How Missteps by WHO, Isolationism and Unconscious Bias Among Global Networks Contributed Towards the
On Thursday of last week, researchers at NYU's Grossman School of Medicine released findings that most of the early cases of Covid-19 in New York City, also known as the novel Coronavirus, originated from Europe, not China. The discovery was based on genetic sequencing results from 91 patients who were among the city's earliest cases.
In an apocalyptic season of tragedy and public unease, the news flash from NYU clarified the our understanding about the virus' European link to the U.S. epicenter. Europe had never even been alluded to as a possible factor in the virus’ U.S. spread, especially in New York.
The discovery by NYU of this connection also underscored how bias and isolationism towards one country, China, created a global blind spot that undoubtedly led to the current crisis impacting 184 countries. In a matter of months.
From the moment that China first alerted the world about the Covid-19 virus on December 31, 2019, this global blind spot anchored misperceptions about the disease and created a false sense of security that closing borders to China would resolve the issue.
More importantly, that blind spot sustained a lack of universal clarity about how to contain Covid-19 through diagonistic testing efforts or leverage the powerful network capital of influential, multinational stakeholders to mitigate its disruption. Time would reveal how much would be lost as a result.
The virus' sweeping impact in the United States has now disproportionately impacted communities of color and the working class, escalated bias incidents against Asian-Americans, and created economic havoc. Moreover, we continue to have limited visibility about the scope of the disease due to deficits in testing capability.
Life in cities like New York City, Los Angeles, New Orleans, as well as small towns like Albany, Georgia and Camden, South Carolina has been ruptured. Communities in nations around the globe have been equally devastated and endangered.
Even in this age of globalization and shared transnational risk, Covid-19 was widely perceived and characterized as the "Chinese virus" with largely regional implications that could not breach the invincibility of other nations. This dangerously myopic point of view was initially the official position of the World Health Organization (WHO), the chief governance body for international public health matters.
The WHO Response in the Pandemic's Early Stages
On January 22, 2020, the first Emergency Committee meeting of WHO's International Health Regulations(IHR) Committee was held to discuss the Covid-19 threat. Under WHO's Pandemic Preparedeness protocols, a disease that poses a a global health risk is designated as a PHEIC. After two days of deliberations, WHO declined to consider Covid-19 a Public Health Emergency of International Consideration (PHEIC).
Considerable evidence was presented to the Emergency Committee. Yet in spite of having reviewed China's daily reports and submission of Covid-19's viral sequence on January 12, receiving a report from the United States on January 19 about its first case, and hearing from a delegation of officials from China, Japan, Korea and Thailand about emerging case clusters (With the exception of Thailand's case, all, including the U.S. case in Washington, were connected to Wuhan City), the Committee held firm.
In its assessment, Covid-19 did not pose an international health risk.
Minutes from the January 22 meeting state:"The Committee expressed divergent views on whether this event constitutes a Public Health Emergency of International Concern or not. At the time, the advice was that the event did not constitute a PHEIC, but the Committee members agreed on the urgency of the situation." A week later on January 30, 2020, after a trip by WHO experts to China and review of Covid-19 cases and data, the Emergency Committee decided to reverse its decision.
This reversal would take place an entire month after first learning about the disease.
Yet, its rationale was more diplomatic, than public health-based. Minutes from the January 30, 2020 meeting state: "The declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency, and, it is to be hoped, with success."
Rather than setting forth a strategic plan, the Committee opted for temporary recommendations urging China to take a number of prescriptive steps. Those measures included exit screening at all international points of entry, surveillance, data reporting, ensuring the resiliency of China's health systems, robust public communications.
The recommendation for other countries was far less specific. No prescriptive framework was offered.
The Committee simply stated:"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. Technical advice is available on the WHO website."
Countries dissatisfied with the direction, moved to implement travel bans, but those actions were in direct conflict with WHO policy. The WHO policy states that its legal regulations, countries should only adopt measures "restricted to public health risks that avoid unnecessary interference with international traffic and trade."
Who Has the Map for Moving Forward?
The lack of defined tactical direction in the pandemic's early phases, especially in terms of testing, exit screening guidelines for all international travel, not just travel related to Asia or a Covid-19 specific strategic plan, which was not published by WHO until March 6, meant countries had no real road map. As a result, a cohesive global mobilization of public, private, and academic sectors to respond with strategic urgency and foresight to Covid-19 was undermined.
For instance, the U.S. and the European Union sent vital medical equipment to China in January and February. The EU sent 12 tons of medical equipment. The U.S. sent 17.8 tons of equipment and pledged State Department aid of $100 million in the early phases of the pandemic.
That assistance, while laudable, reflected an absence of alertness about the daunting stresses Covid-19 virus could potentially impose on their own countries' health systems. In a matter of weeks, health systems in the U.S. and Europe would be pushed to limit from ravages of the disease on their soil.
In retrospect, the initial position and weak guidance of WHO's Emergency Committee as a public health governance body was a profound miscalculation that revealed both a lack of insight about the Covid-19 risk. This miscalculation also revealed deeply entrenched fault line at the global level.
It's a fracture exacerbated by difficult geopolitics often framed by nationalism rather than globalism, systemic inequities, supply chain disconnects and dotted line leadership responsibilities when it comes to global risk. And it existed before this crisis.
Professor John Ruggie, former Director of the Center for Business and Government at Harvard's Kennedy School explains it best. He states: "There is no collective action body at the international level to balance the system or facilitate action" when a disruption or global risk emerges.
The World Economic Forum's 2020 Risk Report underscores this assessment with its own: "The global community is ill-positioned to address vulnerabilities that have come alongside in the 20th century... our collective vulnerability to the societal and economic impacts of infectious disease crises appears to be increasing."
Defining the Current Crisis
The global crisis on our doorsteps is as much a public health and economic crisis, as it is a red flag and public policy disconnect. This crisis reflects a profound underestimation of how interdependent our global networks truly are.
While having a strong national pandemic strategy is crucial moving forward, it must be linked to an effective global strategy. The days of our having an arms-length relationship with other global stakeholders are over.
More importantly, ingrained attitudes about national superiority of health care systems or the skepticism about the cultural attitudes of other the countries can impact how the public health implications of particular infectious diseases are perceived or responded to. For instance, consider this comment from page 79 of the World Economic Forum's 2020 Global Risk Report:
"Weak systems let pathogens and diseases spread because they fail to address fake news about healthcare and preventive care, psychological responses of fear and despair, and lack of compliance with health professionals’ requests."
Or consider this 2013 assessment of China's health care system by the University of Pennysylvania's Wharton School in which China's health care system was called a "ticking time bomb" because its "health care system is ailing, and the prognosis for a cure in the near future is not good."
The article's author acknowledges parallels between China and the U.S: (1)high health care costs;(2) a lack of coordinated care, insufficient numbers of primary care physicians, especially those trained in the Western medical model; (3)access to health care insurance, limited access to good care in rural areas, issues associated with a growing senior population;(4) chronic diseases.
However, he points out that corruption via kickbacks was more rampant in China's health care system. In China, as opposed to the U.S., the author writes "nobody goes to jail."
It also bears noting that when WHO convened a joint mission trip to China from February 16- February 24 to study the Covid-19 virus and China's prevention protocols. Twenty-five representatives participated from the following countries: Japan, Korea, Singapore, Canada, Germany, Nigeria, Russia, the U.S. and its chief health agencies, the CDC and NIH. In spite of the virus' appearance at this point in France, Italy, Finland, Sweden and the UK, Germany was the only country from Europe represented in the delegation.
The WHO mission report praised China for its aggressive efforts and noted them in detail. Measures included: (1) universal temperature monitoring and sanitizers at public sites; (2) active geo-tracking via cell phone and ID information (3) masking; (4) hand washing; (5) social distancing, (6) immediate isolation of affected patients after screening,(7) quarantining; (8) testing; and (9) the strict enforcement of non-pharmaceutical, behavioral protocols.
The mission report urged countries with Covid-19 cases to be equally diligent about preventing the seeding of the virus. The report recommended that those countries with reported cases "immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures."
But a cautionary note was added that tempered this guidance. Delegation observers noted that "much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China."
WHO's pandemic framework contains levers for engaging global networks of multisectoral players, but this simply did not happen. In response to WHO's weak guidance, countries relied on travel bans against China, rather than a rigorous cohesive, international protocol of public health behavioral adjustments and supply chain planning to combat the looming and borderless threat.
Global networks are associated with both economic and human realities that range from policy and information pathways to supply chain viability, workforce readiness manufacturing and international travel. Multinational corporations, firms, academic and research institutions, as well as NGOs control value chains,channels for community engagement, information, innovation, and transportation modalities.
The norms of life as we know are impacted by both the strength and vulnerabilities of these connections. In fact, those networks have an impressive history of working with sovereign states during health crises.When those networks- companies,sovereign governments, academic institutions and NGO- are collaborative and aligned, their combined network capital can mitigate the risk of disruption.
The success of influential global networks at the G20 climate change summits, OPEC oil production summits or via multinational efforts to stem HIV/AIDs, and nuclear disarmament attest to this.
Yet, the strategic risk interventions associated with these networks were not activated for the current situation. The reasons have not been shared for this lapse and we are left to wonder why.
Once the alarm bells were sounded in December 2019 about Covid-19, the elements were in place for effective risk containment- an established governance framework through the World Health Organization, global networks with a track record of success, technology, advanced communication pathways, research institutions and diplomatic actors. The groundwork was in place.
Key disconnects fostered by biases, dismissiveness, assumptions within this chain of interests would underscore longstanding weaknesses. Those weaknesses are framed by the commercial and human realities anchoring supply chains, manufacturing capacity, health care system readiness.
Early on, those weak spots negatively impacted global enforcement and accountability related to this pandemic. Those fissures also reinforced a pervasive sense of nationalism and isolationism from China and Asia, and elevated the role of politics in response to the Covid-19 threat.
To move forward,WHO's initial guidance and failure to recognize the global threat posed by Covid-19 cannot be overlooked. Nor can we overlook how a nationalistic lens and isolationist attitudes towards China contributed towards a skepticism and sluggish response towards the Covid-19 threat and disaster.
This strategic weakness led to a decision-making and leadership gap among multinational players to work in tandem, especially in terms of existing trade restrictions and manufacturing deficits. There was no centralized decision-making line within the global landscape to effectively connect the dots between stakeholders Europe, the U.S, Africa, Southeast Asia, the Middle East, South America.
We can't win the war we are facing by not creating a strategic platform that leverages our combined expertise, capabilities and innovation across countries and sectors. It's crucial that key private sector, academic, NGO, and government influentials with international ties lay the foundation for a global problem-solving platform and rapid response protocol.
It's not too late to connect the dots and resolve the disconnect that has taken place among our global networks in response to the Covid-19 virus. It's an all-hands- on-deck moment that requires countries to act as a global whole. But global benchmarks and strategic pillars are needed to govern resource allocation, investments in innovation, and manpower during this crisis.
It's a small world after all. And we can never ever forget it. Our future depends on it.
This article was originally published on April 14, 2020 on Valerie Kennedy's LinkedIn Page.
Valerie Kennedy is a corporate lawyer and diversity practitioner who practices in New York City.
Her legal experience includes both Biglaw roles at the firms of Skadden, Arps, Slate, Meagher & Flom and Cravath, Swaine & Moore and positions in the public sector. She served as the City’s first Diversity Officer at the New York City Economic Development Corporation and as a Senior Mayoral Advisor on diversity matters in the Mayor’s Office of Appointments.
She has spoken about diversity before New York City’s Gender Equity Commission, Columbia University’s School of International and Public Affairs and at the Womensphere Conference.
She is well-versed in diversity and equity issues pertaining to race and gender.