Controlling the coronavirus is not a medical problem
We wanted to compare and contrast its actions against those of Doctors Without Borders over the same period to determine when public health officials should raise the alarm about a global health emergency. Even though the clinical characteristics of the coronavirus are different from those of Ebola, the way public health authorities currently approach and frame the problem of controlling the current epidemic seem quite similar. This should concern us.
What the WHO failed to appreciate at the onset of the Ebola crisis is that controlling epidemics is not fundamentally a medical issue. The clinical aspects, such as the transmission rate or incubation time, are crucial because they define the constraints in which we can operate. However, no medical procedure or cure exists to stop the coronavirus. Our only chance at this time is to isolate it. The international community needs to do this with limited resources and under high uncertainty, while providing unambiguous messages to the population. This is, at its heart, a leadership problem.
From a solely medical perspective, the WHO has handled the coronavirus outbreak impressively. After less than two weeks (with the help of their international network), they were able to sequence the genes of SARS-CoV-2, recognize it as a new virus, and publish its genome sequences. Just one week after that, they provided countries with the means to develop tests for the virus. Never in history was a new virus identified so quickly. It took a couple of months to do this for the SARS virus in 2003.
But the WHO was not much celebrated for this early achievement. Its victory for medical science has been very quickly tarnished by the poor health crisis communications piece of the puzzle. In particular, many criticisms have been lobbed against the WHO regarding its deference to the Chinese government in the initial stages of the crisis. The ensuing suspicion of conflict of interest between the WHO and China raised serious doubts about the organization’s decision to keep the alert level below its maximum in the first weeks of the outbreak.
As we explored in our Ebola research, raising the alarm is one of the most challenging decisions that a health agency faces. It is especially true for the WHO, whose effectiveness to influence actions on the ground solely rests on its credibility. And the organization has been struggling over the past two decades with maintaining its ability to influence a coordinated reaction.
When the swine flu (H1N1) was spreading in 2009, the WHO raised the alarm very quickly, declaring it a pandemic of international concern. Anticipating high vaccination demand, contracting countries were faced with the choice to off-load or destroy excess vaccine doses at a considerable loss. The WHO was accused of “being in bed” with the pharmaceutical industry and contributing to a public health panic to enrich corporate partners. Factual or not, these suspicions hurt the reputation of the agency.
This loss of credibility affected the WHO’s ability to react with appropriate and timely messaging later on. The West African Ebola virus epidemic of 2014–2016 resulted in more than 10,000 deaths. As our research suggests, the WHO’s cautious response and late declaration of the outbreak as a health emergency of international concern was, in part, due to the reputational blows suffered in 2009.
How and when to raise the alert level is at its core a leadership decision problem. While the medical aspects are crucial, some of the key trade-offs faced by decision-makers are not clinical. For instance, agencies may want to raise the alarm gradually as a way to reflect their true assessment of the risk.
But this creates ambiguity for the population, which may be counter-productive. In Germany, for example, people who had a small but reasonable suspicion of infection could be tested – but at their own cost. This could not be more ambiguous. On the one hand, these people had the right to be tested, which indicated that they should. On the other hand, they had to pay for it, which discouraged them from doing so. (The Federal Ministry of Health has since issued a new rule stating that German public health insurers must assume any testing costs for the coronavirus – at least where a doctor believes there is a reasonable cause).
The coronavirus crisis is undeniably complex – for medical professionals and political leaders alike. The trade-offs between disclosure and reputational risk, between message simplification and open information flow, and between influencing public behavior and mandating public operations remain in dispute. But none of these are medical. The good news is that effective frameworks and knowledge in operations management, behavioral decision-making, and leadership do exist. We ignore them at our own peril.
This article was originally published by Forbes on March 18, 2020 and republished with permission.