The World Has a Plan to Fight Coronavirus. Most Countries Are Not Using it.



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For weeks, the World Health Organization resisted declaring the coronavirus outbreak a pandemic, fearing that doing so would incite panic across the globe.


But facing the cameras on Wednesday, the agency’s director general, Dr. Tedros Adhanom Ghebreyesus, did just that, asking for global unity to “change the course of this pandemic.”

但是在周三,面对镜头的世卫组织总干事谭德塞(Tedros Adhanom Ghebreyesus)博士将其定性为大流行,要求全世界团结起来“改变这场流行病的进程”。

It was a symbolic moment that underscored the standing of the W.H.O. as the world’s leading public health agency. But it also reflected the W.H.O.’s underlying weakness as an organization that by international treaty is supposed to lead and coordinate the global fight against coronavirus — yet that has, in many ways, been marginalized.


Global solidarity has been noticeably absent in the fight to stop an outbreak that has already killed more than 4,300 people and spread to more than 110 countries. No one seems to be in charge. There doesn’t seem to be a plan.


Except there is one. The problem is that relatively few countries are paying much attention to it.


Fifteen years ago, the World Health Organization undertook a major revision of the International Health Regulations, the global framework for responding to outbreaks. The revision was intended to correct flaws in the global response to the 2003 SARS outbreak, which killed hundreds of people and pushed advanced health care systems to the breaking point.

15年前,世卫组织对疫情的全球应对行动框架《国际卫生条例》(International Health Regulations)进行了重大修订,旨在纠正全球在2003年SARS疫情中的反应缺陷,那次疫情造成了数百人死亡,并将多个先进的卫生保健系统推向了崩溃的边缘。

The basic idea was that the W.H.O. would serve as a central coordinating body. Countries would notify the agency about outbreaks and share information to help scientists address an epidemic at the global level. The W.H.O. would coordinate efforts on containment, declare emergencies and make recommendations. The revised regulation is legally binding and has been signed by 196 countries, including the United States.


But dozens of countries are flouting the international regulations and snubbing their obligations. Some have failed to report outbreaks to the organization, as required. Others have instituted international travel restrictions, against the advice of the W.H.O., and without notifying global health officials.


“One of the biggest challenges we face is that too many affected countries are still not sharing data with W.H.O.,” Dr. Tedros said last month. He has also blamed some countries — he has refused to specify which ones — for failing to take the outbreak seriously enough.



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As part of the United Nations, the W.H.O. is broadly influential yet hampered by budget and political pressures. It lacks meaningful enforcement authority, creating a telling power imbalance. It is often accused of kowtowing to its donors — from powerful players like the United States and China to private funders like the Gates Foundation.

作为联合国的一部分,世卫组织具有广泛的影响力,但受到预算和政治压力的阻碍。它缺乏有意义的执法权,造成了明显的权力不平衡。人们经常指责它屈从于捐助者——从美国和中国这样的大国到盖茨基金会(Gates Foundation)这样的私人出资者。

These contradictions contributed to the agency’s much-criticized response to the Ebola outbreak in West Africa and led some scholars to question the need for such a weak institution. But Rebecca Katz, a scholar at Georgetown University, said such criticism misses a fundamental point.

这些矛盾导致该机构在西非埃博拉病毒疫情的应对上遭致广泛批评,一些学者甚至质疑如此软弱的机构是否有必要存在。但是乔治城大学(Georgetown University)的学者丽贝卡·卡兹(Rebecca Katz)表示,这种批评忽略了一个基本点。

“If there wasn’t a W.H.O., you’d have to invent it,” said Dr. Katz, who has studied health regulations for more than a decade. “They are in a bit of a tough spot because you know you have international law but then you also know that every nation is sovereign,” she said.


This time, some former critics credit the W.H.O. for doing a better job, declaring a global emergency much quicker than it did during the SARS and Ebola outbreaks, consistently sharing information with the public and convening more than 300 scientists and research funders to help develop tests, vaccines and medicines.


Even so, the agency is also marginalized in many ways.


The most obvious examples are the global flouting of international travel restrictions. More than 70 countries have instituted the restrictions, according to the W.H.O., including the United States, where President Trump announced on Wednesday night restrictions to travel from the European continent.



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Yet in four advisories it has issued since early January, the W.H.O. has consistently advised against them, cautioning that limits on international movement during public health emergencies are unlikely to stop the pathogen’s spread.


The rules do not apply to domestic travel restrictions or to decisions made by private airlines, but the W.H.O. has repeatedly warned that international bans can block needed resources, or delay aid and technical support. Such restrictions are justified only at the beginning of an outbreak to buy nations time to prepare, the agency said. Beyond that, they are more likely to cause significant economic and social harm.


Meanwhile, only 45 of the more than 70 countries that have adopted international travel restrictions have fulfilled the requirement to report their actions to the agency, a spokesman said.


Then there is the unwillingness of some countries to lift a ban on the export of protective equipment, complicating the broader fight against the disease. France and Germany have put limits on exports of such gear.


“We can understand that governments have a primary responsibility to their own health workers,” said Michael Ryan, who heads the W.H.O.’s health emergencies program.

“我们可以理解,政府对本国的卫生工作者负有首要责任,”领导世卫组织卫生应急计划的迈克尔·瑞安(Michael Ryan)说。

He urged nations to stop hoarding gear and called for solidarity across the globe.


“The life of a health worker in one country is certainly as valued as the life of a health worker in another,” Dr. Ryan said on Monday.



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The national governments that signed onto the international regulation also left themselves a loophole, which they are exploiting now.


The loophole was the product of hours of negotiations in Geneva, where the revisions were finalized in 2005, according to Gian Luca Burci, who served as the agency’s legal counsel for 11 years. Mr. Burci said negotiators stayed up until 5 a.m. before agreeing on a trade-off that balanced “public health considerations and the retention of the ultimate political power.”

曾任世卫组织法律顾问11年的吉恩·卢卡·伯奇(Gian Luca Burci)表示,这个漏洞是2005年该协议修订工作在日内瓦敲定期间经数小时谈判的结果。伯奇说,谈判代表们一直呆到凌晨5点,然后才达成一项折衷协议,在“公共卫生考虑和保留最终政治权力”之间取得平衡。

Countries were reluctant to cede total control to an international agency. They drafted a provision that gave them the right to take health measures that they believed would have similar or better results than W.H.O. recommendations — on the premise that these measures were scientifically grounded and for the common good.


“States gave themselves a ‘get-out-of-jail-free’ card,” Mr. Burci said.


Under the rules, countries are obligated to report to the health agency within 48 hours any measures that they take beyond the collective guidelines, as well as report the rationale behind their actions. Many countries have failed to do so during the coronavirus outbreak, and the W.H.O. can do little about it.


In some cases, W.H.O. officials learned of travel shutdowns only after they happened, from reports in the media.


“What do we really mean if nobody is following W.H.O.’s recommendation with impunity,” Mr. Burci asked.


Because they have no power to enforce international regulations, W.H.O. officials have to walk a diplomatic tightrope. In a statement, a W.H.O. spokesman said that the agency “cannot compel countries to change measures they have implemented.”



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Last month, Dr. Tedros sent two letters, which have not been made public, reminding nations about their obligations. His staff has collated media reports on the flurry of travel restrictions and is chasing after countries to obtain their rationale.


Agency officials have resisted naming and shaming countries that breach the rules and have largely dodged media questions on the subject.