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  • NATURE PODCAST

Coronapod: Fixing the world’s pandemic alarm

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

On 30 January 2020, the World Health Organization (WHO) declared a ‘public health emergency of international concern’, or PHEIC, to raise the alarm of the imminent threat of a global coronavirus pandemic.

Alongside the PHEIC, the WHO made a number of recommendations to curb the spread of the virus. But many of these were ignored by governments around the world.

In this episode of Coronapod, we explore why this emergency warning system failed, and hear about efforts to reform it, and the WHO, to avoid this happening again.

News: Why did the world’s pandemic warning system fail when COVID hit?

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doi: https://doi.org/10.1038/d41586-021-00278-7

Transcript

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

Benjamin Thompson

Welcome to Coronapod.

Noah Baker

In this show, we’re going to bring you Nature’s take on the latest COVID-19 developments.

Benjamin Thompson

And we’ll be speaking to experts around the world about research during the pandemic.

Amy Maxmen

We’re entering a new era now. We have new COVID strategies, there’s some new unknowns and we’ve got a vaccine.

Benjamin Thompson

Hi, listeners, Benjamin here, coming to you once again from the South London basement. Welcome to Coronapod. It feels to us like the pandemic has shifted once again into a new phase, so we’ll be publishing Coronapod as a standalone show for the time being to allow us to cover all that’s going on in more detail. Isn’t that right, Noah Baker?

Noah Baker

Yeah, we launched Coronapod way back in March last year in response to this sort of – it’s not new anymore but at the time – completely unprecedented world event, and then as time went on we felt like it was developing into a new phase. But we’ve spent so much time on Coronapod when it was its own show and when it was sitting within the main Nature Podcast talking about vaccines and endgames and politics and what happens next, and a whole bunch of those things are now happening and it feels like there’s so much to discuss that it’s time to bounce this back out into its own dedicated show again.

Benjamin Thompson

Absolutely. Well, obviously Noah’s here of course, but we’re not alone. Also on the line from the west coast of America, making her return after several months away is Amy Maxmen, senior reporter here at Nature. Amy, welcome back to the show.

Amy Maxmen

Thanks, it’s so good to be back.

Noah Baker

We’re pleased to have you and I have like a thousand questions about the last couple of months because while you’ve not been on the show a hell of a lot has happened.

Amy Maxmen

Yeah, and it’s kind of wonderful for me to come back because I feel like we’re entering a new era now. We’ve new leadership in the US which means there’s different COVID strategies, there’s these new variants which are going to usher in some new unknowns and we’ve got a vaccine.

Noah Baker

We’ve got a bunch of vaccines with a whole bunch of issues, questions, excitement that comes with each of them. And speaking of things that we’ve discussed in the past that are coming back, one of the things we talked about most in those early days of Coronapod was the WHO. So, back at the beginning of the pandemic, a lot of eyes were on the WHO as they were really the central resource that was giving updates about how the pandemic was progressing. They have been less mentioned in recent months but that doesn’t make them any less relevant, and as the new administration comes in in the States and Joe Biden has committed to re-joining the WHO, there is a general thought among many of the member states that some of the protocols need to be looked at again to assess how well it did and how things can change in the future to adapt what might happen in future pandemics or even this continuing ongoing pandemic, and that’s what you’ve been spending a lot of time looking at recently, Amy.

Amy Maxmen

Yeah, exactly, it is. That was the first thing I kind of jumped back into because the WHO has an executive board meeting every January, and that’s where some 30-40 health officials around the world – that means like ministers of health or the heads of health agencies – meet with WHO officials to sort of discuss what role policies around health are going to come up at their World Health Assembly in May, and in May that’s when you actually vote on different proposals and changes actually go into effect. So, this was a quieter yet really important meeting in January, and a big subject right now is that last year, you’ll remember a lot of countries were upset with the WHO and said there should be sort of an investigation into what the WHO did. I mean, this was around the time when President Donald Trump even began the process of revoking membership of the US within the WHO, but a lot of the countries were saying they want to critique in order to reform the WHO so that it performs its jobs better. So, that was sort of the big subject at the executive board meeting last week and it coincided with the first two interim investigations into the first part of last year when the pandemic began.

Benjamin Thompson

And central to what was being discussed then is, I would call it, a public health emergency of international concern but I think some people call it a PHEIC, and this was something that was announced last year and there was some backwards and forwards there as well. Amy, what is a PHEIC, and how is it central to the debates that are going on?

Amy Maxmen

Yeah, so, remember the WHO, they are comprised of countries, 194 countries, so back in 2005 countries decided that there should be some kind of alarm raised when there’s a major health emergency that’s extraordinary, that could threaten countries outside of the one that’s most affected, and that there should be a lot of coordination in preventing that emergency from getting worse, and so that alarm they decided should be called a public health emergency of international concern. Because that’s a very long phrase, you use the acronym, which I’ve heard all number of pronunciations for. Nobody really agrees on that. So, that was declared on 30 January. So, that should be the point when this is the number one highest alarm that the director-general can declare, and the way he declares it or she declares is what they do is when they see a big emergency, say polio resurgence or Ebola in the Democratic Republic of the Congo or this new coronavirus, they convene experts that are outside of the WHO, they convene, they discuss it. It’s kind of behind closed doors. And then they advise the director-general on what they should do. And so, Tedros on 22 January of last year convened his committee. At first they decided ‘No, we shouldn’t declare it,’ and then eight days later on 30 January they said ‘Yes, we should declare this highest alarm.’ And when you declare it, the WHO also makes recommendations that countries are supposed to follow.

Noah Baker

I feel like public health emergency of international concern (PHEIC), I just think it’s so indicative of a frustration that I can imagine a lot of people feel about the function of the WHO. So, the WHO is this huge organisation that can do all these amazing things and has this access to all these amazing resources and expertise, but sometimes there’s a tendency to think that these huge sort of UN organisations are just bogged down in wonky language and they’re slow, and I think that name for me almost encapsulates that frustration with those big organisations. And is it something that could change after this experience with the COVID pandemic? Is that’s what’s on the table right here?

Amy Maxmen

Yes, it’s something that’s on the table, and just to explain why they use the term ‘public health emergency of international concern’ instead of ‘pandemic’, there’s a few reasons. One is not all major health emergencies are going to be a pandemic so they wanted it to be broad for that reason. Also, there’s this feeling among public health people that if you say, ‘This is a pre-pandemic,’ world leaders might panic, and that was what they were afraid of. So, they kind of want to balance this line between not causing a panic yet causing world leaders to do things and respond because in a panic, leaders might go ahead and jump to the things they always jump to, namely blanket bans on travel or on trade, that might do huge damage economically but might not necessarily be super effective. So, those are the reasons why they chose the name.

Noah Baker

PHEIC.

Amy Maxmen

PHEIC, right, and could it be worse, right? People’s eyes glaze over, like who says this term. People pay attention to the word ‘pandemic’. They just do. But I haven’t heard a lot about changing the name itself.

Benjamin Thompson

Well, Amy, if that’s what it is and if we cast our minds back to January last year, the WHO did announce one of these and they make a lot of suggestions to governments around the world about what they should do to try and mitigate whatever’s going on, but it seems in this instance that most or many of those recommendations were ignored.

Amy Maxmen

Yeah, that’s the big problem. So, I think a lot of people who’ve watched this do say why didn’t the WHO declare on 22 January. So, there seems to be some sort of agreement that it was pretty bad. There were clear signs it was being transmitted between humans. It had already spread to some other countries. So, one is okay, they should have declared it a little bit earlier. But I would say the bigger problem is most countries just didn’t really pay attention at all.

Noah Baker

And I guess that’s one of the big things that’s being discussed and is up for review right here. We can talk about the name for as long as we want but really one of the fundamental problems here is how much influence the WHO realistically has to influence global health policy because it doesn’t actually have very much power here. It’s power relies entirely on people listening to it, and is that one of the things that could be up for review in terms of how to encourage a better unified global health response to emergencies in the future?

Amy Maxmen

Yeah, and I think that’s something that this independent panel that was put together to review what the WHO did wrong or how it could be strengthened, that something is the hardest thing they’re really dealing with right now is how do you change that fact? How do you make countries sort of listen, and not just listen but actually have actions that are ready to go? I mean, if we look at like Taiwan, for example, they took really concrete actions.

Noah Baker

So, yeah, places like Taiwan, Singapore, they reacted very quickly and they were held up as these examples in the fight from COVID, but they have also got very recent experience with SARS and so you might have an understanding of why that’s fresh in their memories and we’ve talked about this on Coronapod before. Do you think that moving forward some of this discussion is maybe not as necessary because I’m fairly sure the world will remember the impact of COVID for quite some time and perhaps might take a future threat more seriously by virtue of recent experience?

Amy Maxmen

Yeah, and I think this is the energy that the people talking about reforming the WHO, for example Joanne Liu who was the former president of Doctors Without Borders or Médecins sans frontiers, and she actually in 2014-2015 was really hard on the World Health Organization because they really dragged their feet in declaring a PHEIC for the Ebola outbreak in West Africa. She’s part of the group that’s assessing the WHO now, and one thing that she really impressed upon me was like this is the moment when hopefully much of the world can see the importance of public health and how devastating a pandemic is. I mean, look at the economic impact this is going to have in addition to the number of people who’ve died.

Benjamin Thompson

Well, we can hear her thoughts on the level of importance she thinks the world should place on a pandemic. Here’s a little extract from your interview with her.

Joanne Liu

If we elevate the threat of pandemic to the threat of a chemical weapon or to a nuclear weapon, will people accept that the threat is so big that we need to collaborate and we need to collaborate in a timely fashion because the thing is speed is the variable in a pandemic. It is not the same with a nuclear weapon or a chemical because it doesn’t go exponentially, the threat. But in a pandemic it does. Every single day, it matters.

Benjamin Thompson

Wow, well, she’s really ranking it up there with some of the biggest threats facing humanity, right?

Amy Maxmen

Yes, so this should be the moment that the world sees how important and how grave this threat is, but it’s not a given that countries will do the right thing. I mean, I’m nervous. I’m sitting in the US right now and I’m actually doing some more reporting and I always poke around in different things. I was talking with a group that’s doing contract tracing in the Central Valley in California and basically, when I asked enough questions I realised they don’t reach out to people who tested positive until like it seems about a week from when they get the test result for when they start asking about who they’ve hung out with. I mean, that’s a week of spreading it to all those people so it’s completely ineffective. And the fact that we’re going on a year of this pandemic and that’s where we’re at, to me that suggests that maybe we understand that a pandemic is terrible, but are we really strengthening our systems? So, that’s why it’s not quite a given.

Benjamin Thompson

The WHO at the time said that contact tracing was one of the key things that needed to be done when this health emergency was announced, but here we are a year later and, to sound like a broken record, the same issues are coming up again and again.

Amy Maxmen

They really are, so that’s why it’s not a given, so that’s why it’s something to really focus on. So, there’s different proposals that are put forward for what we could to do to strengthen the World Health Organization, at least in both the way it declares a PHEIC and also in the ways that it could get countries to respond. I mean, those are the kinds of things that people are discussing right now, and I guess I could tell you some of the proposals if you’d like.

Noah Baker

Yeah, I’d love to hear some of the ways that they might be able to tackle this differently in the future or certainly the ways that are being discussed.

Amy Maxmen

Well, first of all, when they declare this PHEIC, there’s a number of people who are saying they have to be more transparent about how they make that decision. Right now, it is a bit behind closed doors. Something else that might help would be if the WHO was allowed to kind of respond to unofficial data, like if they hear on WhatsApp about a strange, new pneumonia somewhere in the world then maybe they could have more powers to kind of respond to that data. Right now, countries have decided that they want the WHO to respond to official data which is great for reasons of accuracy, but if there’s a government that wants to hide an outbreak that can cause kind of a problem. Another recommendation is right now the PHEIC is sort of on or off. It either is a PHEIC or it’s not a PHEIC. So, Tedros, the director-general of the WHO, and others have talked about a dimmer switch, like what if there we like three levels of alert, like an amber alert, a red alert, kind of like how the US has for hurricane systems. And there’s some other idea from the president of the European Council which is to say that there should be a pandemic treaty in addition to these international health regulations and the PHEIC, and that’s sort of an interesting idea.

Benjamin Thompson

Amy, can I ask you something? If there are potential changes, reforms, that we might see to the WHO announced in May, as you’ve said there, do they have any relevance to what’s going on right now because obviously the world has reached a lot of unenviable milestones in different countries in terms of numbers of deaths. Is this something that we can see make a difference to what’s going on at the moment?

Amy Maxmen

Yeah, it is. So, let’s say, and this is completely hypothetical. To be totally clear, this has not happened. Let’s say there’s a variant that either does not respond to the drugs that we’ve found that work or there’s a new variant of coronavirus that escapes the vaccine. Now, a country that has such a variant risks having its borders completely, everyone closing up around them, not allowing anybody from that country to leave, there could be incentives for the country to not report that variant. But the WHO, one of its core purposes, why it even exists, is as like a sentinel. So, we want the WHO to know when variants like that occur and to make it public. So, what tools do they have at their disposal to be able to encourage countries to report, to be open, but also on the reverse make it so that their worst fears don’t come true, which would mean they want other countries to say, ‘Hey, listen, rather than shut all of your borders to this country, what can we do to ensure that they have some economy that’s still moving,’ and also, to tell other countries, ‘Hey, you really need to step up your surveillance for this new variant.’ So, these sort of things could make a difference.

Noah Baker

So, are you a betting woman, Amy? I’m interested to know if you have any suggestions about how the WHO is likely to actually change. You’ve presented a whole bunch of different ways that it could change. Is it going to and is it going to work?

Amy Maxmen

So, different proposals would take longer or shorter. So, like this idea of a dimmer switch, that’s the one where it’s like the amber alert, the red alert, let’s say all countries at the World Health Assembly, and this is my understanding, just say, ‘Yes, we unanimously think this is a great idea,’ I think that could go into effect pretty immediately. Something like a pandemic treaty, that actually repeats a lot of the things that are in the international health regulations, but one reason for it is it uses the word ‘pandemic’. I don’t know rules around the world but like for the US, that requires congressional approval and I’m told from reporting that we’re looking at five years down the road for something like that, for the US to be able to sign on to that, because there’s so many steps involved with signing on to a treaty. And then there’s always the possibility that not too much happens. Joanne Liu who I spoke with, the former president of MSF, she pointed out that there were so many panels and committees formed in the wake of the 2014 West Africa Ebola outbreak and very few of those recommendations were really taken onboard. Ultimately, you need countries to decide that they want to set up long-term systems to deal with this and that they care a lot. Right now, there’s not even laws saying that the WHO must be able to go into a country and investigate themselves when there’s a suspected outbreak, so countries don’t want to give them that power because that means giving up some of there sovereignty. So, it’s actually the countries that need to agree to do these things, and that’s kind of always the balance here, right. It’s like we’ve developed this international agency but in order to give it power means relinquishing some of our own power as separate nations.

Noah Baker

Speaking of countries doing what they can as individual countries, since the last Coronapod episode in which we talked about all of the things the new administration was hoping to do to tackle the coronavirus pandemic, there has been a week and an awful lot has happened. I’m kind of interested to know, Amy, what’s the feeling like in the States? Do you feel like there is a different approach? Does it feel like things have been energised or is it too soon to tell?

Amy Maxmen

Well, I think, yeah, there’s a huge feeling that things are going to be energised. On the international front, Biden’s like first move, the day after he took office, Anthony Fauci who was speaking as sort of ambassadors at the WHO’s executive board meeting kind of announced that the processes in place for making sure that the US remains within the WHO. So, they’re reversing the letter that the Trump administration sent last year saying that we were terminating our relationship. So, it’s clear that the US wants to be a part of the world again. They’ve also said specifically they’re not just there as a cheerleader for the WHO. They’re there to help reform the WHO. Remember, if we left the WHO, we don’t get to reform it. So, on the global front, there’s a lot of action. Similarly, domestically in the US, day one, Joe Biden’s administration posted a 200-page strategy on how they’re going to attack the coronavirus at home as well as try and prevent future pandemics. And kind of the fun part is now, researchers can start critiquing it and say, ‘This is what’s wrong with it.’ Before, there just wasn’t anything to critique. It was just sort of like can we listen to science at all? Now, they’re hoping for some more details, they’re hoping for more funding to back those details, but at least now we’ve got a coordinated plan going forward.

Benjamin Thompson

Well, Amy, it’s great to have you back on the show, and I’ll hope you’ll join us again next week because there’s lots more to discuss, I think, right?

Noah Baker

Yeah, I feel like at the beginning of the show we almost listed a kind of contents page for the next month of Coronapod. We’ve got vaccine rollouts, we’ve got variants, which there’s a lot to talk about and that will be coming on the show. In the meantime, I’ve volunteered to become a vaccinator and I’ve been training about how to administer vaccines, which I think is quite exciting.

Amy Maxmen

Woah.

Benjamin Thompson

Nice.

Noah Baker

I know.

Amy Maxmen

That’s very cool of you to volunteer to do that. It’s also nice to hear that they’re recruiting.

Noah Baker

Yeah, I think they’re actually desperate for people.

Benjamin Thompson

Yeah, my mum came out of retirement, re-upped as nurse, and she’s been spending the last week or so giving them to people. I found it quite moving, I must say. I’m very proud of her to step up and answer the call when it came.

Amy Maxmen

That’s so cool. That’s wonderful.

Benjamin Thompson

Well, let’s leave it there then. Amy and Noah, thanks a lot.

Noah Baker

Thanks, Ben. Thanks, Amy.

Amy Maxmen

Take care.

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