WHO is Responsible for Tracking Country Pandemic Responses?

To glean more lessons from country COVID-19 experiences, we need to know what the responses were. To address this, my colleague Amanda Glassman and others recently published a policy paper about the importance of learning from country experiences in responding to COVID-19. The paper emphasized the role of a country’s commission as an institutional mechanism for “lessons learned” to guide future public policy. This work on COVID-19 commissions may help countries to learn lessons about how to prevent and mitigate a future pandemic.

In order to learn from our experiences, we must first know what the decisions and choices, policies and levers, and interventions and actions are (see Table below). Until recently, I would have shrugged this idea off. Knowing what the response was seemed rudimentary and obvious. 

The IMF Database of Country Fiscal Policy Responses to COVID-19

Recently, while I was reviewing an excellent (but grim) paper on fiscal space by my colleagues Sanjeev Gupta and Lucas Sala, I was pleasantly surprised to learn about the IMF’s database of fiscal policy responses to COVID-19, which summarizes country governments fiscal and economic measures in response to COVID-19. This database also assists in the dissemination and learning from policies and also helps to build a community of practice so that nations can learn from other nations.

Though many features of this database are valuable, perhaps what impresses me the most is that it exists and that a multilateral institution had the foresight to make it. It was established in June 2020, during the first year of the pandemic, by a multilateral institution whose primary job is to maintain global economic and financial stability and share global public goods generated in the process, including knowledge and information.

By cataloging countries’ policies, the database creates a platform for other countries to learn about those policies while reducing the cost to any one country to learn about other countries. Of course, information is generally a public good, with the economics implying a need for government intervention. But information sharing is especially crucial during times when there is no playbook about what is best practice during an unprecedented pandemic.

Table: Menu of COVID-19 Public Health Responses

• Public information campaigns and press briefings
• Face covering (recommended, required in some public spaces, required in all public spaces, require at all times)
• PPE manufacturing, procurement, and distribution*
• International and domestic travel (public transport closures, internal movement restrictions, border screening, international travel controls)
• Testing (testing criteria, types of tests)
• Contact tracing (types of contact tracing)
• Isolation & quarantine* (eligibility criteria, characteristics of isolation & quarantine)
• Public event cancellations (criteria for cancellations of events or gathering sizes)
• Closures of businesses (types of businesses closed)
• Closures of schools (types of schools closed, distance learning policies)
• Institutional populations* (eg prisons, long-term care, and mental health)
• Stay-at-home (recommended, required with exceptions described)
• Vaccination and other pharmaceutical policy (eligibility criteria, allocation planning, delivery strategies)
• Broadband internet and communications infrastructure (hardware)* 
• COVID-19 epidemic data, information, and communication systems* (software and data including types of data collected and reported)
• Health workforce* (hiring, training, staff rotations, shift schedules, contracting out)
• COVID-19 scientific advisory, evidence review, and modeling groups*
• COVID-19 commissions and bodies*
• Other*

Menu of COVID-19 social supports and responses:

• Income supports, unemployment insurance, other cash transfers
• Debt and contract relief (individuals, small businesses)
• Housing
• Food security*
• Other*

* This is a partial and growing list of actions. Some are not tracked in the Our World In Data Policy Responses to the Coronavirus Pandemic database or the COVID-19 US State Policy (CUSP) database.

Who Made a Database of Country Health Policy Responses to COVID-19?

On the health policy side, things are less clear. There was a huge vacuum of public information about what were the health policy responses, both at the international level as well as at the US state level.

Fortunately, for international tracking, the European CDC established an important Country Response Measure database for its European Union members, enabling other countries to learn about their responses. There was also a research team in Blavatnik School of Government at the University of Oxford which created a valuable Policy Responses to the Coronavirus Pandemic database that was published by Our World In Data. This resource was drawn from “public sources by a team of over one hundred Oxford University students and staff from every part of the world.” But it has its limitations, including language barriers and potential lack of digital media dissemination in low-income countries. There was also work from Exemplars in Global Health, examining the successful outliers in COVID-19 responses, unpacking the responses, policies, and implementation.

At the US state level, a helpful COVID-19 US State Policy (CUSP) database was created and disseminated by Boston University and Johns Hopkins University. Its methodology involved scanning government websites and media coverage on a variety of health and economic actions at state level—functions which arguably should have been carried out by a federal public health agency, i.e. the US Centers for Disease Control & Prevention (US CDC).

All of these databases provided essential public goods of information and knowledge. There is nothing wrong with leaving this public health tracking function to the private sector or to universities. In fact, universities have played a crucial role in helping to generate public goods in terms of knowledge and evidence, especially during the pandemic. (Speaking from direct experience, I have seen the value of a public university working in close concert with a local state government to fill important public health functions including the COVID-19 modeling taskforce, isolation and quarantine coordination, and a behavioral health call center.) But while universities can fulfill this function, public health policy tracking is not in their mandate.  

Is Tracking Country Health Policy Responses a Part of the WHO’s Mandate?

Where was the WHO in tracking country health actions (and the US CDC for state actions)? Which organization has the mandate to collect such information as part of their public health surveillance function? To put it bluntly, if leading public health agencies like the WHO, and US CDC, are not responsible for tracking the spectrum of international (and national) pandemic responses, whose job is it? Or should we just leave it to the private sector when the next pandemic strikes?

In order to improve our response to the next pandemic, we must strengthen the capabilities of the WHO and US CDC to carry out this function as part of their mandate. Excuses may be given, such as: the WHO was very busy during a chaotic pandemic; they didn’t have the time or resources to track this information; countries have idiosyncratic responses so tracking was extremely complicated, or simply, they can’t be expected to be everything to all people.

All these explanations are understandable (though arguably tinged by public health professional burn-out). Of course, the WHO did some things well; it is important to give credit where it is due. Regarding information sharing, they held regular press briefings, and displayed a COVID-19 situation dashboard with data on cases and fatalities. They also created an all-cause mortality dashboard, an SDG dashboard, and a health inequality dashboard, among many other actions.

But no public health authority did a perfect job. There were things that could have been done better by the WHO and US CDC, and there are lessons to be learned. Providing constructive feedback to an essential public health agency is necessary.

Encouragingly, the WHO established a new WHO Hub for Pandemic and Epidemic Intelligence (https://pandemichub.who.int/) in 2021, with the objective of “leveraging innovations in data science for public health surveillance and response” and “to address future pandemic and epidemic risks with better access to data, better analytical capacities, and better tools and insights for decision making.” This unit may be the suitable department within the WHO to track country policies and open-source news, and to build institutional communication channels with country ministries and departments of health to track policy responses.

For the US state level, the US CDC is mandated to collect data on COVID-19 which presumably would include information about state COVID-19 responses. While there could be alternative organizations (such as the National Governor’s Association, the National Council of State Legislatures, etc.), state health departments generally have authorities to collect information about pandemics, including being aware of the evolving responses to pandemics.

Of course, countries differ in their decentralization of health functions from national to state or local levels (see more here). But the collection of information about what states (or subnational regions) are doing should not be viewed as an expansionary tactic by a federal public health agency. Indeed, states reporting their policies enables the diffusion of ideas and the building communities of practice.

I do hope constructive feedback is recognized as a form of caring.  In today’s world, any feedback is viewed as criticism that turns us into enemies. Quite the contrary, it is important to embrace and accept constructive feedback, expressed out of respect and appreciation.

Should the WHO be Responsible for Tracking Pandemic Health Policy Actions?

International and federal public health authorities should provide the leadership to convene and bring partners, such as universities, together. The WHO, with its bureaucracy across multiple regions and more than 8,000 employees, should have been playing a crucial role in leading and partnering to track and understand the health policy actions in response to COVID-19 across countries. (Separately, there is an issue of tracking economic, fiscal, and other social supports and actions outside of the domain of health ministries—which I am not addressing here.)

There is precedent. The WHO established systems for tracking policy responses for other areas including scores across the International Health Regulation dimensions in general terms (but not in terms of specific actions for the COVID-19 pandemic), HIV laws and policies, tobacco control, dementia, age-friendly practices, and the list goes on.

We need to dig deeper to understand why exactly the WHO hasn’t carried out this function fully (as well as what the WHO has already done for this function but has not made visible or shared publicly). This gap between mandate and capability can be quite detrimental for public trust and the credibility of public health authorities. Some have raised concerns such as: “Doesn’t every single data point and statistic published by the WHO need to be approved by the member states?” Unlike the WHO, the IMF does not require member state approval for statistics being displayed.

We need to better understand why the WHO can or cannot do so in its present organizational form. Are there specific statutes or governing policies and procedures that need to be addressed and changed? What are the ways in which member states’ blocking of information hinders global responses? What support is needed to empower the WHO and to ensure that countries share information? Is this a function that the WHO is better to contract out or do in-house? What are the issues and challenges of staffing up versus procuring this function and service? What will the pandemic treaty or accord say about these kinds of issues, these important details.

We still need to unpack what the world did well—and not so well—in responding to COVID-19; and the WHO and US CDC are not alone in our need to collectively learn.

With thanks to Sanjeev Gupta, Javier Guzman, Prashant Yadav, and Olusoji Adeyi for helpful comments.