[세션1-1] 코로나19와 WHO의 대응_지영미_코로나팬데믹, 한국의 대응과 과제

We will begin Session 1 right away. The first session will consist of presentations and discussions on the WHO and the Korean government’s responses to the COVID-19 pandemic. First, allow me to introduce the first speaker. The first speaker was Dr. Jee Youngmee. As an expert of infectious diseases, especially viruses, she has served as the director of the Center for Infectious Diseases at Korea’s National Institute of Health, and is a member of the WHO’s COVID-19 Emergency Committee which oversaw the pandemic declaration. She will be speaking on the topic of COVID-19 and the WHO’s response. Hello, everyone. Nice to meet you. I would first like to thank the SNU NSC for inviting me to this special forum.

01:11 - My presentation is about the debate concerning whether the WHO’s response to this unprecedented COVID-19 has been appropriate. What I want to speak about is the situation faced by the Emergency Committee I am part of, especially concerning the following. The role of the WHO in this crisis caused by a new infectious disease, what is involved in the operation of the International Health Regulations (IHR) and the Emergency Committee, what the WHO is doing in terms of R&D. I will also briefly mention the country joint mission and the joint evaluation process with the WHO. Then I’ll give my opinions on whether there is a need for a new global health initiative, which is currently merging as a discussion.

02:13 - What is the role of the WHO in a public health crisis caused by a new infectious disease? Primarily, it has the role of evaluating the crisis, collecting data, and sharing information. Also, the WHO creates and distributes technical guidance. Concerning COVID-19, WHO created and distributed about 234 technical guidance. The WHO also communicates with the focal points set by each country’s IHR to establish an emergency committee and declare emergency situations. In relation to R&D, the WHO’s R&D Blueprint team works in collaboration with GLOPID-R, based in Europe, to oversee R&D operations.

03:07 - For countries in need of technical assistance, the WHO provides technical assistance through a network of experts called GOARN, the Global Outbreak Alert and Response Network, or through its approx. 150 regional or country offices which consist the two levels of the WHO under top headquarter, and their officers provide on-site assistance. In fact, these offices supply goods necessary for emergency responses, and 127 countries have benefited from this assistance. The WHO operates joint missions centering on the countries that are most in trouble. In this pandemic, 80 missions have been operated in countries such as China, Italy, and Iran.

04:01 - To do all of these things, fundraising is a must, and the target amount is set to US$675 million, and just shy of half has been raised, with Korea also committing about US$3.3 million. The WHO receives reports from each country, which is usually divided into 6 regions, and if you look at the slide, until recently, Europe had the largest number of active cases, but now the Americas have surpassed Europe, showing notable surge in active cases especially in South America. Of the six regions, the cases in Africa are still very small in number, but there are a lot of concerns because the infrastructure and WHO’s impact are the weakest here and there are food security problems, etc. The WHO Emergency Committee determined an emergency situation on January 30th which was declared by the Director-general, But, in fact, around January 11th, a lot of technical guidance were made and distributed by the WHO. If you look at the WHO website, you can find a lot of information, and a significant amount of information is being shared in real time under Rolling Update.

05:34 - As I said earlier, more than 234 technical guidance covering diverse fields is shared, and Strategic Preparedness & Responses Plan is a representative example. This was released early February and mentions three major things. issues related to international coordination, scaling up the responsiveness of each country, and accelerating R&D. Concerning R&D, there was a global forum for R&D on February 11-12th, where a roadmap related to COVID-19 was created. And if you look at the slide, this STRATEGY was updated and announced in April.

06:29 - The basis of the WHO’s role in crises brought by new infectious diseases is the International Health Regulation (IHR). IHR is the legal tool that binds the 194 countries participating in the WHO. It was first created as the International Sanitary Regulation following the cholera epidemic in the 19th century, and when the WHO was founded in ’68, it was revised in ’69 to include plagues, etc. other than cholera. The next amendment to the IHR was in 2005, which came into effect in 2007. The IHR aims to prevent the cross-border spread of diseases and to ensure that each country has the minimum capacity to quickly detect and respond to disease-related outbreaks.

07:38 - What the WHO can do through IHR is to declare an emergency. In case of an outbreak, the country is required to report to WHO within 24 hours. Then, the WHO establishes an emergency committee to assess the risks of cross-border transmission and possible impact on trade, etc. and declare an emergency if necessary. So far, there has been six emergency declarations including COVID-19, and the three marked in red are the cases which are still in effect. When an emergency is declared, experts provide on-site assistance through GOARN, and in Asia, APSED, the Asia Pacific Strategy for Emerging Diseases, assists the implementation of IHR in each country.

08:48 - To give a little insight into how the WHO’s emergency declaration for COVID-19 was made, the meetings were held via telephone conference, and due to their importance, the WHO Director-general himself opened and closed the meeting. The conflict of interest is considered very important, so there is a procedure to check each person at each meeting. The affected countries take turns presenting their situation, So, of course, China gave a lengthy presentation, and since, at the time, Japan, Korea, and Thailand had imported cases, these countries gave brief statements. So, after the presentations, a Q&A session is held, then the members leave the telephone conference, after which confidential meeting are held as close sessions between the committee members and the WHO officers. Through this confidential session, the recommendations on whether to declare an emergency are discussed and decided.

09:50 - Even if a decision is made by this emergency committee, a meeting is held at least every three months to revisit whether to maintain the emergency or whether any amendments are necessary to the recommendations. The first meeting was held on January 22nd, and right after, on the 23rd, Wuhan was shut down, and a meeting was called again. China made a long announcement which included critical information. Person-to-person transmission was confirmed, and the RO value was estimated to be at least 1.4 to 2.5, with a mortality rate of 4% out of 557 cases, and fourth generation cases were already occurring, and infections were spreading in hospitals.

10:50 - China also presented that 25% of the cases were severe, but, as at this time, there were only imported cases in countries other than China, the opinions of the committee members were divided. So, the emergency declaration was postponed at this time, but it was recommended for the WHO to hold the meeting again within 10 days and to conduct a WHO-China joint mission, and many recommendations were made to China. As Chinese New Year was about to begin, China was recommended to strengthen surveillance, to cooperate well with the WHO and partners, and to share data actively. At the second meeting, the emergency declaration was decided, and again, it was recommended for the WHO to carry out a joint mission as soon as possible. In fact, the joint mission was conducted from February 16 to 24, and Dr. Lee Jongkoo represented Korea in this mission.

11:52 - The WHO made recommendations concerning assistance to vulnerable countries, and many recommendations for China, including those on exit screening. Countries were not recommended to limit travel or trade at this time, and any country that took measures otherwise were required to report to the WHO, however, not all countries have done so. It was also recommended not to discriminate against or stigmatize specific groups. The third meeting was on April 30th, and there was a consensus that the emergency declaration should be maintained, and the WHO recommendations included coordination issues, especially concerning support for vulnerable countries, and the provision of guidance in adjusting public health measures. Also, a number of solidarity clinical trials are underway, and the WHO recommended clinical trials to include not only high- income countries but also low-income countries.

13:10 - Other recommendations included the need for open access in the search for the source of the virus, and the need for solid provision of basic health services, and issues concerning risk communication and community engagement, etc. The WHO places a lot of weight on R&D, and had been running working groups in nine fields long before the emergency declaration at the end of January. These nine fields have been making preparations for R&D covering a large scope, including social science and ethical issues. After the emergency declaration, a global forum was held over two days from February 11 to 12, after which a roadmap was established and released in March. Funds were raised in connection, and Korea also made a contribution.

14:10 - Concerning the treatments and vaccines, an international solidarity clinical trial is currently being conducted on viable drugs, and the four treatment options are being compared. As of April 27, more than 1,600 patients from 11 countries were enrolled for clinical trials, and more than 120 vaccines are being developed, and to my knowledge, 10 have entered clinical trials. In addition, Access to COVID-19 Tools Accelerator was created on April 24th, and a lot of partners in addition to the WHO, including Welcome Trust, Gavi, Cepi, Gates, Global Fund, etc., have been participating, and more partners are encouraged to participate. The next slide shows the many studies in progress, especially clinical trials for treatments, and this is being updated in real time. This is the number as of the 15th.

As you can see, there are more than 2,500, no, 2,300 studies registered, 15:23 - and by country, there are 8 conducted in Korea, 161 in China, and 153 in the United States. The number of studies in Korea is quite small, and to my knowledge, this is because of the decrease in the number of patients, which is making it difficult to conduct clinical trials. Korea has actually done a very good job in pandemic response, and has accumulated a lot of data in the process including epidemiological data, clinical data, and data on public health response. More effort should be made accelerate the analysis and sharing of this data. Also, more investment in R&D and stronger cooperation with global partners are also necessary.

16:10 - To talk about the challenges laid out by the WHO, we need to strengthen public health capabilities in each field, protect vulnerable population groups, and gain more understanding of this disease since it is new and there is a lot we don’t know about it. Also, the biggest challenge now is to contain the spread while balancing out the economic and social impacts. Concerning the WHO-China joint mission, As you can see, Wuhan was shut down on January 23rd, so the epi curve next to it has already shown a bend. I think this was the data from the last day of the press briefing, and this shows that there are social distance measures put in place. A similar mission took place in 2015 during the MERS outbreak in Korea, and although it has not led to an emergency declaration, we have put a lot of effort in strengthening our infectious disease prevention and control system.

17:25 - A joint evaluation took place in 2017, which was conducted over a week but took almost six months to prepare. It was a very difficult process, and I was in charge of the preparations. It was a very big evaluation involving about 10 government departments, and with cooperative efforts, we received quite a good score, about 4.52 out of 5 points, which was the best score out of all countries evaluated so far, which showed that we improved our ability to respond to public health crises after MERS. Now, concerning the IHR, there are about four categories in the framework for monitoring and evaluating the IHR implementation in each country, and the first is the mandatory report required to be submitted every year.

18:33 - Then, there are three others, the after-action review, simulation exercises, or the joint evaluation I just mentioned, which are done on a voluntary basis. So, in my opinion, we should make these mandatory to strengthen IHR implementation. The 100 noted here is the joint evaluation I just mentioned and shows that it has been conducted in 100 countries from 2016 to 2018, and it has been conducted in about 10 more countries since then, bringing the total to about 110 countries. There are talks about whether the WHO has played an appropriate role and whether we need a new organization, but, in my view, creating something new is not reasonable. As you know, as a specialized agency under the UN, the WHO has 194 country members, and aside from WHO HQ, there are 6 regional offices and more than 150 country offices that employ 7,000 to 8,000 staffs.

19:50 - With many UN partners, the WHO is engaged in COVID-19 response. If you see on the right, concerning WHO reform, there has been a lot of talks about reform from 2011 to 2014, and one of them is IHR related, marked in red but maybe not so visible. There were discussions at the time about the need to strengthen the IHR. To give an example, in 2014, the WHO was criticized for its Ebola response, and a global security agenda, led by the United States, was created. 67 countries including Korea are participating in this agenda, but the fact is, governments change, for example, the US government is led by President Trump who cut the budget significantly, making it difficult to function properly.

20:50 - So, in fact, many of its functions have been delegated to the WHO, and the WHO are managing them. So, it is very difficult to break off from the existing framework and make an organization that can do better. While there is a lot of talk about reforms, in fact, the new Director-general, Dr. Tedros brought a lot of change to the organization. This is the WHO organization chart from the beginning of this year.

21:20 - Notably, a high-level position was added, called the chief scientist, in areas including digital health, and in addition to emergency response, a department for emergency preparedness was created. In particular, Dr. Tedros put a lot of weight on strengthening UHC- related areas. The goal of these changes was to eliminate the silo among WHO programs and strengthen cooperation, and to better serve member countries by aligning the WHO HQ, regional officers, and country offices. I think that to a degree, this change has been successful. Over the last two days, the World Health Assembly was held online for the first time in history, and Korea’s President Moon also participated and spoke at this event.

22:15 - In his speech, he mentions the strengthening of the IHR. So, in conclusion, rather than creating a new initiative, I think it is more appropriate to strengthen the functions of the WHO so that it can play a better role in crisis situations, and a way to do that is strengthening the IHR and making mandatory the non-mandatory components of the four I mentioned earlier. And also, it needs to reflect the demands of its members better. Since the WHO’s basic position is oriented more towards low-income countries than high-income ones, it needs to listen to high-income countries a bit more. Also, in relation to COVID-19, there were some issues surrounding the collective data sharing platform, and the WHO should play a bigger role in coordinating and meet these needs.

23:18 - Among the three levels of WHO organization, the country office is the level that works on-site, so I think it is necessary to strengthen the functions of country offices. Korea participates in various meetings held by the WHO, and I think it’s important to become a meaningful voice to the WHO in these meetings. This is the end of my presentation. (audience claps) .