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Chinese officials note serious problems in coronavirus response. The World Health Organization keeps praising them.

The Washington Post logo The Washington Post 2/9/2020 Emily Rauhala
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As a mysterious virus spread through Wuhan last month, the World Health Organization had a message: China has got this.

And as the coronavirus swept across the Chinese heartland and jumped to other nations, the WHO’s director general, Tedros Adhanom Ghebreyesus, applauded the “transparency” of the Chinese response.

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Even as evidence mounted that Chinese officials had silenced whistleblowers and undercounted cases, Tedros took a moment to extol the leadership of Chinese President Xi Jinping. 

Now — more than a month into an escalating global health crisis — there are questions about whether the WHO’s praise in the early weeks created a false sense of security that potentially spurred the virus’s spread.

“We were deceived,” said Lawrence Gostin, a professor of global health law at Georgetown University who also provides technical assistance to the WHO.

“Myself and other public health experts, based on what the World Health Organization and China were saying, reassured the public that this was not serious, that we could bring this under control,” he continued.

“We were,” he added, “giving a false sense of assurance.” 

On Saturday, the death toll from the new coronavirus recorded its largest daily jump — 86 — to raise the count to more than 800 deaths, nearly all in China. In doing so, the toll surpassed the total number of fatalities — 774 people — attributed to the outbreak of the severe acute respiratory syndrome (SARS) coronavirus in 2002 and 2003. In Wuhan, the center of the outbreak, the first deaths of an American and a Japanese citizen were recorded.

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Managing the outbreak of a new infection is never easy. In times of crisis, the WHO — a U.N. agency based in Geneva — must work with member countries to get information and coordinate a response. 

Experts familiar with the workings of the WHO, including current and former advisers, stressed that careful diplomacy and public praise can keep countries in crisis from shutting out the world. 

The agency learned valuable lessons from the 2002 outbreak of SARS, which China initially tried to cover up. The agency is doing much right this time around, some experts said.

But some fear that the WHO’s embrace of China’s numbers and assessments in the early stages of this outbreak, as well as its ongoing praise for the country’s response, are testing the agency’s global credibility right when it needs it most.

“I’m concerned about whether they can actually assume leadership effectively in terms of the international response,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

“People trust the organization to be the guardian of global health because it is politically neutral and has expertise.”

A statement from the WHO said “ensuring open lines of communications” is critical in efforts to bring a disease outbreak under control.

“To date, 99 percent of the cases are still in China,” the statement added. “The government committed early on to working with WHO, sharing data and more. The Chinese government are in the lead for their national response and WHO is doing its utmost to support them, for the sake of the Chinese people and the world.” 

The WHO said that Tedros “welcomes and expects scrutiny of the response effort. Everyone’s focus must be on ending the outbreak.”

How SARS changed responses

The SARS epidemic shook China and changed the way the WHO responds to threats.

In the aftermath of the crisis, updated rules required the WHO to report emerging diseases and gave it broader power to investigate threats using nonstate sources of information such as civil society groups.

One of the goals: preventing coverups.

In late December, rumors of a mysterious virus started circulating on Chinese social media. China notified the WHO on Dec. 31 that there was a pneumonia of unknown cause in Wuhan. Based on Chinese data, the WHO issued a Jan. 5 statement saying there were 44 cases and no evidence of person-to-person transmission.

But a Washington Post reconstruction of events showed that by Jan. 5, some Wuhan authorities knew that doctors were discussing the spread of a SARS-like virus. For this, they were detained and denounced.

It also found that local officials undercounted cases.

 

Tedros Adhanom Ghebreyesus wearing a suit and tie: Tedros Adhanom Ghebreyesus, director general of the World Health Organization, during the 146th session of the WHO executive board in Geneva on Feb 3.

Tedros Adhanom Ghebreyesus, director general of the World Health Organization, during the 146th session of the WHO executive board in Geneva on Feb 3.
© Salvatore Di Nolfi/EPA-EFE/REX/Shutterstock
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“My sense is there was delay in getting information from Wuhan to Beijing, even as Beijing was relatively open about sharing with WHO,” said Mara Pillinger, an associate in global health policy and governance at Georgetown’s O’Neill Institute for National and Global Health Law.

David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine and current chair of the WHO’s advisory committee on infectious hazards, defended the response.

“It is very difficult in the beginning of an outbreak to understand the potential,” he said, pointing to U.S. failures in the early days of the AIDS crisis and Canada’s struggle to coordinate provincial and federal authorities during SARS.

Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, said the WHO was doing a good job under tough conditions.

But she noted that critical epidemiological data that researchers use to understand a virus — information about who got sick, when — was slow to get out from China.

“One criticism that we should direct at WHO is that when it puts out situation reports, they are basically missing data from China,” she said.

“It’s fair to ask, ‘If you don’t have data, why not? And what are you doing about it?’ ”

Defense of China

In late January, China moved from denial to drastic action.

On Jan. 20, with 400 million people about to travel for the Lunar New Year holiday, officials confirmed what many had long suspected: The virus could spread person to person.

President Xi called for swift, transparent action. “It is necessary to release epidemic information in a timely manner and deepen international cooperation,” according to state media reports.

Authorities started to seal off Wuhan, a city of 11 million, canceling some flights, trains and suspending public transportation.

In Geneva, an emergency panel convened to discuss the situation and decide whether to declare a public health emergency of international concern, or PHEIC, which signals “serious, unusual or unexpected” health crisis “that poses a public health risk to other countries through international spread.”

On Jan. 22, Tedros applauded China’s recent efforts. “What they are doing is a very, very strong measure and with full commitment,” he said.

The comment surprised public health experts because travel bans can create panic and make things harder for first responders.

On Jan. 23, China announced it was expanded the quarantine to other cities — and millions more people.

Later the same day, in Geneva, the WHO decided against declaring a PHEIC. That meant, among other things, no calls for restrictions on travel in and out of China, even as Beijing locked down the Chinese heartland.

Asked about China’s quarantine, Tedros demurred.

“At end of the day, a sovereign country has the autonomy to do what it thinks is right,” he said, adding that he hoped it would be short.

In China, officials were increasingly talking about what went wrong. In a Jan. 27 interview, Wuhan Mayor Zhou Xianwang admitted that information should have been released more quickly.

But in a visit to Beijing, Tedros commended officials. The state-run Xinhua News Agency reported that Tedros lauded not only the coronavirus response, but the very effectiveness of “China’s system.”

On his return from Beijing, he heaped compliments on China and its president.

“I was very encouraged and impressed by the president’s detailed knowledge of the outbreak and his personal involvement in the outbreak,” he said. “This was for me a very rare leadership.”

On Jan. 30 the WHO declared a PHEIC, finally acknowledging the risk the Wuhan outbreak posed to other countries. “The Chinese government is to be congratulated for the extraordinary measures it has taken to contain the outbreak,” Tedros said, adding that China is setting “a new standard” for outbreak response.

'Tricky balancing act'

Some experts have defended the comments as sound strategy.

“WHO has really tricky balancing act,” said Devi Sridhar, a professor of global public health at the University of Edinburgh. “If that means praising China publicly, that’s what he has to do.”

Others worried that it could shake faith in the U.N. body.

Praising China’s leaders “is not a bad idea, but do you want to do it in a professional and credible way,” said the Council on Foreign Relations’ Huang.

For now, the WHO seems to be sticking with the strategy.

At a new conference on Thursday, Tedros was asked, again, about China, including the death of one of the Chinese doctors who sounded the alarm on the virus, only to be detained by police. (He later died of the virus.)

He first deferred to a colleague, then took the chance to speak again, defending China’s handling of the epidemic. “It is very difficult, given the facts,” he said, “to say that China was hiding.”

emily.rauhala@washpost.com

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