, reduce resistance to Russian attacks in Ukraine, and extract concessions in negotiations.  

But these threats represent an absolutely unacceptable escalation of his invasion of Ukraine. The threat of nuclear weapons ratchets up tensions and increases the anxiety and stress that every soldier, resistance fighter, civilian, and politician is experiencing. This threat is also likely to affect analysis and decision making by all parties to the conflict in regard to the potentially far-reaching impacts of decisions. Indeed, history has shown us the risks that these types of situations can pose.  

Since the 1960s the assumption by nuclear armed states was that the prospect of mutually assured destruction would guarantee that nuclear weapons are never used. Nuclear war was believed to be so catastrophic that no leader would ever dare use their nuclear arsenals. More recently, in January, 2022, all the nuclear weapons states that are signatories to the Nuclear Non-Proliferation Treaty (China, France, Russia, the USA, and the UK) reiterated the Reagan–Gorbachev statement that “a nuclear war cannot be won and must never be fought”.  

Nonetheless, documentary research and testimonies have revealed occasions during the decades after the Cuban missile crisis when nuclear weapons were very nearly used as a result of misperceptions and misinterpretation of signals. In 1983, for example, the NATO Able Archer military exercise increased the fear level in the Soviet Union to such an extent that Russian nuclear forces were mobilised. Also in 1983, satellite signals that appeared to be incoming nuclear missiles from the USA to the Soviet Union nearly led to a launch-on-warning response from Moscow. The decision not to do so rested largely on the decisions of one individual, lieutenant colonel Stanislav Petrov. Even after the end of the Cold War, when tensions were low, a Norwegian rocket was initially feared to be an incoming nuclear weapons attack in Russia.  

In the case of nuclear weapons, such mistakes, if they lead to inadvertent use, can never be small or put right. Any use of so-called tactical nuclear weapons (in the low kiloton range) in battle situations would also risk rapid escalation to large-scale nuclear war. The overwhelming humanitarian catastrophic impact of a nuclear weapon is too great to allow these weapons into stressful conflict situations in which such mistakes will occur. Humanity has not avoided nuclear war thus far because of wise leaders, sound military doctrine, or infallible technology. As former US Defense Secretary Robert McNamara observed: “We lucked out. It was luck that prevented nuclear war.”  

An estimated 200 000 people died within 5 months of the nuclear bombs dropped on Hiroshima and Nagasaki, Japan, in 1945 and many survivors suffered long-term effects, including increased risk of leukaemia, other types of cancer, and effects on mental health. The world's nuclear armed states currently have a combined arsenal of around 12 700 nuclear weapons. According to the Federation of American Scientists, the USA deploys 1644 and Russia deploys 1588 strategic warheads on bombers and missiles, many with an explosive power of 100 kilotons or more. Both countries are modernising their nuclear delivery systems.  

If a single warhead of 100 kilotons exploded over a major city it would kill hundreds of thousands of people outright and injure many more, overwhelming the health-care system of an entire nation.  

Even a small-scale nuclear war, involving 250 of the deployed nuclear weapons in the NATO and Russian arsenals, or as might take place between India and Pakistan, would be expected to result in sufficient dust and smoke blocking solar radiation to cause major climate disruption that would trigger a global famine, putting billions of people at risk and destroying modern civilisation.  

A large-scale nuclear war would create a nuclear winter, with temperatures falling an average of about 10°C across the globe, and could kill most of humanity over 10 years. 

The threat by Putin has exposed the weakness of the belief system in nuclear deterrence. Such an approach can never be risk free and the consequences of failure of this strategy are catastrophic. This realisation should lead to more nations signing and ratifying the Treaty on the Prohibition of Nuclear Weapons (TPNW), which currently has 86 signatories and 59 states parties, but that will take time, even with political will. In the near term, it is essential that leaders refrain from exacerbating tensions by implying that such weapons have a military purpose and that immediate steps are taken to reduce the risks of miscommunication and error potentially leading to tragedy on a vast scale.  

NATO and Russia must explicitly renounce any use of nuclear weapons in the conflict in Ukraine. They must join with the other nuclear armed states, at the earliest possible moment, in support of the aims of the TPNW, to commence negotiations for the complete, verifiable elimination of all nuclear weapons.

Expert independent panel calls for urgent reform of pandemic prevention and response systems

A news release from the Independent Panel for Pandemic Preparedness and Response: Expert independent panel calls for urgent reform of pandemic prevention and response systems. Excerpt:

As the COVID-19 pandemic continues to devastate communities across the world, the Independent Panel is making a series of immediate recommendations to halt its spread. It recommends that:  

• High income countries with a vaccine pipeline for adequate coverage should, alongside their scale up, commit to provide to the 92 low and middle-income countries in the COVAX Gavi Advance Market Commitment with at least one billion vaccine doses by September 2021. 

• Major vaccine-producing countries and manufacturers should convene, under the joint auspices of the WHO and the World Trade Organization (WTO) to agree to voluntary licensing and technology transfer. If actions on this don’t occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately. 

• The G7 should immediately commit to provide 60% of the US$19 billion required for the Access to COVID-19 Tools Accelerator (ACT-A) in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden-sharing formula should be adopted to fund such global public goods on an ongoing basis. Every country should apply proven public health measures at the scale required to curb the pandemic. Leadership from heads of state and government to achieve this is crucial. 

The world must also urgently prepare to prevent a future outbreak from becoming a pandemic. To this end, the Independent Panel calls for the engagement of heads of state and government to lead on efforts to transform the existing system. The Panel calls for a series of bold and forward-looking reforms, including:   

• Establishing a Global Health Threats Council that will maintain political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny. Countries should also adopt a Pandemic Framework Convention within the next six months. 

• Establish a new global system for surveillance based on full transparency. This system would provide the WHO with the authority to publish information about outbreaks with pandemic potential on an immediate basis without needing to seek approval and to dispatch experts to investigate at the shortest possible notice.   

• Invest in national preparedness now as it will be too late when the next crisis hits. All governments should review their preparedness plans and allocate the necessary funds and people required to be prepared for another health crisis.   

• Transform the current ACT-A into a truly global platform aimed at delivering global public goods including vaccines, diagnostics, therapeutics, and supplies that can be distributed swiftly and equitably worldwide—shifting from a market model to one aimed at delivering global public goods. 

• Focus and strengthen the authority and financing of the WHO, including by developing a new funding model to end earmarked funds and to increase Member State fees.   

• Create an International Pandemic Financing Facility, which would have the capacity to mobilize long term (10-15 year) contributions of approximately US$5-10B per year to finance ongoing readiness. It would also be ready to disburse from US$50-100B at short notice by front-loading future commitments in the event of a pandemic declaration. The Global Health Threats Council would allocate and monitor the funding to institutions which have the capacity to support the development of preparedness and response capacities. 

• Heads of state and government should at a global summit adopt a political declaration under the auspices of the UN General Assembly to commit to these transformative reforms. 

The Panel’s report also shared recommendations for individual countries, including that heads of state and government should appoint national pandemic coordinators who are accountable to them, and who have a mandate to drive whole-of-government coordination for pandemic preparedness and response.  

In the presentation of the report and its findings, Panel Co-Chair and former President Ellen Johnson Sirleaf stressed the need for bold reform: 

“Our message is simple and clear: the current system failed to protect us from the COVID-19 pandemic. And if we do not act to change it now, it will not protect us from the next pandemic threat, which could happen at any time.”

Covid-19 response was a global series of failures, WHO-established panel says

Via The New York Times: Covid Response Was a Global Series of Failures, W.H.O.-Established Panel Says. Excerpt:

Laying bare a yearlong cascade of failures, a World Health Organization panel recounts in a damning report how governments and public health organizations worldwide responded slowly and ineffectively to the coronavirus, despite years of warnings. 

The interim report, an early blueprint for reform, describes the faulty assumptions, ineffective planning and sluggish responses — including missteps by the W.H.O., itself — that helped fuel a pandemic that has killed more than two million people.  

“We have failed in our collective capacity to come together in solidarity to create a protective web of human security,” the Independent Panel for Pandemic Preparedness and Response writes. 

Many of the failings, such as the inability of governments to obtain protective equipment or do widespread contact tracing, have long been painfully clear over the course of the pandemic. But the report is stark in its assessment that, time and again, those who were responsible for protecting and leading failed to do either.  

The panel, led by Helen Clark, a former prime minister of New Zealand, and Ellen Johnson Sirleaf, a former president of Liberia, is still conducting its investigation. But in drafting an interim report, and laying out the scope of its inquiry, the panel makes clear that the world needs to rethink its approach to outbreaks.  

The report describes one failure leading to another, from the “slow, cumbersome and indecisive” pandemic alert system, to the years of preparedness plans that failed to deliver, to the disjointed and even obstructive responses of national governments. 

Public health officials stumbled, too. Investigators said they could not understand why a World Health Organization committee waited until Jan. 30 to declare an international health emergency. (The Chinese government had lobbied other governments against declaring such an emergency).  

And despite the decades of predictions that a viral pandemic was inevitable, and years of committees, task forces and high-level panels aimed at preparing the W.H.O. for that emergency, reforms were slow to come. “The failure to enact fundamental change despite the warnings issued has left the world dangerously exposed, as the Covid-19 pandemic proves,” the report says. 

But the W.H.O.'s stumbles did not excuse the repeated failing of world leaders. For even after health officials gave a clear warning signal, the report notes, “In far too many countries, this signal was ignored.”

The report also faults public health leaders for responding slowly to early evidence that people without symptoms could spread the new coronavirus. Early reports out of China, and one in Germany, documented this phenomenon. But leading health agencies, including the World Health Organization, provided contradictory and sometimes misleading advice, a New York Times investigation previously found.

W.H.O.’s director general, Tedros Adhanom Ghebreyesus, appointed the panel to review the world’s Covid-19 response. Although the panel said the report was based on hundreds of documents, expert consultations and more than 100 interviews with frontline responders, it is not clear if the investigators have spoken to key health officials or reviewed internal documents.  

Many of the initial findings have been previously identified or been obvious for many months. But the collection of mistakes remains shocking even when it is not surprising, and by spelling them out, the panel hopes to chart a course for change.

Suboptimal US response to COVID-19 despite robust capabilities and resources

Via JAMA Network: Suboptimal US Response to COVID-19 Despite Robust Capabilities and Resources. Excerpt:

Several factors may help explain why the US has struggled more than many other countries to suppress COVID-19, and the GHS Index may provide some possible insights. Despite its top overall ranking on the index, the US received a low score on a key factor that can determine how well a country is able to react to a pandemic: public confidence in the government. 

The US is one of only a small number of high-income countries in the Index that received the lowest possible score on public confidence in the government. Poor confidence in the government can undermine the public’s adherence with disease-control measures, such as wearing masks or stay-at-home recommendations, and has been reported among the existing challenges to the US COVID-19 response.  

In addition, the US received low scores on important indicators pertaining to the strength of its health system and the ability of its people to access health care without barriers. For example, among the 60 high-income countries in the GHS Index, the US ranked 38th for its number of physicians per capita and 40th for its number of hospital beds per capita. On access to health care, the US was ranked 175th globally due to its absence of laws mandating universal health care coverage and large numbers of underinsured and uninsured individuals. A lack of guaranteed access to health care for all citizens leaves many individuals vulnerable during times of emergency. In 2020, the US Congress passed legislation to remove cost barriers for SARS-CoV-2 testing, but testing costs remain and have been cited as a barrier to expanding the number of tests performed in the US.  

Overall, the US was well poised to respond to COVID-19, but it has lacked strength in key areas. Although the US established a national stockpile of medicines, personal protective equipment, and ventilators, when signs of a new outbreak surfaced, calls by federal officials to replenish and augment these supplies were ignored. 

The US also failed to harness its own technical expertise, such as that within the CDC. Although the US has a world-class network of public health and clinical laboratories that had the capacity to develop their own assays to test for SARS-CoV-2, federal restrictions initially prevented these laboratories from doing so. This severely constrained the number of tests the US could conduct (and likely allowed the virus to spread around the country undetected) until these restrictions were eventually lifted. Even now, the lack of a national testing strategy and unaddressed shortages in testing supplies continue to limit the country’s ability to suppress SARS-CoV-2. 

What is most puzzling is that the US has been significantly involved in helping other countries to amass their own capacities to prepare for events like COVID-19. During the Obama administration, the US launched the Global Health Security Agenda and has contributed financial and technical support to help countries develop public health capacities to prevent, detect, and respond to infectious disease outbreaks. Thailand’s epidemiological capabilities were developed with large contributions of funding and expertise from the US. Even though the US lacks a national strategy for testing and conducting surveillance for COVID-19, it has previously helped other countries develop such strategies for other diseases. 

International experts agree that the COVID-19 pandemic as a test case of the capacities as assessed by the GHS Index remains highly relevant. However, going forward, the Index should include new or stronger metrics about additional capacities, such as medical supply chains and a better understanding of national leadership. The strength of a country’s leadership and the confidence of its people in their government and their leaders is just as important (if not more important) than technical capacities. Future versions of the Index will give greater weight to these factors.  

During the years to come, the US undoubtedly will undergo national-level reviews to understand how its strong capabilities were squandered when the country needed them the most. In the meantime, the country’s health and economic security will continue to be adversely affected until national leaders change course.

Covid-19 fed off ‘panic and neglect’, says WHO-backed body that warned of possible pandemic

Via the South China Morning Post: Covid-19 fed off ‘panic and neglect’, says WHO-backed body that warned of possible pandemic. Excerpt:

An international body set up by the World Health Organisation (WHO) and World Bank in 2018 to monitor readiness for public health emergencies has called for sweeping reforms to address failures it says led to the Covid-19 pandemic crisis. 

In its “A World in Disorder” report released on Monday, the Global Preparedness Monitoring Board said Covid-19 “revealed a collective failure to take pandemic prevention, preparedness and response seriously”. 

The independent group said in its inaugural report last year – released in September, just months before the start of the health crisis – that the world was at risk of being hit by a respiratory pandemic.  

But the principal shift the health leaders called for both this year and last was one of mindset, to end a “cycle of panic and neglect” when it came to the response to health emergencies. 

“We warned that the world was ill-prepared for such a pandemic, tragically and catastrophically we have seen our worst fear realised. The impact of Covid-19 is even worse than we anticipated,” said board co-chair and former WHO director general Gro Harlem Brundtland. 

“Actions that we called for last year have still not been taken,” she said, adding the world remained vulnerable to future outbreaks.

Without naming names, the group pointed to the failure of leaders to take early decisive action and listen to science in their responses to the crisis. It also said political tensions and disruption of the G7, G20, and multilateral organisations were major impediments to tackling the Covid-19 pandemic. 

The board includes medical experts like Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, and Gao Fu, director general of the Chinese Centre for Disease Control and Prevention.

Bill Gates on COVID-19, vaccines and global health

Via The New York Times: Bill Gates on Coronavirus, Vaccines and Global Health. Excerpt:

On Monday, the Bill and Melinda Gates Foundation released the fourth of its annual Goalkeeper reports, which track the slow but steady progress the world has made toward more than a dozen health-related goals set forth by the United Nations in 2015.

This year’s was unrelentingly grim. The coronavirus pandemic has scorched away years of work: More families are in dire poverty, malnutrition is increasing, far fewer children are getting immunized. 

The assessment comes as the United States, stung harder by the virus than any other country, is retreating from the global health stage and seems focused primarily on saving itself. Could it ever return to its role as the world’s leader in both competence and generosity? In an interview with The New York Times, Mr. Gates devoted a half-hour to explaining why he was optimistic that it would. 

“It’s my disposition,” he said. “Plus, I’ve got to call these people up and make the pitch to them that this really makes sense — and I totally, totally believe it makes sense.”

By “these people,” he was referring to leading figures in the White House and Congress, whom he has personally lobbied to do “this”: namely, add an extra $4 billion to the fiscal stimulus package now under debate in Congress so that poor countries can get Covid-19 vaccines.  

Ultimately his goal is far more ambitious: to double American foreign aid from less than 0.25 percent of gross domestic product to 0.5 percent or more. He sees the pandemic as an opportunity to do that. 

“As they say,” he added cheerily, “the U.S. government — after it’s tried every other thing — does the right thing.” 

As he did in Silicon Valley while battling competitors and antitrust regulators, Mr. Gates can calculate his chances of success with a ruthless logic. That has rarely been as true as it is now, as a once-in-a-century pandemic devastates the impoverished countries where he focuses his giving.  

The damage has been wrought less by the virus — so far it has killed much smaller percentages of the populations of Asia and Africa than of the Americas and Western Europe — than by the economic impact, which has been far greater in countries where people and governments “have no spare reserves to draw on,” Mr. Gates said. 

The collapse of tourism, declines in remittances from relatives working abroad, the shutdown of ports, mines and oil wells, school closings and new stresses on fragile health care systems have all created enormous suffering. 

Not since 1870 have so many countries been in recession at once, according to the Goalkeeper report. Between 1990 and 2020, the percentage of the world’s population living in extreme poverty, which is now defined as living on less than $2 a day, shrank to less than 7 percent from 37 percent. In just the past few months, 37 million people have fallen back below the line, the report estimated.  

“The longer the pandemic lasts, the worse its economic scars will be,” it added.

WHO’s next — the United States and the World Health Organization

An editorial in NEJM: WHO’s Next — The United States and the World Health Organization.

Suppose a large forest fire hits California. Millions of acres are burning, and many towns are threatened. The Forest Service firefighters are cutting breaks and dropping water from helicopters. They plan their strategy using weather models that predict which way wind patterns will push the fire. Unfortunately, the models are imperfect. The wind turns in an unexpected direction. As a result, several towns are destroyed, and there are billions of dollars in damage. 

What’s the proper response to such a disaster? If you were the current U.S. government, you would shut down the Forest Service in the midst of the fire. At least that’s what’s happening now with the World Health Organization (WHO). On July 7, 2020, the President notified the United Nations that the United States plans to withdraw from the WHO. 

The full implications of this decision are not yet clear. The United States is responsible for the largest amount of funding for the WHO, 22% of assessed dues, and provides the largest voluntary contributions — to polio eradication, nutrition, and vaccine programs, for example. Because of the Covid-19 pandemic, measles and polio campaigns have already been suspended in dozens of countries, and these delays will be exacerbated by the withdrawal of U.S. financial support. 

The WHO and its staff have many roles in global health. They set the standards for case definitions and therapies for common diseases in countries that lack the public health resources to set their own policies. They provide a global standard for drug approval, helping to ensure drug safety in countries that don’t have robust regulatory capacity. They develop guidelines for disease treatment, particularly for illnesses such as malaria and tuberculosis that predominantly affect the developing world. And they help persuade member states to provide adequate nutrition to infants and children and family planning resources to parents. They convene the world’s top experts to provide advice to all countries. Their work touches the lives of hundreds of millions. And, of course, this work has important ramifications for the United States as well. As we have clearly seen, infectious diseases don’t respect borders. What happens to our neighbors and even to remote countries affects our health as well. 

The WHO is not perfect. It is governed by the consensus of 194 member states, which often renders decision-making slow and bureaucratic. In particular, the WHO has not been a highly effective rapid-response organization; its missteps in the 2010 cholera epidemic in Haiti, the 2013–2016 Ebola virus outbreak in West Africa, and the current outbreak of SARS-CoV-2 are clear. The fact is, however, that it relies on information from affected countries, along with invitations from those countries, to investigate outbreaks, and it lacks adequate funding for those investigations.  

The WHO serves a role that is a bit of a hybrid of the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, and various other federal health agencies in the United States. It needs the authority and the funding to fulfill that role. There is no question that as the current pandemic recedes, the international community should reevaluate the priorities and needs of the WHO and should raise the funds needed for more effective responses. 

Of course, our own CDC, the world’s premiere public health agency, has had its own issues during the Covid-19 pandemic. Funding for the CDC’s international programs, and particularly for the CDC office in China, have been severely cut back. Despite the advantage of a long lead time, the United States was inadequately prepared for Covid-19 when it arrived and stumbled through testing and early policy making. And the national response, countrywide, has been inconsistent and often ineffective. 

At some point there should be a reckoning, an evaluation of why the United States has done so poorly and who is responsible for the tens of thousands of excess deaths and billions of dollars in additional economic damage that have resulted. But today, in the middle of the outbreak, we must take stock of where we are and how we can do better. To do that effectively, we need the WHO. We must not make the mistake of firing the firefighter in the midst of a fire.