WHO and the origins of COVID-19
Science and cooperation for the common good of humanity
In May 2020, the World Health Assembly (WHA) requested the Director-General of the World Health Organization (WHO) to continue working with the World Organization of Animal Health to identify the animal species that had been the source of the virus that caused COVID-19. The World Health Assembly elects the Director-General of the World Health Organization, and it meets once a year to decide policy questions with respect to world health and to review WHO policies. At its first assembly in 1948, WHA had 55 members states; today it has 194 member states.
Why did the WHA frame the task as identifying the zoonotic source of the virus? The reason is that previous scientific investigations of pandemics and endemics pointed to a general pattern in which a virus circulating in a non-human animal species evolves the capacity to infect humans and to transmit among human individuals. Such was the prevailing wisdom in the scientific community, based on previous investigations of pandemics in human populations, which often found that viruses with similar characteristics had been circulating in an animal species that had known contact with infected humans. However, in the previous studies of pandemics among humans, an immediate progenitor virus in the animal species in question had never been successfully isolated and identified.
WHO issued a call to specialists for expressions of interest in joining an international team of investigators to cooperate with Chinese specialists in searching for the origins of the COVID-19 pandemic. WHO developed a list of ten qualified candidates which was shared with China; the government of China indicated that it had no objection to the list of international team members. The ten international experts were from Australia, Denmark, Germany, Japan, Netherlands, Russian Federation, Sudan, United Kingdom, Viet Nam, and United States of America. Each submitted a declaration of interests, which were reviewed by team members and by the WHO Secretariat, and it was determined that none had interests that would interfere with the independence of the work. In addition, seven experts and support staff from WHO and from the World Organization for Animal Health were named. The Chinese nationals on the international team included specialists from the Chinese Center for Disease Control and Prevention, the China National Center for Bioinformation, and the Chinese Academy of Sciences. The team of seventeen international specialists and seventeen Chinese nationals was jointly chaired by Dr. Peter K Ben Embarek of WHO and Professor Liang Wannian, Executive Vice-President of the Vanke School of Public Health, Tsinghua, China.
The Joint WHO-China team held a series of virtual meetings from October to December 2020. It conducted investigations in China from January 15 to February 10, 2021.
The Joint WHO-China Study determined that the “likely to very likely pathway” of the virus was from bats via an unknown intermediate host species, with transmission to humans in late December 2019 in the Huanan food and animal market in Wuhan, China.
However, the Joint WHO-China team was not able to isolate and identify a progenitor virus in an intermediate host species, so the team did not rule out an alternative pathway. It considered direct zoonotic spillover from bats as possible or likely, and it reported that transmission through cold-chain products imported to the market from other countries was possible.
In the view of the Joint WHO-China team, a pathway involving a laboratory incident was possible, but very unlikely. It wrote:
“The three laboratories in Wuhan working with either CoVs diagnostics and/or CoVs isolation and vaccine development all had high quality biosafety level (BSL3 or 4) facilities that were well-managed, with a staff health monitoring programme with no reporting of COVID-19 compatible respiratory illness during the weeks/months prior to December 2019, and no serological evidence of infection in workers through SARS-CoV-2-specific serology-screening. The Wuhan CDC lab which moved on 2nd December 2019 reported no disruptions or incidents caused by the move. They also reported no storage nor laboratory activities on CoVs or other bat viruses preceding the outbreak.”
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The outbreak and China’s response
The WHO-China Study reports that Chinese health workers recognized the outbreak of severe respiratory diseases—subsequently determined to be due to infection with SARSCoC-2—toward the end of December 2019. The market was closed by authorities on January 1, 2020, and on the early morning of January 1 the Chinese Center for Disease Control and Prevention began to collect environment and animal samples from the Huanan market, other markets in the area, sewerage wells in nearby communities, animal products stored in warehouses and cold-storage facilities related to the Huanan market, and stray cats in the area. Searches for additional cases of infection began immediately. The identified cases were reported to the National Notifiable Disease Reporting System (NNDRS), which had been developed in the aftermath of the 2003 SARS epidemic.
The Joint WHO-China Study notes that China rapidly isolated the patients infected by the virus that caused COVID-19. It undertook a study of the virus, which showed that it was new to humans; the results were published in January 2020. Epidemiological investigations of all cases reported by hospitals and primary health care clinics to NNDRS were carried out in the first months following the outbreak. Patients diagnosed with SARS-CoV-2 were asked about their contacts during the two weeks immediately prior to their becoming ill, in order to identify sick persons and persons at risk of illness. During the next year, there were extensive studies globally on virus sequencing and evolution, and the results have been published internationally through the platform of GISAID (Global Initiative on Sharing Avian Influenza Database).
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Dimensions of the Joint WHO-China Study
The study notes that China operates a national health surveillance system, which consists of a network of hospitals and the Chinese Center for Disease Control and Prevention. The system monitors cases of ILI (influenza like symptoms) and SARI (severe acute respiratory infection) throughout the year. The surveillance system provided data to the WHO-China team which aided its epidemiological analysis and its retrospective testing of respiratory test swabs collected by the surveillance system.
The epidemiological analysis conducted by the WHO-China team found that there was a marked increase in ILI at the end of December 2019, but there was no evidence to suggest substantial SARSCoV-2 transmission in the months preceding the outbreak in Wuhan in December. At the same time, retrospective testing of respiratory tract swabs revealed no clear indication of substantial unrecognized circulation of SARS-CoV-2 in Wuhan during the latter part of 2019. In addition, mortality studies document a rapid increase in deaths in the third week of 2020, which suggests that virus transmission was widespread in the population of Wuhan by the first week of January.
Seventy-four clinically diagnosed cases of COVID-19 were reported in December, with the first clinically diagnosed case reported on December 16. The earliest cases were mostly residents in the central districts of Wuhan, but cases were appearing in all districts of Wuhan by the end of December. Some 55.4% had been exposed to the Huanan market and/or the other food and animal markets in Wuhan, with approximately three/fifths of these exposures occurring in the Huanan market. In addition, it was found that 26.4% had been exposed to “dead animals” (including meat and fish) and an equal amount of 26.4% had been exposed to cold-chain food products, with 11.8 % exposed to live animals.
The WHO-China Team conducted a widespread scan of food animals (pigs, cattle, sheep, and chicken) across the country. It did not find evidence of SARS-CoV-2.
The WHO-China Team looked at the possible impact of the Seventh Military Games, held from October 18-27, 2019. It noted that the Games were attended by the Jinyintan Hospital, which included on-site clinics. It noted that four African participants were diagnosed and treated for malaria, and one U.S. citizen had gastroenteritis. It observed that no severe respiratory disease requiring hospitalization was identified with respect to the Military Games.
The Joint Team noted that the number of infected patients at the Huanan market were disproportionately connected to the stalls that sold cold-chain products. In the early stage of the Pandemic, cold-chain products were not tested, due to lack of awareness that SARS-CoV-2 is able to persist in conditions of frozen-food packaging. The team undertook a study of cold-chain products related to the Huanan market, both upstream wholesalers and imported cold-chain products from other countries. It identified 440 types of cold-chain products imported from twenty countries in North America, Latin America, Eurasia, and East Asia. The team suggested further investigation in a second stage of study.
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Review of previous studies
The Joint WHO-China Study reviewed the coronavirus studies that previously had been conducted in China with funding from U.S. and Chinese entities, which found that coronaviruses were associated with the SARS outbreak in 2002 and the Middle East respiratory syndrome (MERS) outbreak of 2013. SARS-CoV and MERS-CoV have caused largescale epidemics among humans, but their exact origins have not been identified. These coronaviruses have been identified in bats, and evidence suggest that civets or related species may be the intermediate host of SARS-CoV; and that dromedary camels were the intermediate hosts for MERS-CoV. (A civet is a small, lean, mostly nocturnal mammal native to tropical Asia and Africa, especially the tropical forests).
The Joint WHO-China Study also observes that “although the virus was first identified as the cause of a cluster of cases of severe pneumonia in Wuhan, to date it is uncertain from where the first cases originated.” It refers to studies that suggest the possibility that SARS-CoV-2 cases existed before December 2019 in Barcelona (Spain) and Brazil; and in December 2019 in Italy, France, and the USA. These studies from different countries suggest that SARS-CoV-2 circulation of the virus was occurring in different regions prior to the detection of the first case in Wuhan.
In addition, the WHO-China Study emphasizes the high susceptibility and transmissibility of SARS-CoV-2 in mink. Natural infections have been found in mink farms in Canada, Denmark, France, Greece, Lithuania, the Netherlands, Poland, Spain, Sweden and the USA.
The Joint WHO-China Study also reports that three quarters of emerging infectious diseases have animal reservoirs, which include wildlife (for example bats, primates, rodents, and birds) and domesticated animals (poultry, pigs, and camels). It notes that animal and environment studies show that “spillover events are driven by factors that include large-scale environmental and socioeconomic changes, including land use change, deforestation, agricultural expansion and intensification, trade in wildlife, and expansion of human settlements.” This has led scientists toward the view that human populations are increasingly vulnerable to pandemics of animal origin, taking into account the extensive intrusion of human activities and settlements into wildlife areas in recent decades.
Such scientific investigations provide a context for the task assigned to the Joint WHO-China team by the World Health Assembly. The Joint WHO-China Study asserts:
“Most emerging viruses originate from animals. Understanding the process that may lead to a crossspecies transmission event, also known as “spillover”, and global spread requires a deep understanding of both the virus diversity and evolution in an animal reservoir, the interactions between animals, their environment and humans, and the factors contributing to efficient human to human transmission. A virus causing a global pandemic must be highly adaptive to human environments. Such adaptation may be gained suddenly or may have been evolving through multiple steps with each step driven by natural selection.
“The search for the origin of SARS-CoV-2 therefore needs to focus on . . . viral circulation in animal hosts (such as bat, pangolin, mink or other wild animals) before zoonotic transfer. During this evolutionary process, various animal species may serve as reservoir hosts. Upon circulation, SARS-CoV-2 progenitor strains may have acquired increased ability to infect humans. Finding viral sequences nearly identical to SARS-CoV-2 helps the elucidation of the origin of SARS-CoV-2 from zoonotic transmissions from intermediate host species.”
The Study proceeds to assert that “viruses identified so far from neither bats nor pangolins are sufficiently similar to SARS-CoV-2 to serve as the direct progenitor of SARS-CoV-2. . . . The high susceptibility of mink and cats suggests the potential of additional species of animals (belonging to the mustelid or felid family, as well as other species) as potential reservoirs.” It maintains that the “spillover of viruses from animals to humans can occur through direct contact with infected animals, indirectly through animal products or excreta, or via intermediate hosts.”
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Further considerations
WHO’s framing of the problem is rooted in a sustained scientific search for understanding specific cases of viral evolution, with the expectation of identifying origins of spillover to human populations, thereby enabling strategies for prevention and treatment. The scientific frame is different from a political-economic analysis, which would identify the extent to which the research is driven by profit motives that could override possible negative consequences of the research undertaken, and it would recognize economic and political actors who would have an interest in covering-up a laboratory accident. In addition, the scientific frame of reference is different from a military/security perspective, which would focus on possibilities for development of biological arms, addressing the issue in the context of the history of states and non-state actors engaging in terrorist activities and using weapons of mass destruction, creating a need for all states to cooperate in protecting themselves against biological terrorism.
The political-economic and military side of the origin of COVID-19 question ought to be investigated, but the global structures for doing so have not been developed. The various organizations of the United Nations are home to competing and often contradictory political-economic perspectives, and it is unlikely that a consensual approach that investigates all relevant questions from all current perspectives could possibly take shape. Such a consensual approach would have to include not only the possibility of an escape from a lab in Wuhan, but also the possibility that China was the target of a biological weapons attack. For its part, China would have no reason to cooperate with an investigation that is designed as an international lynching as part of a Western New Cold War against China.
Reflections on the issue should have cognizance of the fact that socialist countries like China and Cuba practice an international diplomacy that stresses cooperation among all nations of the world, and this especially pertains to a field like human health, in which common principles and joint strategies can be attained with less difficulty than others. In this diplomacy, the socialist countries do not leave aside critiques of capitalism and especially neoliberal capitalism with respect to health. The critiques by the socialist countries typically stress corporate concentration in health, the definition of priorities based on profit rather than human need, the privatization of health in the neoliberal stage, and the inequality of distribution of health services in the world and within nations. They are joined in these critiques by progressive states and social movements. Nevertheless, the orientation of the socialist countries in their international diplomacy is to emphasize and develop in practice cooperation with respect to the common problems of humanity, in spite of political and ideological differences.
In accordance with this perspective, the socialist countries affirm the principles of the UN Charter, and they work with UN agencies (such as WHO) in the resolution of problems. Practical challenges in this regard are aided by the political fact that the organizations of the UN system have for decades attracted young people with progressive ideas from the nations with advanced economies, to some extent functioning to channel their youthful idealism toward reformist international cooperation. As a result, the organizations of the UN system are headed and staffed by persons who are fully committed to the principles of mutual respect and cooperation expressed in the UN Charter, and they are oriented toward cooperation with socialist and anti-imperialist governments in the resolution of common human problems.
The cooperation of China and Cuba with the World Health Organization has emerged from this global political dynamic, which has been evolving since the end of World War II. With respect to the COVID-19 pandemic, China, Cuba, and WHO have supported protective health measures, even when they constitute temporary suspensions of individual liberties. And they support the development and wide distribution of vaccines. In the case of Cuba, vaccination was not mandated; but it did not need to be, because more than 90% of the population voluntarily took advantage of the availability of free vaccines in local distribution centers, using vaccines that had been developed by the Cuban health research and pharmaceutical systems.
It should be noted that the socialist nations have managed the COVID-19 pandemic in a far more effective manner than the principal capitalist nations of the West. As of January 14, 2024, China has had four accumulated COVID-19 deaths per one million population; DPRK, 3; Nicaragua, 33; Venezuela, 200; Vietnam, 437; and Cuba, 754. The higher rate in Cuba in comparison to the other nations constructing socialism is a consequence of several factors: the importance of international tourism in the nation’s economy; certain characteristics of indiscipline in Cuban popular culture; the erroneous reopening of tourism at the beginning of 2022; and errors in the geographical prioritizing of the distribution of the vaccine. In contrast, the Western nations with capitalist economies were less capable of formulating and implementing a coherent national plan in response to the pandemic, and they had much higher death rates. The United States as of January 14, 2024, has had 3,560 deaths per one million population; UK, 3,389; Sweden, 2,634; France, 2,556; Germany, 2,518; Luxembourg, 1,918; Switzerland, 1,646; Denmark, 1,511; Canada, 1,492; and Netherlands, 1,336.
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