Independent COVID-19 response review: WHO and governments failed

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Describing the COVID-19 pandemic as the 21st Century's "Chernobyl moment", an independent panel has found that there were serious failures by both the World Health Organization (WHO) and individual governments in the world's response to the coronavirus pandemic.

BBC News reports that the Independent Panel for Pandemic Preparedness and Response, established by the WHO, called the response a "toxic cocktail". Without urgent change the world will be at the mercy of another disease outbreak, it said.

The WHO should have declared the outbreak in China an international emergency at the WHO's Emergency Committee first meeting, held on 22 January last year, instead of waiting until 30 January. The month following the WHO's declaration was "lost" as countries failed to take appropriate measures to halt the spread of the virus, the Covid-19: Make it the Last Pandemic report said.

The report says the WHO was hindered by its own regulations that travel restrictions should be a last resort, with Europe and America wasting the entire month of February, acting only when their hospitals began to fill up. When countries should have been preparing their healthcare systems for an influx of COVID patients, much of the world descended into a "winner takes all" scramble for protective equipment and medicines, the report said.

To prevent another catastrophic pandemic, the report suggests key reforms:

The WHO should have a global health threats council with the power to hold member states accountable

There should be a disease surveillance system to publish information without the approval of countries concerned

Vaccines must be classed as public goods and there should be a pandemic financing facility

"The situation we find ourselves in today could have been prevented," co-chair Ellen Johnson Sirleaf, a former president of Liberia, told reporters. "It is due to a myriad of failures, gaps and delays in preparedness and response."

Panel co-chair and former New Zealand Prime Minister Helen Clark said it was "critical to have an empowered WHO". "If travel restrictions had been imposed more quickly, more widely, again that would have been a serious inhibition on the rapid transmission of the disease and that remains the same today," she added.

The panellist's co-chairs, Ellen Johnson Sirleaf and Helen Clark, writing in The Lancet, summarised the findings:

In May, 2020, with COVID-19 affecting just about every country on the planet, the World Health Assembly requested the WHO Director-General to initiate an independent, impartial, and comprehensive review of the international health response to the pandemic. He asked us to convene an independent panel for this purpose. The members of the Independent Panel for Pandemic Preparedness and Response have spent the past eight months examining the state of pandemic preparedness before COVID-19, the circumstances of the identification of SARS-CoV-2 and the disease it causes, and responses globally, regionally, and nationally, particularly in the early months of the pandemic. The panel has also analysed the wide-ranging impacts of the pandemic on health and health systems, and the social and economic crises that it has precipitated.

The panel has produced a definitive account to date of what happened, why it happened, and how it could be prevented from happening again. This report was published on May 12, 2021, together with a companion report that describes 13 defining events which have been pivotal in shaping the course of the COVID-19 pandemic. In addition, the panel is publishing a series of background papers representing in-depth research, including an authoritative chronology of the early response. As the panel's Co-Chairs, we have been asked to present the report to the 74th World Health Assembly, to be held from May 24 to June 1, 2021.

COVID-19 exposed the extent to which pandemic preparedness was limited and disjointed, leaving health systems overwhelmed when actually confronted by a fast-moving and exponentially spreading virus. The panel's conclusion is that closing the preparedness gap not only requires sustained investment, but also requires a new approach to measuring the leadership dimensions of preparedness and strengthened accountability in a system of universal periodic peer review of country preparedness.

It is clear to the panel that the international alert system does not operate with sufficient speed when faced with a fast-moving respiratory pathogen, and that the legally binding International Health Regulations (IHR) (2005) are a conservative instrument that constrain rather than facilitate rapid action. The panel's chronology presented in the report and in the accompanying documents shows the time lost to IHR processes as SARS-CoV-2 spread internationally. The declaration of a Public Health Emergency of International Concern by the WHO Director-General on Jan 30, 2020, was not followed by forceful and immediate responses in most countries, despite the mounting evidence that a contagious new pathogen was spreading around the world. February, 2020, was a lost month in many countries, when steps could and should have been taken to curtail the epidemic and forestall the pandemic.

On the basis of the panel's comparative analysis of 28 countries from across the spectrum of responses that is published alongside the report, it is clear that countries with successful responses had timely triage and referral of suspected COVID-19 cases to ensure swift case identification and contact tracing, and provided designated isolation facilities, either for all or for those unable to self-isolate. High-performing countries also developed partnerships on multiple levels across government sectors and with groups outside government, communicated consistently and transparently, and engaged with community health workers and community leaders as well as the private sector.

Countries with poor results had uncoordinated approaches that devalued science, denied the potential impact of the pandemic, delayed comprehensive action, and allowed distrust to undermine efforts. Many had underfunded health systems beset by long-standing problems of fragmentation and undervaluing of health workers. They had insufficient capacity to mobilise rapidly and coordinate between national and subnational responses. The denial of scientific evidence was compounded by a failure of leadership to take responsibility or develop coherent strategies aimed at preventing community transmission.

Importantly, COVID-19 has been a pandemic of inequality, exacerbated between and within countries, with the impact being particularly severe on people who are already marginalised and disadvantaged. Inequality has been a determining factor in explaining why the COVID-19 pandemic has had such differential impacts on peoples' lives and livelihoods.

The combination of poor strategic choices, unwillingness to tackle inequalities, and an uncoordinated response system allowed the pandemic to trigger a catastrophic human and socioeconomic crisis.

The panel's report also highlights strengths on which to build. Open data and open science collaboration were central to alert and response. For example, sharing of the genome sequence of the novel coronavirus on an open platform quickly led to the most rapid creation of diagnostic tests in history. COVID-19 vaccines were developed at unprecedented speed. Doctors, nurses, midwives, long-term caregivers, community health workers, and other front-line workers, including at country borders, are still working tirelessly to protect people and save lives.

The panel's recommendations flow from the diagnosis made of what went wrong at each stage of the pandemic in preparedness, surveillance and alert, and early and sustained response. These recommendations have two objectives: first, to end the pandemic, and, second, to prevent a future disease outbreak from becoming a pandemic.

To end COVID-19 the panel recommends the following three immediate actions. First, high-income countries with a COVID-19 vaccine pipeline for adequate coverage should, alongside their scale-up, commit to provide at least 1 billion vaccine doses to the 92 low-income and middle-income countries of the Gavi COVAX Advance Market Commitment, no later than Sept 1, 2021, and more than 2 billion doses by mid-2022. Second, major vaccine-producing countries and manufacturers should convene, under the joint auspices of WHO and the World Trade Organization, to agree to voluntary licensing and technology transfer with intellectual property rights to be waived immediately if voluntary action, including action on the required technology transfer, does not occur within 3 months. Third, the G7 should immediately commit to 60% of the US$19 billion required for the Access to COVID-19 Tools (ACT) Accelerator 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 a continual basis.

To prepare the world for the future so that the next disease outbreak does not become a pandemic, the panel calls for a series of crucial reforms that will address gaps in high-level coordinated leadership globally and nationally, funding, access to what must become global goods, and WHO's independence, focus, and authority. Some of these reforms are shown in the panel.

The message for change is clear: COVID-19 should be the last pandemic. If the global community fails to take this goal seriously, we will condemn the world to successive catastrophes.

 

Full BBC Live report (Open access)

 

The Lancet summary by Sirleaf and Clark (Open access)

 

Full Independent Panel Report (Open access)


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