The Outbreaks That Never Happened and the Unseen Success of Global Institutions

Given all the death and dysfunction resulting from the COVID-19 pandemic, it is worth appreciating the many potential outbreaks that never happened, thanks to the efforts of Kenya, Mozambique, and Niger, alongside the United Nations and other international partners

In December 2019, just months before the COVID-19 pandemic came in full swing, these nations managed to halt an outbreak of a rare strain of “vaccine-derived polio”, which occurs “where overall immunization is low and that have inadequate sanitation, leading to transmission of the mutated polio virus”. It is all the more commendable given that Niger is among the ten poorest countries in the world.

The fact that polio remains both rare and relatively easy to quash is the results of a U.N.-backed campaign announced in 2005 to immunize 34 million children from the debilitating disease, which often leaves victims permanently disabled. The effort was led by  by World Health Organization the U.N. Children’s Fund (UNICEF), Rotary International, and the United States Centers for Disease Control and Prevention.

A nurse administers an oral poliovirus vaccine (OPV) to a baby at the Kaloko Clinic, Ndola, Zambia.
© UNICEF/Karin Schermbrucke

A little over fifteen years later, two out of three strains of polio have been eradicated—one as recently as last year—while the remaining strain is in just three countries: Afghanistan, Nigeria, and Pakistan. This once widespread disease is on its way to becoming only the second human disease to be eradicated, after smallpox, which once killed tens of millions annually. That feat, accomplished only in 1979, was also a multinational effort led by the U.N., even involving Cold War rivals America and Russia.

Even now, the much-maligned WHO actively monitors the entire world for “acute public health events” or other health emergences of concern that could portend a future pandemic. As recently as one month ago, the U.N. agency issued an alert and assessment concerning cases of MERS-Cov (a respirator illness related to COVID-19) in Saudi Arabia. Dozens of other detailed reports have been published the past year through WHO’s “Disease Outbreak News” service, spanning everything from Ebola in Guinea to “Monkeypox” in the United States. (WHO also has an influenza monitoring network spanning over half the world’s countries, including the U.S.).

Not bad for an agency with an annual budget of slightly over two billion—smaller than many large U.S. hospitals. (And contrary to popular belief in the U.S., the WHO did in fact move relatively quickly with respect to the COVID-19 pandemic:

On 31 December 2019, WHO’s China office picked up a media statement by the Wuhan Municipal Health Commission mentioning viral pneumonia. After seeking more information, WHO notified partners in the Global Outbreak Alert and Response Network (GOARN), which includes major public health institutes and laboratories around the world, on 2 January. Chinese officials formally reported on the viral pneumonia of unknown cause on 3 January. WHO alerted the global community through Twitter on 4 January and provided detailed information to all countries through the international event communication system on 5 January. Where there were delays, one important reason was that national governments seemed reluctant to provide information

Of course, it goes without saying that the WHO, and global institutions generally, have their shortcomings and failings (as I previously discussed). But much of that stems from structural weaknesses imposed by the very governments that criticize these international organizations in the first place:

WHO also exemplifies the reluctance of member states to fully trust one another. For example, member states do not grant WHO powers to scrutinise national data, even when they are widely questioned, or to conduct investigations into infectious diseases if national authorities do not agree, or to compel participation in its initiatives. Despite passing a resolution on the need for solidarity in response to covid-19, many member states have chosen self-centred paths instead. Against WHO’s strongest advice, vaccine nationalism has risen to the fore, with nations and regional blocks seeking to monopolise promising candidates. Similarly, nationalistic competition has arisen over existing medicines with the potential to benefit patients with covid-19. Forgoing cooperation for selfishness, some nations have been slow to support the WHO organised common vaccine development pool, with some flatly refusing to join.

The tensions between what member states say and do is reflected in inequalities in the international governance of health that have been exploited to weaken WHO systematically, particularly after it identified the prevailing world economic order as a major threat to health and wellbeing in its 1978 Health for All declaration. WHO’s work on a code of marketing of breastmilk substitutes around the same time increased concern among major trade powers that WHO would use its health authority to curtail private industry. Starting in 1981, the US and aligned countries began interfering with WHO’s budget, announcing a policy of “zero growth” to freeze the assessed contributions that underpinned its independence and reorienting its activities through earmarked funds. The result is a WHO shaped by nations that can pay for their own priorities. This includes the preference that WHO focus on specific diseases rather than the large social, political, and commercial determinants of health or the broad public health capacities in surveillance, preparedness, and other areas needed for pandemic prevention and management

In fact, it was this prolonged period of chronic underfunding, and of WHO member states prioritizing nonemergency programs, that precipitated the agency’s abysmal failings in the early phases of the 2014 Ebola outbreak. But once that crisis ended, member states, rather than defund or abandon the organization, opted to reform and strengthen its emergency functions; this overhaul resulted in the Health Emergencies Program, which was tested by the pandemic and thus far proven relatively robust:

On 31 December 2019, WHO’s China office picked up a media statement by the Wuhan Municipal Health Commission mentioning viral pneumonia. After seeking more information, WHO notified partners in the Global Outbreak Alert and Response Network (GOARN), which includes major public health institutes and laboratories around the world, on 2 January. Chinese officials formally reported on the viral pneumonia of unknown cause on 3 January. WHO alerted the global community through Twitter on 4 January and provided detailed information to all countries through the international event communication system on 5 January. Where there were delays, one important reason was that national governments seemed reluctant to provide information.

I know I am digressing into a defense of WHO, but that ties into the wider problem of too many governments and their voters believing that global governance is ineffective at best and harmfully dysfunctional at worst. We Americans, in particular, as constituents of the richest country in the world, have more sway than any society in how institutions like the U.N. function—or indeed whether they are even allowed to function.

As our progress with polio, smallpox, and many other diseases makes clear, what many Americans decry as “globalism” is actually more practical and effective than we think, and increasingly more relevant than ever. We fortunately have many potential outbreaks that never happened to prove it.

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