Too late, already bolted: how a faster WHO response could have slowed COVID-19’s spread


Victor He/Unsplash

Michael Toole, Burnet InstituteUrgent global action is needed to end the COVID-19 pandemic and prepare for future threats, according to a new report by the Independent Panel for Pandemic Preparedness and Response.

The panel, co-chaired by former New Zealand prime minister Helen Clark and former Liberian president Ellen Johnson Sirleaf, criticises the World Health Organization (WHO) for its tardy actions during the first months of 2020.

The WHO was slow to warn of person-to-person transmission after it first received this information in Wuhan, China, in early January.

And it was slow to declare a public health emergency of international concern (PHEIC), which it did on January 30.

The WHO also opposed international travel restrictions that, if implemented earlier, might have slowed the international spread of the virus. By the time the PHEIC was declared, COVID-19 had spread to 18 countries outside China.

But WHO’s hands were tied

While this may appear just a scathing criticism of the world’s peak health body, the WHO had its hands tied by the international framework that governs the response to emerging infectious diseases and pandemics, the International Health Regulations (IHR).

These regulations were drafted in 2005 in response to the SARS (severe acute respiratory syndrome) and H5N1 (avian flu) pandemics and endorsed by member nations in 2007.

The regulations imposed new requirements that must be met before the WHO director general could act on emergencies, rather than enabling the WHO to act immediately and independently.

The regulations also prohibit international travel restrictions in public health emergencies.




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Many member nations failed to act

The report describes February 2020 as a “lost month”, referring to the time between the declaration of a PHEIC and the WHO statement on March 11 that characterised COVID-19 as a pandemic.

The panel found this was due to a lack of understanding that the PHEIC declaration was the loudest possible alarm open to the director general. The pandemic declaration was not based on International Health Regulation guidelines.

The panel found a number of countries took a wait-and-see attitude during February 2020, allowing the virus to spread uncontrollably.

Effective and high-level coordinating bodies were critical to a country’s ability to adapt to changing information. Yet only a few countries set in motion comprehensive and coordinated COVID-19 protection and response measures.

Of the 28 country responses the panel analysed in depth, only a handful adopted aggressive containment strategies, including China, New Zealand, South Korea, Singapore, Thailand and Vietnam.

Some others had uncoordinated approaches that devalued science, denied the potential impact of the pandemic, delayed comprehensive action and allowed distrust to undermine efforts. While not named, the United States and Brazil were probably among them.

The report praises the role of the African Union and the Africa CDC in leading a continent-wide coordinated response.

It also singles out research and development as a major achievement, especially in vaccine development.




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Preparation was inadequate

Despite the lessons learned from previous outbreaks of SARS, H1N1 (avian flu), Zika, MERS (Middle East respiratory syndrome) and Ebola, preparedness was vastly underfunded.

The US government, led by the Centres for Disease Control, established the Global Health Security Agenda, a group of 70 countries — including Australia – committed to building global capabilities to implement the International Health Regulations. But the Trump administration defunded most of the US CDC’s activities under the agenda.




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After the H1N1 pandemic, Australia reviewed its health sector response and made many recommendations for future preparedness. However, inaction followed. Australia has not run a large-scale pandemic simulation exercise since 2008.

Australia also dropped the ball on regional pandemic preparedness. After the SARS outbreak in 2003, the government developed a five-year regional emerging diseases and pandemics strategy, which received A$100 million from the Howard government. Yet the second five-year strategy attracted very little funding.

Fixing the global system

The panel urges immediate action to end the pandemic through:

  • accelerated vaccination
  • proven measures such as masks and social distancing
  • testing and contact tracing.

However, the focus of its recommendations is on future preparedness.

The panel is convinced a Global Health Threats Council at the most senior level is vital to future success. It would help secure high-level political leadership and ensure attention to pandemic prevention, preparedness and response is sustained over time. Such a body is long overdue.

To ensure the WHO is more agile, the panel recommends an increase in the proportion of funding that is unearmarked for specific programs and countries. This would allow for financial reserves to respond to sudden, unexpected events. It also needs an improved surveillance system, quicker alerts for emerging virus threats, and authority to publish information and dispatch expert missions immediately.

Transparency, speed, flexibility to act more independently and better resourcing are critical to the reforms proposed. Efforts to do this will need unqualified support from its member nations, starting at this month’s World Health Assembly.

After the disruptive years of the Trump presidency, the WHO needs restoration. Australia is influential and should be at the forefront of ensuring this happens.The Conversation

Michael Toole, Professor of International Health, Burnet Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

I was the Australian doctor on the WHO’s COVID-19 mission to China. Here’s what we found about the origins of the coronavirus


Dominic Dwyer, University of Sydney

As I write, I am in hotel quarantine in Sydney, after returning from Wuhan, China. There, I was the Australian representative on the international World Health Organization’s (WHO) investigation into the origins of the SARS-CoV-2 virus.

Much has been said of the politics surrounding the mission to investigate the viral origins of COVID-19. So it’s easy to forget that behind these investigations are real people.

As part of the mission, we met the man who, on December 8, 2019, was the first confirmed COVID-19 case; he’s since recovered. We met the husband of a doctor who died of COVID-19 and left behind a young child. We met the doctors who worked in the Wuhan hospitals treating those early COVID-19 cases, and learned what happened to them and their colleagues. We witnessed the impact of COVID-19 on many individuals and communities, affected so early in the pandemic, when we didn’t know much about the virus, how it spreads, how to treat COVID-19, or its impacts.

We talked to our Chinese counterparts — scientists, epidemiologists, doctors — over the four weeks the WHO mission was in China. We were in meetings with them for up to 15 hours a day, so we became colleagues, even friends. This allowed us to build respect and trust in a way you couldn’t necessarily do via Zoom or email.

This is what we learned about the origins of SARS-CoV-2.

Animal origins, but not necessarily at the Wuhan markets

It was in Wuhan, in central China, that the virus, now called SARS-CoV-2, emerged in December 2019, unleashing the greatest infectious disease outbreak since the 1918-19 influenza pandemic.

Our investigations concluded the virus was most likely of animal origin. It probably crossed over to humans from bats, via an as-yet-unknown intermediary animal, at an unknown location. Such “zoonotic” diseases have triggered pandemics before. But we are still working to confirm the exact chain of events that led to the current pandemic. Sampling of bats in Hubei province and wildlife across China has revealed no SARS-CoV-2 to date.

We visited the now-closed Wuhan wet market which, in the early days of the pandemic, was blamed as the source of the virus. Some stalls at the market sold “domesticated” wildlife products. These are animals raised for food, such as bamboo rats, civets and ferret badgers. There is also evidence some domesticated wildlife may be susceptible to SARS-CoV-2. However, none of the animal products sampled after the market’s closure tested positive for SARS-CoV-2.

We also know not all of those first 174 early COVID-19 cases visited the market, including the man who was diagnosed in December 2019 with the earliest onset date.

However, when we visited the closed market, it’s easy to see how an infection might have spread there. When it was open, there would have been around 10,000 people visiting a day, in close proximity, with poor ventilation and drainage.

There’s also genetic evidence generated during the mission for a transmission cluster there. Viral sequences from several of the market cases were identical, suggesting a transmission cluster. However, there was some diversity in other viral sequences, implying other unknown or unsampled chains of transmission.

A summary of modelling studies of the time to the most recent common ancestor of SARS-CoV-2 sequences estimated the start of the pandemic between mid-November and early December. There are also publications suggesting SARS-CoV-2 circulation in various countries earlier than the first case in Wuhan, although these require confirmation.

The market in Wuhan, in the end, was more of an amplifying event rather than necessarily a true ground zero. So we need to look elsewhere for the viral origins.




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Frozen or refrigerated food not ruled out in the spread

Then there was the “cold chain” hypothesis. This is the idea the virus might have originated from elsewhere via the farming, catching, processing, transporting, refrigeration or freezing of food. Was that food ice cream, fish, wildlife meat? We don’t know. It’s unproven that this triggered the origin of the virus itself. But to what extent did it contribute to its spread? Again, we don’t know.

Several “cold chain” products present in the Wuhan market were not tested for the virus. Environmental sampling in the market showed viral surface contamination. This may indicate the introduction of SARS-CoV-2 through infected people, or contaminated animal products and “cold chain” products. Investigation of “cold chain” products and virus survival at low temperatures is still underway.




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Extremely unlikely the virus escaped from a lab

The most politically sensitive option we looked at was the virus escaping from a laboratory. We concluded this was extremely unlikely.

We visited the Wuhan Institute of Virology, which is an impressive research facility, and looks to be run well, with due regard to staff health.

We spoke to the scientists there. We heard that scientists’ blood samples, which are routinely taken and stored, were tested for signs they had been infected. No evidence of antibodies to the coronavirus was found. We looked at their biosecurity audits. No evidence.

We looked at the closest virus to SARS-CoV-2 they were working on — the virus RaTG13 — which had been detected in caves in southern China where some miners had died seven years previously.

But all the scientists had was a genetic sequence for this virus. They hadn’t managed to grow it in culture. While viruses certainly do escape from laboratories, this is rare. So, we concluded it was extremely unlikely this had happened in Wuhan.




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A team of investigators

When I say “we”, the mission was a joint exercise between the WHO and the Chinese health commission. In all, there were 17 Chinese and ten international experts, plus seven other experts and support staff from various agencies. We looked at the clinical epidemiology (how COVID-19 spread among people), the molecular epidemiology (the genetic makeup of the virus and its spread), and the role of animals and the environment.

The clinical epidemiology group alone looked at China’s records of 76,000 episodes from more than 200 institutions of anything that could have resembled COVID-19 — such as influenza-like illnesses, pneumonia and other respiratory illnesses. They found no clear evidence of substantial circulation of COVID-19 in Wuhan during the latter part of 2019 before the first case.

Where to now?

Our mission to China was only phase one. We are due to publish our official report in the coming weeks. Investigators will also look further afield for data, to investigate evidence the virus was circulating in Europe, for instance, earlier in 2019. Investigators will continue to test wildlife and other animals in the region for signs of the virus. And we’ll continue to learn from our experiences to improve how we investigate the next pandemic.

Irrespective of the origins of the virus, individual people with the disease are at the beginning of the epidemiology data points, sequences and numbers. The long-term physical and psychological effects — the tragedy and anxiety — will be felt in Wuhan, and elsewhere, for decades to come.




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The Conversation


Dominic Dwyer, Director of Public Health Pathology, NSW Health Pathology, Westmead Hospital and University of Sydney, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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‘I still cannot get over it’: 75 years after Japan atomic bombs, a nuclear weapons ban treaty is finally realised



Eugene Hoshiko/AP

Gwyn McClelland, University of New England

The UN Treaty on the Prohibition of Nuclear Weapons will finally come into force after the 50th country (Honduras) ratified it over the weekend. The treaty will make the development, testing, stockpiling and use of nuclear weapons illegal for those countries that have signed it.

This is an extraordinary achievement for those who have suffered the most from these weapons — including the hibakusha (survivors) of the bombings of Hiroshima and Nagasaki and the islanders who lived through nuclear weapons testing in the Pacific.

Since 1956, the hibakusha in Japan, South Korea, Brazil and elsewhere have been some of the most strident campaigners against the use of these weapons. Among them is a group of Japanese Catholics from Nagasaki whom I interviewed as part of my research collecting the oral histories of atomic bomb survivors.

A 92-year-old hibakusha of the atomic bombing of Nagasaki in 1945 and a brother in a Catholic order, Ozaki Tōmei, explained the significance of the treaty to survivors like him. He was orphaned from the bombing at 17 and never found his mother’s body.

The Germans made tools for war including poisonous gas, which was [eventually] banned […] However, when the USA made an atomic weapon, then they … wanted to try it out. It was a war […] they were human.

And so this is why we say we have to eliminate nuclear weapons […] They said they did it to end the war, but for the people who were struck, it was horrific […] there was no need to use it.

Lanterns with messages of peace are lit on the 75th anniversary of the Nagasaki bombing.
DAI KUROKAWA/EPA

Treaty does not have support of nuclear powers

The treaty was adopted at the United Nations in 2017 by a vote of 122 nations in favour, one against and one abstention.

Sixty-nine nations, however, have not signed it, including all of the nuclear powers such as the US, UK, Russia, China, France, India, Pakistan and North Korea, as well as NATO member states (apart from the Netherlands who voted against), Japan and Australia.

Since the treaty was adopted, it needed ratification by 50 countries to come into force. This will now happen in 90 days.

Shacks made from scraps of debris from buildings that were leveled in the aftermath of the atomic bomb that was dropped over Nagasaki.
AP

The campaign for the treaty has relied heavily on civil society and organisations such as the Nobel Peace Prize-winning International Campaign Against Nuclear Weapons (ICAN).

And from the beginning, it has exposed political fault lines. The United States has been particularly outspoken in its opposition to the treaty, warning last week the treaty “turns back the clock on verification and disarmament and is dangerous” to the 50-year-old Nuclear Nonproliferation Treaty (NPT).




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The NPT sought to prevent the spread of nuclear arms beyond the five original weapons powers (the US, Russia, China, UK and France). It has been signed by 190 countries, including those five nations.

The head of ICAN, Beatrice Fihn, says the new treaty banning nuclear weapons merely builds on the nonproliferation treaty.

There’s no way you can undermine the nonproliferation treaty by banning nuclear weapons. It’s the end goal of the nonproliferation treaty.

States like Japan and Australia have opposed the treaty on the grounds their security is boosted by the US stockpile of nuclear weapons. Japan’s former prime minister, Shinzo Abe, has said the treaty

was created without taking into account the realities of security.

Survivors of the Hiroshima atomic bomb await emergency medical treatment.
AP

The efforts of hibakusha in advocating for a treaty

Making the bomb illegal turns an old US justification for the weapon on its head. Harry Stimson, the former US war secretary, argued in 1947 the bombings of Hiroshima and Nagasaki were necessary to compel the Japanese to surrender at the end of the second world war.

The atomic bomb was more than a weapon of terrible destruction; it was a psychological weapon.

The damage from the bombings was colossal. It is unknown how many people were killed, but estimates range from 110,000 (the US army’s toll) to 210,000 (the figure accepted by ICAN and others).




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At the forefront of the campaign to support the nuclear weapons ban treaty have been the voices of hibakusha who experienced the carnage firsthand.

Another Catholic hibakusha, Nakamura Kazutoshi, told me the stockpiling of nuclear weapons enables states to carry out genocide.

In war, we are at a level below animals. Among monkeys, or chimpanzees, there are no animals who would carry out a genocide.

Nakamura Kazutoshi.
Author provided

A third hibakusha, 90-year-old Jōji Fukahori, told me about how he lost his mother and three younger siblings in the Nagasaki bombing.

His younger brother, Kōji, died an excruciating death around a week after the bombing, walking in the hot ash with no shoes and complaining to his brother, “I’m so hot!”

At the site where Fukahori’s brother was exposed, the temperature was about 1,000 degrees Celsius. Fukahori said,

You would have thought everyone would have turned into charcoal.

For Fukahori, the lasting effects of radiation exposure is a major reason why nuclear weapons must be banned. He continued:

the terror of radiation has to be fully communicated … The atomic bomb is unacceptable. I still cannot get over it.

Since 2009, Fukahori has been speaking out at the Nagasaki Atomic Bomb Museum and on the Peace Boat, a non-governmental organisation that organises cruises where passengers learn about the consequences of using nuclear weapons from hibakusha.

Jōji Fukahori telling his story.

Pressure building on Japan

The Japanese government is now under mounting pressure to ratify the treaty. Major Japanese financial institutions and companies have said they will no longer fund the production of nuclear weapons and nearly a third of all local assemblies have adopted proposals calling on the government to act.

The government, however, has been unmoved. In August, Abe gave a speech at a memorial service in Nagasaki, in which he suggested the effects of the bombings had been overcome.

Seventy-five years ago today, Nagasaki was reduced to ashes, with not a single tree or blade of grass remaining. Yet through the efforts of its citizens, it achieved reconstruction beautifully as we see today. Mindful of this, we again feel strongly that there is no trial that cannot be overcome and feel acutely how precious peace is.

Visitors pray for the atomic bomb victims at the Hiroshima Peace Memorial Park.
Koji Ueda/AP

A Japanese atomic researcher, who knows how Fukahori and other hibakusha have not been able to move on, told me Abe’s words don’t go far enough:

Rather than placing a ‘full-stop’ at the end of damages such as this, we have a necessity to make our claim that the damages are not finished.

The nuclear weapons ban treaty offers a moment of hope for all the hibakusha of Hiroshima and Nagasaki still with us after 75 years. It is certainly their hope the ratification of the treaty now moves us one step closer to a world free of nuclear war.




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The Conversation


Gwyn McClelland, Lecturer, Japanese Studies, University of New England

This article is republished from The Conversation under a Creative Commons license. Read the original article.