WHO Head Praises China Response To Coronavirus Emergency; Criticizes “Unnecessary” Trade and Travel Restrictions

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus called for “solidarity, solidarity and solidarity” amongst WHO member states to meet the new challenge of a novel coronavirus epidemic – at Monday’s opening of a week-long meeting of WHO’s Executive Board in Geneva.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed,” he said, speaking before the 34-member governing board.

The WHO Director General also stressed that “there is no reason for measures that unnecessarily interfere with travel or trade” – despite the widespread curbs that many countries have imposed on travel to or from China.

Dr Tedros gives his annual report at the 146th Meeting of the WHO Executive Board

WHO is tracking countries that impose travel and trade restrictions, and some of those imposing limits have been asked to justify their policies on public health grounds, a WHO official told Health Policy Watch. The official declined to indicate which countries might be called to account. A global WHO roundup of such measures is reported to Member States on a weekly basis. But that won’t be made public until the World Health Assembly in May, the official added.

Under the provisions of the International Health Regulations, a binding treaty among WHO member states, countries are supposed to refrain from unnecessary travel and trade restrictions when health emergencies occur.

But as the case load of the novel virus soared to over 17,341 people worldwide and 361 deaths reported on Monday, what might be a  “necessary” or “unnecessary” restriction has varied widely in different corners of the world. Countries across Europe, Asia and North America have severely tightened travel restrictions, also imposing mandatory quarantine measures on travelers returning from China. African countries, such as Nigeria, however, said the doors would remain open.

It remained unclear exactly what measures WHO was recommending that countries outside of China do take to meet the challenge of the spiraling outbreak-turned-epidemic, which some observers now warn could even become a “pandemic.”

Speaking Monday morning, the WHO Director-General called on countries “to implement decisions that are evidence-based and consistent,” adding that WHO stood ready “to provide advice to any country that is considering which measures to take.”

He said that universal measures should include policies to:

  • combat the spread of rumours and misinformation;
  • review preparedness plans, identify gaps and evaluating the resources needed to identify, isolate and care for cases, and prevent transmission;
  • sharing data, sequences, knowledge and experience with WHO and the world.

The world must also “support countries with weaker health systems,” as well as “accelerate the development of vaccines, therapeutics and diagnostics” to combat the new virus, he said.

Dr Tedros praised China’s response to the outbreak, and the “personal leadership” and “commitment” of President Xi Jinping, saying that China’s actions were protecting other countries around the world.

Medical workers conduct temperature checks of passengers at a subway station in Beijing.

“If we invest in fighting at the epicentre, at the source, then the spread to other countries is minimal and also slow.  If it’s minimal and slow, that is going outside can also be controlled easily,” Dr Tedros said. “So it can be managed – when I say this, don’t make a mistake, it can get even worse. But if we give it our best, the outcome could be even better.”

Dr Tedros added: “The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation. We are all in this together, and we can only stop it together.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed.”

While most EB board members followed Tedros example in praising China’s response to the outbreak, stories about delays in the initial Chinese government response were multiplying in global media.

Valuable time was thus lost to contain the mushrooming epidemic, critics said. One expert, Anthony S. Fauci, director of the US National Institute of Allergy and Infectious Diseases, told the New York Times, “It’s very, very transmissible, and it almost certainly is going to be a pandemic… some epidemiological models indicated that there could actually be 100,000 or more cases.”

Spat over Taiwan Status in Emergency Response  

Solidarity was singularly absent in a subsequent EB debate over the treatment of Taiwan – which in WHO terms, falls under the jurisdiction of the mainland government in Beijing.

Complaining of “political conflicts” that hinder outbreak response, Eswatini’s representative complained that “The Republic of China Taiwan has limited access, if any, to the WHO IHR (International Health Regulations) processes.

“Taiwan’s technical experts are denied participation in technical meetings of the WHO. This unfortunately leaves over 23 million people in Taiwan vulnerable to such epidemics, yet we know that Taiwan has cutting-edge expertise that will benefit all of us. A case in point is the management of the current novel coronavirus outbreak where inaccurate info enlisting what lead to unfortunately misplaced decisions impacting the people of Taiwan.”

China’s EB representative hotly denied the claims, saying that Taiwan had been fully informed of cases involving Taiwanese on the mainland, and that Taiwanese specialists had even visited the mainland and Hubei province to learn about containment measures being taken.

“There does not exist a so called gap in the epidemic preparedness system as a consequence of Taiwan’s inattendance at the WHA,” said China’s EB representative. “Instead it is just the lies and excuses of the Taiwanese authorities made in an attempt to participate in the WHA [World Health Assembly].”

Year In Review – Unprecedented Challenges, Achievements & Transformation

While the coronavirus outbreak has dominated headlines in early 2020, the threat posed by the deadly outbreak of Ebola in the Democratic Republic of Congo, has now been virtually squashed, the WHO Director-General reminded the EB – in remarks that also included a wide-ranging review of the challenges and accomplishments of 2019.

Paying homage to the health workers who lost their lives combating both the Ebola virus as well as DRC armed groups that frequently attacked health responders, Dr Tedros said their determination is the reason: “Why Ebola is almost zero, the last 16 days are almost done. We had one case again yesterday, but I hope we will finish it as soon as possible. For the Ebola situation to be what it is now, we paid in lives.. we have to give them due respect.”

Fighting the Ebola outbreak, he said, was just one example of how, “2019 was a year of unprecedented challenges, unprecedented achievements and unprecedented transformation. We touched every corner of the organization while fighting emergencies and launching new initiatives.”

New WHO Focus on “Healthy Populations”  

The year also saw a new emphasis on health promotion and illness prevention, Dr Tedros noted, with the foundation of a WHO division on “Healthy Populations” as well as a new department on Social Determinants of Health.

An agreement was reached with the  International Food and Beverage Association to eliminate cancer-causing “transfats” from processed foods by 2023.

More than 80 cities in more than 50 countries committed to reaching WHO air quality guidelines, and WHO also began implementing a new initiative on climate and health in Small Island States – countries threatened with virtual extinction by rising seas and climate change.

“The urgency of this challenge was brought home to me during my trip to my trip to Tahiti, Tonga, Tuvalu and Fiji last year,” said Dr Tedros. “In Tonga, I planted a mangrove in an area which used to be a rugby field, where Tonga and Fiji played each other in 1924, but it’s now fully consumed by saltwater.”

In terms of preventing non-communicable diseases that cause 70% of the world’s deaths, the WHO Director-General noted that:

  • Countries are scaling up hypertension control – only 200 million of the 1.2 billion people with hypertension currently use control measures. Another effort aims to dramatically expand diabetes diagnosis and treatment.
  • The number of men using tobacco is finally starting to decline…. on the other hand the threat of e-cigarettes is rising.
  • Global initiatives were launched on mental health – aiming to increase access to services for 100 million more people as well as to combat childhood cancer.
  • Global standards were published for safe use of personal audio devices to reducing hearing loss.
  • A draft strategy for eliminating cervical cancer, now mostly preventable through vaccines and screening, has been developed; it is to be considered at this week’s Executive Board.
Universal Health Coverage

In terms of progress on Universal Health Coverage (UHC), South Africa and The Philippines passed new laws for UHC, while Greece, India and Kenya rolled out “ambitious programmes to expand coverage”, Dr Tedros said.

The WHO flagship initiative that aims to expand affordable, accessible health care to the entire world by 2030 was also the focus of a high-level UN declaration in September 2019.

In line with the UHC drive, the WHO Director General said that “access to health services expanded in all regions of the world and across all income groups in 2019. But that comes with a big caveat – we are going backwards on financial protection.”

“In 2015, 930 million people spent 10% or more of their household consumption on health, and we know that number is growing every year… The world spends almost 10% of global GDP on health,” Dr Tedros said, adding that “too many countries spend too much of their health budgets on managing disease, instead of promoting health and preventing disease, which is far more cost-effective.”

He repeated a longstanding WHO call for countries to increase public spending on primary health care by at least 1% of their GDP: “As you have heard me say many times, health is a political choice. But it’s a choice we see more and more countries making.”

Executive Board members and observers rise for a moment of silence in memory of Peter Salama, WHO Executive Director of Universal Health Coverage, who died suddenly in late January.
Access To Medicines

In another historic moment last year, WHO signed a memorandum of understanding with the African Union to establish an African Medicines Agency. The new agency is expected to speed approval and rollout of new medicines across the continent – overcoming the complexities of national approvals. Last year, WHO also launched new initiatives to approve through WHO “pre-qualification” channels, new manufacturers for an expensive breast cancer treatment as well as for human insulin, which is often too pricey for the poor to afford.

The moves are expected to foster more competition in the production of life-saving drugs that are now often too expensive now for low- and even middle-income countries.

“We expect to prequalify more and more of these very effective but very expensive medicines in the coming years,” said Dr Tedros.

Infectious diseases – Egypt Leading in Hepatitis C Elimination

Egypt, which has one the world’s highest burden of hepatitis C (HCV) infections, is now on track to be one of the first countries to eliminate the disease, noted Dr Tedros.

The national elimination strategy has included access to screening for 60 million people, and treatment for 3.7 million found to be infected. HCV screening has been combined with screening and treatment of hypertension and diabetes, as well as cervical and breast cancer – at primary health care level. “This is a truly stunning achievement, which could be a good lesson for other countries,” declared the WHO Director General.

Australia, France, Georgia and Mongolia are also moving towards Hepatitis C elimination, enabled by dramatic reductions in the price of direct-acting antivirals that offer 95% or greater cure rates. In terms of other leading infectious diseases, the Director General noted progress on the following:

  • HIV/AIDS – By the end of 2019, 77 countries had national policies that support HIV self-testing, helping to reach people at higher risk from HIV, including those who are most marginalized and not accessing health services.
  • Malaria – a pilot programme for the world’s first malaria vaccine was launched in Ghana, Malawi and Kenya. Argentina and Algeria were certified as malaria-free. And a WHO Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication both published milestone reports on what the world needs to do to eliminate malaria.  “Despite these gains, we continue to see more than 200 million cases of malaria annually. More than 400,000 people die each year from this preventable and treatable disease,” he said. In response, WHO and the RBM Partnership to End Malaria launched a new initiative to accelerate action on malaria in the 11 countries of Sub-Saharan Africa that are responsible for 70% of the global malaria burden.
  • Tuberculosis – 7 million people were diagnosed and treated for TB in 2018, up from 6.4 million in 2017. WHO’s aim for 2020 is 8 million.WHO has also developed new policies and guidelines to ensure better outcomes for those affected, including strong recommendations for the first time for fully oral regimens for the treatment of multi-drug resistant TB.
  • Polio – WHO certified the global eradication of wild poliovirus type 3, and launched a new Global Polio Eradication strategy with US $2.6 billion pledged by donors. Despite 173 cases of another wild polio virus type in 2019, as well as many outbreaks of vaccine devised outbreaks, mostly in Africa, the WHO Director General said he was “confident we are on our way to realizing our vision of a polio-free world.”
  • Neglected Tropical Diseases – Yemen and Kiribati eliminated lymphatic filariasis, and Mexico eliminated rabies. And for the first time, the number of human African sleeping sickness cases reported globally fell below 1000.
Antimicrobial Resistance – Drug Resistant Pathogens

WHO has strengthened collaboration with the Food and Agriculture Organization (FAO) as well as the World Organization For Animal Health (OIE) to make more rational use in agriculture and animal husbandry of antibiotics critical to  human health.

To stimulate research and development into new and much-needed medicines, WHO is working with the European Investment Bank on a new investment fund – “we will have more news about that in the coming months,” said Dr Tedros. “At the same time, we’re striving to protect the antibiotics we have by working with countries to strengthen infection prevention, stewardship, hygiene and water and sanitation. As part of that:

  • Some 135 countries have developed national action plans to combat drug resistant germs.
  • Some 90 countries have enrolled in the WHO global surveillance platform (GLASS) that will monitor how well countries are doing in fighting AMR, as part of a new Sustainable Development Goals indicator.
  • With support from the Governments of the Netherlands and Sweden WHO launched the Multi-Partner Trust Fund on AMR, to catalyse action in countries.

 

Image Credits: Wikimedia Commons: Pau Colominas, Twitter: @WHO, Twitter: @WHO.