By early February 2020, China had effectively locked down tens of millions of its citizens. Entire hospitals were sprouting from scratch to cope with an onslaught of coronavirus cases there. The World Health Organization had just declared that the outbreak of the novel coronavirus was a “public health emergency of international concern.” And on February 7, I went on a radio show and spent much of the segment discussing the economic implications of the ordeal for East Asia.
I often think about that segment now and wonder how I could have been so unimaginative. I was so focused on the desperate scenes in China that I failed to consider that similar scenes could soon transpire around the world. Why didn’t I grab the mic, dispense with the usual commentary, and issue an urgent plea for the world to wake up?
I was not the only one—far from it. And that was, in large measure, the problem. In a report released today, the Independent Panel for Pandemic Preparedness and Response—a body established last year by the WHO’s director-general to identify lessons from the present pandemic and apply them to avert future ones—arrives at a stark conclusion. Drawing on a detailed chronological reconstruction of the pandemic, it finds that February 2020 stands out as “a lost month, when steps could and should have been taken to curtail the epidemic and forestall the pandemic.”
Had that month not been squandered, by a world “lulled into complacency” by the lack of a catastrophic pandemic in more than a century, “we believe we wouldn’t be looking at an accelerating pandemic,” former New Zealand Prime Minister Helen Clark, one of the panel’s co-chairs, told me and other journalists in a briefing on the report.
The report contains all sorts of ambitious recommendations for pandemic-proofing the world, including establishing a council on global health threats and launching an international pandemic-financing facility. But perhaps its most significant contribution is retrospective, showing in detail how unprepared the world was to contend with a pandemic “that has spread wider and faster than any in human history.”
The Cold War and 9/11 accustomed policy makers to thinking about threats, such as those posed by nuclear weapons and terrorist groups, that require us to react near-instantaneously when alerted to imminent danger. Many officials are struggling to process others, such as climate change, that play out over much longer time horizons.
But what COVID-19 has demonstrated is that the international system is not constructed to respond to the in-between speed of a pandemic—slower than a ballistic missile and faster than the cumulative effects of carbon emissions, yet just as much of a danger to humanity.
The threat of new pathogens, especially zoonotic diseases, is growing because of population booms and corresponding environmental pressures, while increasing air travel allows, as the report notes, “a virus to reach any place in the world in a matter of hours.” But global frameworks for countering such threats haven’t adapted to these contemporary realities. As Preeti Sudan, another panelist and India’s health secretary during the first months of the pandemic, told me, we need to better position ourselves to run “the race with the virus so that humanity wins.”
In February, the world stood at the starting block, waiting for the WHO to fire the gun, while the virus raced ahead.
In general, the panel does not apportion blame to particular parties, though there’s clearly plenty of that to mete out right now. But it has trained its reformist zeal on the 2005 International Health Regulations, which delineate legally binding rights and responsibilities for the WHO and its member states in assessing and responding to potential public-health emergencies.
The report calls out the International Health Regulations for being overly conservative and cumbersome relative to a highly contagious respiratory pathogen and the various means in the digital age of swiftly spotting and sharing signals that one might be coming. The current system for alerting the world about potential pandemics is biased toward inaction, the report notes, so that “steps may only be taken if the weight of evidence requires them.”
But that bias should be reversed in the case of respiratory infections, the panelists argue, where it is reasonable to apply “the precautionary principle” and assume that there will be sustained transmission between people unless the evidence specifically contradicts this assumption.
The panel concluded, for example, that the coronavirus outbreak in Wuhan, China probably fulfilled the conditions to be declared a “public health emergency of international concern,” or PHEIC, at least as early as the first meeting of the WHO’s International Health Regulations Emergency Committee on COVID-19, on January 22, 2020. But the divided committee didn’t make the declaration until a week later—a crucial delay in the early stages of a potential pandemic—when there were already 98 cases in 18 countries outside China.
Clark noted that “if travel restrictions had been imposed more quickly, more widely … that would have been a serious inhibition on the rapid transmission” of COVID-19. But when the emergency committee declared the PHEIC on January 30, it did not recommend travel or trade restrictions. The WHO’s approach was guided by the International Health Regulations, which aim to “avoid unnecessary interference with international traffic and trade.”
And the declaration of the PHEIC itself was ineffective. The WHO was essentially ringing its “loudest alarm” under the International Health Regulations, as the report puts it, yet the sound registered only faintly around the globe; many people didn’t even realize that it was the WHO’s loudest alarm. (The WHO later declared a pandemic on March 11, when roughly 118,000 cases had been reported in 114 countries, but that term has no legal significance for the institution.)
The report notes that the PHEIC announcement in late January did not produce “forceful and immediate emergency responses in most countries,” which only occurred in March after the pandemic designation and once governments were already receiving reports of major COVID-19 outbreaks in other nations or rampant transmission and hospital overcrowding in their own countries—by which point, of course, the world was already battling against the viral tide.
There were exceptions; a small minority of countries, including several Asian nations that mined their experiences with previous disease outbreaks, reacted to the PHEIC declaration and other alerts by rapidly rolling out whole-of-government responses to the outbreak, some before they’d even registered their first COVID-19 case.
But the majority did not, and the panel identified two main reasons why: first, because “they did not sufficiently appreciate the threat and know how to respond,” and second, because “in the absence of certainty about how serious the consequences of this new pathogen would be, ‘wait and see’ seemed a less costly and less consequential choice than concerted public health action.” Trillions of dollars in pandemic-related expenses and myriad global convulsions later, we know that this was a tragically misguided calculation.
In its report, the panel sketches out a new international alert system. It proposes, for instance, that the WHO be granted new powers by the World Health Assembly, the institution’s decision-making body, to immediately “publish information about outbreaks with pandemic potential” without needing preapproval by national governments and to “investigate pathogens with pandemic potential in all countries” on short notice, using epidemic experts with standing visas. It urges the WHO to reward countries that respond early to outbreaks and to establish performance standards for issuing alerts about and responding to different types of outbreaks.
In the future, the panelists assert, the declaration of a PHEIC should be based on clear criteria and, in cases such as respiratory infections, on the precautionary principle. They maintain that the declaration should include explicit guidance on how countries should respond to the public-health threat, and thus “serve as a clarion call for emergency pandemic response across the world.”
“The disease surveillance and alert system needs to be overhauled,” Clark said. “Sensitivities about sovereignty should surely not delay alerting the world to the threat of a new pathogen with pandemic potential.”
Human nature, of course, often resists the precautionary principle; when confronted with problems that seem distant (say, a disease outbreak halfway around the world), we tend to put off urgent action—rather than recognizing that if we wait until we see the problem right in front of us, it may be impossible to avert. But if we manage to bake the principle into our international systems, it could have an impact on longer-term challenges such as climate change as well.
As Elizabeth Sawin, a co-director of the think tank Climate Interactive, recently told the journalist Beth Gardiner, “If we can tell [the] story of what we just went through [with the pandemic] and help people understand that this is an accelerated version of another story we’re going through that has the same plot structure but a different timeline, that could be transformative,”
I asked Clark whether there was a risk of overlearning the lessons from this pandemic (as ludicrous as that might sound at the moment) and engineering a system that, for instance, shuts down international trade and travel at the slightest sign of a potential pandemic.
A novel pathogen that can result in respiratory infections warrants “a particularly precautionary approach,” she said. “So it’s not that we’re saying ‘jump at every ghost.’ But this kind of ghost needs to be jumped at.”