If they could rewind time, would officials from the World Health Organization have declared COVID-19 a pandemic earlier?
Questions of whether to declare it a pandemic and why it wasn’t declared sooner have been common during WHO’s thrice weekly news conferences. Yesterday was no different.
The responses tend to reveal how a panel of science and medical professionals are technical and factual to a fault, sometimes failing to meet the lexical expectations of the masses and the media.
Dr. Michael Ryan, executive director of WHO’s Health Emergencies Programme, reminded journalists, “WHO raised its highest level of alert under international law on the 30th of January and declared a global public health emergency.”
The law references the International Health Regulations (IHR) of 2005, a legal framework that outlines rights, obligations and requirements for 196 countries—including all 194 WHO member states—to report public health events and emergencies that have the potential to cross borders.
The term “pandemic” is not one tossed around freely in the WHO lexicon; excluding the title page, there are only three mentions of the word in the 32-page IHR document, which mostly refers to epidemics.
However, when the pandemic was declared on March 11, the masses seemed to heed the term as more potent, even though it had more to do with geography than severity or transmissibility.
“The characterization of the disease as a pandemic in itself has no basis other than a description of the event at that time in regards to how many countries were affected,” Dr. Ryan explained.
Though the question was, and usually is, posed to WHO Director-General Dr. Tedros Ghebreyesus, making a declaration of any kind was not his call alone to make.
On January 23, less than a month after the outbreak was reported in China, a global delegation of experts meeting with WHO officials were divided on how loud to sound the alarm, recalled Dr. Ghebreyesus. It would take another week for the experts to reach a consensus on whether the IHR criteria had been met to declare a “public health emergency of international concern.”
That declaration was made as early as possible, said Dr. Ghebreyesus, noting that many cases “were still in the neighborhood” of China, and fewer than 100 cases were confirmed outside of China, affecting only a few countries. There were 10 cases in Europe, and Africa had yet to report any cases, he said.
“We triggered the highest level of emergency when the rest of the world had only 82 cases and no deaths,” Dr. Ghebreyesus said.
According to the IHR guidelines, COVID-19 met the criteria because it implied a situation that was serious, sudden, unusual or unexpected; carried implications for public health beyond the affected state’s national border; and required immediate international action.
“Looking back, I think we declared the emergency at the right time, when the rest of the world had enough time to respond,” Dr. Ghebreyesus said, adding that there was ample time for countries to nip the virus in the bud.
Dr. Maria Van Kerkhove, WHO’s technical lead for COVID-19, highlighted how some countries used that window of time wisely. A number of countries have been ramping up testing, strengthening surveillance systems and readying the public health infrastructure, she said.
“That message has reached many, and that has been our message from the very beginning,” Dr. Van Kerkhove said. “And we will keep saying this because this is what works. Even in countries that are seeing a resurgence in cases, they are coming back to this: How do we find every case? How do we test all of the suspect cases? How do we care for all of them appropriately? How do we trace and quarantine all of the contacts and keep our communities engaged?”
It was in January, Dr. Ryan reminded journalists, that WHO officials began providing containment and mitigation strategies for COVID-19.
Beyond the powers outlined in the IHR, officials from WHO have no rights of enforcement when it comes to health implementation, Dr. Ryan explained, and officials are not even allowed to enter member states without permission or discussion.
“We have the power to persuade. We have science, evidence and the normative role we play,” Dr. Ryan said. “We have a mandate to establish global standards and to give strong advice to countries regarding what are rational public health measures.”
Many countries implemented those measures, and their politicians have implemented science-based policy, he said.
Those are the countries, Dr. Ryan pointed out, that have responded well to the virus.