Reflections on ‘The WHO?’
Last week I posted ‘The WHO?’ which included some thoughts on the Irish Governments deference to the World Health Organisation (WHO) advice on mask wearing as a defence against covid-19. In the post, I am quite critical of this deference and I express my dismay with the WHO.
Since then, I have been contemplating the extent to which this a fringe view in my home country, Ireland. Here, The WHO is considered a wise leader shepherding us to safety. To the man on the street, questioning of the WHO will sound conspiratorial. The mainstream view is that the WHO tracked the outbreak competently, analysing the evidence available and updating their advice to governments around the world accordingly as the crisis unfolded.
While I believe that view is substantially accurate, I think the WHO have failed. Before I explain why, let me make this crystal clear in order to distance myself from other critiques I have read — I do not think the WHO are corrupt or compromised. I do think the organisation is dysfunctional and ill equipped to respond effectively to a crisis such as covid-19.
What the WHO Continue to Get Wrong
My critique will centre around the tweet seen below, which I also shared in my earlier post.
‘Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission’. My problem with the approach of the the WHO is encapsulated in this sentence. Let’s break down what it means. In early January, the Chinese were worried about a new virus. They were worried enough that they decided to conduct a study to try and figure out whether it was spreading between humans. To conduct this study, they would have formulated a hypothesis somewhat like this;
Does the virus spread between humans?
They carried out the study, but they couldn’t build ‘clear evidence’ that the virus was spreading between humans. Now, crucially, that does not mean that the virus is not spreading between humans (as we now know, unfortunately). It means they cannot say conclusively that it is spreading between humans. So, at this point, in January, the answer to the question of whether the virus is spreading between humans is unknown. The WHO shared this information, governments throughout the West listened, and life carried on as normal (it is notable that many Asian countries did not listen, but that is a blog post in itself).
A Better Way
My ideal World Health Organisation would have acted in a completely different manner. Their tweet would have looked something like this — ‘we cannot say definitively that this virus is spreading between humans. If this virus is spreading between humans, it could be catastrophic. We assign a X% probability that the virus is spreading between humans. Please prepare accordingly.’
The WHO did not believe the probability that the virus could spread between humans was 0% on January 14th. They simply couldn’t have. If they believed X was > ~5%, in a situation where the stakes are this high, the alarm bell simply HAS to be sounded. You are rolling the dice with faith otherwise, and there is a 1 in 20 chance that you lose.
Instead of communicating a probability, the WHO communicated there was ‘no clear evidence of human-to-human transmission of covid-19’. The WHO did not communicate a probability because they function in a black or white manner. They need clear evidence. If they don’t have clear evidence, they will wait until they have it before making their decision. This approach is fine in normal times — you will move slowly but you will reliably arrive at the right answer. However, these were not normal times. A novel coronavirus was circulating in China and there were concerns there was human-to-human transmission. In times like that, when ambiguity abounds and the costs of a bad outcome are so high, this ‘clear evidence’ approach is so so so so wrong. I do not want my World Health Organisation to be set up to perform reliably well in the normal times. I want my World Health Organisation set up to perform when it really, really matters. This requires a different approach, a different posture, a different organisational design to the ‘clear evidence or nothing’ WHO that we currently have.
Clear evidence is a burden of proof invented by humans. The path to clear evidence looks something like this — research the issue, gather data, analyse and interpret the data, write up the findings, have it peer reviewed, submit for publishing, disseminate, have experts read. If they agree — you now have clear evidence. Three weeks (absolute best case scenario) have passed in the meantime. Then, and only then, act. My Twitter feed, which is comprised mostly of geeky people who have an affinity for technology, was sounding the alarm months before my World Health Organisation was. It was weird.
The problem is that the virus does not care about WHO customs. It is indifferent to their procedure, their ways of doing things, their established norms. The raw, harsh biological reality is that the virus is out there, in the wild, yearning to leap to the next host, and the next host, and the next host. It does not sleep. When your opponent behaves like this, insisting on ‘clear evidence’ is paralysing. It plays into the strengths of the virus. The WHO is not designed to fight a battle with this opponent. That’s fine, but the problem is Western Governments looked to them for guidance and deferred to their expertise. While collecting ‘clear evidence’ to dispel dreaded ambiguity, the virus was multiplying and being exported around the world via oblivious hosts, and a precious window of opportunity to contain it was squandered.
This post, and my thinking generally, is strongly influenced by the writings of Scott Alexander in his blog Slate Star Codex. If you liked this, I strongly recommend you check it out.
