China stifles coronavirus research in apparent bid to control narrative, analysts say

China censoring research on COVID-19 origins, deleted page on Wuhan University website suggests

Are the Chinese hiding vital information on the coronavirus origins?

Two websites for leading universities in China seem to have published and then deleted academic research about the origins of the coronavirus, according to a report.

The posts on the websites of Fudan University and the China University of Geosciences (Wuhan) were erased from online caches -- in a possible bid to control the narrative surrounding the pandemic, The Guardian reported.

The Wuhan university appeared to have published and then deleted posts about academic research that China’s ministry of science and technology needed to approve before publication.

Similar apparent censorship turned up in the form of deleted posts originally published on April 9 by the school of information science and technology at Fudan University in Shanghai.

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“They are seeking to transform it from a massive disaster to one where the government did everything right and gave the rest of the world time to prepare,” Kevin Carrico, a senior research fellow of Chinese studies at Monash University, told The Guardian.

“There is a desire to a degree to deny realities that are staring at us in the face … that this is a massive pandemic that originated in a place that the Chinese government really should have cleaned up after SARS,” he added.

China’s science and technology ministry had announced on April 3 that academic researchers needed to report their coronavirus findings to officials within three days or be terminated.

The news outlet noted that China’s President Xi Jinping published an essay in March that included “tracing the origin of the virus” a national priority; the science and technology ministry referenced the essay shortly before the universities changed tunes.

On New Year’s Eve, China informed the World Health Organization of a “mysterious pneumonia outbreak” spreading through Wuhan, an industrial city of 11 million.

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The government closed a seafood market at the center of the outbreak, moved all patients with the virus to a specially designated hospital and collected test samples to send to government laboratories. Doctors were told to stay quiet; one who issued a warning online was punished. He later died of the virus.

The Pentagon was said to have first learned about the new coronavirus in December from open-source reports emanating from China. By early January, warnings about the virus had made their way into intelligence reports circulating around the government. On Jan. 3, the head of the U.S. Centers for Disease Control and Prevention [CDC], Robert Redfield, received a call from his Chinese counterpart with an official warning.

Dr. Anthony Fauci, the government’s top infectious disease expert, said he was alerted to the virus around the same time — and within two weeks was fearful it could bring about a global catastrophe.

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Quickly, U.S. intelligence and public health officials started doubting China’s reported rates of infection and death toll. They pressed China to allow in U.S. epidemiologists — both to assist the country in confronting the spread and to gain valuable insights that could help buy time for the U.S. response. U.S. officials also pressed China to send samples of the virus to U.S. labs for study and for vaccine and test development.

On Jan. 11, China shared the virus’ genetic sequence. That same day, the National Institutes of Health started working on a vaccine.

Ultimately, the U.S. was able to get China’s consent to send two people on the WHO team that traveled to China later in the month. But by then precious weeks had been lost and the virus had raced across Asia and had started to escape the continent.

Xi Jinping’s China did this The corrupt, criminal regime wasted 40 days blocking information while it crushed domestic dissent and ensured COVID-19 would become a global pandemic By IRWIN COTLER and JUDITH ABITAN

There is authoritative and compelling evidence — including a study from the University of Southampton — that if interventions in China had been conducted three weeks earlier, transmission of COVID-19 could have been reduced by 95 percent.

For 40 days, President Xi Jinping’s CPC concealed, destroyed, falsified, and fabricated information about the rampant spread of COVID-19 through its state-sanctioned massive surveillance and suppression of data; its misrepresentation of information; its silencing and criminalizing of its dissent; and its disappearance of its whistleblowers.

In late December 2019, Dr. Ai Fen, director of the Emergency Department at the Central Hospital of Wuhan — “The Whistle-Giver” — disseminated information about COVID-19 to several doctors, one of whom was Dr. Li Wenliang, and eight of whom were later arrested. Dr. Ai has recently disappeared.

Dr. Ai also detailed efforts to silence her in a story titled, “The one who supplied the whistle,” published in China’s People (Renwu) magazine in March. The article has since been removed.

On January 1, 2020, Dr. Li Wenliang — the “hero” and “awakener” — was reprimanded for spreading rumors, and was summoned to sign a statement accusing him of making false statements that disturbed the public order. Seven other people were arrested on similar charges. Their fate is still unknown.

On January 4, 2020, Dr. Ho Pak Leung — president of the University of Hong Kong’s Centre for Infection — indicated that it was highly probable that COVID-19 spread from human-to-human, and urged the implementation of a strict monitoring system.

For weeks, the Wuhan Municipal Health Commission declared that preliminary investigations did not show any clear evidence of human-to-human transmission.

On January 14, 2020, the WHO reaffirmed China’s statement, and on January 22, 2020, Director-General Tedros Adhanom Ghebreyesus praised the CPC’s handling of the outbreak, commending China’s Minister of Health for his cooperation, and President Xi and Premier Li for their invaluable leadership and intervention.

On January 23, 2020, Chinese authorities announced their first steps to quarantine Wuhan. By then, it was too late. Millions of people had already visited Wuhan and left during the Chinese New Year, and a significant number of Chinese citizens had traveled overseas as asymptomatic carriers.

On February 23, 2020, Ren Zhiqiang — former real estate tycoon and longstanding critic of the CPC — wrote in an essay that he “saw not an emperor standing there exhibiting his ‘new clothes,’ but a clown stripped naked who insisted he continue being emperor.” He spoke of a “crisis of governance” and the strict limits on free speech, which had magnified the COVID-19 epidemic. He has also gone missing, and it has recently been reported that the CPC has opened an investigation against him.

The world would have been more prepared and able to combat COVID-19 had it not been for President Xi’s authoritarian regime’s widespread and systematic pattern of sanitizing the massive domestic repression of its people.

Forty days of silence and suppression cost Italy — the epicenter of Europe’s COVID-19 pandemic — a death toll of 12%, more than double that of China’s, followed by Spain with a fatality rate of 9%. As we write, the United States — whose presidential leadership has been wanting — has become the pandemic’s new epicenter, and there is heightened concern about what could become of developing countries like India, and South Africa’s immunosuppressed population of over 10 million.

While global infections continue to surge relentlessly upwards, China — ironically — is now considered safer than the majority of countries. The South Korean model — where it pioneered drive-through COVID-19 testing centers collecting swabs from over 15,000 people a day, and quarantining the infected immediately thereafter — is one of the only precedents and case studies to date, along with China, that significantly reduced the number of infected people and fatalities.

Attention should also be drawn to the CPC’s massive surveillance and suppression of data juxtaposed with its misrepresentation of information. China’s big data collection — approximately 200 million CCTV cameras — not only precipitated the highest tech epidemic control ever attempted by the CPC, but also underpinned the salience of its repression.

The CPC’s infodemic — in addition to its intense spinning of solidarity on social media and its framing of a “people’s war against the virus” — was both a deceitful and farcical illusion of a coming together in China. The extent of the CPC’s self-promotion and its portrayal of President Xi as a hero ready to save the world — while making Western democracies look grossly incompetent — is as shameful as it is duplicitous.

In a word, President Xi’s government has exacerbated the world’s COVID-19 health and systemic crises, which has paved the way for one of the greatest humanitarian crises in history.

The world is watching. People in China no longer stand alone. Many are no longer fearful. They have already started publishing firsthand accounts of the CPC’s orchestrated cover-ups and monumental failures, revealing the rotten core of Chinese governance.

In defending the struggle for democracy and human rights in China, the international community must stand in solidarity with the people of China in seeking to unmask the CPC’s criminality, corruption, and impunity.

The community of democracies must undertake the necessary legal initiatives — be they international tort actions as authorized by treaty law, or the utilization of international bodies, like the International Court of Justice — to underpin the courage and commitment of China’s human rights defenders. This is what justice and accountability is all about.

The untold origin story of the N95 mask. The most important design object of our time was more than a century in the making.

It’s hard to think of a symbol of COVID-19 more fraught than the N95 respirator. The mask fits tightly around the face and is capable of filtering 95% of airborne particles, such as viruses, from the air, which other protective equipment (such as surgical masks) can’t do. It’s a life-saving device that is now in dangerously short supply. As such, it has come to represent the extreme challenges of the global response to COVID-19.

How did a flimsy polymer cup become the most significant health device of the 21st century? It all started in 1910 with a little-known doctor who wanted to save the world from one of the worst diseases ever known.

THE FIRST MASKS WERE ABOUT STOPPING SMELL
Going back even further—long before we understood that bacteria and viruses could float through the air and make us sick—people improvised masks to cover their faces, says Christos Lynteris. Lynteris is a senior lecturer at the Department of Social Anthropology at the University of St. Andrews, who is an expert in medical mask history.

He points to Renaissance-era paintings where people cover their noses with handkerchiefs to avoid illness. There are even paintings from Marseilles in 1720, which was the epicenter of the bubonic plague, that show gravediggers and people handling bodies with cloth around their faces, even though the plague was spread by the bites of fleas that traveled on rats.

“It was not meant to be against the contagion,” says Lynteris of the practice. “The reason these people were wearing cloth around their mouths and noses was, at the time, they generally believed diseases like the plague were miasma, or gases emanating from the ground. It wasn’t to protect you from another person, they believed plague was in the atmosphere—corrupt air.”

The theory of miasma is what drove the design of the infamous plague masks seen across Europe in the 1600s, which would be worn by doctors who identified the plague and marked the infected by tapping them with a stick. These elongated masks resembled large bird beaks and had two nostril ports at the edge of the mask that could be loaded with incense. People thought that by protecting themselves from the smell of the plague, they’d be protected from the plague itself.

“The stench causes disease. This [thought] continued all the way to the early 19th century,” says Lynteris. (It’s worth noting that, 200 years later, a French physician named Antoine Barthélemy Clot-Bey argued that the bird-like plague masks themselves were responsible for the spread of the plague because they made people scared, and a frightened body was at greater risk for disease.)

By the late 1870s, scientists learned about bacteria. Miasma fell from fashion as the modern field of microbiology emerged. And yet, what came next looked a whole lot like what came before—minus the creepy birds. “We often think of scientific paradigm shifts leading to breaks, but all the technologies used against germs by the end of the 19th century were [riffs] on technologies from miasma.”

A GLORIFIED HANDKERCHIEF

Doctors started wearing the first surgical masks in 1897. They weren’t much more than a glorified handkerchief tied around one’s face, and they weren’t designed to filter airborne disease—that’s still not the point of surgical masks today. They were (and are) used to prevent doctors from coughing or sneezing droplets onto wounds during surgery.

This distinction between a mask and a respirator is important. It’s why healthcare professionals are upset that they’re being instructed to wear surgical masks when respirators are unavailable. Masks are not only made of different materials; they fit loosely on the face, so that particles can come in from the side. Respirators create an airtight seal so they actually filter inhalation.

THE FIRST MODERN RESPIRATOR IS BORN FROM PLAGUE—AND RACISM.

In the fall of 1910, a plague broke out across Manchuria—what we know now as Northern China—which was broken up in politically complex jurisdictions shared between China and Russia.

“It’s apocalyptic. Unbelievable. It kills 100% of those infected, no one survives. And it kills them within 24 to 48 hours of the first symptoms,” says Lynteris. “No one has come across something like this in modern times, and it is similar to the descriptions of Black Death.”

What followed was a scientific arms race, to deduce what was causing the plague and stop it. “Both Russia and China want to prove themselves worthy and scientific enough, because that would lead to a claim of sovereignty,” says Lynteris. “Whomever is scientific enough should be given control of this rich and important area.”

The Chinese Imperial Court brought in a doctor named Lien-teh Wu to head its efforts. He was born in Penang and studied medicine at Cambridge. Wu was young, and he spoke lousy Mandarin. In a plague that quickly attracted international attention and doctors from around the world, he was “completely unimportant,” according to Lynteris. But after conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air.

Expanding upon the surgery masks he’d seen in the West, Wu developed a hardier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.

“There’s a famous incident. He’s confronted by a famous old hand in the region, a French doctor [Gérald Mesny] . . . and Wu explains to the French doctor his theory that plague is pneumonic and airborne,” Lynteris says. “And the French guy humiliates him . . . and in very racist terms says, ‘What can we expect from a Chinaman?’ And to prove this point, [Mesny] goes and attends the sick in a plague hospital without wearing Wu’s mask, and he dies in two days with plague.”

Other doctors in the region quickly developed their own masks. “Some are . . . completely strange things,” Lynteris says. “Hoods with glasses, like diving masks.”

But Wu’s mask won out because in empirical testing, it protected users from bacteria. According to Lynteris, it was also a great design. It could be constructed by hand out of materials that were cheap and in ready supply. Between January and February of 1911, mask production ramped up to unknown numbers. Medical staff wore them, soldiers wore them, and some everyday people wore them, too. Not only did that help thwart the spread of the plague; the masks became a symbol of modern medical science looking an epidemic right in the eye.

Wu’s mask quickly became an icon through international newspaper reports. “The mask was a very novel thing . . . it had an effect of strangeness, which the press loved, but you imagine a black-and-white photograph with a white mask—it reads well,” says Lynteris. “It’s a marketing success.”

When the Spanish flu arrived in 1918, Wu’s mask was well-known among scientists and even much of the public. Companies around the globe increased production of similar masks to help abate the spread of flu.

THE N95 IS MADE FOR INDUSTRIES BUT ARRIVES JUST IN TIME TO HOSPITALS

The N95 mask is a descendant of Wu’s design. Through World War I and World War II, scientists invented air-filtering gas masks that wrapped around your entire head to clean the air supply. Similar masks, loaded with fiberglass filters, began to be used in the mining industry to prevent black lung.

“All the respirators were these giant, gas mask-looking things,” says Nikki McCullough, an occupational health and safety leader at 3M, which manufactures N95 respirators. “You’d wash them out at night and you could wear them again.”

This equipment saved lives, but it was burdensome, and a large reason why were the filters. The fiberglass required a lot of effort to breathe, and the full head enclosures were hot to wear. By the 1950s, scientists began to understand the dangers of inhaling asbestos, but people working with asbestos preferred not to wear bulky respirator masks. Imagine working in construction in 85-degree heat and having your head wrapped in rubber to protect yourself from an invisible threat.

Around the same time, a former décor editor for House Beautiful magazine named Sara Little Turnbull began consulting with the 3M’s giftwrap division. To make stiff ribbons, the company had developed a technology to take melted polymer and air-blast it into a fabric of tiny fibers. Turnbull realized a greater potential for this process, though, and she began experimenting with the material for shoulder pads, leveraging connections in the fashion industry for advice. Then in 1958, she gave a presentation at GM simply titled: “Why,” which explained why 3M should go into this business of non-woven products in a bigger way. She presented over 100 product ideas for the technology, and was assigned to design a molded bra.

But the late ’50s were tough for Turnbull, who spent a lot of time visiting sick family members in hospitals. She lost three loved ones in quick succession. And out of that grief came a new invention: A “bubble” surgical mask that 3M released in 1961, that yes, takes its inspiration from the cup of a bra. When 3M learned it couldn’t block pathogens, the mask was re-branded as a “dust” mask.

Of course, it was hard to build standards around something that didn’t even exist yet—for medicine or workplace safety. By the 1970s, the Bureau of Mines and the National Institute for Occupational Safety and Health teamed up on creating the first criteria for what they called “single use respirators.” The first single-use N95 “dust” respirator as we know it was developed by 3M, and approved on May 25, 1972. (Turnbull herself consulted on this line into the 1980s—and for many other corporate clients including General Mills, Ford, Corning, and Revlon.) Instead of fiberglass, the company repurposed that technology it had developed for making stiffer gift ribbons into a proper filter. Under a microscope, “they look like somebody dropped a bunch of sticks—and they have huge spaces between them,” says McCullough.

As particles, whether silica or viruses, fly into this maze of sticks, they get stuck making turns. 3M also added an electrostatic charge to the material, so even smaller particles find themselves pulled toward the fibers. Meanwhile, because there are so many big holes, breathing is easy.

The longer you wear an N95 respirator, the more efficient it becomes at filtering out particles. More particles just help filter more particles. But breathing becomes more difficult over time as those gaping holes between the fibers get clogged up with particles, which is why an N95 respirator can’t be worn for more than about eight hours at a time in a very dusty environment. It doesn’t stop filtering; it just prevents you from breathing comfortably.

N95 respirators were used in industrial applications for decades before the need for a respirator circled back to clinical settings in the 1990s with the rise of drug-resistant tuberculosis. HIV had a lot to do with its spread across immunocompromised patients, but tuberculosis infected many healthcare workers, too. To stop its airborne spread, N95 standards were updated for healthcare settings, and doctors began wearing them when helping tuberculosis patients. Even still, respirators are rarely used in hospitals to this day because it’s only outbreaks like COVID-19 that necessitate so much protection.

As Lynteris and many others point out, the respirator never really faded from significance in China. Wu went on to found China’s version of the CDC, narrowly miss winning a Nobel Prize, and be featured in many biographies (including his own autobiography). More recently, during the SARS outbreak, people in China wore facial protection to prevent the spread of illness. Then as pollution took over cities like Beijing, they wore respirators to filter pollution.

The N95 respirator isn’t perfect. It isn’t designed to seal well to the face of children or those with facial hair, and if it doesn’t seal, it doesn’t work as advertised. Furthermore, the N95 variants that are worn in high-risk operating rooms don’t have an exhalation valve, so they can get particularly hot to wear.

But the N95 respirator evolved over hundreds of years in response to multiple crises. That evolution will only continue through and beyond the COVID-19 pandemic. McCullough says that 3M is constantly reevaluating the N95 respirator, tweaking everything from its filters to its ergonomics. “My mom would say they look pretty much the same [as in 1972], but we want them to look simple so they’re easy and intuitive to use,” says McCullough. “We’re always improving the technology. We have thousands of scientists at 3M working on [it].”

The WHO vs coronavirus: why it can't handle the pandemic

Attacked by Trump and ignored by many of its most powerful members, the World Health Organization is facing a major crisis – just at the moment we need it most. 
By Stephen Buranyi
lf, like me, you have been confined to your home, glued to the news and nursing ever greater anxiety about the state of the world, you have probably become familiar with the sight of the World Health Organization’s director general, Tedros Adhanom Ghebreyesus, and his daily press briefings. Tedros, as he is known, is a calming presence in the midst of the crisis. Flanked by an international cast of scientists, he always seems confident that if we have hope, listen to the experts and pull together, we will get through this.
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Watching this reassuring spectacle, it is possible to imagine a world in which every nation respects the WHO’s authority, follows its advice and lets it coordinate the flow of information, resources and medical equipment across national boundaries to areas of greatest need.
That is not the world we live in. “The W.H.O. really blew it. For some reason, funded largely by the United States, yet very China centric,” tweeted Donald Trump on 7 April, summing up just one of the many lines of criticism the WHO is currently facing. It is not just Trump – even some of the WHO’s supporters in government, academia and NGOs argue that since the start of the coronavirus crisis, it has caved in to nationalist bullies, praised draconian quarantine measures and failed to protect the liberal international order of which it is a linchpin. “You’ve got a situation where it looks like WHO doesn’t want to exercise its authority,” said David Fidler, a fellow in global health at the Council on Foreign Relations and a regular consultant to the WHO.
Meanwhile, the WHO is desperately struggling to get its 194 member states to actually follow its guidance. The WHO’s leaders are “very frustrated,” said John MacKenzie, a virologist and adviser on the WHO’s emergency committee. “The messages come out loud and clear, and some disregard the warnings. The US largely did, the UK largely did.”
On 11 March, the day Tedros declared the coronavirus a pandemic, he spoke darkly of “alarming levels of inaction” from many countries. Pressed by journalists to name them, Mike Ryan, the usually no-nonsense Irish trauma doctor who heads the WHO’s Covid-19 response, demurred. “You know who you are,” he said, adding that “we don’t criticise our member states in public”.

There is a simple reason for this. For all the responsibility vested in the WHO, it has little power. Unlike international bodies such as the World Trade Organization, the WHO, which is a specialised body of the UN, has no ability to bind or sanction its members. Its annual operating budget, about $2bn in 2019, is smaller than that of many university hospitals, and split among a dizzying array of public health and research projects. The WHO is less like a military general or elected leader with a strong mandate, and more like an underpaid sports coach wary of “losing the dressing room”, who can only get their way by charming, grovelling, cajoling and occasionally pleading with the players to do as they say.

The WHO “has been drained of power and resources”, said Richard Horton, editor of the influential medical journal the Lancet. “Its coordinating authority and capacity are weak. Its ability to direct an international response to a life-threatening epidemic is non-existent.”

At the same time, the international order on which the WHO relies is fraying, as aggressive nationalism becomes normalised around the world. “All the previous rules about global norms, public health and understanding of what’s expected in terms of an outbreak has crumbled,” said Lawrence Gostin, director of the WHO Collaborating Center on National and Global Health Law. “None of us know where this is leading.”

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The WHO was born during the moment of hopeful internationalism that followed the chaos of the second world war. The idea of global collaboration in fighting disease was not new – in the 19th century, at periodic International Sanitary Conferences, countries had standardised quarantine procedures for cholera and yellow fever – but the WHO constitution, adopted in 1948, envisioned a far grander global mission, nothing less than “the attainment by all people of the highest possible levels of health”.

One of the WHO’s favourite success stories is the role it played in eliminating smallpox, a disease that was still killing millions each year in the 50s, despite the existence of a vaccine. Although the WHO worked on immunisation research, its most vital role was organisational and diplomatic. In 1959, it convinced the Soviet Union to manufacture 25 million vaccine doses, which the WHO would distribute. Not to be left behind, the US donated millions of dollars to vaccination programmes, both directly and through the WHO. By the late 60s, every nation in the UN was sending a detailed weekly report to WHO headquarters on their number of smallpox cases and recent progress. And in 1979, WHO declared smallpox eradicated, a first in world history. The WHO didn’t provide the most money, immunise the most people, or invent key technologies such as the bifurcated needle, but it is hard to imagine smallpox having been defeated without it.

If the story of smallpox eradication shows the WHO acting as something like an international ministry of public health, it doesn’t explain its current position as an emergency service, surveying the world for disease outbreaks and springing into action to contain them. That is a more recent addition to its portfolio, which came after a period, in the 80s and 90s, when the WHO seemed to be losing its earlier dynamism. The diseases it was partly created to address – smallpox, yellow fever and the plague – had either been eradicated or were in decline, and it was slow to identify new threats such as HIV/Aids. Under the leadership of Dr Hiroshi Nakajima, from 1988 to 1998, the organisation stagnated, and some member states complained about poor management and alleged petty corruption.

Two things happened at the turn of the century that would shape the WHO we now see tackling the Covid-19 crisis. In 1998, the fiery former prime minister of Norway, Dr Gro Harlem Brundtland, was elected director general. And in 2002, a farmer in China’s Guangdong province became sick with a deadly, never-before-seen respiratory disease that quickly spread among the hospital staff who had treated him, and went on to become the first pandemic of the newly globalised 21st century: one that arose suddenly, had no treatment or cure, and spread with the speed and reach of international business.

Given the WHO’s sprawling structure, vague mandate and reliance on diplomacy, its director general holds immense power to shape it. Even before she took on the role, Brundtland was comfortable on the world stage. “I was already a political leader, and I was used to this kind of authority,” she told me. Like her friend Kofi Annan, the charismatic UN leader, Brundtland believed that international bodies should be prepared to lead when necessary, rather than being bossed around by powerful nations. “If the job is to direct and coordinate global health, it’s not a question of what one or several governments ask you to do,” she said. “We are working for humanity.”

Brundtland pushed the WHO to use its local contacts, diplomatic channels and the emerging internet to locate potential outbreaks, all of which made the organisation less reliant on national governments for information. Within just a few years, this strategy proved its worth. In November 2002, when the Chinese government became aware of the first cases of a novel respiratory disease, later named Sars, it failed to alert the WHO. But, as part of Brundtland’s new approach, WHO staff were monitoring Chinese medical message boards and news media anyway, and were aware of what was then thought to be an atypical pneumonia outbreak. Adding to their suspicions, on 10 February 2003, David Heymann, who was then executive director of the WHO’s communicable diseases cluster, received an email from the son of a former WHO staff member in China warning of a “strange contagious disease” that had already killed 100 people, but which was “not allowed to be made known to the public”. The WHO took the information it had to China, which made its first official report to the WHO the next day.

Although the WHO had no formal powers to monitor and censure its members, Brundtland wasn’t shy about doing so anyway. In the ensuing months she would accuse China of withholding information, claiming that the outbreak might have been contained “if the WHO had been able to help at an earlier stage” and exhorting the Chinese to “let us come in as quickly as possible!” With remarkable speed, China fell in line and shared its data with the WHO. “After her statements to China, no other countries hesitated,” said Heymann.

In March 2003, as the disease spread – reaching Hong Kong, Vietnam and then Canada – for the first time in its history, the WHO issued advice against travelling to affected areas. (Before then, the decision to advise on travel had always been left up to member states.) Despite having no formal powers to ground planes, the measures worked. “Passengers and flights dropped dramatically as soon as we issued the recommendations,” said Heymann.

Brundtland’s approach was not always popular, and some bridled under this new upstart WHO. “It wasn’t just China,” Brundtland told me. “The mayor of Toronto [Mel Lastman] flew to Geneva to tell us take down the travel recommendation – while at the same time he was not containing the outbreak. He had people with Sars riding around the subway, no contact tracing, no following up. He couldn’t accept we were telling him what to do!”

The WHO’s response to Sars was considered a huge success. Fewer than 1,000 people worldwide died of the disease, despite it reaching a total of 26 countries. The pandemic was defeated not with vaccines or medicines, but with NPIs, or “non-pharmaceutical interventions” in WHO parlance: travel warnings, tracking, testing and isolating cases, and a huge information-gathering operation across multiple countries, all made possible by the WHO’s willingness to wield authority that it had, in a sense, created simply by speaking it into existence. “Brundtland did things the WHO had no authority doing. She just did them,” said Fidler. “She sort of used Sars as a way to test drive some very radical changes.”

“After Sars, the WHO’s position was essentially: that was great, let’s formalise it,” said Clare Wenham, a professor of global health policy at LSE. In 2005, the WHO drew up a new version of the International Health Regulations (IHR), the central legal document that all member states are bound by. According to Fidler, the updated IHR, which is in force to this day, is a radical document. It asks its members to prepare for public health threats according to standards set by the WHO, and to report any outbreaks and all subsequent developments. It also allows the WHO to declare a public health emergency of international concern (or PHEIC, pronounced, incredibly, “fake”), using its own information, over the objection of any single country. During an emergency, countries are expected to take the lead from the WHO’s guidelines and report any deviations to the organisation. All of these requirements, bar the reporting of outbreaks, were new.

But the document stopped short of giving the WHO real power if states refuse to comply. “The WHO isn’t Nato, it’s not the security council,” said Gian Luca Burci, who was the WHO’s legal counsel until 2018. The US, fixated on bioterrorism after 9/11, supported giving the organisation some extended powers, but was opposed by Brazil, Russia, India and China, which were wary of US influence. There was a general reluctance to hand an international organisation any more power. “WHO members were happy with the actions that were taken during Sars, but there was definitely a sense afterward of ‘What if that was us in China’s spot?’,” explained Catherine Worsnop, a professor at the University of Maryland School of Public Policy. In short: thanks for stopping the pandemic, but we don’t want to be told what to do.

If the WHO has seemed at times weak or tentative – very un-Brundtland-like – in its handling of the coronavirus crisis, it is partly because of its bruising experiences during the past decade. From 2009 onwards, the WHO faced condemnation from the press and the international community for its handling of successive crises, all during a decade when the financial and diplomatic order that sustained it began to break down.

First, there was the outbreak of H1N1, or “swine flu”. The novel influenza virus was discovered in Mexico in March 2009, and by June, when the WHO declared a pandemic, there were more than 28,000 cases in 74 countries. Over the next year, the WHO coordinated the global response – less aggressively than during Sars – and on 10 August 2010, it declared the pandemic over. Almost immediately, the WHO’s approach came under scrutiny. The death toll – 18,500 confirmed deaths worldwide – was far lower than initially expected, particularly given the disease reached more than 200 countries. “Suddenly you have people saying: ‘Wait a minute, you really cried wolf on this,’” says Wenham. The media and several prominent European politicians demanded inquiries as to whether the WHO had mistakenly rung the alarm, and “cost huge amounts of money and frightened people unnecessarily”, as Paul Flynn, the former Labour MP who chaired one of the inquiries, told the Times in 2010.

To this day, opinions are split as to whether H1N1 was a crisis headed off, or a false alarm. “The WHO is always at risk of being criticised as doing too much or too little,” said Keiji Fukuda, the former WHO assistant director general who led the H1N1 response. Most of the former WHO staff and academics I spoke with agreed, proposing some version of the following as an iron law of public health: act slowly and you will be criticised for failing to stop preventable deaths; act aggressively and stop an outbreak before it becomes serious, and you will be accused of having overreacted. (After all, in the latter case, nothing too bad happened, so what was the big deal in the first place?)

Fidler, who largely approves of WHO’s quick action during H1N1, believes that the backlash led the WHO, which was then under the command of director general Margaret Chan, to become too tentative about calling for action in the future. This was a period when the fallout from the 2008 financial crisis was also starting to take its toll on its budget. “There was a big funding shortfall,” said Andrew Cassels, director of strategy at the WHO between 2008 and 2013. “Cuts made to the emergency response programmes, personnel cuts.” The funding gap stood at nearly $300m in 2012. Entire offices were shut, including a team of social scientists working on pandemic response.

When the Ebola outbreak struck west Africa in 2014, the combination of the WHO’s greater caution and reduced budget resulted in disaster. In contrast to the previous pandemic, this time the WHO was slow to act, and was widely perceived to have lost control of the situation. In the end, the US and several other nations deployed more than 5,000 military personnel at the request of the affected countries, and an ad-hoc UN committee was created to take over responsibilities from the WHO. The outbreak eventually killed 11,310 people, the vast majority in just three countries – Guinea, Liberia and Sierra Leone – paralysing their health systems for months, and causing panic across the world. Prominent scientists judged the WHO’s response an “egregious failure”.

Much of the blame fell on Chan herself. She appeared shell-shocked, stressing to the press that the WHO was a technical advisory body, and that it was national governments that had ultimate responsibility for their citizens’ health. “She wanted the WHO to be an apolitical agency – more like technical support. There was a hesitancy there to push the full powers of the WHO,” said Sara Davies, a professor of global health at Griffith University in Australia.

The bold, proactive culture established after Sars had seemingly faded. Fidler believes that by delaying calling Ebola an emergency, and thus failing to organise an international response at a crucial moment, the WHO’s leadership had shown they “no longer had any faith in their authority”.

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Today, under Tedros, the WHO finds itself in uncharted territory. Not only is it facing by far the biggest pandemic in its history, it is also having to defend itself from the nations on which it most depends. “In my 25-plus years of working on global health issues, I cannot recall the leader of a prominent developed country threatening to punish WHO in the manner President Trump did,” said Fidler, referring to the recent press conference in which Trump suggested putting “a very powerful hold” on US contributions to the WHO. In the same press conference, Trump accused the WHO of concealing information, being too slow to react to the virus, and, above all, showing favouritism towards China.

Since the crisis began, Tedros has been repeatedly accused of being soft on China. Senator Marco Rubio recently told Fox News that the Chinese government had “used the WHO to mislead the world”, and claimed that the WHO “is either complicit or dangerously incompetent”. The US senator Rick Scott put it more bluntly, accusing the WHO of “helping Communist China cover up a global pandemic”. (Tedros, meanwhile, has warned of the dangers of politicising the virus.)

Until very recently, the WHO was seen as a relatively neutral arena for China to extend its power. “China likes to find ways within the global system to give it a leading and benevolent image. The WHO was an uncontroversial place to do it,” said Rana Mitter, the director of the University of Oxford China Centre. No longer. The extent of the initial coverup is still unclear, but there is no question that at least at the local level, Chinese officials knew about the outbreak of a novel disease for weeks before it was reported to the WHO. During that time, Chinese doctors were prevented from speaking out.

John MacKenzie, the WHO’s emergency committee adviser, told me that the organisation was “a little misled” about the Wuhan outbreak. He says that by the time the government alerted the WHO on 31 December, scientists in China had already determined via genome sequencing that the outbreak was caused by coronavirus. Yet the government didn’t confirm that until 7 January and the full genome sequence was not officially shared until 12 January. “That’s very slow,” MacKenzie told me. “For at least two weeks, we could have been making far more kits and so on for testing.” MacKenzie added that the number of cases officially declared by the Chinese in the first week – 59 in the week ending 5 January – was “nowhere near as many cases as you’d expect”. (The statistics released by the Chinese government continue to be questioned, with some reports suggesting they may have seriously understated the number of coronavirus deaths.)

Despite mounting frustrations – in mid-January, China also refused the WHO’s request to send a team of scientific observers to Hubei province, the centre of the outbreak – Tedros has never come close to doing what Brundtland did and calling China out. Instead, on 28 January, he had a closed-door meeting with Xi Jinping in Beijing, and two days later, he praised Chinese efforts to contain the disease, declaring that China is “setting a new standard for outbreak control”. That same day, 30 January, the WHO declared a Pheic, and began issuing prescriptions to countries around the world. On 8 February, China finally allowed WHO observers into the country. For Tedros’s supporters, this was vindication of his strategy of keeping China onside. For his critics, it was too little, too late.

Elected as WHO director general in July 2017, Tedros was supported by a bloc of African and Asian countries, including China, which has considerable influence with those members. (Tedros is himself from Ethiopia, where he served as health minister and then foreign minister between 2005 and 2016.) It was a “really nasty” election, said Davies, in which the powers that have traditionally shaped the WHO, such as the US, UK and Canada, lent their support to one of Tedros’s rivals, the British doctor David Nabarro. During the campaign, Tedros was criticised for having served in a repressive government with a poor human rights record, and one of Nabarro’s backers even accused Tedros of covering up a cholera epidemic during his time as health minister. (Tedros denied the claim, describing it as a “last-minute smear campaign”, while Nabarro told the New York Times that he had never authorised his team to make this accusation against Tedros.) In response, Tedros’s supporters mounted “a collective pushback”, said Davies, against the UK and its allies, eventually winning out. Tedros became the first director general from a so-called developing country since the Brazilian Dr Marcolino Gomes Candau in 1953.

While his background is in politics, Tedros is not forthright or confrontational like Brundtland. In Ethiopia, his political party, the Tigray People’s Liberation Front (TPLF) was mostly comprised of ex-revolutionaries, men that “seemed carved out of a rock”, said Fantu Cheru, a professor at American University and former advisor to the Ethiopian government. Tedros was different – jovial and accessible, said Cheru, and able to make personal connections easily. “He is not very ideological, he believes he can work with anyone,” said Mehari Taddele Maru, a professor at the European University Institute in Florence, Italy. Cheru also sees Tedros as a pragmatist. “He’s not in the Chinese pocket. The Americans in particular wanted to destroy his image. Tedros knows how this game works. You need to have more allies than enemies, and those allies may not have a good track record.”

“I don’t think Tedros did anything previous director generals would not have done,” said Anthony Costello, the director of the UCL Institute for Global Health. “He needed a good relationship with China in order to get in.” Even Lawrence Gostin, who has been a prominent critic of Tedros in the past, told me that “his high praise for China is understandable. He is seeking to coax China into cooperation.” He went on to note, though, that this strategy “does risk the credibility of WHO as an objective agency.”

If the WHO thought it could sacrifice a bit of its credibility – overlooking China’s obvious blunders in December and January in exchange for its compliance in February – and move on, it was mistaken. The argument over China’s influence has been raging for weeks, not least since the government of Taiwan claimed that the WHO had ignored its own early reports of human-to-human transmission of coronavirus as part of a larger history of appeasing China – which has blocked Taiwan from joining the WHO (and the UN) for decades.

Now that Trump, scrambling for an answer to explain why the US now has more cases of coronavirus than any other nation, has alighted upon the WHO and China as his preferred scapegoats, these questions will not go away. “I don’t think we will see the US government cut off funding,” said Fidler. “But what’s happened with this pandemic – with the WHO caught between the US/China rivalry – is not a good omen for the WHO going forward.”

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While the focus has been on what happened between China and the WHO in January, in epidemiological terms the crisis has moved on. Covid-19 has spread fastest and furthest in the US and Europe, through the very rich nations that largely fund and staff the WHO. Before the outbreak, the WHO struggled to get these same nations to prepare for future pandemics. Now the pandemic is here, and they are at the centre of the crisis, the WHO has been unable to keep them following its advice.

Richard Horton of the Lancet said that after the WHO declared a public health emergency, “countries, especially western countries, didn’t listen. Or didn’t seek to understand what was actually taking place in China.” On 5 February, the WHO asked for $675m to fund its Coronavirus response through to April. Anthony Costello of UCL said that when he met with Tedros on 4 March, the WHO had received only $1.2m. (Tedros announced last week that the funding goal had finally been reached, around the time the number of worldwide cases passed 1 million.)

Even the decision to declare a pandemic on 13 March – a largely rhetorical distinction, since calling a Pheic already requires WHO members to respond – was calculated to wake its member states up. In the UK the Premier League was still playing games, and the previous week the US had held primary election contests. “They declared a pandemic because countries weren’t taking the advice,” said Adam Kamradt-Scott, a professor of global health at the University of Sydney.

The WHO stresses that the ideal response to the crisis is relatively simple. Individual states should limit public exposure, especially by tracking and tracing all known cases – a strategy that worked in South Korea and appears to be working in Germany. On an international level, states should share scientific information and resources. These are the mantras Tedros goes back to in his briefings: “Test test test” and “solidarity solidarity solidarity”.

But countries have repeatedly ignored WHO advice. In the UK, the response has been erratic, lurching between the WHO’s norms and its own strategies, such as the now-discredited pursuit of “herd immunity”. The US didn’t recommend school closures or avoiding travel until 16 March. In Sweden, restaurants are still open.

Many wealthy nations have not only pursued their own national strategies for public health, but have also withdrawn from the globalised world of diplomacy and trade that they themselves set up. Earlier this year, for instance, the NHS ordered millions of masks from a French company named Valmy SAS. But in early March, the French government requisitioned all masks produced within the country, so the masks never reached Britain. This week, Germany accused the US of seizing a shipment of masks bound for Berlin from a port in Thailand; while Germany previously sent inspectors to the factory of an American company in Jüchen to ensure their medical masks weren’t being exported against government orders.

The WHO is battling against a breakdown in international cooperation that is far beyond its capacity to control. “Governments have retreated to national policies, and this problem predates this crisis,” said Clare Wenham, the health scholar. States have been turning away from international institutions for a long time. The WHO hasn’t driven globalisation in the same way as the WTO or IMF, but in a way it has administered it – quietly promising to take on the outbreaks that arise in an industrialised and interconnected world, and relying on the often unspoken norms of international collaboration that underlie it.

Ironically, it is most needed now, at a time when faith in the other administrators and overseers of the global order are in decline – a trend that Covid-19 only seems to be accelerating. “As it’s gone on, you see the WHO becoming less important,” said Wenham. “No one is thinking about reducing the global numbers, only their own. The WHO is a global force, but people aren’t thinking globally.”