The Thankless Work of the WHO

Despite having one-fourth the budget of the American CDC—and a host of structural problems owed to being governed by nearly 200 countries—the WHO does quite a lot of good work, most of it behind the scenes and thus unappreciated—hence most Americans being indifferent, if not supportive, of our recent withdrawal.

➡️ It helped eradicate smallpox, a scourge of humanity throughout history that used to kill millions annually, even into the mid 20th century. This was accomplished partly by getting Cold War rivals the U.S. and Russia to consolidate their scientific and technological resources. In 1975, less than a decade after launching this effort, smallpox was vanquished.

➡️ It is close to eradicating polio, another horrific infectious disease that was once widespread, but now lingers in only two or three countries. Rates of polio infection dropped 99% since the global campaign was launched in 1988.

➡️ HIV/AIDS is no longer the death sentence it used to be, thanks in large part to the WHO, which reduced the cost of HIV medication by literally 95.5%. Over 80% of people with HIV/AIDS use drugs backed by the WHO; consequently, AIDS-related deaths have declined by over half since their peak in 2004.

➡️ The WHO is currently working on reducing the cost of insulin as well, as nearly half the world’s 80 million diabetics cannot afford it (including in the U.S.). It hopes to achieve the same results as with HIV/AIDS, through the same process known as “prequalification” (in which cheaper drugs, mostly from developing countries, are approved for safety and efficacy, allowing them to enter the global market).

➡️ In 2017 alone, it helped stem a yellow fever outbreak in Brazil (by providing 3.5 million vaccine doses), provided vaccines to nearly five million children in Yemen in the midst of its civil war; expanded mental health support to Syrians affected by their civil war; and provided new healthcare support (such as ambulances) in places like Iraq and South Sudan).

➡️ With respect to COVID-19, the WHO has shipped literally millions of items of personal protective equipment to 133 countries. It has launched a global trial involving the world’s top medical experts to find the most promising treatments and vaccine. As of now, 5,500 patients have been recruited in 21 countries, with over 100 countries joining or expressing interest in joining the trial.

➡️ Early on, the U.S. received vital early epidemiological data from China only because the WHO used its good relations to broker access. That’s the same reason the otherwise secretive Chinese eventually published the first genetic profile of the virus for the world to use. Against initial resistance, the WHO succeeded in making China allow observers into the country; in early February, an international team led by the agency visited Wuhan, including those from the CDC and NIH.

➡️In 2018, the WHO warned the world that it was not ready for a pandemic and needed to do more. It declared COVID-19 an emergency on January 30, when there were still relatively few reported cases outside China. World leaders still had the info and time to act, and some countries responded immediately; South Korea, New Zealand, and others implemented an effective blend of policies that made them one of the top success stories. The WHO cannot be blamed for our slow response.

➡️ Even Trump himself seemed to acknowledge the WHO’s work with gratitude. In late February, he tweeted “Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart…” In the weeks leading up to its withdrawal, the U.S. was still leaning on WHO experts for assistance, with even Secretary of State Pompeo trying to get the administration to soften its break up with the organization.

As always, I welcome any fact checking on these claims.

Africa’s Little Known COVID-19 Success Stories

As many of the world’s wealthiest countries continue to battle COVID-19, many countries in Sub-Saharan Africa—considered a looming public health crisis given its poverty and lack of healthcare infrastructure—are actually doing a more than decent job at keeping the worst case scenarios at bay. As the Guardian reports:

Senegal is in a good position because its Covid-19 response planning began in earnest in January, as soon as the first international alert on the virus went out. The government closed the borders, initiated a comprehensive plan of contact tracing and, because it is a nation of multiple-occupation households, offered a bed for every single coronavirus patient in either a hospital or a community health facility.

As a result, this nation of 16 million people has had only 30 deaths. Each death has been acknowledged individually by the government, and condolences paid to the family. You can afford to see each death as a person when the numbers are at this level. At every single one of those stages, the UK did the opposite, and is now facing a death toll of more than 35,000.

Ghana, with a population of 30 million, has a similar death toll to Senegal, partly because of an extensive system of contact tracing, utilising a large number of community health workers and volunteers, and other innovative techniques such as “pool testing”, in which multiple blood samples are tested and then followed up as individual tests only if a positive result is found. The advantages in this approach are now being studied by the World Health Organization.

Of all places, Ghana is also the first country in the world to utilize drones to ensure its tests reach distant and poorly connected rural areas.

AS NPR elaborates, Senegal is a particularly exemplary pandemic success story—thanks in large part to the much-maligned WHO, as well as the CDC and UNICEF.

Senegal’s response to the coronavirus is notable not only for its humanity but for its thoroughness. For example, each newly diagnosed individual – no matter how mild or severe the case – is provided a hospital or health center bed where he or she stays isolated and observed– a key element to Senegal’s strategy to contain the virus.

“Senegal is doing quite well, and we were impressed at the beginning at the full engagement and commitment by the head of state,” says Michel Yao, program manager for emergency response for the World Health Organization Africa.

Officials from both Senegal’s ministry of health and WHO stress that the wheels of the response team were set in motion five years ago in response to the Ebola outbreak in West Africa. Yao explains: “What we advised countries to have in place following Ebola in West Africa was to have an operations center, to have in one place the required information for effective decision making. It’s quite an important tool to control the crisis, and this was a good plan from Senegal to have this structure.”

Senegal set up its Health Emergency Operation Center (also known by its French acronym, COUS), in December 2014, in response to the Ebola outbreak spreading in nearby countries. At the start of this year, the center had some 23 staff members – five of them doctors.

Over the past five years, that center, working with the ministry of health and the support of international partners such as the World Health Organization, the U.S. Centers for Disease Control and Prevention and UNICEF, have run simulations of mock outbreaks and crafted emergency measures to activate in case of an epidemic.

Even Rwanda, better known for its horrific genocide over 25 years ago, has rolled out robots in its COVID-19 response.

Launched on Tuesday, May 19 at the Kanyinya COVID-19 Treatment Centre by the Ministry of Health with support from the United Nations Development Programme, the five high-tech robots can perform a number of tasks related to COVID-19 management, including mass temperature screening, delivering food and medication to patients, capturing data, detecting people who are not wearing masks, among others.

Made by Zora Bots, a Belgian company specialised in robotics solutions, they are designed with various advanced features to support doctors and nurses at designated treatment centres, and can also be leveraged into screening sites in the country.

Of course, it helps that these countries are relatively wealthy and peaceful; with the exception of Rwanda, they are also fairly robust democracies.

While many African countries are vulnerable to COVID-19, it’s worth highlighting how much better the continent is weathering this crisis than expected (in part thanks to hard lessons learned from past outbreaks).

The Pandemic Success Story No One Has Heard Of

Senegal is the pandemic success story no one has heard of—which actually tells you how successful it has been! The much-maligned WHO, as well as the CDC and UNICEF, played a key role in that.

In this country of 16 million known for its peaceful democracy and sense of community, Senegal’s response to the coronavirus is notable not only for its humanity but for its thoroughness. For example, each newly diagnosed individual – no matter how mild or severe the case – is provided a hospital or health center bed where he or she stays isolated and observed– a key element to Senegal’s strategy to contain the virus.

“Senegal is doing quite well, and we were impressed at the beginning at the full engagement and commitment by the head of state,” says Michel Yao, program manager for emergency response for the World Health Organization Africa.

Officials from both Senegal’s ministry of health and WHO stress that the wheels of the response team were set in motion five years ago in response to the Ebola outbreak in West Africa. Yao explains: “What we advised countries to have in place following Ebola in West Africa was to have an operations center, to have in one place the required information for effective decision making. It’s quite an important tool to control the crisis, and this was a good plan from Senegal to have this structure.”

Senegal set up its Health Emergency Operation Center (also known by its French acronym, COUS), in December 2014, in response to the Ebola outbreak spreading in nearby countries. At the start of this year, the center had some 23 staff members – five of them doctors.

Over the past five years, that center, working with the ministry of health and the support of international partners such as the World Health Organization, the U.S. Centers for Disease Control and Prevention and UNICEF, have run simulations of mock outbreaks and crafted emergency measures to activate in case of an epidemic.

Along with Vietnam and the Indian state of Kerala, Senegal proves that wealth alone is not a predictor for a successful pandemic response. It also shows the importance of working with international partners to get as many different perspectives, resources, and knowledge as possible.

Expecting Too Much from the W.H.O.

The World Health Organization’s annual budget is roughly the size of a large hospital and one-fourth the budget for the C.D.C.

With these comparatively small funds, the W.H.O. must carry out its official mission of ensuring “the highest possible level of health” for “all peoples.” That includes eradicating diseases (such as smallpox and soon polio), facilitating research and cooperation (which recently gave us the first Ebola vaccine), promoting nutrition, setting universal healthcare and medical standards, and responding to emergencies like pandemics.

With this small budget, backed by its pleading for further funds, the W.H.O. has shipped more than two million items of personal protective equipment to 133 countries, and is preparing to ship another two million items in the coming weeks. Just a couple days ago, it delivered one million face masks, along with gloves, goggles, ventilators and other essential goods to Africa. More than a million diagnostic tests have been dispatched to 126 countries worldwide and more are being sourced as we speak.

As early as February, the organization brought together 400 of the world’s leading researchers (including from rivals the U.S. and China) to identify research priorities. It launched an international “Solidarity Trial” involving 90 countries, to help find effective treatment, and is currently running a “mega-trial” of the four most promising COVID-19 treatments and vaccines from around the world.

The W.H.O. has developed research protocols and guidelines that are being used in more than 40 countries. It got 130 scientists, donors, and manufacturers to commit to speeding up the development and delivery of a vaccine.

Through its innovative online “OpenWHO” platform, the W.H.O. pools together the world’s knowledge and best practices and delivers it to frontline personnel rapidly through an app. Users take part in social learning network, based on interactive, online courses and materials covering a variety of subjects. OpenWHO also provides a forum for the rapid sharing of expertise, in-depth discussion and feedback on key issues. So far, more than 1.2 million people have enrolled in 43 languages.

Again, all this for the cost of running a big hospital. While the U.S. does contribute one-fifth of the agency’s budget, this amounts to $893 million—a drop in the budget of our annual budget, which includes over $700 billion for the military alone. Talk about bang for our buck.

Moreover, we had pledged $656 million for specific programs, including polio eradication, health and nutrition services, vaccine-preventable diseases, tuberculosis, HIV—and preventing and controlling outbreak. And we’re still trying to do more damage to them.

Even as it launches another international mega-trial of the most promising treatments and vaccines, the U.S. is stubbornly refusing to take part.

Lawfare does a great job of breaking down how absurd our expectations of the W.H.O. are. While it concedes that the W.H.O. dropped the ball with China (something I also admit), it also reminds us of the far bigger and more complex picture regarding its relations with member countries (and the inherently political nature of health problems to begin with).

The work of the WHO is inherently technical; it does not need to make the sort of charged political decisions demanded of the U.N. Security Council, where the vital interests of different countries repeatedly conflict. Nor is it required to take a stance on the sensitive ideological values of different countries, as human rights organizations must. And because the WHO’s mission is narrowly defined in relatively objective terms, its performance can be evaluated with relative ease—for example, by using straightforward public health metrics. This ought to give WHO officials incentives to act appropriately and reduce the risk that countries are unable to discipline it if it fails to. The WHO’s leadership in the eradication of smallpox and in advances against polio seemed to validate this theory.

[…]

It is tempting to blame the WHO itself for its problems—its notoriously complex bureaucracy, its decentralized structure, its “culture” or the persons who run it. But all of those things are a result of the political constraints it operates under, as many reform-minded critics have observed. Big bureaucracies are established to guard against errors. In this context, this means staying away from actions that will offend member states whose support (financial or otherwise) is necessary for WHO’s operations. The sorts of bureaucratic reform that WHO insiders and sympathetic critics have called for over many decades would not protect the WHO from leaders like Trump.

It turns out that even the expert-led technical interventions of the WHO are politically charged. And this is not just because some countries want to hide disease outbreaks from the world. Countries also disagree about the problems that the WHO should focus on in the first place. The setting of priorities and allocation of resources among different public-health challenges are policy choices, not technical choices. The WHO is not an anti-pandemic organization or an infectious-disease organization: It is a health organization, and health policy is intensely contested around the world.

Many of the familiar cleavages in international politics had begun to pull apart the WHO long before the coronavirus pandemic. People disagreed about which health threats should be given priority, and the WHO found itself torn between governments, interest groups, activists and donors who wanted the organization to give priority to different things—HIV/AIDS and other infectious diseases, tobacco use, obesity, even climate change. And then there is intense disagreement about whether the WHO should give priority to developing countries and, if so, how much. The WHO has set itself the goal of correcting global health care inequality, which begins to seem like a redistributive program from north to south—the sort of thing applauded by academics and commentators but politically explosive, to say the least.

As I have previously argued, the W.H.O. doesn’t have the resources or power to stand up to any country, especially since virtually every country plays a role in its funding, governance, and the election of its director-general. If even most of the world is deferential to China—only fourteen nations officially recognize Taiwan instead—how can we expect an organization responsible for so much, with a small budget, few personnel, and no sovereign power, to somehow be any different.

COVID-19 and Glass Houses

China deserves criticism for its initial handling of the COVID-19 outbreak, its continued air of secrecy that makes it difficult to verify its alleged success, and its blocking of Taiwan—a major pandemic success story—from the W.H.O. and other international institutions.

But I feel a lot of American criticism is of the “glass houses” variety. Our response to the virus, both initially and still now, has hardly been stellar. The behavior of governments at all levels, as well as by private citizens and businesses, makes it difficult to claim any moral high ground over the Chinese response (and no, this isn’t to say we’re the same in terms of totalitarianism, etc.).

Insurance companies will reportedly be raising their premiums next year. Many of those treated are left with bills in the tens of thousands. Profit-centered hospitals are actually laying off well needed staff because treating COVID-19 is too costly. A man in Brooklyn was raided for hoarding precious medical equipment, while a Georgia man was fraudulently going to sell $750 million in nonexistent masks to the Veterans Affairs Department. Doctors have been censored and even fired by hospitals for speaking out against the lack of protective equipment, which of course shouldn’t be happening in the first place. Masks are being sold at marked up prices. Many of our “essential workers” are still dying and underpaid; millions are illegal immigrants (ironically the Dept. of Homeland Security reminds them of their essential status while targeting them for their illegal one).

Our economy of nearly $20 trillion, home to most of the world’s billionaires, top innovators, and tech companies, somehow cannot allocate its resources to test and treat people and ensure they don’t starve during the lockdown. Our rapacious and hyper-individualistic attitude to money and self interest is somehow intact, if not thriving, in the face of senseless death and suffering ( notwithstanding the many touching and inspiring stories I’ve acknowledged and shared here about the better side of our society.

Yeah, the Chinese government (among others) has several times dropped the ball on this virus. It’s used it as an excuse to tighten its grip and even to bully Taiwan. The cultural practice of the wet market is problematic on a lot of levels. There are probably many more sordid stories we don’t know about.

But given how our far wealthier and better resourced country has mishandled this—across both the public and private sectors, and as a society—I’m not sure we would have done much better with an outbreak of an unknown disease.

I wish the folks putting all their energy and focus on China would hold businesses, healthcare companies, and government officials accountable—or, at the very least, direct some scrutiny and ire their way—and engage in some introspection about our own problematic practices and values (lack of community engagement and concern, hyper-individualism at the expense of others, employer-sponsored healthcare that leaves us at the mercy of unaccountable and disengaged bosses, etc.)

Inequities and Injustices Laid Bare by the Pandemic

Given that there’s enough anxiety and bad news going around, I’ve been consciously minimizing sharing anything negative here. But it’s hard not to vent about the tremendous amount of unnecessary suffering out there.

Its bad enough that tens of thousands of Americans are dying in a country with literally trillions of dollars sloshing around in its financial markets and economy (and that millions more have or will face grinding poverty, even as “essential” workers). But the developing world is about to face a reckoning as well.

Given how devastating the virus has been for richer nations, imagine countries with even fewer resources. There are already tens of thousands of confirmed cases in countries across Latin America, Africa, and South Asia; it’s very likely there are even more that haven’t been detected due to the lack of public health infrastructure.

Not only is it difficult to test and treat the infected, but imagine forcing hundreds of millions of already-poor people in their homes and out of work. Pakistan and India alone have together quarantined a fifth of humanity, which, while necessary, poses tremendous risks (the mantra is, either die of the disease or we die of hunger). Both countries have rolled out plans to provide support, but the sheer cost and logistics will pose tremendous challenges (look how hard a time we’ve had).

In the end, none of this should be surprising. In a “normal” year, we lose millions of people to preventable diseases with treatments and cures worth literally pennies. Hundreds of thousands of kids die of something as banal to us as diarrhea. A mere eight people have more wealth than half of humanity (about 3.5 billion people). This pandemic has dramatically highlighted the horrifically stark and senseless disparities within our species, and many of us feel frustrated at our apparent powerlessness to do anything about it.

The “Wuhan Virus” and Human Progress

Believe it or not, the saga of the “Wuhan coronavirus” demonstrates a considerable amount of human progress since the days that diseases would claims tens of millions of lives (which wasn’t that long ago).

First, it was identified and determined to be a new strain of the coronavirus family at record speed. (Coronaviruses are best known for causing the “common cold”.) Just one week after it was discovered, Chinese authorities had already sequenced the virus and shared it with labs around the world; an Australian lab did the same not long after, allowing the whole world to pool its resources together to learn more about this pneumonia-like virus and develop a possible treatment.

“Something that’s remarkable here is that within a week, the RNA sequences of the virus are available on the internet, and many can look at it and begin to understand it,” Richard Martinello, an associate professor of infectious disease at the Yale School of Medicine, told Business Insider. “That’s something that’s never been done before.”

Second, since the discovery of coronaviruses around 60 years ago, medical technology has come a very long way, advancing to the point that we can conduct far more in-depth research into the way these viruses work. For example, while it was known that coronavirus could infect humans, the SARS outbreak marked the first time a coronavirus was traced back to animals. We will likely learn a lot from this experience as well.

And that leads to my third point: Thanks to the advent of institutions like the U.N. World Health Organization, there is unprecedented cooperation, monitoring, and exchanging of data and resources across the world. Just as diseases do not adhere to borders, so too are we humans learning the value of cooperating and coordinating to prevent or contain these pandemics.

To that end, Americans are presently far more likely to catch the seasonal flu than the Wuhan coronavirus. Plus, the preventative measures for both are the same: wash your hands frequently, avoid touching your face, and keep away from anyone who is sick.

None of this is to promote complacency, but to prevent unwarranted or possibly counterproductive panic.

Ghana’s Public Health Milestone

Here’s the sort of progress that rarely makes the news: Ghana, a country of about 30 million best known for being the first African colony to achieve independence, has now earned another distinction–eliminating one of the nastiest infectious diseases in the world. As The Telegraph reports:

Trachoma, the leading infectious cause of blindness in the world, is spread by flies and human touch, and is linked to poverty and lack of access to clean water and sanitation. It starts as a bacterial infection and, if left untreated, causes the eyelashes to scratch the surface of the eye, causing great pain and, potentially, irreversible blindness.

In 2000, about 2.8 million people in Ghana were estimated to be at risk of the disease but the World Health Organization (WHO) has now officially recognised that the country has eliminated it.

The WHO director-general, Dr Tedros Adhanom Ghebreyesus, hailed the country’s achievement: “Although there’s more work to do elsewhere, the validation of elimination in Ghana allows another previously heavily-endemic country to celebrate significant success.”

Ghana eliminated the disease through a partnership between its ministry of health, the WHO, pharmaceutical companies, and charities. Around 3.3 million doses of an antibiotic effective against trachoma were donated by Pfizer, one of the world’s larges pharmaceutical companies; another 6,000 had surgery to treat more advanced stages of the disease. (Amazing what civil society can accomplish when it comes together.)

Thanks to these efforts,Ghana now joins six other countries where trachoma is endemic — Oman, Morocco, Mexico, Cambodia, Laos, and Nepal — that have eliminated the disease.

Nevertheless, trachoma still remains a significant global problem: over 200 million people across 41 countries (mostly in Africa) are at risk of infection. Ghana and several other nations have shown the way. Here is hoping more health agencies, pharma companies, and charities take note.

The Benefits of Indoor Plants

Though I cannot confirm the efficacy of the many studies cited in the following
Vice article, I can speak from experience that gardening and caring for indoor plants has always been therapeutic for me; in fact, I attribute it to helping me cope with many a stressful or melancholic episode.

What’s good for the body is good for the brain, and the toxin-absorbing, air-purifying abilities of plants like pothos, aloe vera, and ivy are worth considering on your next trip to the nursery. Scented plants have health benefits, too: the smell of flowers like jasmine and lavender have been shown to lower anxiety and stress, and promote a good night’s sleep.

Researchers have been promoting the mental health benefits of horticulture for decades, and for good reason. Studies have repeatedly shown that the act of tending to plants can take our minds off the bad stuff, relieve stress, and have an overall calming effect. Gardening is so good for your brain that it’s even thought to lower the risk of dementia.

[…]

One recent study was able to demonstrate that a group of people in their early twenties experienced a massive decrease in blood pressure and other physical stress symptoms when they followed a computer-related task with an indoor gardening session; the results suggested that tending to indoor plants “reduced physiological and psychological stress, especially in comparison to mental tasks performed using technology.

[…]

The science is pretty clear on all this: humans are happier when they’re close to aesthetically-pleasing living things. Office workers have been found to be more productive and happy when surrounded by indoor plants, and having plants in hospital rooms helps surgical patients recover faster by lowering blood pressure, pain, and fatigue levels. Studies have found that even the literal act of looking out the window at a tiny strip of sad urban park can have restorative mental health properties—which means by investing in a couple of hanging baskets, you’ll actually be ahead of the game. Eyeballing the colour green has been found to promote emotional stability, whereas the presence of bright-coloured flowers can provide an instant mood booster.

Perhaps this isn’t too surprising, given that we did evolve and live in nature across millennia, after all.

Fifty Cents to Avoid a Lifetime of Debilitation

Some weeks ago, I read a piece in The Economist that has stayed with me. It was about the efforts of Sierra Leone, among the world’s poorest countries, to combat “neglected tropical diseases” (NTD), a family of 17 diverse communicable diseases that afflict over 1.5 billion in tropical and subtropical areas worldwide.

It featured one victim named Hannah Taylor, who woke up one day with a fever, followed by her legs swelling up to four times their normal size. The physical damage was irreversible, and the subsequent appearance and putrid smell led to her being ostracized by her community. She was a victim of lymphatic filariasis (a.k.a. elephantiasis), a mosquito-borne infection that could have been treated safely with a pill costing no more than fifty cents before it progressed.

But instead, the microscopic worms infested her body, debilitating her. For years she thought she had been a victim of evil witchcraft and was deeply depressed.

Eventually, Taylor put on a brave face and campaigned to raise awareness about the disease, its causes, and why victims shouldn’t be stigmatized. She passed away some weeks prior to the publishing of the article; she was quoted as expressing  happiness that her children would not suffer the way she would, thanks to Sierra Leone’s remarkable progress in fighting the disease.

Progress or not, it is incredible to think that billions of lives are negatively impacted by something as mundane to most of us as a mosquito bite. It is even more incredible that a mere fifty cents – spare change we’d throw in a tip jar without a thought – is all that stands between someone and a debilitating disease. It is utterly senseless that in a world with so much wealth and resources sloshing around that we have not been able to address this vast disparity in health outcomes and quality of life.