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W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads
(about 5 hours later)
The World Health Organization declared on Thursday that the Wuhan coronavirus outbreak was a global health emergency, acknowledging that the disease now represents a risk beyond China, where it emerged last month. The World Health Organization declared a global health emergency on Thursday as the coronavirus outbreak spread well beyond China, where it emerged last month.
The decision reversed the organization’s decision just a week ago to hold off such a declaration. The move reversed the organization’s decision just a week ago to hold off such a declaration. Since then, there have been thousands of new cases in China and clear evidence of human-to-human transmission in several other countries, including the United States.
Since then, W.H.O. officials said, thousands of new cases in China and clear human-to-human transmission in several other countries — now including the United States — warranted a reconsideration of that decision by the agency’s expert committee. All of which warranted a reconsideration by the W.H.O.’s emergency committee, officials said.
The W.H.O.’s declaration — officially called a “public health emergency of international concern” — does not have the force of law. But it serves notice to all United Nations member states that the world’s top health advisory body thinks the situation is grave. The declaration “is not a vote of no-confidence in China,” said Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general. “On the contrary, the W.H.O. continues to have confidence in China’s capacity to control the outbreak.”
Governments then make their own decisions about whether to close their borders, cancel flights, screen people arriving at airports or take other protective measures. The declaration comes now, he said, because of fears that the coronavirus may reach countries with weak health care systems, where it could run amok, potentially infecting millions of people and killing thousands.
Declaring emergencies also adds urgency to any W.H.O. appeal for money. Thus far, that is hardly relevant: The countries most affected — China, Japan, Germany, South Korea, the United States and Vietnam — can afford to wage their own battles against the virus. In response to the W.H.O. declaration, China’s Foreign Ministry spokeswoman, Hua Chunying, said that the country “is fully confident and capable of winning the battle against this epidemic.” In a statement on the ministry’s website, she added that China was willing to continue to work with the W.H.O. and other countries to safeguard public health.
By contrast, the Democratic Republic of Congo has needed large infusions of cash and medical expertise to fight an ongoing Ebola outbreak, and the need for money was one of the reasons the W.H.O. declared an international emergency in that case, even though Ebola has not spread outside of Congo except in a few patients who briefly entered Uganda. The W.H.O.’s declaration — officially called a “public health emergency of international concern” — does not have the force of law.
Last week, the committee was divided. Declaring emergencies is always a hard decision, said Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, because closed borders and canceled flights lead to personal hardships for millions of healthy people near the epicenter and can cause massive economic disruption. The agency is governed by an annual convocation of the health ministers of all U.N. countries, and its role is only to offer advice. Governments then make their own decisions about how they protect themselves.
In the worst cases, supplies of food and medicine can run short and panic can spread, threatening to do more damage than the disease does. States of emergency are “merely guidance,” said Dr. David L. Heymann, a former W.H.O. assistant director-general who now analyzes the work of the agency’s emergency committee. Governments and even private companies “may or may not follow it.”
The agency has lavishly praised China’s aggressive response to the virus. Nonetheless, emergency declarations signal that the world’s top health advisory body thinks the situation is grave. Many scientific experts welcomed the decision.
China effectively isolated Hubei Province, stranding more than 30 million people, at the height of the New Year holidays — an act tantamount to quarantining the Midwest at Christmastime. The public health emergency “allows them to further lean into the role of global leadership for governments and the private sector,” said Dr. Thomas R. Frieden, the former director of the Centers for Disease Control and Prevention and a veteran of several global health emergencies.
Dr. Tedros, who met with President Xi Jinping in Beijing on Tuesday, said Mr. Xi had led “a monumental national response,” and that he was “struck by the determination of Chinese leadership” and by how much Mr. Xi personally understood about the outbreak. The first goal, he said, should be to understand more about how the virus is spreading — whether mostly in hospitals and clinics, what ages and sexes or professions are most affected, how sick they become and what risk factors are dangerous.
China said on Thursday that another 38 people had died from the disease, bringing the total to 170. Nearly 8,000 cases have been reported worldwide, almost all of them in mainland China. But Amir Attaran, a professor of law and epidemiology at the University of Ottawa and a frequent W.H.O. critic, called the declaration “inexcusably late.” The committee’s reasoning that it lacked enough scientific evidence to declare an emergency last week was “balderdash,” he added.
On Thursday, Russia closed its 2,600-mile border with China and stopped all trains except for one between Moscow and Beijing. “W.H.O. is paralyzed for the same political reasons that ruined its scientific judgment in SARS, Ebola and Zika,” he said. “Borders are closed, aircraft grounded and ships anchored as W.H.O. mutely dithers over whether or not to declare an emergency.”
Within China, some medical experts have questioned their country’s response, arguing that local officials could have put in place stricter travel restrictions before the virus spilled beyond the central city of Wuhan. The country has now confirmed cases in every province and region. “Events have comprehensively overtaken them, proving their uselessness yet again,” he added.
The W.H.O. has made such declarations just five times since its power to do so was established in 2005: for the pandemic influenza in 2009, a polio resurgence in 2014, the Ebola epidemic in West Africa that same year, the Zika virus outbreak in 2016 and an Ebola outbreak in the Democratic Republic of Congo last year. Declaring emergencies is always a hard decision, Dr. Tedros said on Wednesday. Border closings and flight cancellations may cause hardships for millions of healthy people near the epicenter, and massive economic disruption.
Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the discoverers of the Ebola virus and the presence of AIDS in Africa, said he personally considered the outbreak an emergency and found the process flawed. In the worst cases, supplies of food and medicine can run short and panic can spread, threatening to do more damage than the disease.
“It is time for the W.H.O. to change its all-or-nothing, binary approach to declaring a PHEIC,” he said, referring to the emergency declaration. “In every emergency, there is a spectrum of alert levels, rather than ‘PHEIC or not PHEIC.’” Experts at the W.H.O. have lavishly and repeatedly praised China’s response as remarkably aggressive.
Dr. Tedros said the same thing at a news conference on Wednesday, suggesting that the agency might want to go to a graduated green-yellow-red system. The country is building two hospitals, in just two weeks, to house coronavirus patients. Chinese scientists deposited the genetic signature of the coronavirus in public databases, greatly speeding the development of diagnostic tests and, potentially, vaccines.
Chinese authorities cordoned off the major cities at the outbreak’s epicenter, Hubei Province, stranding more than 50 million people at the height of the Lunar New Year holidays — a measure that few other countries could have undertaken.
Whether that massive cordon will prove effective remains to be seen. Five million people were able to leave Wuhan, the city where the outbreak began, before its train and bus stations and airports were closed, the mayor. There were soon outbreaks across the country.
Dr. Tedros praised the Chinese government, saying it “is setting a new standard for outbreak response.” Other countries should be grateful that only 98 of the nearly 10,000 cases confirmed so far have occurred outside China’s borders, he said.
Despite the emergency declaration, the W.H.O. opposes restrictions on travel to China or on trade with it. Measures the agency considers unwarranted include border closures, visa restrictions and the quarantining of apparently healthy visitors from the affected regions, said the chairman of the agency’s emergency committee, Dr. Didier Houssin, an adviser to France’s national health security agency.
Many such measures have already been taken against China by other countries, and Dr. Houssin said the W.H.O. would question the scientific rationales behind them.
Neither he nor Dr. Tedros questioned the decision by the United States and other countries to evacuate their citizens from China, and they said the cancellation of flights by airlines was justified if the real reason was that they had no passengers.
Dr. Tedros, who met with President Xi Jinping in Beijing on Tuesday, said he was struck by how much Mr. Xi knew about the outbreak and by the fact that Ma Xiaowei, director of China’s National Health Commission, was on the ground in Wuhan leading the response.
That is not say there haven’t been missteps. The W.H.O. last week described its risk assessment for the outbreak as “moderate,” when it should have said “high.” The error was corrected in a footnote to the agency’s report; Dr. Tedros described it on Twitter as a “human error.”
Experts in the United States have complained of spotty epidemiological information from China.
Also, the W.H.O. cannot share information with Taiwan, which now has eight coronavirus patients, because Taiwan is not a member of the United Nations.
The agency “doesn’t want to upset its major stakeholders,” said Charles Clift, a senior consulting fellow at the Chatham House, an international affairs research group in London. “China carries the political clout that other countries don’t.”
And the outbreak seems to accelerating, along with its consequences. China said on Friday that another 43 people had died from the disease, bringing the total to 213. No deaths have yet occurred outside China.
On Thursday, Russia closed much of its 2,600-mile border with China and stopped all train service between the countries, except for a regular train between Moscow and Beijing. Some airlines, including British Airways, have stopped flying there; others are greatly reducing their service.
Within China, some medical experts have questioned their country’s response, arguing that local officials should have imposed stricter travel restrictions before the virus spilled out of Wuhan. The country has now confirmed cases in every province and region.
Residents have complained that local authorities kept mum about the outbreak’s severity — initially insisting that there was no evidence of person-to-person transmission outside Wuhan — but admitted the truth after press reports in Hong Kong.
As the dimensions of the outbreak became clear, the mayor of Wuhan on Monday offered to resign.
A W.H.O. delegation was allowed to visit Wuhan for just one day. Dr. Gauden Galea, the organization’s representative in Beijing, said the visit was not intended “to pass judgment.”
“Everything is being done with a sense of intensity, and to our assessment, good practice,” he added. “I don’t want to be an apologist. You have to understand the large scale and the comprehensiveness of the operation.”
Following the trip, China agreed to permit international experts coordinated by the W.H.O. into the country to work with Chinese scientists on containing the epidemic. The C.D.C. is assembling a team to join them.
The W.H.O. has made just five emergency declarations since its power to do so was established in 2005: for the pandemic influenza in 2009; a polio resurgence in 2014; the Ebola epidemic in West Africa that year; the Zika virus outbreak in 2016; and an Ebola outbreak in the Democratic Republic of Congo last year.
Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the discoverers of the Ebola virus and the presence of AIDS in Africa, agreed with the W.H.O.’s emergency declaration but felt the process was flawed.
“It is time for the W.H.O. to change its all-or-nothing, binary approach” to declaring an emergency, Dr. Piot said. “In every emergency, there is a spectrum of alert levels.”
Dr. Tedros expressed the same frustration at a news conference on Wednesday, suggesting that the agency might need to switch to a graduated “green-yellow-red" system.
Austin Ramzy contributed reporting from Hong Kong, and Chris Horton from Taipei. Elsie Chen contributed research.