Covid-19: How to Coordinate a Global Response

There’s a fire in your neighborhood. A blazing tree falls and crushes a home down the street. A fireball bursts from a house two doors down. Your next door neighbors roar off in an SUV. You’re hosing down your roof. Then, many of your neighbors do as well. Water pressure plummets. The fire burns closer.

Viruses, like fire, can thrive in the absence of collective action. While most humans respect property lines and national borders, the SARS-CoV-2 virus demonstrated a monstrous capacity to blaze through them. The first known case of COVID-19 emerged in late 2019. Just 15 months later, the virus has been documented in 192 countries, causing more than 110 million cases and 2.5 million deaths.

Countries have tried travel bans, municipal and nationwide lockdowns, school closures, partial restaurant seatings, sports bubbles, and numerous other measures that varied by country. 

The only thing that wasn’t tried: a unified global response. Why? 

In swift-moving, multicountry outbreaks, government officials look to the WHO. The organization codified its leadership status among 194 member nations in the International Health Regulations adopted in 2005. The agreement directs the WHO to make recommendations “to prevent, protect against, control and provide a public health response to the international spread of disease.” Countries agreed to designate IHR focal point agencies that would share information on disease outbreaks with the WHO and implement WHO recommendations. 

Problem: This didn’t really happen in late January 2020 when WHO declared a public health emergency of international concern. Initially, at least, most countries ignored WHO’s social distancing, testing, and tracing recommendations. The U.S., in particular, acted late or not at all on some recommendations. But Americans weren’t the only ones. Even as late as last September, one in three countries had no blueprint for coping with COVID. 

WHO’s lack of enforcement powers means the political support of the world’s influential nations is critical to any global COVID-19 response, says Ilona Kickbusch, PhD, a Geneva-based global health policy expert. But the WHO’s ability to persuade the world to take a unified approach was undermined early in the pandemic by the U.S., the WHO’s largest financial backer. 

Traditionally a leader in global health, the U.S. stepped back from that role during the Trump administration—retreating so far, in fact, that it left the WHO entirely. President Biden reversed that policy, but the damage may be lasting. Rebuilding America’s influence in global public health will require regaining the trust of nations that increasingly have come to regard the U.S. as unreliable. “Absent American leadership, the EU has to take on an active role in shaping the international response it can no longer rely on others to craft,” says Kickbusch, a member of the Global Preparedness Monitoring Board established by the WHO and the World Bank.

The world has to give the WHO and other international organizations the resources and mandate they need ... to stay ahead of disease outbreaks before they become pandemic.

So, what’s the best option for a genuinely global, coordinated response? “On the global stage, I think there is no alternative to WHO being at the center of it,” says Jennifer Nuzzo, DrPH ’14, SM, an Environmental Health and Engineering associate professor and a senior scholar at the Johns Hopkins Center for Health Security. “The world has to give the WHO and other international organizations the resources and mandate they need to spot potential threats, collect and share data, and to encourage individual countries to develop specific therapeutics and other health infrastructure that would be needed to stay ahead of disease outbreaks before they become pandemic.”

An empowered WHO could also pull other global levers to help countries. For example, it could advocate for debt relief and financial assistance that would allow low- and middle-income countries to divert money they now spend on interest payments to build health infrastructure. It also could persuade the World Bank and the International Monetary Fund to support countries that cannot hold their own in a global effort.

The WHO did take some important global steps. It successfully launched a consortium of countries and NGOs known as the ACT-Accelerator to promote the development, production, and distribution of COVID testing materials, vaccines, and therapies. The consortium hopes to produce at least 2 billion vaccine doses by the end of 2021, as well as a half billion rapid COVID tests for distribution to LMICs. 

COVAX, a branch of the ACT-Accelerator, is tasked with establishing guidelines to ensure that rich nations don’t hoard the world’s vaccine supply. But it may be too late on that front. By February, wealthy countries with just 16% of the world’s population had bought up more than half of all global vaccine doses, wrote Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health, in a Nature commentary. 

Another challenge in desperate need of coordination: The world’s nations have vastly differing manufacturing capabilities and will face COVID-19 spikes at different times. So, planners must devise ways to coordinate the production and distribution of test reagents, syringes, super-cold freezers, and other equipment, as well as face shields, surgical gowns, and other personal protective gear needed to protect health workers.

Kickbusch and other health officials say the U.S. must do a better job of providing global leadership, supplying economic and material resources, and encouraging other nations to work with the WHO. 

Past successes at confronting deadly outbreaks—notably the smallpox campaign that led to eradication—show the power of coordination, says David Peters, MD, DrPH ’93, MPH ’89, chair of International Health. Such global efforts require countries to see that their own health depends on the health of others, even those far beyond their own borders. Rich countries hoarding vaccines, for example, could leave poor nations unprotected for years—possibly creating reservoirs of dangerous variants that could reinfect the rest of the world. 

“Political and financial commitments need to be sustained,” Peters says, noting also the importance of better collective governance that can address the nationalistic tendencies of governments and the power of multilateral corporations. 

“This is a long-term and ongoing need,” he says.