Did the WHO flip-flop?

"There is a need to balance saving lives and saving livelihoods."


Who and what are we to believe now?

Some days back, Britain’s Representative to the World Health Organization (WHO) and that body’s Special Envoy on COVID-19, Dr. David Nabarro, called for governments to stop lockdowns as “the primary method of controlling Covid 19.” This is a major departure from the earlier and continuing guidance from the UN’s principal agency in charge of providing direction on global health concerns particularly the declaration of and collective response to pandemics and related issues.

Said Nabarro: “I want to say it again: We in the World Health Organization do not advocate lockdowns as the primary means of control of COVID-19. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large, we’d rather not do it.”

Continuing with his discourse in an interview with the Spectator magazine, Nabarro said: "The economic impact on small countries that rely on tourism and increased poverty levels are two major effects of shutting communities down. Lockdowns have just one consequence that you must never ever belittle, and that is making poor people an awful lot poorer."

This same message was contained in an earlier piece, Reflections about the Middle Path, which Nabarro had written early on and which apparently the WHO leadership had somehow muted as it pushed the world to a global lockdown after declaring a pandemic just a month or so after the discovery of the COVID-19 virus in Wuhan. In that article, Nabarro noted that health measures which involve strict personal hygiene, effective contact tracing and isolating when ill are the essential measures which should be taken – not strict and widespread lockdowns.

"Too many restrictions,” Nabarro emphasized, “damage people's livelihoods and provoke resentment. 'Virus run wild' will lead to lots of deaths as well as debilitating long-COVID among younger people. Public health services are organized to offer locally-integrated support for interrupting transmission and suppressing clusters," he wrote.

Nabarro’s position aligns with the much-debated Great Barrington Declaration issued earlier this month by a group of medical experts and scientists advocating “focused protection” for vulnerable members of the population instead of continuing lockdowns and allowing the immediate return to normal life of those considered low risk.

The WHO special envoy joins a growing number of scientists and public health experts numbering 30,000 as of last count advising that this “focused protection” approach will minimize overall mortality and lessen the disproportionate burden of lockdowns on the working class and underprivileged.

The day after Nabarro made his remarks, WHO Director-General Dr. Tedros Adhanom Ghebreyesus flatly contradicted him, declaring that lifting lockdowns would be a recipe for “unnecessary infections, suffering and death.”

He noted that lockdowns are only one part of a public health response, not the “end-all and be-all” of the guidance provided by the organization. Tedros emphasized that lockdowns just freeze the virus, not lead to its elimination. The WHO had earlier put forward a six step plan for governments to ease lockdown known as “test-trace-isolate-protect services everywhere, with clearly justified performance metrics.”

Under this system, the WHO advised that governments should be able to carry out the following: a) ensure transmission is under control (test and trace); b) make sure health systems can care for every case — including tracing and isolating (upgrade the health system); c) Minimize risks in health facilities specially health workers; d) ensure preventive measures in workplaces, transportation, schools and other essential places; e) manage the risk of the virus being imported in from another place and f) fully educate and involve the community on the new normal, and how they can protect themselves.

In a sense, Tedros and Nabarro, both accomplished doctors who had earlier competed for the number- one WHO position, are walking on the same plane only that the latter is now aggressively advocating immediate lifting of restrictions instead of easing up on a phased basis. So when Tedros spoke about the “impracticality of lockdowns in countries with weaker economies,” he was actually airing the same sentiments as Nabarro did when he talked about the need to take care of the “poor and underprivileged.”

In fact, Tedros said early on that “in countries with large poor populations, the stay-at-home orders and other restrictions used in some high-income countries may not be practical. Many poor people, migrants and refugees are already living in overcrowded conditions with few resources and little access to healthcare. How do you survive a lockdown when you depend on your daily wage to avoid death?”

That statement perfectly aligns with that of Nabarro, who had also said in his interview with the Spectator that: “Lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer. Just look at what’s happened to smallholder farmers all over the world. Look what’s happening to poverty levels. It seems that we may have contributed to suffering more than we admit at all.”

So, did the WHO flip-flop? Apparently not. These two WHO leaders agree and continue to advocate the six-point plan which the organization had earlier advised governments to follow. They just differ in the manner and the timing by which restrictions or lockdowns should be worked out. Given the economic, social and cultural differences among countries and between communities within, the needed balance between Saving Lives and Saving Livelihoods will have to be carefully calibrated to avoid any undue resurgence as restrictions are eased up on the way to a new normal. 

Topics: Jonathan Dela Cruz , Britain , World Health Organization , WHO , COVID-19 , Dr. David Nabarro
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