How the World Health Organization is trying to learn lessons from Covid-19

More than three years on, the WHO has recently downgraded Covid-19 from a global health emergency. But we still don't know its origin for sure. Copyright 2023 The Associated Press. All Rights Reserved

The World Health Organization (WHO), which holds its annual Assembly in Geneva from May 21-30, says it is still looking for the origins of Covid-19. It has also set up intergovernmental negotiations on a new treaty to help prevent and prepare for the next pandemic. But what are the chances of success?

More than three years after the outbreak of Covid-19, the world’s worst pandemic in modern history, its origins are still not known for certain. China, where the outbreak started in a Wuhan animal market, is accused of lacking transparency. A WHO investigative team was not able to visit until a year after the outbreak. And while the majority of scientists believe the virus jumped from bats to humans via an intermediate animal in the Wuhan market, some sources in the United States have claimed again that the source was a leak from a Wuhan laboratory.

“I think there’s been a lot of scrutiny on the Chinese government and why it has not shared data more quickly, openly and widely,” says Suerie Moon, co-director of the Global Health CentreExternal link in Geneva. “I don’t see this as reflecting badly on the WHO but rather why did this particular government not make information available much sooner or openly?”

She refers in particular to the latest bizarre twist in this saga. In March this year, a group of researchers from several countries said they had found and downloadedExternal link newly released Chinese data which appeared briefly on a genetic database called GISAIDExternal link. This, they said, points to live wild raccoon dogs that were being sold for meat in the Wuhan market as the most likely intermediate host for the virus. The data was withdrawn from GISAID shortly afterwards to allow the Chinese to update their own reportExternal link, which has subsequently been published by the science magazine Nature.

Professor Edward Holmes of Sydney University in Australia, an expert in infectious diseases who co-authored a report on the new Chinese data, says he feels a mix of “anger and frustration” at its late release. “These data were generated in early 2020 and yet it has taken them three years to be released,” he told SWI. “This is in no way acceptable.”

Is it too late?

The so-called raccoon dog data, according to Holmes, “is probably the best evidence for a zoonotic origin that we will ever get”. “The key observation is that it shows there were multiple wildlife species in the Huanan market in 2019, completely contrary to what we were originally told,” he says. “In addition, we know that some of the wildlife species found at the market are susceptible to SARS-CoV-2. Although these data do not prove that any of the animals in the market were infected with the virus, they are exactly as expected if there was a zoonotic origin in the market.”

But will we ever know the origin of Covid-19 for sure, or is it too late? “I think it is very likely now too late to find the exact zoonotic origin,” Holmes told SWI. “The virus would likely have rapidly spread through a population of intermediate animal hosts and would not now be present in that population. Gone. The only way to trace it would be to look for antibodies to the virus in these animals, proving past infection, rather than the virus itself. But we don’t know exactly what species these animals were, where they came from, or if any of them alive in late 2019 are still alive today.”

Moon points out that there are other diseases, including HIV, for which we still don’t know the origin for sure. In the case of Covid, she thinks there are bona fide scientific challenges, but it is also not clear if all the data that exists has been shared. “Even if every single swab, every last fragment of data had been shared, would we know and have strong proof this is how it originated? The answer could be no,” she says. “I think that makes it quite challenging. And, of course, it’s highly political.”

In March, WHO director Tedros Adhanom Ghebreyesus denounced the “continuous politicisation” of the Covid origins issue and called once again for it to be left to scientists. He told the press in Geneva that the world health body had no intention of abandoning its research and that its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) had last year recommended some of the things that still need to be done.

SAGO, a group of scientific experts from various countries including Switzerland, said of the raccoon dog data in a March 18 statementExternal link that “although this does not provide conclusive evidence as to the intermediate host or origins of the virus, the data provide further evidence of the presence of susceptible animals at the market that may have been a source of human infections”.

Data sharing and vaccine equity ‘at heart’ of pandemic treaty

As part of WHO efforts to learn lessons from Covid-19, its member states in December 2021 agreed by consensus to start talksExternal link on a possible pandemic treaty to protect the world from future health emergencies. An Intergovernmental Negotiating Body (INB) was launched to draft the treaty and held its fifth meeting in April this year. The INB is working from a so-called “zero draftExternal link”, and the target date for completing negotiations is May 2024.

“One of the most controversial, sensitive and consequential issues is can governments strike a deal and say that in exchange for a commitment to share data, there will be a commitment to share vaccines, drugs and diagnostics,” Moon told SWI. “Right now, there’s no deal, governments have not agreed to that.”

On data sharing, she says governments also need to agree on platforms and rules. GISAID, which holds the largest amount of scientific data on Covid-19, is a private platform. This creates a “huge vulnerability”, she thinks. Governments also need to make public platforms such as INSDCExternal link more attractive to scientists by better protecting their ownership rights.

Moon says there are currently many sticking points, such as on the definition of a pandemic, intellectual property rules, financing and compliance arrangements. But the issue of data sharing in exchange for vaccine and medicine access is at the heart of the matter, she believes. While debate on this reflects the same divide between North and South seen during the pandemic, she hopes emerging middle income countries like China, India, Brazil and South Africa which have an interest in both could help serve as a “bridge” to a compromise.

Civil society is sidelined

Meanwhile, civil society groups say they are not sufficiently involved in the talks. “It’s a really big concern and has become more difficult as they’ve moved into the drafting group phase,” says Courtenay Howe of STOPAIDSExternal link and the Civil Society Alliance for Human Rights in the Pandemic TreatyExternal link (CSA).

Civil society has been lobbying from the start for more inclusion, she told SWI, and there was some progress with open hearings and sessions available online. But only groups in official relations with the WHO (“a long process”) or nominated by member states were allowed to participate. And since February 23, “we’re very concerned because now that it’s gone to the drafting group, it’s just member states”.

“Seeing the response to Covid-19 and health emergencies in the past, we don’t always see that more human rights-based response, and we see unequal access to medical countermeasures,” says Howe.

Accountability is key

She thinks civil society and grassroots organisations need to be more involved at both the drafting and subsequent monitoring stages. Howe stresses that even if the result is a legally binding text, it will need political will from member states to implement it.

“What we call the compliance and implementation parts of a treaty become very important, because all these commitments can be just words on a page unless you have some kind of effective accountability mechanism,” Moon agrees.

So what happens if there are binding commitments on data sharing and putting money into the health service but governments don’t follow up? “If the UK government says yes we signed this treaty, but we don’t have money to invest in the National Health Service, can anyone force the UK to do differently? No. But there is evidence that having monitoring, regular conferences where governments do peer review, naming and shaming can help. There are lots of little tools you can use so that over time you try to nudge countries into doing what they said they would do.”