Declaring coronavirus emergency alone is not enough, experts say

MANILA — The World Health Organization on Thursday declared the novel coronavirus outbreak a public health emergency of international concern, but that alone might not be enough, experts say.

The 2019-nCoV has infected thousands in China and is spreading rapidly to other countries across the world. Declaration of the outbreak as a global emergency will help unlock much needed resources — financial and personnel — and cooperation among countries, particularly for countries with little capacity to handle an outbreak. However, much more needs to be done to coordinate responses internationally and strengthen China’s public health response.

WHO needs to launch a global action plan to get the outbreak under control, Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law, and director at the WHO Collaborating Center on National and Global Health Law, told Devex. Apart from the rapid development of a vaccine, the plan should also include actions that will allow for a surge in public health response in China, particularly Hubei province, the center of the epidemic, he said.

“I'm currently not seeing a surge [in] public health response — going from neighborhood to neighborhood, community to community, and doing intensive testing, screening, contact tracing. We don't really have good case registries of known contacts, and so we have no idea of how widespread this is. I think we need to get more control over the outbreak,” he said.

The action plan should also ensure the needs and human rights of people under quarantine in China are being met, as well as include a large cadre of WHO health emergency program personnel and other international partners, including the U.S. Centers for Disease Control and Prevention, working in partnership with China.

“I think we need to set aside our political differences and come together as one common humanity to fight this global threat,” he said, noting that efforts to contain the outbreak are of international importance and are not just limited to China.

However, accomplishing this will be in large part dependent on China.

“Everything's reliant on China … and I think that is the problem. I think WHO should be more assertive with China. I'm really calling on China to let these international experts in. I think it would send a powerful signal to the world that this isn't a closed society. China's trying to make it appear the epidemic is under control, that they're fully competent and in control. But I don't think they are,” Gostin said.

Coordinated response

“In lower- and middle-income countries that don't have either a functioning health system or adequate frontline health workers to deal with the response, a public health emergency of international concern is vital to be able to stem the outbreak and to be able to respond accordingly,” said Ashley Arabasadi, senior external affairs manager for Management Sciences for Health and chair emeritus of the Global Health Security Agenda Consortium.

It will also help provide a more coordinated and coherent response, which has proven to be a challenge in past emergencies, said Olga Jonas, senior fellow at the Harvard Global Health Institute.

Jonas gave the example of the Ebola outbreak in West Africa in 2014, where the response was initially “very uncoordinated and haphazard.”

“All the different U.N. agencies had a hard time working together, that's why the U.N. even appointed a U.N. coordinator like a czar ... because without that, coordination is very difficult,” she said.

Urgency during emergencies

The outbreak comes with a silver lining — it brings back attention to gaps in countries’ capacity to respond to outbreaks, including attention to boost countries’ preparedness response.

The Global Preparedness Monitoring Board, a high-level body set up by WHO and the World Bank in 2018 to monitor the world’s preparedness to outbreaks, reiterated their calls for countries to dedicate resources for preparedness measures, and for donors, including multilateral institutions such as the World Bank, to financially support low resourced countries.

“Donors and development partners should prioritize financial and technical support to low- and middle-income countries/communities at-risk to assist them in building these capacities, notably to improve early detection and control of the virus, limit the risk of transmission, and their ability to respond,” according to a statement from GPMB.

Often, efforts to boost countries’ capacity to prevent and handle an epidemic comes in the midst of an emergency, said Harvard’s Jonas, who coordinated the World Bank’s response to avian flu and other pandemic flu threats during her time there, prior to joining the Harvard Global Health Institute.

When avian flu became a global concern around 2005, she said then U.S. President George Bush went to the United Nations to declare a plan on how to defeat it. However, the international community was not able to sustain those efforts years after.

“That was sustained but only for five years because then … attention turned somewhere else. And the institutions that were sort of being charged at sustaining it, mainly the World Bank, just dropped it because there was no sort of political pressure for them to keep pursuing preparedness. It's very easy to sideline this agenda of capacity to respond to emergencies,” she said.

But Jonas hopes the current outbreak will once again bring more attention in strengthening countries’ capacities to handle emergencies, not just in the present but also in the future.

“Hopefully ... there will be more attention to strengthening these capacities, not only for this emergency, but also for the next one. I mean, this is not the last such emergency,” she said.