WHO Investigation: Anne Sénéquier (Iris) "This crisis has highlighted the WHO’s shortcomings"

Leaders League. Is the current health crisis comparable to the Ebola or H1N1 crises in terms of the extent of the spread and the number of deaths?

Anne Sénéquier. The Covid-19 pandemic is definitely not comparable to Ebola, SARS-CoV-1 or H1N1. On the other hand, the criticisms levelled at the WHO, and in particular its lack of responsiveness, are similar. It must be borne in mind that the WHO's options are limited and that the organization cannot compel member states to do anything, nor can it send an army of observers and check whether the situation on the ground or the figures provided by its members are accurate.

What is the significance of the International Health Regulations (IHR), introduced following the SARS-CoV-1 outbreak in 2002?

The aim of those regulations was to give the WHO an international coordinating role during epidemics and the possibility of going into the field, subject to the acceptance of member states. Although it has the merit of being there, it is understandable that it does not solve anything because some countries are less cooperative than others. If the WHO alienates a given country, it can rest assured that there will be no cooperation or transmission of information on the origin of the virus and what has really happened in that location. Which is why the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, gave a speech praising China at the end of January, because there was a need to be able to go there to understand the first few weeks of the epidemic.

States retain full control over their decisions. We have seen it clearly with the United States. When there were only a few sporadic cases on the US west coast originating from Wuhan, the WHO offered the US government kits so it could start testing the population. The United States refused, stating that it wanted to conduct its own tests, thus following the recommendations of the CDC (Centers for Disease Control and Prevention). The problem is that they were unable to produce a test quickly for the entire population. This resulted in a delay of around three weeks, which, in the timescale of such a pandemic, is enormous.

Is there a need for fundamental reform of the IHR?

These regulations are highly theoretical and not very practical. The situation in which we find ourselves has shown that they are hopelessly out of date. Although the original aim was to reduce the spread of disease and prevent an epidemic from crossing borders, it clearly did not work in the case of this pandemic, since prevention was limited to posters in airports  informing people about the presence of the virus. This was a very light-touch decision based solely on the responsibility of travellers, and was, in fact, widely criticized. Although throughout this health emergency the WHO has issued recommendations, the countries decide whether or not to apply them. And therein lies the real problem. As we have seen, it was not the WHO that restricted travel and trade permits, but rather the governments, based on the importance they attached to this new virus from China.

No two epidemics are alike and the WHO gives the impression that it wants to base its decisions on the lessons learned from previous health crises, but this is not necessarily a good fit and highlights its shortcomings.

What about the Health Emergencies Programme?

This programme, set up by the WHO in the wake of Ebola, aims to bypass the hierarchy and administrative complexity in order to speed up the process. The idea was to have a system that would allow for better feedback from the field and to have a reserve fund. The real question is why this programme did not work for this pandemic.

Why do you think the WHO national office in China was unable to issue a warning earlier?

Countries show what they want to show. The WHO must find a solution to counteract this reality and not wait for authorization from member states to carry out the necessary investigations on the ground. This is no longer an option in our ultra-connected world.

Does the WHO's funding also need to be reflected upon, or even reformed?

In addition to mandatory and voluntary contributors, there are above all contributions with a designated purpose to ensure that the WHO works, for example, on the prevention and control of epidemics, HIV or hepatitis. 27% of US funding [the WHO's largest contributor at $500 million] is directed towards polio eradication. This is a legacy of the public health policy that prevailed in the United States in the 1950s because of the need to get young men back to work.

Let’s not forget that the WHO’s budget of around $5.8 billion is far from sufficient to stop a global pandemic. It should be both increased and made more flexible.

What do you think tomorrow's WHO should look like?

International dialogue is needed to give more power to the WHO and less to the member states, because it is no longer possible to maintain a diplomatic stance in response to a pandemic. The WHO must be able to react quickly because at present a new disease crosses over from animals to humans every four months.