WHO are you going to call?

If they made a movie about the World Health Organisation, one of the themes might take a leaf out of the movie Ghost Busters.  With COVID-19 being a reality of life there is a lot of work to be done in keeping watch on the world’s health and wellbeing. 

Question:  How long is the COVID—19 outbreak going to be a factor in life?  Answer:  It is literally anyone’s guess but one organisation with more clues than most is the World Health Organisation.  With the advent of Coronavirus (COVID-19) WHO is at the forefront of monitoring and managing this pandemic, a global crisis.  Overseeing immediate responses, co-ordinating medium-term interventions and striving for long-term solutions.

There are international standards and measures to assess the health status of a nation, regions of the world and the world collectively. WHO continually gathers, analyses, and publishes this data to keep governments and key central bodies such as New Zealand Ministry of Health constantly informed. New Zealand citizens can easily access WHO information portals to learn more about what is at work in dealing with this pandemic. 

WHO is a specialized agency of the United Nations (UN).  While the parent entity deals with solving international problems of an economic, social, cultural, or humanitarian nature, WHO’s territory and mandate is in the global health arena. 

In the case of a pandemic such as COVID-19, this means every person on the planet is reliant on the work of WHO.    

Its main objective is "the attainment by all peoples of the highest possible level of health and keeping the world safe.”  It provides leadership in many forms on matters critical to health and engaging in partnerships where joint (or several) action is needed. 

The world health watchdog

As with other major health crisis* WHO has been at the centre of the COVID-19 storm both in terms of pandemic management and global media attention.  Despite the efforts of some member states in trying to politicise the process and role, WHO have continued to provide its key ‘watch dog’ and leadership functions and expertise. It remains one of the most important sources for credible information and appropriate action. 

7,000 WHO staff worldwide connect, and collaborate, with 194 member states and partners, at a global, regional, country, organisation, and even individual level. Those layers of connectivity deal with both the macro and microelements of crisis management.  Firstly to ‘ring fence’, then contain, then systematically control, and eradicate the problem, such as an epidemic or pandemic.  This is not the only aspect of the organisation’s work and function. 

The range of threats to public health faced by countries worldwide is broad and highly diverse.  This can include infectious disease outbreaks, unsafe food and water, chemical and radiation contamination, natural and technological hazards, wars and other societal conflicts, and the health consequences of climate change.

WHO collaborates with a wide variety of governmental and non-governmental agencies to respond to national and global health challenges and to bring better health to people of a region. WHO partners include countries, the United Nations system, international organisations, civil society, foundations, academia, research institutions and people and communities. WHO convenes and participates in a number of forums that influence the policy and practice of all aspects of health developments and health care, inclusive of emergency risk management planning and responses, such as the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. WHO’s work is also aligned with and informed by international frameworks such as the Sendai Framework for Disaster Risk Reduction 2015-2030 and other UN system policies and plans.

WHO does not work solely with health-focussed entities?  For example, it cooperates with The World Bank—an international financial institution that provides loans and grants to governments for pursuing capital projects. This is in line with the bank’s efforts to achieve universal health coverage.   

The global leadership of WHO in relation to COVID-19 provides safety for all citizens of the world. Literally each day brings new insights into how to prevent, manage and contain outbreaks. 

An alliance led by WHO during September 2020 resulted in 156 nations signing up to a global scheme for fair distribution of future vaccines against COVID-19.  This will account for about two-thirds of the world population. Sixty-four of these nations are rich nations who have agreed with the other 92 nations to deliver 2 billion vaccine doses round the world by the end of 2021, prioritising health care workers and the vulnerable. WHO director-general Tedros Adhanom Ghebreyesus said, “this is not a charity, it’s in every country’s best interest. We sink or we swim together… This is not just the right thing to do; it’s the smart thing to do.”

Another WHO initiative saw Helen Clarke former Prime Minister of New Zealand and Ellen Johnson-Sirleaf former President of Liberia and a Nobel laureate appointed as joint chairs of the Independent Panel for Pandemic Preparedness and Response. This panel led the early stage international investigations into the emergence (when and how it emerged), the global spread of COVID-19, and how the world is responding to the pandemic.

Historical Perspective:  How does progress with COVID-19 compare to previous epidemics and pandemics?

COVID-19 was first identified in December 2019, by 20 August 2021 there had been 210million confirmed cases, and 4.4million million deaths across the world.  New variants of the COVID-19 virus, and despite the introduction of vaccines, means this toll will continue to rise into the foreseeable future.   How does this compare with some of the world’s most devastating *disease outbreaks?

Disease Name	Spread	Start Date	End Date	Cause	Total Deaths in millions
HIV/AIDS	Global	1981	Continues	Chimpanzee	32
Hong Kong Flu (H3N2)	Global	1968	Continues	Birds	1
Asian Flu (H2N2)	Global	1957	1958	Birds	1.1
Spanish Flu (H1N1)	Global	1918	1919	Pigs	50
Poliomyelitis (Polio)	Global	Pre-history, but major epidemics since 1900	Since 2020 endemic in  only Pakistan & Afghanistan	Poliovirus	1940’s & 1950’s paralyze or kill 1/2m per year
Cholera 6	Global	1899	1923 (note 7th wave is now in Indonesia)	Bacterium Vibrio	10
3rd Plague Pandemic	Global	1894	1922	Rats & Fleas	10
Russian Flu	Global	1889	1890	Influenza A	1
Cocoliztli 2	Mexico	1576	1578	Rodents	7 – 15 (50% of native population)
Cocoliztli 1	Mexico	1545	1548	Cause not identified	5 – 15 (80% of native population)
Black Death (Bubonic Plague)	Global	1347	1351	Fleas & Lice	75-200
Plague of Justinian	Byzantine Empire	541 – 549 (1st Plague Pandemic)	767 (15 – 18 major waves of plague followed 549 until 767)	Bacteria Yersinia Pestis	15-100
Smallpox	Worldwide	10,000 BC	1980	Variola Virus	500 from 1880-1980 (estimated ≥   5m/yr 10,000BC – 1880)

Historical Perspective:  How does progress with COVID-19 compare to previous epidemics and pandemics?

COVID-19 was first identified in December 2019, by 20 August 2021 there had been 210million confirmed cases, and 4.4million million deaths across the world.  New variants of the COVID-19 virus, and despite the introduction of vaccines, means this toll will continue to rise into the foreseeable future.   How does this compare with some of the world’s most devastating *disease outbreaks?

The Disease Police: 

WHO continually monitors local through to global disease outbreaks including epidemics and pandemics.  Given the severity of many of the world’s health challenges having a ‘watch dog’ in the form of WHO is of immense value.  Along with any new strains that might be incubating somewhere prior to a more major outbreak.

Somewhere in the world, the next COVID-19 could be hatching.          

• Chikungunya-- a mosquito-borne viral disease that causes fever and severe joint pain. The disease was first recognized in 1952 during an outbreak in southern Tanzania. The disease occurs in Africa and Asia, although imported cases have been recorded in the WHO European Region and the Region of the Americas. Over 2 million cases have been reported since 2005.  
• Cholera--an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and is an indicator of inequity and lack of social development. Researchers have estimated that every year, there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to the infection.
• Crimean-Congo haemorrhagic fever--a viral haemorrhagic fever usually transmitted by ticks. It can also be contracted through contact with viraemic animal tissues (animal tissue where the virus has entered the bloodstream) during and immediately post-slaughter of animals. CCHF outbreaks constitute a threat to public health services as the virus can lead to epidemics, has a high case fatality ratio (10-40%), potentially results in hospital and health facility outbreaks, and is difficult to prevent and treat. CCHF is endemic in all of Africa, the Balkans, the Middle East and in Asia. 
• Ebola virus disease (EVD)--a severe, often fatal illness affecting humans and other primates. The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-human primates) and then spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. The average EVD case fatality rate is around 50%. Case fatality rates have varied up to 90% in past outbreaks.
• Hendra virus infection--is a rare emerging zoonosis (disease that can be transmitted to humans from animals) that causes severe and often fatal disease in both infected horses and humans. The natural host of the virus has been identified as being large fruit bats (flying foxes). Occasionally the virus can spread from these large fruit bats to horses, and horses can then pass the infection onto humans. The first recorded outbreak of the disease was in Brisbane in the suburb of Hendra, Australia, in 1994. The outbreak involved 21 stabled racehorses and two human cases. As of July 2016, 53 disease incidents involving over 70 horses have been reported. These incidents were all confined to the north-eastern coast of Australia. A total of seven humans have contracted Hendra virus from infected horses.
• Lassa fever--is an acute viral haemorrhagic illness caused by Lassa virus, a member of the arenavirus family of viruses.  Humans usually become infected with Lassa virus through exposure to food or household items contaminated by rodents.  Lassa fever is known to be endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, Togo, and Nigeria. About 80% of people who become infected with Lassa virus have no symptoms. 1 in 5 infections result in severe disease, where the virus affects several organs such as the liver, spleen, and kidneys. 
• Marburg virus disease-- A highly virulent condition that causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Two large outbreaks that occurred simultaneously in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, in 1967, led to the initial recognition of the disease. Once an individual is infected with the virus, Marburg can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes); with the blood, secretions, organs or other bodily fluids of infected people; and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
• Meningitis--is a serious infection of the meninges, the membranes covering the brain and spinal cord. It can be a devastating disease and remains a major public health challenge. The disease can be caused by many different pathogens including bacteria, fungi, or viruses, but the highest global burden is seen with bacterial meningitis. Meningococcal meningitis can affect anyone of any age, but mainly affects babies, preschool children, and young people. The disease can occur in a range of situations from sporadic cases, small clusters to large epidemics throughout the world, with seasonal variations. 
• Monkeypox-- causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, Monkeypox continues to occur in countries of Central and West Africa. Human-to-human transmission is limited, with the longest documented chain of transmission being six generations, meaning that the last person to be infected in this chain was six links away from the original sick person. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects. 
• Nipah virus infection--Is a zoonotic virus (it is transmitted from animals to humans) and can be transmitted through contaminated food or directly between people. In infected people, it causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis (brain swelling). The virus can also cause severe disease in animals such as pigs, resulting in significant economic losses for farmers. Although Nipah virus has caused only a few known outbreaks in Asia, it infects a wide range of animals and causes severe disease and death in people.
• Rift Valley fever-primarily affects animals but also has the capacity to infect humans. It is transmitted by mosquitoes and blood feeding flies. In humans, the disease ranges from a mild flu-like illness to severe haemorrhagic fever that can be lethal. When livestock are infected, the disease can cause significant economic losses due to high mortality rates in young animals and waves of abortions in pregnant females. It was first identified in 1931 in a sheep epidemic on a farm in the Rift Valley of Kenya. Since then, outbreaks have been reported in sub-Saharan Africa and North Africa. In 2000, the first reported cases of the disease outside the African continent came from Saudi Arabia and Yemen. 
• SARS-- Severe Acute Respiratory Syndrome (SARS) is a respiratory illness that affected many people worldwide in 2003. SARS was caused by a new coronavirus that had never been found in people before, it is a coronavirus correct name is SARS-CoV. First reported in Asia in February 2003, the illness spread to 29 countries, where 8,096 people got SARS and 774 of them died. The SARS global outbreak was contained in July 2003. Since 2004, there have not been any known cases of SARS reported anywhere in the world.
• Yellow fever--An epidemic-prone mosquito-borne vaccine preventable disease that is transmitted to humans by the bites of infected mosquitoes.  A global strategy has been developed by a coalition of partners (Gavi, UNICEF and WHO) to face yellow fever’s changing epidemiology, resurgence of mosquitoes, and the increased risk of urban outbreaks and international spread. This global, comprehensive long-term strategy (2017-2026) targets the most vulnerable countries, while addressing global risk, by building resilience in urban centres, and preparedness in areas with potential for outbreaks and ensuring reliable vaccine supply.
• Zika virus disease--The Zika virus, first identified in Uganda in 1947, is transmitted by Aedes mosquitoes, the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific. The virus causes birth defects in babies born to some infected pregnant women, including microcephaly, where babies are born with underdeveloped heads and brain damage. Zika has also been linked to Guillain-Barre syndrome, a condition in which the immune system attacks the nerves. 

The WHO Surveillance System is an established process that monitors and reports across the world on the numbers of people with a diagnosed disease, rates of occurrence, patterns of spread, characteristics of the disease in that country, operational actions in that country; etc, etc of both emergent and established diseases. Countries signed up to the Surveillance System have a population data set and specific questions they have to regularly report to the WHO which in turn collates, reports and keeps the world informed; and provides leadership regarding interventions, collaborations and efforts to prevent, manage and contain the spread of these diseases. The current WHO surveillance data for COVID-19 can be seen at: WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data.