COVID-19: Not just a global public health emergency

The World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) disease outbreak as Public Health Emergency of International Concern (PHEIC) on Jan. 30. The WHO International Health Regulations (IHR, 2005), 3^rd edition defines PHEIC “as an extraordinary event which is determined, as provided in these Regulations (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response.” Public health risk is defined as “a likelihood of an event that may affect adversely the health of human populations, with an emphasis on one which may spread internationally or may present a serious and direct danger.” WHO Director-General Dr. Tedros Adhanom Ghebreyesus explained during a news conference at WHO’s Geneva headquarters that the declaration of 2019-nCov outbreak as PHEIC was made because of “the potential for the virus to spread to countries with weaker health systems, and which are ill-prepared to deal with the disease outbreak.” At the time of the declaration, the WHO recorded 7,834 confirmed cases, including 7,736 in China, and 98 cases in 18 countries outside China, plus eight cases of human-to-human transmission in four countries: Germany, Japan, Vietnam, and the United States of America. WHO also recorded 170 deaths all in China due to the outbreak.

The 2019-nCov was first reported from Wuhan, China on Dec. 31, 2019. Almost six weeks later, on Feb. 11, the WHO announced an official name for the disease. The disease caused by 2019-nCov was officially named COVID-19, where “CO” stands for “corona,” “VI” for “virus,” and “D” for “disease” while “19” was for the year the outbreak was first identified in December 2019.

Ghebreyesus explained that under agreed guidelines between WHO, the World Organisation for Animal Health, and the Food and Agriculture Organization of the United Nations, there was a need “to find a name that did not refer to a geographical location, an animal, an individual or group of people and which is also pronounceable and related to the disease.” Based on “WHO Best Practices for the Naming of New Human Infectious Diseases” document dated May 2015, the aim is “to minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.”

Almost two weeks after being declared as PHEIC, COVID-19 has already infected 42,708 people in China and 393 people in 24 countries worldwide. There have been 1,017 deaths in China, mostly in Wuhan in Hubei province, while one death of a Chinese national outside China was reported in the Philippines. A second death due to COVID-19 was reported in Hong Kong.

During the news conference wherein the coronavirus outbreak was declared as PHEIC, Ghebreyesus congratulated China “for the extraordinary measures it has taken to contain the outbreak despite the severe social and economic impact those measures are having on the Chinese people.” But has China succeeded in containing the outbreak? And didn’t WHO’s declaration of the disease outbreak as PHEIC and renaming of the disease come a little too late?

The numbers of confirmed cases and deaths keep on increasing despite global and national responses to COVID-19. As of Feb. 160, the “WHO Coronavirus disease 2019 (COVID-19) Situation Report — 27” recorded 51,857 laboratory-confirmed cases (1,278 new) globally; 51,174 laboratory-confirmed cases (1,121 new), and 1,666 deaths (142 new) in China; and 683 laboratory-confirmed cases (157 new) in 25 countries and three deaths (one new) outside of China.

Various international news services have documented how China’s lockdown of a number of its cities has caused misery among its own people and caused a flared up of old anti-government sentiments. Outside China, the effects of COVID-19 are quite alarming.

In what seemed like an outbreak of anti-China and anti-Chinese hatred and revulsion, anti-China and anti-Chinese posts, messages, and tweets flooded cyberspace in almost every part of the world. Since the outbreak, international and national news reports were never empty of anti-Chinese incidents and confrontations in public places, including in institutions of higher learning.

While containing the COVID-19 outbreak remains high on the global and national agenda, COVID-19 has created or is creating another outbreak, inciting “moral panic” across the globe resulting in increased feelings of fear and anxiety exacerbated by feelings of lack of protection and certainty.

Who is manipulating the COVID-19 outbreak to cause moral panic across the globe? What is there to gain for these manipulators of moral panic or these moral entrepreneurs?

In his 1972 book Folk Devils and Moral Panics, known moral panic theorist Stanley Cohen defined moral panics in the following manner:

“Societies appear to be subject, every now and then, to periods of moral panic. A condition, episode, person or group of persons emerges to become defined as a threat to societal values and interests; its nature is presented in a stylized and stereotypical fashion by the mass media; the moral barricades are manned by editors, bishops, politicians and other right-thinking people; socially accredited experts pronounce their diagnoses and solutions; ways of coping are evolved or (more often) resorted to; the condition then disappears, submerges or deteriorates and becomes more visible. Sometimes the object of the panic is quite novel and at other times it is something which has been in existence long enough but suddenly appears in the limelight” (p.9).

Is there a justified cause for moral panic among us?

At the State level, the COVID-19 outbreak revealed not only the increased vulnerabilities of States, particularly those with weak public health infrastructures, it also intensified citizens and media’s increased demand for transparency and accountability from their governments in spite of governments’ increased call for tolerance and calm from their citizens and media.

At the global level, COVID-19 re-opened debates on the question, “Is the world better prepared?” In terms of a global public health response, COVID-19 resurrects debates about the weaknesses or limitations of the existing global health security regime. But have we created a global security regime? Empirical evidence shows that the answer is a “No.”

First, the WHO is considered as the supranational health authority. Despite its tremendous success in new Health Emergencies Programs and revised International Health Regulations (IHR 2005), all aimed at enabling a faster, more effective response to outbreaks and emergencies, the organization faces financial capacity limitations that affect the effectiveness of its organization and operations.

Second, the IHR (2005) requires all countries to develop, strengthen, and maintain eight core public health capacities, namely: 1.) national legislation, policy and financing; 2.) coordination and national focal point communications; 3.) surveillance; 4.) response; 5.) preparedness; 6.) risk communication; 7.) human resources; and, 8.) laboratory. However, the document “Lessons learnt from implementation of the International Health Regulations: a systematic review,” submitted to the WHO in 2017, revealed that “[g]iven varying levels of health and socioeconomic development across countries, there have been challenges in implementing these requirements… [b]y the original deadline of June 2012, only 42 (22%) of the 192 WHO Member States had met the core capacity requirements” (p. 110).

Third, issues of State sovereignty clash with the WHO’s mandate and its global legislation in the form of the IHR. The IHR 2005 has strengthened WHO’s position as a central global force with authority and accountability in the field of international health. But WHO’s position is constrained when States assert their national sovereignty.

The challenges are real as captured by former WHO Director-General Dr. Margaret Chan in her report, titled, “Ten years in public health 2007 — 2017” (2017) — “the factors that govern global health security extend well beyond the mandate of WHO and its capacity to respond… [m]uch responsibility falls to countries… affected countries need to report unusual disease events promptly and openly… [and] countries move out of the sanctuary of national sovereignty in the interest of common good” (p.26).

If not WHO, who will lead the charge of reforming the existing global health security regime? If the concept of WHO as a supranational health authority is evolving, then is the global health security regime still in the making? How many more disease outbreaks and how many more lives must be lost to disease outbreaks to attain a global health security regime? Finally, is the world better prepared to face COVID-19? Or is this article contributing to moral panic around the world?

Diana J. Mendoza, PhD, is Chair of the Department of Political Science at the Ateneo de Manila University.