As COVID-19 continues its relentless spread across the world, concerns about leadership are mounting. At the national level in the United States, institutions the public relies on for guidance and assurance around health matters, like the Centers for Disease Control and Prevention (CDC), have gone conspicuously quiet. In Brazil, the health ministry stopped reporting data on COVID-19 cases and deaths on its official website in early June, before a Supreme Court justice ordered the government to reverse course. At the global level, leading health authorities – specifically, the World Health Organization (WHO) – have been criticized for purportedly mismanaging the pandemic response.
Questions around WHO’s effectiveness echo recent calls to dismantle traditional systems of multilateralism, like the United Nations. Critics contend that WHO is an antiquated institution, not suited to meet today’s global public health needs.
However, most global health experts assert that the world needs WHO – now more than ever. WHO is leading the coordination of a unified global response to the pandemic, an essential role at this time. COVID-19 – and its associated economic and social impacts – exemplifies the need for an institution like WHO and why it requires member nations’ support.
This week’s edition of Rabin Martin’s COVID-19 Briefing highlights the challenges WHO has faced over the course of this unprecedented pandemic and explores its response. What mechanisms are needed to ensure WHO can fulfill its mandate? It is clear that WHO must evolve once the pandemic subsides. The question is how and whether the organization has the support it needs to achieve its mission: to build a better, healthier future for people all over the world. Please find our earlier COVID-19 Briefings here.
World Health Organization at a Crossroads
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases (NIAID)
Missteps and Consequences
Since the beginning of the pandemic in China, WHO has been under a microscope for its seemingly delayed response to COVID-19. Critics claimed that the organization failed to warn the rest of the world about the virus and that it aligned itself too closely with Chinese interests, spreading misinformation in the early months.
Yet, a systematic review of WHO activity by Richard Horton, Editor-in-Chief of The Lancet, shows the comprehensive and swift action WHO took following the first report from Chinese officials on December 31, 2019. The agency established an Incident Management Support team the next day, issued a disease outbreak warning within a week, and declared the coronavirus crisis an official Public Health Emergency of International Concern by the end of January.
Still, as the coronavirus has challenged scientists’ understanding of COVID-19, WHO has not been immune to the uncertainties and, at times, has had to backtrack. Last week, WHO caused confusion among the public and scientific community by suggesting that asymptomatic transmission of COVID-19 is “very rare.” It has since clarified the statement, with Dr. Maria Van Kerkhove, WHO Technical Lead on COVID-19, noting, “There are a subset of people who don’t develop symptoms, and to truly understand how many people don’t have symptoms, we don’t actually have that answer yet.” However, the comment added fuel to detractors’ arguments that the institution is out of touch.
Against this backdrop, President Trump stated in April that the U.S. will cease all funding to WHO, repeating the threat last month on the heels of the World Health Assembly. In a similar move, on Tuesday, June 9, Brazilian President Jair Bolsonaro threatened to withdraw the country from WHO once the pandemic abates, criticizing WHO as a “partisan political organization.”
Such actions and threats against WHO have been condemned by prominent global leaders and public health experts. Josep Borell, European Union High Representative for Foreign Affairs and Security Policy, denounced President Trump’s decision to cut funding, saying, “There is no reason justifying this move at a moment when their efforts are needed more than ever to help contain and mitigate the coronavirus pandemic. Only by joining forces we can overcome this crisis that knows no borders.”
Dr. Patrice Harris, President of the American Medical Association, asserted in a statement that the Trump administration’s decision to withdraw funding “serves no logical purpose and makes finding a way out of this public health crisis dramatically more challenging. This senseless action will have significant, harmful repercussions now and far beyond this perilous moment.”
Dr. Horton argued further that President Trump’s action amounted to a crime against humanity: “A crime against humanity is a systematic attempt to hurt the health and wellbeing of a population. President Trump has clearly committed that crime” by hampering WHO’s ability to defend the health of the world’s population. “The World Health Organization is the world’s only health agency… We need a super strong WHO right now,” he concluded.
Dr. Richard Horton, editor, The Lancet
Throughout the pandemic, Dr. Anthony Fauci, Director, NIAID, has defended WHO against allegations of partisanship and ineffectiveness. On Thursday, June 11, Dr. Fauci noted, “I would hope that we would continue to benefit from what the WHO can do – at the same time that they continue to improve themselves.”
WHO maintains open channels of review and feedback to its processes. In May, an Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme published a report of WHO’s COVID-19 response from January to April. “Checking and learning our lessons is in WHO’s DNA,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO, in response to the report.
Further, at the close of the 73rd World Health Assembly last month, delegates made a commitment to undertake another comprehensive evaluation of WHO’s response to the pandemic. The evaluation is meant to identify missteps and gaps in the response that can be averted in the future. “We welcome any initiative to strengthen global health security, and to strengthen WHO, and to be more safe,” said Dr. Tedros. “As always, WHO remains fully committed to transparency, accountability and continuous improvement. We want accountability more than anyone.”
Private Sector Insights
Earlier today, the head of the Africa CDC and the co-chairs of the Private Sector Roundtable on Global Health Security (PSRT) spoke with Raj Kumar, President & Editor-in-Chief of Devex to discuss global health security in today’s context of the COVID-19 pandemic response. Dr. John Nkengasong, Director, Africa CDC, Ashling Mulvaney, Global Head of Access to Healthcare, Global Sustainability, AstraZeneca, and Dr. Alan Tennenberg, Chief Medical Officer, Global Public Health, Johnson & Johnson agreed on the urgent need for collaboration, coordination, and breaking down silos to prevent the next health emergency and strengthen global health security.
Dr. Nkengasong expressed frustration with the cycle of forgetfulness and panic, referencing the Ebola epidemic and the many reports that were written in its aftermath but have not had a major impact. “We have talked about global health security more than what we have done about it. We need to be bold and take global health security seriously.” He added that we need to move beyond political will and focus on political commitment, translating political declarations into mobilizing resources and allocating them appropriately.
Ms. Mulvaney emphasized that health is a human right and “no access to health care is a threat in itself.” She spoke about the importance of strong health systems and that this should be everyone’s business – regardless of sector. She noted “we are only as strong as our most immature health system.”
Dr. Tennenberg highlighted the innovations and capabilities that the private sector brings to global health security. He gave specific examples of technologies, supply chain and logistics, workforce training, and communications support that companies have provided to countries, like Uganda, to help strengthen their local health security.
All three agreed on the importance of being proactive, rather than reactive, the need for targets to support accountability, and the imperative to focus locally – as well as globally – to ensure better preparedness and mitigate the health and economic threats of health emergencies.
To view the event overview click here.
On Thursday, June 11, as of 11:00 am ET, Johns Hopkins University reported 7,414,050 confirmed cases and 417,514 deaths attributed to COVID-19, globally. The epidemic reached a new peak in the U.S. surpassing 2 million cases. There have been 2,003,930 confirmed cases and 113,038 deaths, more than twice as many as any other nation.
Global COVID-19 Cases (Johns Hopkins University Center for Systems Science and Engineering)
Globally, the pandemic continues to wreak havoc as countries relax social distancing restrictions. Infections are surging in Brazil, Russia, and India. On Tuesday, June 16, Brazil reported a new daily record of 34,918 new cases, even as the government continues to insist the outbreak is under control.
While it seemed that the epidemic was waning in the U.S. as hotspots like New York controlled their outbreaks, infections are spiking as all 50 states have reopened to some degree. Arizona, Florida, and Texas – three states that quickly rolled back constraints on social distancing – reported their highest daily case rate on Tuesday, June 16. Some argue that the increase in infections stems from more widespread testing, but a concurrent rise in hospitalizations confirms that the epidemic is in fact worsening in many states.
Statistics released by the CDC this week confirmed that people living with underlying medical conditions have a significantly greater risk of developing severe COVID-19 requiring hospitalization. In the U.S., these patients were six times more likely to be hospitalized and twelve times more likely to die compared to those without such conditions. A study by The Lancet estimates that 1.7 billion people, 22% of the world’s population, have at least one comorbidity that increases their risk of developing severe COVID-19.
Pre-empting concerns about access to vaccines – following early challenges that patients and at-risk healthcare workers confronted in getting access to COVID-19 diagnostic testing – the Trump administration pledged on Tuesday, June 16, to make any COVID-19 vaccine free to “vulnerable” Americans “who cannot afford the vaccine.” The U.S. government has invested heavily in vaccine development through Operation Warp Speed, with the goal of delivering 300 million doses by January 2021.
“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support. This is great news and I congratulate the Government of the U.K., the University of Oxford, and the many hospitals and patients in the U.K. who have contributed to this lifesaving scientific breakthrough.”
Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO
From the Experts
“People keep talking about a second wave. We’re still in a first wave.”
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Disease
Tuesday, June 16
“The reality is this virus is with us. It’s almost like Groundhog Day. We’re going to have to live the same story over and over.”
Dr. Ashish Jha, Director, Harvard Global Health Institute
Tuesday, June 16
“I’m absolutely delighted that today we can announce the world’s first successful clinical trial for a treatment for COVID-19. This astounding breakthrough is testament to the incredible work being done by our scientists behind the scenes.”
Matt Hancock, Health Secretary, U.K.
Tuesday, June 16
“There’s no other country in the world that has as chaotic a response to this pandemic as we. You have one policy in one place, one policy in another place.”
Laurie Garrett, Science journalist
Tuesday, June 16
“The decisions taken to respond to this pandemic will have an impact on the lives of millions of people, workers, and families. Post-COVID-19, companies will be remembered for how humanely they handled this crisis.”
Michelle Bachelet, United Nations High Commissioner for Human Rights
Tuesday, June 16
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Situation Reports, June 15, June 16, June 17
- CDC Coronavirus Resource Page
- COVID-19 Health Systems Response Monitor
- NCD Alliance COVID resources relevant to NCDs
Funding and Policy Trackers
- International Monetary Fund Policy Tracker
- Kaiser Family Foundation Coronavirus Policy Tracker
- U.S. Chamber of Commerce Foundation Corporate Aid Tracker
- Devex Interactive Funding Tracker
Resource Pages and Market Research Literature
- JAMA Resource Center
- The Lancet COVID-19 Resource Centre
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT Preparedness Tool
- International Association of National Public Health Institutes COVID-19 Resources
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
What We’re Reading
- COVID-19 Pandemic, Unemployment, and Civil Unrest: Underlying Deep Racial and Socioeconomic Divides – Sandro Galea and Salma Abdalla, Journal of the American Medical Association
- A Conversation With J&J’s Vaccine Hunter – Riley Griffin, Bloomberg
- Slowing the Coronavirus Is Speeding the Spread of Other Diseases – Jan Hoffman and Ruth Maclean, The New York Times
- Keeping Governments Accountable: The COVID-19 Assessment Scorecard (COVID-SCORE) – Jeffrey Lazarus, Agnes Binagwaho, et al, Nature
- How Well Did OECD Countries Respond to the Coronavirus Crisis? – The Economist Intelligence Unit, The Economist
- The Long Road to a Covid-19 Vaccine – Anjana Ahuja, Financial Times
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About Rabin Martin
Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.
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