We Need a Strong and Better World Health Organization - Dr. Joseph Amaral
Saturday, May 23, 2020
We need the World Health Organization. It plays a critical role and it can and must be improved.
The World Health Organization was established in 1948 by the United Nations to coordinate international health policy and set guidelines with the objective of coordinating worldwide medical responses. WHO has three strategic priorities: Providing health coverage to one billion more people; Ensuring another one billion people enjoy better health and well-being, including protection from non-infectious diseases; and protecting one billion more from health emergencies, such as epidemics. Its two-year budget goal is $4.4 billion, of which 20 percent comes from member states and the remainder from voluntary contributions.
Given the large remit of the organization, an independent analysis by the Kaiser Family Foundation noted that WHO’s funding, structure, and governance cause institutional challenges including but not limited to: the scope of responsibility has outgrown its budget; greater reliance on voluntary contributions earmarked for specific initiatives; and a dual mandate as health experts and political influencers.
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The COVID-19 pandemic has raised serious concerns about how WHO has provided information to the world. On the one hand, arguments are made that they were slow in addressing the crisis, disregarded Taiwan’s early warnings, failed to evaluate the seriousness of the disease, provided erroneous information such as informing SARS-CoV-2 was not transmitted from human to human, failed to warn there were asymptomatic cases, kept a faulty database, undervalued the importance of facemasks, and were slow to call the outbreak a pandemic.
On the other hand, some argue that WHO rapidly corrected the errors they made, that they can only provide the information they are given by specific countries, and that they have shared the best scientific evidence possible and are coordinating treatment and vaccine trials.
Underlying the controversial view of WHO is the xenophobia and finger-pointing that occurs with every pandemic. While the names of past pandemics usually derive from the initial source of the infection, those who experience the infection outside that region almost always blame the source. SARS-COV-2 is thought to have started in Wuhan, China, so some might place the blame on them. To limit the xenophobia, the name COVID-19 was chosen by WHO.
Many countries believe that China bears some responsibility for what has transpired in this pandemic. China has a history of lack of transparency during previous infectious outbreaks. The leadership has not allowed foreign scientists into China to try to determine the source, and the Chinese did not identify the high number of asymptomatic patients. Also, China censors’ publications regarding the origins of the virus, has destroyed original viral samples, demonstrated strong initial opposition to a coordinated worldwide investigation, and continues to oppose Taiwan as an observer in WHO discussions. In addition, many doubt the validity of their reported cases. On the other hand, China has supporters, including WHO, who believe China has been completely transparent, has responded rapidly with a lockdown, and has offered support with supplies and information sharing.
Two things are irrefutable, nonetheless. There is a critical need to review all the information regarding the pandemic in a thorough and unbiased manner. This includes how countries responded, what is known and not conjectured about the disease, whether WHO is appropriately resourced and structured to allow it to function globally in an unpolitical manner, what the timelines were for how the pandemic transpired and finally to make future recommendations on what to do should SARS-COVID-19 erupt again or a new threatening virus emerges. The purpose should not be to place blame or garner political leverage.
The second is that given the politics, nationalism, and controversy, WHO, China, the United States, or for that matter any country, are not fit to lead an investigative effort to understand what has transpired and how to address future pandemics. They are conflicted beyond the point where any bias can be excluded or managed. To do so will be a wasted effort since the findings will always be challenged.
In my opinion, there is only one group that is best equipped to lead an evaluation of the COVID-19 Pandemic; a coalition of multinational, highly respected, and unbiased physicians and scientists . . . one that would represent the world rather than a country or region. I do not believe such a group exists. The National Academy of Sciences which has the highest prestige and a global membership, might be qualified to as the best to lead such an effort. Unfortunately, it is conflicted because it is a United States-based and should be disqualified.
Nevertheless, a multinational coalition based on reputation, investigative rigor and skillsets can be formed to apply the principles of evidence-based medicine. These rigorous and validated principles are widely used to create guidelines that determine the best approaches to disease management. Thus, they are ideally suited to understand what happened during the COVID-19 pandemic, assign best practices, and provide guidelines for the future. Such an effort will require considerable expertise, financial support, and time.
We cannot settle for simple answers, political expediency, or avoidance of critical issues.
We owe future generations of the world thoughtful, unbiased, and sound guidance on how to deal with such events in the future.
#Raisetheline
Dr. Joe Amaral is the former President of RI Hospital and is the Founder of Tipping Point Healthcare Innovation.
