In the early afternoon of Jan. 31, the lead World Health Organization representative in Beijing held a video briefing to update diplomats on the spread of a deadly new virus – and to laud China for everything it was doing.
Only a day before, the WHO had declared a “public-health emergency of international concern” over the deadly new coronavirus that causes COVID-19, after an initial outbreak in China’s Hubei province began to spread around the world. The WHO also said no restrictions on travel or trade were necessary.
On the video briefing, the WHO’s top man in China, Gauden Galea, praised the Chinese virus response. Then he went a step further, calling on other countries not to step out of line with the WHO recommendations, a key concern for Beijing, which was furious that countries were beginning to close their borders to Chinese travellers.
Any United Nations member country “will have to scientifically justify” any measure that "goes beyond UN recommendation. This justification will be made public,” Mr. Galea said, according to notes of the meeting made by one of the participants and seen by The Globe and Mail.
Being worried, even scared, in these circumstances is totally understandable. Looking out for your mental, as well as physical, health is important, but the physical distancing required to protect others from the coronavirus can create a “cocoon” of isolation that makes self-care difficult.
What can you do? We asked experts for advice:
- Keep a routine: Give yourself structure. Eat healthy, stay active and get plenty of sleep.
- Keep things in perspective: Remind yourself that most people experience mild illness and this will come to an end. Avoid going down internet rabbit holes.
- When and where to seek help: Feeling very irritable, snapping at others and having a hard time sleeping are signs you are not able to cope on your own. CAMH and the Canadian Psychological Association have resources to recognize that behaviour and adapt. The Globe also has a guide to what services are available and how to protect your mental health.
- Communication: Remote teams can’t rely on body language. Any way you can help your staff feel involved and connected organically is a win.
- Check-ins: There’s enormous value in discussing morale, mental health and social wellness.
- Social distance – not isolation: Start traditions. Remote teams need things to look forward to and opportunities to connect in stress-free ways.
It amounted to a warning from the WHO, said the person, whose identity The Globe is not disclosing because the source is not authorized to speak publicly. And it was directly in line with messages from Beijing, which in subsequent days said it “deplored” countries that ignored WHO recommendations and enacted travel bans that, according to Foreign Ministry spokeswoman Hua Chunying, “sowed panic among the public” and “gravely disrupted” trade.
Now, with the virus rapidly spreading across Canada, new questions are being asked about the WHO’s relationship with China and whether the organization has sought to curry favour with Beijing – for access or money – in ways that have undermined the reliability of its advice.
In 2003, the WHO vocally criticized Chinese leadership for covering up the initial spread of the virus that caused SARS. Amid the COVID-19 pandemic, however, the organization has pointedly refused to denounce China’s concealment of information, even after it became clear that authorities in China had muzzled doctors.
In mid-January, the WHO said it had no evidence of person-to-person transmission of a virus that has subsequently shown a remarkable ability to spread through communities. And the WHO has relied on Chinese official data even when their veracity have been called into doubt – most recently by the U.S. intelligence community, which believes China deliberately manipulated numbers to mask the severity of its COVID-19 toll.
The trustworthiness of the WHO is a particular concern for countries like Canada, where public-health leaders have sought to follow WHO recommendations despite internal warnings about the reliability of information coming from China. On Thursday, Ms. Hua sought to deflect concern, saying, “China has been giving open, transparent and timely updates to the world.” Rather than listen to those accusing China of a cover-up, she said, “we should listen to the WHO.“
But concern about the relationship between the WHO and China has grown more intense as the virus pandemic claims tens of thousands of lives, bringing new attention to early failures in detection and containment. The WHO cannot work in China without Beijing’s support, and the organization has won praise for its more recent advocacy of strong measures to counter COVID-19.
The WHO, in a statement, said Mr. Galea in the January briefing “referred to the sovereign right of all countries to take the measures they see fit.” But to some in attendance, his admonition only added to worry that the WHO was prioritizing the interests of China over those of other countries.
“National governments didn’t get warned as urgently as perhaps they could have by World Health officials about the severity and potential for non-containment of the virus,” said Andrew Lakoff, an anthropologist of science and medicine at University of Southern California Dornsife. A key question now is: ”What did the WHO know and why didn’t they earlier and more urgently warn other member states?” he said.
Andrew Cooper, a professor at the Balsillie School of International Affairs in Waterloo, Ont., who studies global health governance, is blunt: For WHO director-general Tedros Adhanom Ghebreyesus, “his priority is to maintain good relations with China.” Beijing has provided more cash than Washington to the WHO COVID-19 response. But China remains far from the largest contributor to the WHO, giving less than 10 per cent of what the United States provided last year.
Beijing, however, has made concerted efforts to increase its influence at key international organizations, and the WHO missteps on COVID-19 have brought that into striking relief.
The “evident bias” in favour of China at the WHO “matches the weakness of other UN organizations in the face of China’s powerful campaigning,” François Godement, senior adviser for Asia at the Institut Montaigne, wrote in a recent internet post. Once China itself began to act decisively against the virus, the WHO became a valuable clearinghouse for information, he wrote. But a key question for the WHO remains “how to lessen the impact of a relentless authoritarian regime.”
Canada has publicly expressed confidence in the WHO. Canadian Health Minister Patty Hajdu initially said Canada would follow WHO advice to avoid travel bans, saying “there isn’t evidence” for their effectiveness. It was not until March 18 that Canada closed its borders to most foreigners.
On Thursday, Ms. Hajdu said “there is no indication” that China has falsified data about virus infection and death rates, and accused a reporter of “feeding into conspiracy theories” for questioning the accuracy of Chinese data – and the WHO information that relies upon China.
Chinese authorities have themselves admitted that, until recently, their numbers of confirmed cases did not include people without obvious symptoms. Even in China’s tightly controlled media, numerous questions have been raised about the accuracy of China’s numbers, particularly after photos from coronavirus epicentre Wuhan showed large numbers of boxes containing cremated remains.
It’s a question that has been raised at the highest levels in Canada, too.
Beginning in late January, the Prime Minister’s Office received internal warnings questioning the reliability of China’s reporting on the spread of the virus epidemic, according to a person with knowledge of the information shared internally. The Globe is not identifying the person because they are not authorized to make public comments.
Canada had long since lost some of its own ability to independently scrutinize information coming from China. Under David Butler-Jones, Canada’s Chief Public Health Officer between 2004 and 2014, the Public Health Agency of Canada stationed a representative in Beijing – a medical doctor with a specialization in public health.
“It’s a way of getting an earlier heads up … so that if something is developing, we can get good intelligence on it early and get ahead of it,” Mr. Butler-Jones said in an interview. But the doctor who occupied that post left Beijing in 2015 and has not been replaced, leaving Canada with no one in such a position in China during the spread of COVID-19.
“For me, it’s frustrating,” Mr. Butler-Jones said. The position was in China “for good reason.”
Still, other sources of information underscored the threat. One was Taiwan, a region still plagued by memories of the Chinese cover-up of the SARS epidemic nearly two decades earlier. Taiwan, shut out of the WHO at the insistence of China, was ill-disposed to believe Beijing’s early assurances on the new coronavirus.
“We don’t trust anything related to new outbreaks from China,” said Chang-Chuan Chan, dean of the college of public health at National Taiwan University.
Taiwan began inspecting passengers arriving from Wuhan on Dec. 31, and sent a technical team to the virus-stricken city on Jan. 13 to 14. The delegation, which also included experts from Hong Kong and Macau, was controlled in what it could see, and denied access to the seafood market that is believed to be at the epicentre of the COVID-19 outbreak. But the Taiwanese experts came away convinced that “there is already person-to-person transmission,” Prof. Chan said.
This was out of step with the WHO, which issued a tweet on the night the Taiwanese left Wuhan saying “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission” of COVID-19.
The WHO acted “on the basis of available information,” said spokesperson Tarik Jasarevic, citing a statement from Chinese authorities on Jan. 14 that “there is no evidence to date of a highly contagious virus.”
The close partnership between Beijing and the WHO has continued, with some of the organization’s key leaders showing a striking deference to Chinese priorities, including Bruce Aylward, the Canadian doctor who led a WHO mission to China in February.
He attracted global attention last week when he disconnected a video interview with a Hong Kong journalist after being asked about Taiwan, which Beijing considers its territory. (“The question of Taiwanese membership in WHO is up to WHO member states, not WHO staff,” the organization said in a statement this week. On Thursday, the Hong Kong government said broadcaster RTHK “breached the One-China Principle” with the interview.)
Mr. Aylward’s mission provided another opportunity for co-operation between the WHO and China, which provided 12 of the 25 people on the delegation. Chinese involvement extended to the final edits of the subsequent report, including over which specific language was used.
“There was a bit of wording manipulation, but not the sentiment,” said Dale Fisher, a professor of medicine at the National University of Singapore, and one of the delegates. For example, “we wanted to call it a ‘dangerous’ pathogen, and they felt the word ‘dangerous’ could be linked to bio-terrorism.”
The final report calls COVID-19 “a new pathogen that is highly contagious, can spread quickly, and must be considered capable of causing enormous health, economic and societal impacts.”
The report is effusive toward China, whose virus response it calls “exceptional” and whose people it praises for a deep commitment to “collective action in the face of this common threat.”
All members of the delegation “contributed to the writing, intense discussions and finalization of the report and fully concurred with the final content and language,” said Mr. Jasarevic, the WHO spokesperson. “No major or even minor finding of the mission was not included in the final report.”
Dr. Fisher dismissed criticism that the WHO was too sunny in its report from the mission. ”Everything we saw and everything we learned has completely been replicated elsewhere,” he said, pointing to findings about the ratio of mild, severe and critical cases that have been similar in other countries. “If you’re asking me could it have been any better, my answer is no,” he said.
And it’s not fair to fault the WHO for the failures of other governments to respond, particularly after the severity of the virus became clear in Wuhan, said Bilahari Kausikan, an international affairs specialist who previously served as ambassador-at-large for Singapore.
The United States “wasted time denying that this was a serious issue,” he said. “You can’t blame the WHO for that. You can’t blame the WHO for the Europeans having a terrible, nonchalant attitude toward the whole thing.”
With a report from Alexandra Li
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