The World Health Organization (who) has attracted an unprecedented level of criticism over its handling of the response to the covid-19 pandemic. To enhance its legitimacy and better prepare for a future pandemic, various proposals to reform the who and the International Health Regulations have been made. Against this background, this article seeks to contribute to the ongoing discussions by investigating the nature of who’s work and its activities. Starting from the premise that much of the criticism stems from the uneasy coexistence of politics and expertise in who’s work, this article analyses some of the most controversial aspects of who’s initial response to the covid-19 pandemic: (i) the alleged leniency towards China; (ii) the delay in declaring a public health emergency of international concern (pheic); and (iii) the delay in recommending the use of face masks for the general population. The article shows that politics infiltrates who activities in different ways, influencing even the processes that are conventionally seen as purely technical and science-based. At the same time, it argues that the influence of politics in who’s work should not be seen as some kind of atrophy, but should rather be considered a natural element that should be managed rather than dreaded.
The covid-19 pandemic has wreaked havoc in many aspects of our modern lives. Mandatory face masks, local and national lockdowns, and compulsory social distancing in public places have become a part of everyday routine all around the world. Despite these restrictions, the number of infections as well as related deaths have risen dramatically. As of 15 September 2021 – almost two years after the identification of the first patient in Wuhan – there were 227 million registered cases and approximately 4.67 million deaths.1 In reality these data only show a part of the picture and the real numbers are definitively much higher.2 However, the impact of the pandemic is not limited to the public health aspect, but also extends to the economic and political spheres. According to the latest estimates the global gross domestic product fell by 3.2% in 2020, with some parts of the world being affected even more severely (for example, the Euro Area saw a 6.5% contraction).3 One may also witness the progressive decline of the US as the global political leader and the rise of China, combined with the overall weakening of liberal democracy as a dominant political model.4 While none of these processes are new, the pandemic has clearly reinforced the pre-existing tendencies.
From the point of view of the World Health Organization (who) the covid-19 pandemic has been not only a serious organizational challenge but also an opportunity to show leadership and to reaffirm its authority in the field of global health. Unfortunately, as any reader is probably aware, its performance has been – to say the least – controversial. In particular, the who has been labelled as China’s accomplice in obscuring the real gravity of the outbreak in the initial phase of the pandemic.5 It has been also criticized for its supposedly late response in declaring a public health emergency of international concern (pheic), and for its various – purportedly deficient or delayed – recommendations (eg on face masks or on travel restrictions).6
The criticism levelled against the who has led to the establishment of the formal evaluation mechanisms: The Review Committee on the Functioning of the International Health Regulations (2005) during the covid-19 response,7 and the Independent Panel for Pandemic Preparedness and Response (ipppr).8 In their recent reports, many areas for improvement have been identified, both in national preparedness and in international cooperation in pandemic response. In line with the suggestions made by global health scholars,9 the reports have made several recommendations, ranging from ‘applying the precautionary principle’ in deciding whether to impose travel restrictions,10 to increasing who’s financing,11 and to adopting a new ‘Pandemic Framework Convention’.12
Without replicating the work of the evaluation mechanisms, this article seeks to contribute to understanding who’s covid-19 response by investigating the nature of the who and of its work. For an organization established in 1948, such an inquiry may seem tardy. Although the who has never been so much at the center of public debate as it is now, its work on infectious diseases (from smallpox to hiv/aids) as well as in public health in general has been analyzed by several generations of scholars from different disciplines.13 Nonetheless, in the context of the covid-19 pandemic, there is a renewed interest in better understanding why the who’s work is so easily exposed to criticism.
In the above context, some of the recent academic contributions have focused on the uneasy coexistence of expertise and politics in the work of the who. While the tension between these two dimensions was visible and discussed already in the 1990s,14 during the covid-19 pandemic it has arguably become even more acute. The spectrum of available scholarly voices is quite broad. For example, Kavanagh, Singh and Pillinger have argued that the mix of expertise and politics has actually produced some successful covid-19 initiatives (eg sharing of epidemiological data by Member States or setting up an innovative structure such as the Access to covid-19 Tools Accelerator).15 Taking a different point of view, Benvenisti has addressed the topic by referring to the distinction between political cooperation problems (which require ‘enforcing mechanisms to ensure compliance’16) and more technical coordination problems (which do not require such mechanisms and can be solved through the authority of knowledge and expertise).17 In this respect, he has contended that, although global health poses several cooperation problems, the who has been entrusted only with powers to resolve coordination problems. Therefore, the failures of the who would lie in its design, rather than in its actions.18
Other authors, however, believe that, even within the current legal and organizational constraints, the who could do more to successfully manage the co-existence of the political and expert dimension of its work. Alvarez, for instance, has indicated that some of the who’s shortcomings lie in typical ‘organizational pathologies’ that derive from being an expert-driven organization mostly made up health professionals, where different forms of expertise are often sidelined.19 Davies and Wenham have also taken a similar approach by criticising the who for failing to appreciate the importance of politics in global health and even considering it an ‘ignoble irritant’.20 They review a considerable body of literature on previous disease outbreaks such as h1n1 and Ebola, to suggest that there are at least ‘five entry points’ that the who could consider to start engaging more with the political side of global health.21
Building on this scholarship, this article starts from the premise that, like any international organization,22 the who is a hybrid creature that combines elements of technical and scientific expertise with politics.23 However, the coexistence of these two elements, as well as their impact on the organization and its work, does not seem to be not properly recognized. The who appears to portray itself as an expert-driven organization that stays away from the politics. In this narrative, specific public health decisions are taken solely on the basis scientific evidence. It is science, and not political considerations reflecting one’s preferences, that dictates specific course of action. This belief is also shared by many of the Members of the organization.
While dispelling this myth is valuable in itself, the ambition of this article goes further than that as it also attempts to show that political elements may infiltrate who activities in different – sometimes surprising – ways and influence even the processes that are conventionally seen as purely technical and science-based. Moreover, by undertaking our task in the context of the specific event (ie the early who pandemic response), we are not only able to test our general claims against the actual practice but also provide some new insights into how the pandemic has been handled at the international level, and what does it tell us about the organization as such. In our opinion, looking at the who pandemic response through the prism of interaction between expertise and politics can help to explain the limits of the currently existing mechanisms/processes. We also think that the proper understanding of the complex relation that exist between these two is a prerequisite to any successful reforms of the organization.24
The article proceeds as follows: Section 2 traces the history of the who as an epistemic authority, founded on the utmost respect for science. Section 3 discusses three specific features that make the organization an inherently political body: its dependence on Member States; its role as a risk manager; and the very nature of the regulatory science that it is involved in. Section 4 proceeds to analyze how the coexistence of expertise and politics has played out during the covid-19 pandemic. In this context, we concentrate on three specific points of contestation that have been raised against the who: (i) the alleged leniency towards China; (ii) the delay in declaring a pheic; and (iii) the delay in recommending the use of face masks for the general population. The article concludes that the penetration of who’s work by political elements should not be seen as some kind of atrophy, but rather be considered a natural element that should be properly managed (which is however not possible without its prior acknowledgment) rather than dreaded. Consequently, any reform of the who, in order to be successful, will need to properly acknowledge this fact.
2 The who’s Self-Image of an Epistemic Authority
The covid-19 pandemic has uncovered a badly kept secret. Despite its almost 73 years of existence, the who has never been truly able to define its own identity. Now when it is at the center of the world’s attention, the who’s undefined identity has contributed to the rising criticism on how it has responded to the pandemic.
Undoubtedly, the who was initially conceived as an organization that would exercise its authority through technical expertise. In the post-wwii architecture, the organization was deemed to belong to the field of ‘low-politics’, as opposed to other entities like the United Nations or human rights organizations, which would pursue core values and thus do ‘high politics’.25 This view is partially reflected in the who Constitution, which mostly concentrates on technical-like activities. In addition to acting “as the directing and coordinating authority on international health work” (art 2(a)), the who is, inter alia, supposed to “furnish appropriate technical assistance” (art 2(d)), “to establish and maintain such administrative and technical services” (art 2(f)), “to promote co-operation among scientific and professional groups” (art 2(j)), “to promote and conduct research in the field of health” (art 2(n)), and “to provide information, counsel and assistance in the field of health” (art 2(q)).
Although from time to time political tensions have emerged within the who, technical work has always dominated its agenda. This technical focus is perhaps best represented by its choice of normative tools. Traditionally, the who has preferred to rely on soft law instruments (which aim to provide technical and science-based guidance based on the best available evidence), rather than to have a recourse to hard law norms.26 As eloquently explained by Klabbers, the who prefers exercising “passive epistemic authority” (that is, an authority “resting on epistemic elements” exercised through non-legal instruments such as technical briefings, guidelines, trainings), rather than “active epistemic authority” (that is, an authority that is exercised “on th[e] basis” of “knowledge and science” through a legal instrument).27 The reliance on flexible, non-binding instruments is probably the reason why global health law has remained a niche area in the realm of international law. Nonetheless, it is also arguably the reason why the who has been able to successfully expand its actions to many different areas, from malaria eradication to breast milk substitutes, and tobacco control and non-communicable diseases.
The expertise-driven vision of the organization has been reinforced over time by its institutional culture. The who has, in fact, traditionally been populated by a ‘transnational Hippocratic society’ with little knowledge of law and international politics.28 who Director-Generals (dg s) have always been medical doctors or public health specialists.29 Additionally, by mandate States are supposed to send to the World Health Assembly (wha) delegates “chosen from among persons most qualified by their technical competence in the field of health, preferably representing the national health administration of the Member.”30 This means that more often than not diplomats do not attend the wha’s yearly meetings, and let the discussion be steered by their colleagues from the Ministries of Health. A similar rule applies to the Executive Board, which is composed of State-appointed representatives who are technically qualified in the field of health.31
The institutional culture of the who is also reflected in its self-cultivated image. The who describes itself as “a science and evidence-based organization”32 with “science … at the core of everything [it] do[es].”33 In this respect, the who is similar to many other international organizations that have built their authority on the basis of their expertise and specialist knowledge,34 thus ‘depoliticizing’ their work and making it more widely accepted.35 This self-image has been only reinforced during the covid-19 pandemic. In a message echoed by the other high-level who officials,36 the current dg, Dr. Tedros Adhanom Ghebreyesus affirmed that “my focus is saving lives, we don’t do politics in the who”.37 Likewise, he called on Member States to quarantine the pandemic from politics.38
In this narrative, not only the tasks of the who are of technical and scientific character (eg helping countries to prepare and respond to the pandemic by using its scientific, medical, and public health capabilities, coordinating their activities, furnishing accurate and evidence-based information, and providing vital medical supplies), but they are also immune from political considerations of any kind. Yet, as the next sections demonstrate, the dividing line between science and politics is not as neat as the who would like it to be. Despite its reluctance to admit it, the who does engage in politics as much as any other international organization.
3 The Inherently Political Dimension of the who’s Activities
International organizations are political creatures. While some organizations are at the heart of international politics, others may remain in the shadows, on the surface seeming to be engaged in uncontroversial or technical activities. However, even the second group does not lose its political dimension, which may suddenly emerge in a time of crisis or other tensions between the main actors.39
As noted above, scholars have already highlighted the political dimension of the who’s activities in both law-making and in some specific policy areas.40 The problem, however, is that a political dimension can be (and usually is) present even in the most technical activities of an international organization.41 There are at least two features that make the who’s activities inherently political: its heavy dependence on Member States, and the very nature of the activities that it engages in. These two categories can be seen as relating to two forms of politicization – one from outside and one from inside.
3.1 The who’s Lingering Dependence on Member States
The complex dynamics between an international organization and its Member States have been extensively covered by international relations (IR) scholarship under the principal-agent theory.42 These studies have shown that an international organization’s mandate is restricted not only by the relevant ‘constitutional’ documents, but also by the political realities in which the organization operates.43 Moreover, in practice international organizations, rather than commanding anything, tend to look for consensual solutions that would be acceptable to their members, mitigate emerging political tensions, and avoid stigmatizing individual states,44 unless there is some predefined procedure for doing so.
Of course, this does not mean that the secretariats of international organizations always and exclusively execute states’ wishes.45 However, even in cases where they enjoy formal authority to act autonomously, they often choose to have their functions fulfilled, to the extent they are politically allowed to do so, by the participating States. For this reason, Cortell and Peterson, in their study of ‘agency slack’, have concluded that the who Secretariat engages in autonomous decision-making much less often than it could.46 As direly summarized by the Lancet editor Richard Horton, “[t]he who has been drained of its power and resources. Its coordinating authority and capacity are weak. Its ability to direct an international response to a life-threatening epidemic is non-existent.”47 While this statement may be exaggerated, the empirical studies indeed show that the who ranks relatively low on the scale of delegation (understood as the “conditional grant of authority by member states to an independent body”).48
In addition, it should be underscored that international organizations do not always enjoy the privilege of being able to decide whether or not to act autonomously. In certain situations, they can only perform their functions if members are willing to cooperate. This is also true for the who, which frequently needs to rely on the goodwill of its Members when collecting and analyzing data and coordinating activities at the international level. Since the organization does not have any formal legal tools to compel such cooperation, keeping up friendly relations with the Members is key for its effective functioning. If one adds to these the existing budgetary constraints and its dependence on voluntary contributions (both from its Members and private actors),49 it becomes clear that the who has only a limited ability to operate in a manner that is insulated from the influence of its Members.50
Finally, it is worth underlining that although one may be tempted to think that at least technical, non-politically controversial activities can be carried out quite autonomously by agents (eg the who Secretariat), these activities always occur in a framework where the principals (the States) retain some form of direct or indirect control. In other words, it seems difficult to imagine that any activity that takes place in an international organization would not be somehow – albeit to varying degrees – influenced by its relationship with its principals. This statement proves particularly true when one considers the who’s engagement in regulatory science and risk management, as explained below.
3.2 The Not-so-hidden Political Nature of Global Health
As noted above, the guidelines and recommendations issued by the who are greatly followed by Member States and health operators because they are perceived as incorporating the best available science and technical expertise.51 Nevertheless, the who’s main objective (ie the promotion of global health) cannot really be achieved with the sole help of medicine, technology and science. As it is now widely accepted, promoting global health requires addressing various political determinants of health such as distribution of wealth, access to medical services, etc.52
The social dimension of health was actually acknowledged at the who as early as 1978 when so-called Declaration of Alma Ata was adopted.53 Since then, the who has progressively opened up toward an understanding of its role as one that goes beyond that of a depoliticized epistemic authority, but also embraces the social dimensions of health,54 and in some cases even rights-based approaches to health.55 Although these approaches do not have an impact on all of the who’s activities, they indicate that the promotion of global health requires much more than supporting the development and the sharing of science and technology. However, despite supporting these initiatives, the who has not been equally ready to admit that the influence of political elements extends much beyond this area, to encompass the work that falls within the scope of its epistemic authority.
Furthermore, and more importantly for the purpose of this article, one also needs to recognize that the who is not only responsible for technical and scientific tasks, but it also performs a number risk management functions – that is, it takes decisions on how to address the risks identified by scientific research (during the phase usually labelled as risk assessment).56 Although such decisions, or other equivalent actions, are always based on the outcome of scientific research, they predominantly reflect political considerations and may require balancing the benefits of recommended actions with their potential costs (eg introducing travel restrictions vs costs of doing this for the local economy).57
Finally, the who’s technical and scientific work as such is not immune from biases and political considerations. When, for example, a who technical committee assesses the risks associated with the emergence of a new pathogen or the burden of a diseases, it does not simply carry out scientific assessment, but rather what the sts literature has labelled as ‘regulatory science’.58 This enquiry is a distinct domain of science production, accountable to epistemic as well as normative demands. Its shapes and outcomes are embedded in specific social and political contexts (in the vocabulary of Sheila Jasanoff, so-called ‘social zones’ in which scientists and decision-makers try to provide answers to questions that advance a specific policy59) and determined by the past experiences of a specific body or individuals involved.
The appreciation of the context in which regulatory science takes place makes it clear that this type of scientific process involves various normative judgments, which may sometimes remain undisclosed or even unconscious. Questions such as how to deal with uncertainties – ie what weight to attach to contradictory evidence; how much precaution to apply in a given context; how to translate a tentative language of science into the binary logic of policy-legal recommendations (ie something is recommended/required or not) – cannot be answered solely on the basis of science and scientific evidence. They clearly have a normative component that may depend on the individual preferences of a risk assessor, institutional culture of a body within which assessment is undertaken or a character of risks/threats that are investigated. While risk regulatory processes are conventionally divided into risk assessment and risk management phase, as a matter of fact, the dividing line between which questions should be answered as part of each phase is often not clear-cut and is negotiated by the actors involved (again in the vocabulary of Sheila Jasanoff, this can be considered part of the ‘boundary’ work demarking science from not-science60).
Taken together, the above elements suggests that all the activities of the who, including its most technical and scientific ones, are not as devoid of politics as the organization would like to think, and as many external observers still believe. The next section shows that this is true under all circumstances, including in the context of a responses to outbreaks of infectious diseases.
4 The who’s Response to the covid-19 Pandemic
When the covid-19 began to show the pandemic potential, the who was put at the center of the world stage and was expected to deliver quick and effective solutions to our problems. It did not take long before many were disappointed. Former President Trump has been one of the most vocal critics of the who, as he frequently accused the organization of making ‘inaccurate or misleading’ claims, including praising China for its transparency as well as for the public health measures that it took.61 He also regularly described the who as China-centric62 and condemned the allegedly late declaration of a pheic.63
Clearly, the US criticism can be seen as a classic attempt to find a scapegoat for its own failures in handling the pandemic.64 However, the US was not alone in its disapproval of the who’s stance on China. This sentiment was shared by other states (eg the Japanese deputy prime minister referred to the who as the “Chinese Health Organization”65), as well as a number of experts and commentators who thought the who did not do as much as it could have.66 For those familiar with the who and its struggles, this criticism seems to confirm that the expectations were probably too high.67 What realistically could we expect from an organization that we have constantly under-funded and under-empowered? Yet, as with any of such landmark event, it seems not only correct but imperative to investigate the underlying causes of the criticism.
Against the observations made in the sections above, this section reviews how the who handled the response to the covid-19 pandemic in its initial phase. As already stated in the introduction, this review is not intended to be, nor could it be, a comprehensive assessment of whether the who committed any mistakes, and if so which ones. Rather, by taking three examples (ie the alleged leniency towards China, the purported delay in declaring a pheic and inconsistent recommendations on face mask), this review shows that at least part of the criticism directed at the who is grounded in the misperception of what the organization is and how it really works. Before going into details, Table 1 below summarizes the most important actions taken by the who at the beginning of the covid-19 pandemic.
4.1 who’s Alleged Leniency Towards China as a Strategy
As noted above, one of the most frequent criticisms raised against the who and its actions is that it adopted a lenient stance towards China, accepting delays in sharing information and not publicly condemning it. Although it cannot give a picture of the whole story, the timeline above indeed shows that it took more than twenty days for the who to acknowledge the possibility of human-to-human transmission, and a full month to declare a pheic – all of these while the outbreak was already ravaging Wuhan. This delay has also been noted with disapproval by the ipppr report, which added that, faced with the uncertainty concerning the human-to-human transmission, the who could have taken a more precautionary approach.74
While it hesitated to declare a pheic, the who leadership commended China’s collaboration as “invaluable”,75 and praised it for the actions it took “in response to the outbreak, its speed in identifying the virus and openness to sharing information with who and other countries.”76 If this praise had come later on in the pandemic, it could have been taken as an objective statement. But as it came in a moment when things were still very unclear, it is understandable that some have felt that it had not (or at least not at that time) been earned.
Contrary to the accounts of many critics, we do not believe that the who has been lenient towards China based on any reasons connected with economic dependence. The who’s top contributor, as a matter of fact, is the US, and China’s contribution is relatively minor – particularly if one considers that the who gets half of its funds from non-state actors such as international organizations and philanthropic foundations.77 Similarly, we do not believe that the who has been lenient towards China because of any form of ideological or geopolitical bias (which, in any case, would be very hard to prove).78 Instead, we argue that the approach taken by the who towards China reflects, at least partially, its position as an international organization with only limited autonomy, and with no legal and limited political means to force its Members to cooperate with it.
In this regard, the most important observation is that the ihr mandates governments to report any public health emergencies of international concern and to cooperate with the who, but it does not provide any tools to enforce this obligation.79 The who, thus, needs States to cooperate to ensure the functioning of the ihr. If one adds to this that the who, as any international organization, tends to work on a consensual basis, mitigating rather than increasing political tensions among its Members and avoiding any forms of stigmatization, its reaction in the first months of the pandemic is even less surprising. As summarized by Mike Ryan – an executive director of the who’s Health Emergencies Programme – when he was asked during one of the press conferences about the countries which were not doing enough: “[t]he who doesn’t interact in public debate or criticize our member states in public. What we try to do is work with our member states constructively, pointing out to them when we believe their measures are not adequate, aggressive enough or comprehensive enough.”80
Compliments are therefore a normal part of organizational practice in order to maintain good relations and ensure smooth cooperation. It should be noted that China was not the only Member praised by the organization. For example, the who dg in one of his tweets applauded the US by saying: “[p]roductive call with President @realDonaldTrump. I appreciated him for the great job he is doing to fight #covid19 through whole-of-government approach, leveraging R&D, engaging private sector incl. on essential medical supplies, expansion of testing, educating public.”81 On that day, US had altogether 58,553 registered cases and 963 covid-19-related deaths, while the experts were warning of uncontrolled community transmission.82 Before the dg made his statement, the Trump administration had, among other things, introduced travel restrictions with China in clear contradiction to the who guidance; the President had been regularly comparing covid-19 to a regular flu; and the initial testing efforts had failed completely, mostly because of poor internal coordination.83
Occasionally, Members do get a rebuke. Several journalists and public health experts have compared the stance of the current who dg with that of Gro Harlem Brundtland, who dg during the sars outbreak.84 In that case, Gro Harlem Brundtland took a strong stance against China, harshly criticizing it for failing to react faster to the sars epidemic and for not sharing sufficient information.85 Even during the covid-19 pandemic, the dg Tedros Adhanom Ghebreyesus eventually criticized China for failing to cooperate in the mission to discover the zoonotic origins of the sars-CoV-2 virus.86 However, it is worth noting that this criticism was offered only in January 2021, a year after the beginning of the pandemic and at a time when China’s cooperation was not very strategic anymore. Overall, the practice of publicly criticizing States for failing to abide by their commitments looks more like the exception than the rule.
In the case of the covid-19 pandemic, the general inclination of the who to take a consensual approach and to reduce the existing political tensions was further reinforced by the need to secure access to as much information as possible about the outbreak.87 In its initial phase this was only possible via the on-going cooperation with China. The importance of having access to the relevant data was highlighted in the first statement of the Emergency Committee, which called for cooperation between the who and China:
to understand epidemiology and the evolution of [the] outbreak, including specific … the source of the novel coronavirus, notably the animal reservoir, and animals involved in the zoonotic transmission, as well as the understanding of its full potential for human-to-human transmission, and where transmission is taking place, the clinical features associated with infection, and the required treatment to reduce morbidity and mortality.88
Paradoxically, from the who’s perspective, praising China rather than criticizing it could be seen as the best way for it to carry out its tasks as an epistemic authority, allowing it to assess the existing risks and ensuring that the international community gained access to as much information as possible. This argument also finds additional support in the fact that the moments when the who publicly praised China coincided with those moments when the who or its affiliated experts needed to obtain more information from China. This correlation is shown in Table 2 on the next page.
The correlation of the events suggests that the who praised China when it most needed its collaboration in sharing information. Rather than being lenient, the who simply adopted a political strategy to fulfil one of its functions. Clearly, this was in itself a political decision.
4.2 who’s Declarations and Recommendations as Normative (Policy) Choices
The political nature of the who is also visible when one looks at the various declarations and recommendations made by the organization as the covid-19 pandemic unfolded. Here, the first useful example is the declaration of a pheic, which many denounced as arriving too late.98 The ihr 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.”99 The determination is made by the dg on the basis of, among other things, the assessment of the Emergency Committee,100 although in practice it is hard to imagine the dg taking a decision against an Emergency Committee recommendation, considering its epistemic weight. The Committee is composed of experts in the relevant fields who are assisted by advisors (also experts).101 The wording of the relevant provision, as well as the composition of the Committee, would suggest that its task is narrow and predominantly technical, consisting of an epidemiological evaluation of the situation.
However, this is not how the Committee works. Its recommendations are as much based on the assessment of risk as on other factors that are clearly non-scientific, as they relate to economic, political and social considerations. In this context, it is worth recalling that the Committee concluded during its first meeting that it was too early to make a pheic declaration, “given its restrictive and binary nature”.102 During the press conference on 23 January 2020, its Chair also openly admitted that the Committee had to balance “concerns about how people in China who are struggling with the virus would perceive such a declaration by the international community.”103 It appears from these statements that the members of the Committee were aware of the potential economic and political costs of their recommendation, and eventually decided to postpone the decision not so much because of any compelling epidemiological reasons, but rather due to other – essentially political – concerns.
Furthermore, it should be highlighted that a pheic status has to be decided within the organization with its own unique past experience (eg presumably premature declaration of the h1n1 pandemic which affected the who’s credibility104), and operating in a particular legal framework. For example, Art. 2 ihr requires the organization to balance the need to “prevent, protect against, control and provide a public health response to the international spread of disease” with the need to avoid causing “unnecessary interference with international traffic and trade.”105 All of these factors arguably encouraged the Committee to take a rather conservative stance and await further developments.
This way of thinking can be also detected in past events. For example, the Chair of the previous Emergency Committee, when justifying the advice against declaring a pheic for the Ebola outbreak in Congo, stated:
but if someone thought that it was a global emergency we risk seeing, as we have seen with previous public health emergencies of international concern, restrictions on travel and trade, we risk seeing airlines stopping their flights to the area and we also risk border closures or restrictive measures at borders which could severely harm the economy in the Democratic Republic of (the) Congo. So it was the view of the committee that there is really nothing to be gained by declaring a pheic but there is potentially a lot to lose.106
The internal documents obtained by Associated Press also confirm that this is a normal practice. In one of the memos prepared by one of the high who officials, declaring a pheic or even convening a committee to discuss it was labelled as a potentially “hostile act.”107
A similar observation can be made with respect to some of the who’s temporary recommendations on public health measures to be adopted in the event of a pheic.108 In the course of the covid-19 pandemic, the who has issued a number of such documents, including those on human-to-human transmissions, asymptomatic transmissions, the use of face masks, and international travel restrictions.109 Among these, the recommendations on the use of face masks by the general public constitute an instructive example of how non-scientific (normative) factors can infiltrate the processes that are conventionally regarded as technical in nature.
The who published its first advice on face masks on 29 January 2020.110 It did not recommend their use for individuals without respiratory symptoms, and noted that there was no evidence which would indicate their usefulness in protecting non-infected persons. The document also stressed the use of a mask alone is insufficient to provide an adequate level of protection. Consequently, masks were advised only for individuals with suspected covid-19 infection and/or with respiratory symptoms, their relatives or caregivers in home settings, as well as for patients with symptoms and health care workers at health care facilities.
The updated versions of the document were made available on 19 March and 6 April 2020, and basically repeated the previous recommendation.111 Although the second document recognized some potential advantages of the general use of masks, it also stated that “the wide use of masks by healthy people in the community setting is not supported by current evidence and carries uncertainties and critical risks.”112 In the meantime, more and more countries around the globe started issuing orders requiring their citizens to wear a face mask in public places.113 The who only changed its stance on 5 June 2020, when it recommended non-medical masks for the general population in public places, and medical masks for certain groups.114
Why did the who take such a critical stance on face masks, and why was it so reluctant to alter it until considerably later? Was it about getting things wrong, as opposed to those governments that had introduced face mask requirements already in January or in early February 2020? This might be the case, but we would like to offer an alternative explanation that concentrates on the normative elements (some of them being of political character) present in regulatory science and the inherently political character of risk management activities.
The initial position was based on the assumption that only symptomatic individuals can transmit the virus and such transmission is droplet-based rather than airborne.115 In such case, making face masks mandatory for the general population would not be very useful, distancing and hand hygiene was more important. At the time, this was actually a mainstream scientific view, followed by the health agencies around the world.116 On the other hand, mindful of their experience with 2003 sars outbreak and thanks perhaps to some fortuitous coincidences, governments in East Asia (eg China, Hong Kong, Taiwan and Japan) opted for a more precautionary approach, and started recommending masks use.117 Both decisions were taken in situations of high uncertainty and incomplete scientific information, and clearly involved a normative judgement (i.e. to be more precautionary or less precautionary).118 While for the East Asian governments such a decision might have been easier (considering the existing culture of mask-wearing in Asian societies), this was not necessarily the case for the who, which issues global guidance (think about the popular opposition against mask in Western societies) and was perhaps influenced by other factors such the professional background of the members of its technical committee.119 In any case a decision to be more or less precautionary is a normative (political) one and involves (if not openly, at least in an implied form) weighting and balancing of different factors.120
It is less clear, however, why it took the who so long to change its position. By 5 June 2020, both the US Centers for Disease Control and Prevention and European Centre for Disease Prevention were firmly advocating for the universal use of face masks, while many countries had already made them mandatory. At the same time there was a growing consensus among scientists that asymptomatic and pre-symptomatic individuals can transmit the virus and that the airborne transmission of sars-CoV-2 is possible. We can only speculate here about the reasons behind the delayed response of the organization. One of them might be the rather conservative approach of the who to scientific evidence,121 reflecting the most rigorous medical culture: we cannot act if we do not have the evidence.122 It should be noted that even in its June guidance, the who stressed that “[a]t the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider.”123 Only in May 2021, more than 16 months since the notification of the new sars-CoV-2 virus outbreak, did the who update its technical guidance to acknowledge that current evidence suggests that transmission occurs via aerosols as well as droplets.124
Perhaps psychological elements also played a role here. Scientists are not immune to confirmation biases, ie the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one’s prior beliefs or values.125 This seems to be suggested by the account of prof. Linsey Marr – who specializes in the interaction of viruses with the atmosphere – from the expert meeting with the who that was organized on 3 April 2020. She summarized it in the following words “[t]he who is driven not just by science but also by political considerations. There are some strong personalities there who are just anti-airborne transmission. They just accept that large-droplet transmission is happening and somehow there’s a higher burden of proof for airborne transmission.”126
Apparently other factors also weighed on the who’s choice not to recommend face masks for the general public. who experts were concerned that an incorrect usage of masks could actually increase the risk of infection, and that they could give people wearing them a false sense of security, to the neglect of other essential measures.127 Moreover, given the limited supply available at the beginning of the pandemic, the who feared that a general recommendation could lead to a shortage of face masks for medical workers.128
It is not our place to state whether the who’s decision was better than that of those governments which decided early on to promote the use of face masks in public places. Both decisions were in a sense rational in a specific point in time. Both of them were also taken in the context of high uncertainty and incomplete scientific information. What is important, however, is to affirm that these decisions, like all risk regulation decisions, are not purely scientific. Some of the factors that led the who to take its decision were scientific (lack of evidence on effectiveness,); but others (shortage of supply, risk of misuse, possible human biases, the preferred level of precaution) were not.
In both cases discussed above, the who was criticized for not doing its technical job well. The problem, however, is that its job is not, as many believe, being a neutral supranational risk assessor. The who is not only involved in the business of knowledge production and dissemination, but also acts as a risk manager that weighs different factors against each other.
While it is still too early to draw general conclusions on the who’s handling of the covid-19 pandemic, this article has provided a reflection on the nature of the who and its work against which an overall assessment of the organization’s role should be undertaken.
After discussing in section 2 the history of the who as an epistemic authority, founded on the utmost respect for science, section 3 has proceeded to contend that the who is a hybrid creature that combines epistemic and political elements. Drawing on insights from ir and sts scholarship, we have identified three specific features that make the who’s activities inherently political. On one hand, it is an international organization, with all the limits and implications that this status implies. On the other hand, it engages in risk management and regulatory science, which are per se activities that combine epistemic and political elements.
Having in mind these considerations, section 4 has presented a summary of the who’s actions in the early phase of the covid-19 pandemic, and analysed how the above features influenced the response of the organization. To this end, we have used three specific examples that show different ways in which politics infiltrates who’s activities. First, the alleged leniency towards China can be seen not only as a normal reaction of an international organization with constrained competences, operating in the consensual environment but also as a political strategy allowing the who to carry out its task to collect as much information and data as possible about a new pathogen. Second and third, the who’s alleged delays in taking certain decisions that it is empowered to take under the ihr (i.e. declaration of pheic) and releasing controversial recommendation (i.e. on the use of face masks) should be seen as the result of complex risk management choices made in a context where politics and science are particularly intertwined.
So where does this picture leave us? When a crisis arises, there is always a call for reforms. As noted in the introduction, the ipppr has endorsed the recommendation made by some scholars and observers to negotiate a new ‘Pandemic Framework Convention’. Additionally, the Review Committee on the Functioning of the International Health Regulations (2005) during the covid-19 response has made a number of recommendations on how the ihr could be improved. While a new treaty or some targeted changes may indeed be desirable, this article has pointed such reforms require prior comprehensive discussion on and understanding of the who’s institutional structure and the nature of its work. who’s activities have an inherent political dimension, and this dimension sometimes coexists uneasily with the epistemic work that the who carries out. This is true not only of high-level recommendations such as a declaration of pheic, but also of the very technical and scientific work that a committee may carry out to establish whether the sars-CoV-2 is mostly spread through aerosols or droplets (and propose appropriate recommendations). The objective of this article is to raise the attention to this frequently overlooked problem.
In many ways, the ihr already reflects an understanding that in providing epistemic guidance the who may have to take into account political factors. For example, with respect to the pheic declaration, the ihr provide not only that the dg’s recommendations should be based on the advice of experts,129 but also that the dg has the power to make ‘the final determination’ on the views provided by the experts.130 Moreover, the ihr clarifies that the dg, in issuing his or her recommendations, should take into account – in addition to the advice of experts and other scientific or technical information – ‘the views of the State Parties directly concerned.’131 These clarifications show that the drafters of the ihr were careful not to give the final decision-making authority to experts and wanted to preserve some space for political and similar considerations by the dg. Managing a pheic is not something that can be left to scientists alone.
These elements show that the ihr already provide many elements that should encourage the who and Members to think about the who’s work as a policy endeavour. While a deeper, structural reform could be beneficial, such a reform could also be frustrated by a lack of understanding of the nature of who’s activities. From the point of view of who’s Members, any shortcomings or even mistakes in who’s work (such as the ones seen above), should thus not be seen as a failure of the organization or as some kind of atrophy, but rather as part of the normal process of policymaking in an emergency context. At the same time, from who’s part, acknowledging that some shortcomings or mistakes are the result of a misjudgement about risk or about a certain strategy would help dispel any accusations that they are the result of geopolitical or ill-intentioned calculations.
Lukasz Gruszczynski is an Associate Professor at Kozminski University (Poland) and Research Fellow at the Centre for Social Sciences – Institute for Legal Studies (Hungary). He holds a LL.M. diploma from the Central European University and a Ph.D. from the European University Institute. Prof. Gruszczynski regularly teaches risks regulation, public international law and international economic law at various Polish and foreign universities (e.g., University of Zurich, University of Warsaw, osce Academy in Bishkek, American University of Central Asia). He is an author/editor of Regulating Health and Environmental Risks under WTO Law (2014) and Deference in International Courts and Tribunals: Standard of Review and Margin of Appreciation (2014), both with Oxford University Press. His most recent book The Regulation of E-cigarettes: International, European and National Challenges was published by Edward Elgar in 2019. He specializes in international economic law, risk regulation and global health law.
Margherita Melillo is an Associate at the O’Neill Institute for National and Global Health Law (Georgetown University). She holds a Ph.D. from the European University Institute (2020). Her thesis investigates the role of evidence in the international law on tobacco control, with a focus on law-making at the World Health Organization (the negotiations of the who Framework Convention on Tobacco Control, and later adoption of its guidelines), and on international litigation before investment and trade tribunals. In past Dr Melillo was a Research Fellow at the Max Planck Institute Luxembourg for Procedural Law. She is an author of several publications in this field, including articles in European Journal of Risk Regulation, Journal of World Trade and Globalization & Health.
For up-to-date information see ‘Reported Cases and Deaths by Country or Territory’, Worldometer (Chart, 15 September 2021) <covid Live Update: 254,728,689 Cases and 5,125,684 Deaths from the Coronavirus – Worldometer (worldometers.info)>.
See ‘Estimation of total mortality due to covid-19’, Institute for Health Metrics and Evaluation (Web Page, 13 May 2021) <https://bit.ly/3fL2IXh>; ‘Ten million reasons to vaccinate the world’, The Economist (online, 15 May 2021) <https://econ.st/3hsP90Z>.
World Economic Outlook Update, International Monetary Fund (Report, July 2021 <https://bit.ly/3EquLXa>.
Hinnerk Feldwisch-Drentrup, ‘How who Became China’s Coronavirus Accomplice’, Foreign Policy (online, 2 April 2020) <www.foreignpolicy.com/2020/04/02/china-coronavirus-who-health-soft-power/>.
See eg Apoorva Mandavilli, ‘In the W.H.O.’s Coronavirus Stumbles, Some Scientists See a Pattern’, The New York Times (online, 9 June 2020) <www.nyti.ms/2MMUva7>; Thomas J. Bollyky and David P Fidler, ‘It’s Time for an Independent Coronavirus Review’, Foreign Affairs (online, 24 April 2020) <https://fam.ag/3zdVJxx>.
who, Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the covid-19 response (Annex, A74/9 Add.1, 5 May 2021).
The Independent Panel for Pandemic Preparedness and Response, covid-19: Make it the Last Pandemic (Report, 12 May 2021) <https://bit.ly/2RhrFRW>.
See eg Armin von Bogdandy and Pedro Villarreal, ‘Critical Features of International Authority in Pandemic Response: The who in the covid-19 Crisis, Human Rights and the Changing World Order’ (Research Paper, No. 2020-18, Max Planck Institute for Comparative Public Law & International Law, 13 May 2020); Tine Hanrieder, ‘Priorities, Partners, Politics: The who’s Mandate beyond the Crisis’ (2020) 26 Global Governance: A Review of Multilateralism and International Organizations 534; Kelley Lee and Julianne Piper, ‘The who and the covid-19 Pandemic: Less Reform, More Innovation’ (2020) 26 Global Governance: A Review of Multilateralism and International Organizations 523.
who Report of the Review Committee on the Functioning of the International Health Regulations (n 7) para 6.
Ibid; The Independent Panel for Pandemic Preparedness and Response (n 8) 48.
Robert W Cox et al, The Anatomy of Influence: Decision Making in International Organization (Yale University Press, New Haven, 1973); Javed Siddiqi, World Health and World Politics (University of South Carolina Press, Columbus, 1995); Gian Luca Burci and Claude-Henri Vignes, World Health Organization (Kluwer Law International, The Hague, 2004); Kelley Lee, The World Health Organization (who) (Routledge, New York, 2008); Yves Beigbeder, The World Health Organization: Achievements and Failures (Routledge, New York, 2017).
See eg Javed Siddiqi, World Health and World Politics (University of South Carolina Press, Columbus, 1995).
Matthew M. Kavanagh, Renu Singh and Mara Pillinger, ‘Playing Politics. The World Health Organization’s Response to covid-19’ in S.L. Greer et al (eds), Coronavirus Politics: The Comparative Politics and Policy of covid-19 (Michigan University Press, Ann Arbor, 2021) 34.
Eyal Benvenisti, ‘The who – Destined to Fail?: Political Cooperation and the covid-19 Pandemic’ (2020) 114(4) American Journal of International Law 588, 590.
Jose E. Alvarez, ‘The who in the Age of the Coronavirus’, (2020) 114(4) American Journal of International Law 578, 585.
Sara E. Davies and Clare Wenham, ‘Why the covid-19 response needs International Relations’ (2020) 96(5) International Affairs 1227.
Michael Barnett and Martha Finnemore, Rules for the World: International Organizations in Global Politics (Cornell University Press, Ithaca, 2004); Jens Steffek, International Organization as Technocratic Utopia (Oxford University Press, 2021).
Understood here broadly as any action/decision involving normative judgements relating to one’s preferences, which require weighting and balancing of different values.
Depending on this assessment different reforms may be needed. For example, it makes a little sense to improve the quality of processes leading to a declaration of pheic if the main problem is political one (eg relating to the who consensual model of work).
Lee (n 13) 10.
Gian Luca Burci, ‘Global Health Law: Present and Future’, in G.L. Burci and B. Toebes (eds), Research Handbook on Global Health Law (Edward Elgar, Cheltenham, 2018) 486.
Jan Klabbers, ‘The Normative Gap in International Organizations Law: The Case of the World Health Organization’ (2019) 16 International Organizations Law Review 272, 279.
David P. Fidler, ‘International Law and Global Public Health’ (1999) 48 University of Kansas Law Review 1, 15.
‘Former Directors-General’, who (Web Page, 15 September 2021) <www.who.int/dg/who-headquarters-leadership-team/former-directors-general>.
Constitution of the World Health Organization, opened for signature 22 July 1946, 14 unts 185, (entered into force 7 April 1948) art 11.
Ibid art 24.
who, Draft Twelfth General Program of Work, A66/6, 66th World Health Assembly, Provisional agenda item 12.2 (19 April 2013) .
who, who Director-General’s opening remarks at the media briefing on covid-19 – 28 December 2020 (opening remarks, 28 December 2020) <www.bit.ly/38HGwK4>.
Ernst B. Haas, When Knowledge Is Power: Three Models of Change in International Organizations (University of California Press, Berkeley, 1990); Michael Barnett and Martha Finnemore, Rules for the World: International Organizations in Global Politics (Cornell University Press, Ithaca, 2004); Guy Fiti Sinclair, To Reform the World: International Organizations and the Making of Modern States (Oxford University Press, 2017).
In this understanding, ‘depoliticization’ is different from ‘apolitical’ insofar as it is “the process in which a situation, an actor or an issue is considered outside of politics and framed as apolitical”. See Marieke Louis and Lucile Maertens, Why International Organizations Hate Politics: Depoliticizing the World (Routledge, Abingdon, 2021) 3.
See eg Stephanie Nebehay, ‘who’s Ryan: don’t turn covid-19 into “political football”’, Reuters (online, 17 September 2020) <www.reut.rs/2Jrx70z>.
Barnett and Finnemore (n 31); Sinclair (n 31).
Cox et al (n 13); Lee (n 13) 87–89; Sara E. Davies, Adam Kamradt-Scott and Simon Rushton, Disease Diplomacy: International Norms and Global Health Security (John Hopkins University Press, Baltimore, 2015); José E. Alvarez, The Impact of International Organizations on International Law (Brill, Leiden, 2016) 190–261; Ching-Fu Lin, Han-Wei Liu and Chien-Huei Wu, ‘Breaking State-Centric Shackles in the who: Taiwan as a Catalyst for New Global Health Order’ (2020) 61 Virginia Journal of International Law Online 99.
See also the controversies generated by the activities of the Codex Alimentarius Commission – an international organization with a narrowly formulated mandate of a technical character, see Kuei-Jung Ni, ‘Does science speak clearly and fairly in trade and food safety disputes?’ in B. Mercurio and K.-J. Ni (eds), Science and Technology in International Economic Law. Balancing Competing Interests (Routledge, New York, 2013) 30 et seq. For a more theoretical background on science and politics see Sheila Jasanoff (ed), States of Knowledge: The Co-production of Science and the Social Order (Routledge, New York, 2004).
Darren G. Hawkins et al (eds), Delegation and Agency in International Organizations (Cambridge University Press, 2006).
See eg John J. Mearsheimer, ‘The False Promise of International Institutions’ (1994) 19(3) International Security 5.
Gayl D. Ness and Steven R. Brechin, ‘Bridging the Gap: International Organizations as Organizations’ (1998) 42(2) International Organization 245, 252.
Note that we are not here taking any position in the debate between realism and institutionalism. Our only claim is that international organizations do take seriously the demands of their members, and as a consequence some of them have very limited autonomy. For the general discussion of both approaches see Michael Brecher and Frank P. Harvey (eds), Realism and Institutionalism in International Studies (University of Michigan Press, Ann Arbor, 2002).
Andrew P. Cortell and Susan Peterson, ‘Dutiful Agents, Rogue Actors, or Both? Staffing, Voting Rules, and Slack in the WHO and WTO’ in D.G. Hawkins et al. (eds), Delegation and Agency in International Organizations (Cambridge University Press, 2006) 255.
Cited in Theodore Brown and Susan Ladwig, ‘covid-19, China, the World Health Organization, and the Limits of International Health Diplomacy’ (2020) 110(8) American Journal of Public Health 1149.
See eg Liesber Hooghe and Gary Marks, ‘Delegation and pooling in international organizations’ (2014) 10(3) Review of International Organizations 305.
For the impact of those elements on the autonomy of an international organization see Eugenia Heldt and Henning Schmidtke, ‘Measuring the Empowerment of International Organizations: The Evolution of Financial and Staff Capabilities’ (2017) 8 Global Policy 51.
Similarly, Lawrence O. Gostin, Devi Sridhar and Daniel Hougendobler, ‘The Normative Authority of the World Health Organization’ (2015) 30 Public Health 1, 2 (who label the who as “a Servant to Member States”).
Klabbers (n 27).
Richard Parker and Marni Sommer (eds), Routledge Handbook of Global Public Health (Routledge, London, 2010); Richard Parker and Jonathan García (eds), Routledge Handbook on the Politics of Global Health (Routledge, London, 2018).
Declaration of Alma-Ata, International Conference on Primary Health Care (6–12 September 1978) <www.who.int/publications/almaata_declaration_en.pdf?ua=1>. The document was criticized by the Western Members as an attempt to politicize the activities of the who.
Lee (n 13) 75–98.
Benjamin Mason Meier and Lawrence O. Gostin, Human Rights in Global Health: Rights-Based Governance for a Globalizing World (Oxford University Press, 2018).
For a comprehensive analysis of the notion of risk management in risk analysis, see Lukasz Gruszczynski, Regulating Health and Environmental Risks under WTO Law: A Critical Analysis of the SPS Agreement (Oxford University Press, 2010) 21–31.
Giandomenico Majone, ‘Foundations of Risk Regulation: Science, Decision-Making, Policy Learning and Institutional Reform’ (2010) 1 European Journal of Risk Regulation 5.
On the distinction between these two see Sheila Jasanoff, The Fifth Branch: Science Advisors as Policymakers (Harvard University Press, New Haven, 1990).
Ibid 14. One way to deal with the problem of normative judgements in the process of risk assessment is to formulate risk assessment policies that formalize interaction between scientific and non-scientific elements by providing relevant criteria for risk assessors when exercising normative judgements.
See @realDonaldTrump, ‘China has been working very hard to contain the Coronavirus’ (Twitter, 25 January 2020, 5:18 AM) <www.twitter.com/realDonaldTrump/status/1262577580718395393?s=20> (account currently suspended).
Huileng Tan, ‘China defends the who after Trump – and others – say it is deferring to Beijing’, cnbc (online, 13 April 2020) <https://www.cnbc.com/2020/04/13/china-defends-the-who-after-trump-critics-say-it-defers-to-beijing.html>.
‘Donald Trump Coronavirus Press Briefing Transcript April 14: Trump Halts who Funding’, Rev (online, 14 April 2020) <www.bit.ly/2KVFyBz>.
See eg Julian Borger, ‘Trump scapegoating of who obscures its key role in tackling pandemic’, Guardian (online, 8 April 2020) <www.theguardian.com/world/2020/apr/08/world-health-organization-coronavirus-donald-trump>.
See eg Javier C. Hernandez, ‘Trump Slammed the W.H.O. Over Coronavirus. He’s Not Alone’, The New York Times (online, 8 April 2020) <www.nyti.ms/3nZGxzs>.
See eg Brahma Chellaney, ‘The who has failed the world in its pandemic response’, Australian Strategic Policy Institute (Blog Post, 23 April 2020) <www.bit.ly/3aJ2gb0>; Lawrence Freedman, ‘How the World Health Organisation’s failure to challenge China over coronavirus cost us dearly’, New Statesman (online, 5 April 2020) <www.bit.ly/2WThySu>.
‘The World Needs a Better World Health Organisation’, The Economist (online, 10 September 2020) <www.econ.st/3oCNC8s>.
Unless the specific source is indicated, information was taken from ‘Listings of who’s response to covid-19’, who (Web Page, 29 June 2020) <www.who.int/news/item/29-06-2020-covidtimeline>.
‘Pneumonia of Unknown Cause – China’, who (Web Page, 5 January 2020) <www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/>.
‘Statement on the First Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus 2019 (n-CoV)’, who (Statement, 23 January 2020) <www.bit.ly/3armi8e>.
‘Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-NCoV)’, who (Statement, 30 January 2020) <www.bit.ly/2MJhzq9>.
‘Report of the who-China Joint Mission on Coronavirus Disease 2019’, who (Report, 16–24 February 2020) <www.bit.ly/2YAN3RY>.
‘WHO Director-General’s opening remarks at the media briefing on covid-19’, who (Speech, 11 March 2020) <www.bit.ly/3nnrtKJ>.
The Independent Panel for Pandemic Preparedness and Response (n 8) 25–26.
‘WHO Director-General’s Statement on IHR Emergency Committee on Novel Coronavirus’, who (Statement, 22 January 2020) <www.bit.ly/3pJnQAO>.
‘WHO, China Leaders Discuss Next Steps in Battle against Coronavirus Outbreak’, who (News release, 28 January 2020) <www.bit.ly/3tg6xJT>.
Kristina Daugirdas and Gian Luca Burci, ‘Financing the World Health Organization: what lessons for multilateralism?’ (2019) 16(2) International Organizations Law Review 299.
Feldwisch-Drentrup (n 5).
ihr art 7.
‘Virtual press conference on covid-19’, who (Press Conference, 11 March 2020) <www.bit.ly/38rR9Sn>.
See @DrTedros Tedros Adhanom Ghebreyesus (Twitter, 24 March 2020, 12:21 AM) <www.twitter.com/DrTedros/status/1242230036645785601>.
Brianna Ehley, ‘U.S. coronavirus outbreak inevitable, CDC official says’, Politico (online, 25 February 2020) <www.politi.co/2LgujEo>.
See eg Abby Goodnough and Sheila Kaplan, ‘C.D.C.’s Dr. Robert Redfield Confronts Coronavirus, and Anger’, The New York Times (online, 13 March 2020) <www.nytimes.com/2020/03/13/health/robert-redfield-cdc-coronavirus.html>; ‘Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in a Fox News Virtual Town Hall’, Trump White House (Remarks, 24 March 2020) <Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in a Fox News Virtual Town Hall – The White House (archives.gov)>.
Stephen Buranyi, ‘The who v Coronavirus: Why It Can’t Handle the Pandemic’, Guardian (online, 10 April 2020) <www.bit.ly/3tjmGOB>.
‘China under fire for virus spread’, bbc News (online, 6 April 2003) <www.news.bbc.co.uk/2/hi/health/2922993.stm>.
‘who’s Tedros “very disappointed” China hasn’t granted entry to coronavirus experts’, Reuters (online, 6 January 2021) <www.reuters.com/article/us-health-coronavirus-who-china-idUSKBN29A28B>.
Kate Kell and Stephanie Nebehay, ‘Caught in Trump-China Feud, who Leader under Siege’, Reuters (online, 15 May 2020) <www.reuters.com/investigates/special-report/health-coronavirus-who-tedros/>; Gian Luca Burci, ‘WHO Let the Bats Out?’, ejil: Talk! (Blog Post, 6 May 2020) <www.ejiltalk.org/ejil-the-podcast-who-let-the-bats-out/>.
who, First Meeting of the International Health Regulations (n 70).
who, Director-General’s Statement on IHR Emergency Committee on Novel Coronavirus (22 January 2020) (n 75).
who, Novel Coronavirus (2019-nCoV), Situation Report – 1 (Report, 21 January 2020) <www.bit.ly/39IDert>.
‘WHO Timeline – covid-19’, who (Web Page, 27 April 2020) <www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19>.
who, Director-General’s Statement on IHR Emergency Committee on Novel Coronavirus (n 75).
who, First Meeting of the International Health Regulations (n 70).
who, Report of the who-China Joint Mission on Coronavirus Disease 2019’ (n 72).
Buranyi (n 84).
ihr art 1.1.
Ibid art 12.
For the current composition of the Emergency Committee see ‘covid-19 IHR Emergency Committee’ who (Web Page, 2021) <www.who.int/groups/covid-19-ihr-emergency-committee>.
who, First Meeting of the International Health Regulations (n 70).
Lawrence O. Gostin and Rebecca Katz, ‘The International Health Regulations: The Governing Framework for Global Health Security’ (2016) 94(2) The Milbank Quarterly 264.
See also Caroline Foster, ‘Justified Border Closures do not violate the International Health Regulations 2005’, ejil: Talk! (Blog Post, 11 June 2020) <www.bit.ly/2VjTXtO>.
‘Emergency Committee press conference – 14 June 2019’, who (Press Conference, 14 June 2019) <www.who.int/news/item/13-06-2019-emergency-committee-press-conference---14-june-2019>.
Maria Cheng and Raphael Satter, ‘Emails: UN health agency resisted declaring Ebola emergency’, Global News (online, 20 March 2015) <www.bit.ly/2XqDMeA>.
Pursuant to arts 15 and 49 of ihr.
‘Coronavirus Disease (covid-19) pandemic’, who (Web Page, 15 September 2021) <www.who.int/emergencies/diseases/novel-coronavirus-2019>.
Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak. Interim guidance, who Doc who/nCov/ipc_Masks/2020.1 (29 January 2020).
Advice on the use of masks in the community, during home care, and in health care setting in the context of covid-19. Interim guidance, who Doc who/nCov/ipc_Masks/2020.2 (19 March 2020).
Advice on the use of masks in the context of covid-19. Interim guidance, who Doc who/nCov/ipc_Masks/2020.3 (6 April 2020). Emphasis added.
Karen Leigh and Iain Marlow, ‘Countries Learn to Love Face Masks in Struggle to Contain Virus’ Bloomberg (online, 7 April 2020) <www.bloomberg.com/news/articles/2020-04-07/more-countries-are-embracing-face-masks-after-initial-reluctance>.
Advice on the use of masks in the context of covid-19: interim guidance, who Doc who/nCov/ipc_Masks/2020.4 (5 June 2020) [5–6]. The most recent document was issued on 1 December 2020 (who/nCov/ipc_Masks/2020.5.).
See Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak: interim guidance, 29 January 2020, who Doc who/nCov/ipc_Masks/2020.1 (29 January 2020) who advisories in documents ; See also @DrTedros Tedros Adhanom Ghebreyesus (Twitter, 6 March 2020) <www.twitter.com/DrTedros/status/1236037605101314053>.
See eg European Centre for Disease Prevention and Control, ‘Q & A on covid-19’, undated, <www.web.archive.org/web/20200402204303/https:/www.ecdc.europa.eu/en/covid-19/questions-answers>. See also the statement of the US Surgeon General – Talia Kaplan, ‘Surgeon general: Data doesn’t back up wearing masks in public amid coronavirus pandemic’, Fox News (online, 31 March 2020) <https://fxn.ws/38t16yB>.
Zeynep Tufekci, ‘Why did it take so long to accept the facts about Covid?’, The New York Times (online, 7 May 2021) < https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html>.
See Mandavilli (n 6). She particularly notes that “[s]ome experts said that the W.H.O. uses the phrase ‘there is no evidence’ to indicate uncertainty”.
Tufekci (n 117).
See eg Communication from the Commission on the precautionary principle  COM(2000) 1 final (noting that a decision based on precaution should be “proportional to the chosen level of protection” and “based on an examination of the potential benefits and costs of action or lack of action”).
Mandavilli (n 6).
Larry D. Curtis, ‘who: There Is No Evidence Wearing a Mask in Public Setting Prevents covid-19 Infection’, wsbt (online, 7 April 2020) <https://wsbt.com/news/nation-world/who-there-is-no-evidence-wearing-a-mask-in-public-setting-prevents-covid-19-infection-1>.
who, who/nCov/ipc_Masks/2020.4 (n 114) 6.
Tufekci (n 117).
See generally Raymond S Nickerson, ‘Confirmation bias: A ubiquitous phenomenon in many guises’ (1998) 2(2) Review of General Psychology 175, and more specifically for scientific research Barbara Koslowski, ‘Scientific reasoning: Explanation, confirmation bias, and scientific practice’ in G.J. Feist and M.E. Gorman (eds), Handbook of the psychology of science (Springer, New York, 2013) 153 et seq.
Linsey Marr was quoted in Megan Molteni and Adam Rogers, ‘How Masks Went From Don’t-Wear to Must-Have’, Wired (Online, 2 July 2020) <www.wired.com/story/how-masks-went-from-dont-wear-to-must-have/>.
See eg who Doc who/nCov/ipc_Masks/2020.1 (n 110) 1.
See eg who, who/nCov/ipc_Masks/2020.3 (n 112) 2. See also Erin Schumaker, ‘CDC and WHO offer conflicting advice on masks. An expert tells us why’, abc News (online, 29 May 2020) <www.abcn.ws/2XseHjC> (quoting Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases).
ihr arts 17, 48 and 49.
Ibid art 49(5).
Ibid art 17(1)(a).