Globetrotter Vijay Prashad

How the Chinese Authorities and the World Health Organization Handled the Coronavirus, and Why the WHO Didn’t Declare a Pandemic Until March

By Vijay Prashad

Part 1: How the Chinese Authorities and the World Health Organization Handled the Coronavirus

The attack on the Chinese government and the World Health Organization’s work on the new virus by the Trump administration is unfounded.

April 22, 2020

On April 14, 2020, U.S. President Donald Trump addressed a news conference at the White House, where he said that his administration would “halt [all] funding” for the World Health Organization (WHO). The WHO, founded in 1948, is the principal United Nations agency tasked with the improvement of the health of the world; it is also widely acknowledged as an agency that is best suited to deal with health emergencies.

On March 11, a month before Trump’s announcement, the WHO had declared a global pandemic as a result of its deep concern of both the alarming levels of spread and severity, and the alarming levels of inaction. Up to this April, this highly infectious virus has sickened at least 2 million people and killed 183,000 people around the globe. The number of people who have died in New York City—Trump’s hometown—from the novel coronavirus outbreak is far higher than that of 9/11. To cut funding to the only agency able to coordinate the global response drew a sharp intake of breath from people around the world.

Why would Trump withdraw $400 million—15 percent of the WHO budget—in the midst of a crisis that does not seem ready to abate? Trump’s answer is that the WHO “failed in this basic duty” by “severely mismanaging and covering up the spread of the coronavirus.” It is essential to detail why Trump’s accusations against the Chinese government and the WHO are wrong, starting with why Chinese authorities learned about the coronavirus, and how the WHO and the Chinese authorities named and shared information about the virus.

Emergence

Doctors in Wuhan observed an unusual kind of pneumonia in late December. On December 31, a high-level team arrived from Beijing to investigate the reports coming from the hospitals. That day, on the last day of 2019, the Chinese authorities informed the Beijing office of the WHO of “cases of pneumonia unknown etiology [medical term for cause].”

On January 2, according to the WHO’s situation report, “the incident management system was activated across the three levels of WHO (country office, regional office and headquarters).” Four countries had by January 20 reported incidents of what would later be known as COVID-19—China, Thailand, Japan, and South Korea. Six people had died in Wuhan City.

On January 4, the WHO announced publicly that the Chinese authorities had informed it of “a cluster of pneumonia cases—with no deaths—in Wuhan.” This was also reported by the WHO on its official Twitter account. The next day, on January 5, the WHO published its first risk assessment. “There is limited information to determine the overall risk of this reported cluster of pneumonia of unknown etiology,” the WHO wrote. “The symptoms reported among the patients are common to several respiratory diseases, and pneumonia is common in the winter season; however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.”

It is important to know that the population of Wuhan City is 11.2 million and of Hubei Province is roughly 58 million. The 44 cases of what was then called pneumonia were of concern, but there was not—at that time—an imperative to sound a global alarm.

Evidence of Human-to-Human Transmission

A virus provokes alarm if it can be proved that it moves from an infected human to another human being. This was not clear to either Chinese authorities or to the WHO until January 20.

On December 31, the Wuhan Municipal Health Commission declared that there was no evidence to show human-to-human transmission at this point (for instance, no medical worker had been infected). That conclusion was verified on January 4 by the first expert team of China’s National Health Commission. At regular intervals, both the National Health Commission and the Wuhan Municipal Health Commission reported that there was simply no clear evidence of human-to-human transmission. On January 15, the Wuhan Municipal Health Commission reiterated this, but then said that the possibility of limited human-to-human transmission could not be ruled out; however, the commission noted that the possibility of sustained human-to-human transmission remained low.

The first official statement that verified human-to-human transmission was made on January 20 by China’s leading respiratory disease expert, Zhong Nanshan. The next day, the National Health Commission reported that the novel coronavirus was a Class B infectious disease and that Class A methods of prevention had to be adopted.

With this notification, everything changed. On January 23, Wuhan was shut down, and the Chinese government operated on an emergency basis.

Coronavirus and the WHO

China first informed the WHO about the virus on December 31. On a regular basis, the Chinese government sent information to the WHO office in Beijing and—by January 3—informed Hong Kong, Macao, and Taiwan and relevant countries and regions. On January 4, on its Twitter account, the WHO summarized for the public that there was a “cluster” in Wuhan and that investigations were underway.

On January 9, the Chinese authorities told the WHO about initial progress toward determining the cause of the viral pneumonia. It needs to be understood that at that time there was no clarity about the virus. It was just two days earlier, on January 7, that the Chinese Center for Disease Control and Prevention (CDC) identified the novel coronavirus (nCoV). The WHO posted a note on its website on January 9. It made two points: first, that the Chinese investigators had done a preliminary identification of the novel virus, which—in such a short period—is “a notable achievement and demonstrates China’s increased capacity to manage new outbreaks”; second, that such viruses are complex, since “some transmit easily from person to person, while others do not. According to Chinese authorities, the virus in question can cause severe illness in some patients and does not transmit readily between people.” On January 11, the WHO informed the public that it has received “the genetic sequences for the novel coronavirus from the Chinese authorities”; that day, the WHO issued an interim guidance on how to prepare if this virus spread widely.

Two days later, on January 13, based on increased understanding of the lethal virus, the Chinese National Health Commission (NHC) told Wuhan City to reduce public gatherings and to check people’s temperature at transport hubs. This was in the public domain. On January 14, the WHO’s technical team held a press briefing, where they said that there was “limited human-to-human transmission of the coronavirus (in the 41 confirmed cases), mainly through family members, and that there was a risk of a possible wider outbreak.”

By January 14, the Chinese authorities and the WHO had made the following clear: there was a new kind of coronavirus that had a limited human-to-human transmission capability and had until now been restricted within China, with one person taking the infection to Thailand from Wuhan. These were all public statements.

Bizarrely, the Associated Press ran a story on April 15 arguing that the Chinese government did not report the news of the outbreak to the public for six crucial days from January 14 to 20; in fact, the Chinese government had informed the U.S. CDC and the WHO on January 3, and had made public statements of what they knew until January 14. After Dr. Zhong Nanshan’s announcement of the lethality of the virus on January 20, everything changed.

Public Health Emergency

After Dr. Zhong Nanshan’s announcement, and based on more epidemiological work, the WHO said on January 21 that there was evidence of human-to-human transmission, although there was still no conclusive evidence that the transmission happened consistently. While Dr. Zhong made this statement, a WHO team was in Wuhan conducting a field visit. On January 22, the WHO team’s mission statement noted, “Data collected through detailed epidemiological investigation and through the deployment of the new test kit nationally suggests that human-to-human transmission is taking place in Wuhan. More analysis of the epidemiological data is needed to understand the full extent of human-to-human transmission.”

On January 22, the WHO director-general convened the WHO’s International Health Regulations (2005) Emergency Committee, which makes the decision to declare a “public health emergency.” The 15-member committee is made up of officials from the United States, France, Australia, Singapore, Canada, China, and Thailand. The committee was divided; it eventually declined to declare an emergency, but suggested that it should reconvene 10 days later to assess the situation. The committee had advice to countries around the world: “It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.”

When the committee next met on January 30, earlier than the 10 days it gave itself, it decided to declare a “public health emergency of international concern.” Such an emergency is defined as an “extraordinary event” that is a risk due to “international spread of disease” and that requires “a coordinated international response.”

The WHO first made a public announcement of the virus on January 5; three weeks later, after more knowledge was gathered about the virus and after its spread matched the institutional definition of a public health emergency, the WHO made the appropriate announcement.

Part 2: Why Did the World Health Organization Wait Until March to Declare a Global Pandemic?

The 2005 regulations pushed on the World Health Organization by the United States and the Europeans hampered the WHO’s ability to declare an emergency and a pandemic.

April 28, 2020

When U.S. President Donald Trump cut off his government’s funding to the World Health Organization (WHO), one of his grievances was that the WHO—under Chinese tutelage—failed to declare the global coronavirus outbreak as a pandemic soon enough. Not long after the virus brought patients to Hubei Provincial Hospital, the Chinese medical and public health authorities brought it to the notice of the WHO. The WHO investigated the virus over the course of early January, sending a team into Wuhan and making public whatever credible information it could report.

The WHO’s International Health Regulations (2005) Emergency Committee met twice in January, first on January 22-23 and then again on January 30; in the first meeting, the committee felt it had insufficient evidence to declare an emergency, but at the second meeting it took the decision to declare a public health emergency of international concern (PHEIC). This is the penultimate step for the WHO; on March 11, after it became clear that the virus was spreading across borders, but not before the WHO made many warnings to governments, the WHO declared a global pandemic.

Trump and his Democratic rival Joe Biden, as well as a host of other U.S. politicians, made the argument that the WHO did not act fast enough with its declaration. Whatever problems posed to the United States by the virus were not the responsibility of the U.S. government, they suggested; the fault lay with the Chinese government and with the WHO.

Our investigation finds that this argument has little foundation. The WHO’s reporting mechanisms are sound, but the WHO’s own ability to make these formal declarations—a public health emergency and a global pandemic, which come with serious financial consequences for member states—has been circumscribed; those who have constrained the World Health Organization—the United States and European nations—are the very same countries whose leaders are now complaining about Chinese influence over the WHO.

Revisions

By the 1990s, it had become clear that the WHO’s old International Health Regulations—originally issued in 1969, with only a few minor updates and new editions over the two decades after that—were inadequate. For one, these regulations were produced before the emergence of very infectious, lethal, and recurrent infections such as Ebola and the avian influenzas. Secondly, these old regulations were made before air travel began to move about 4.3 billion passengers per year, the scale of air traffic now making the movement of viruses so much easier.

In May 2005, the 58th World Health Assembly revised the 1969 regulations, pointing out that the new regulations would “prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.”

The North American and European states, in particular, insisted that the declaration of a PHEIC or global pandemic only be made after it was clear that air travel and trade would not be unduly interrupted. This restriction, essentially the core foundations of globalization, has constrained the WHO since 2005.

The 2009 Test

The new WHO regulations were tested when a new influenza emerged out of Mexico and the United States in mid-April 2009. This H1N1 was a combination of influenza virus genes that had links to swine-lineage H1N1 from both North America and Eurasia (thus the 2009 outbreak was commonly known as “swine flu”). It was first detected on April 15. On April 24, the U.S. Centers for Disease Control and Prevention uploaded a gene sequence onto a publicly accessible influenzas database. On April 25, ten days after the first detection of the virus, the WHO declared the 2009 H1N1 outbreak a PHEIC. On June 11, the WHO said that a global pandemic was underway.

In 2020, the WHO took a month to declare a PHEIC for the coronavirus and took an additional two months after that to pronounce a global pandemic. It was slower to announce the emergency, but it took the same time to declare a global pandemic.

By July 2009, the dangerous H1N1 virus had a less lethal impact than the WHO had feared. However, for the full year from its first detection, 60.8 million people were infected and 12,469 died.

Almost immediately, the WHO was attacked for the June 11 description of the outbreak as a pandemic. When the WHO declares a pandemic, governments are expected to do a variety of things including mass purchase of drugs and vaccines. These are costly.

That December, members of parliament in the Council of Europe opened an inquiry into the WHO declaration. Fourteen members of the Council charged the WHO with what was essentially fraud. They said that “pharmaceutical companies have influenced scientists and official agencies, responsible for public health standards, to alarm governments worldwide. They have made them squander tight health care resources for inefficient vaccine strategies and needlessly exposed millions of healthy people to the rise of unknown side-effects of insufficiently tested vaccines.” “The definition of an alarming pandemic,” they wrote, “must not be under the influence of drug-sellers.”

The criticism of the WHO stung. It had declared a pandemic, but the virus had stabilized very soon after the declaration. The WHO responded to such criticism with humility. “Adjusting public perceptions to suit a far less lethal virus has been problematic,” the WHO responded. “Given the discrepancy between what was expected and what has happened, a search for ulterior motives on the part of the WHO and its scientific advisers is understandable, though without justification.”

Trump’s Attacks

A WHO official told one of us that the agency had been shaken by the assault in 2009. Over the past ten years, the agency has struggled to regain its confidence, working through the Ebola outbreak in 2014 and then Zika in 2016. In neither of those cases was there a need to make any global declaration.

This year, the WHO declared a global pandemic within three months of the first cases. But there is no doubt that the attack on the WHO a decade ago has made an impact. Former WHO employees tell us that fear of being attacked like this by the main donors seriously hampers the independence of the WHO and its scientific advisers. Trump’s current attack is going to weaken further the ability of the WHO to operate at its own pace and with credibility.

The World Health Organization is not the first UN agency to face the wrath of the U.S. administration. The Trump administration sent its budget to Congress with zero dollars for a line item called International Organizations and Programs. Under this line item comes United States funds for UN Development Program, UNICEF, UNESCO, Office of the High Commissioner for Human Rights, UN Women, and UN Population Fund. In 2018, the United States stopped funding the UN’s Palestine agency (UNRWA). When the UN is useful, the United States uses it; when the UN goes against United States interests, it will lose its funding.

When Trump said that the WHO is “China centric,” he offered no evidence; he did not have to.

No doubt that the United States is currently facing the wrath of the global pandemic. If the U.S. government had begun to plan effectively after the WHO declared a public emergency on January 30 or even when it declared a global pandemic on March 11, the problems would not be so grave. But there was no planning at all, which is distressing. As George Packer put it in the Atlantic, the United States in the months after January was “like a country with shoddy infrastructure and a dysfunctional government whose leaders were too corrupt or stupid to head off mass suffering.” From Trump, the U.S. citizenry got “willful blindness, scapegoating, boasts, and lies.” This sums it up. Part of the scapegoating was directed at China; it is far easier to blame China—already part of a dangerous trade war and a simmering regional struggle in Asia—than to accept responsibility oneself.

About the Author:

Vijay Prashad is an Indian historian, editor and journalist. He is a writing fellow and chief correspondent at Globetrotter, a project of the Independent Media Institute. He is the chief editor of LeftWord Books and the director of Tricontinental: Institute for Social Research. He has written more than twenty books, including The Darker Nations and The Poorer Nations. His latest book is Washington Bullets, with an introduction by Evo Morales Ayma.

Globetrotter, a project of the Independent Media Institute, explores the struggles for independence, dignity and democracy in the developing world, from economic models to war and imperialism.