10th of March 2020 – The Minister for Foreign Affairs appears on Morning Ireland.
Gavin Jennings: “It looks like there are two choices – lock everything down before thousands become infected, or lock everything down after thousands become infected, like what’s happened in Italy. Why are we waiting to make more moves here?
Simon Coveney: “Well we are, I think, trying to provide responses that are proportionate. So, if you shut a country down without good reason and evidence to back that up, then I think you can cause, you know, significant damage to people’s quality of life also. So, what we’re trying to do is follow the public health advice that is appropriate given the level of threat at any given time, and, I’m a politician, a policy-maker, we need to listen to experts in terms of the recommendations and the advice that they give, and I think we need to follow that. This response needs to be health-driven and that is what we’re doing, rather than politicians going off on solo-runs and doing things that aren’t recommended.”
The following day the WHO would declare the outbreak a pandemic, citing “alarming levels of inaction” from governments in the developed world.
There was much to lament in the Minister’s response. The “good reason and evidence” he demanded was everywhere to be seen, and nowhere more so than the continent – hence Jennings’ question. The Minister’s promise of a proportionate response was proportionately empty; it was already too late for that. Whether the reference to “solo-runs” was a dig at Boris Johnson or Donald Trump, I don’t know. Either way, the comment was unnecessary and inappropriate coming from the person responsible for managing Ireland’s international relationships.
I want to address the text in bold. If you watch the video below, you’ll see the Minister shift uncomfortably in his chair under Jennings’ questioning. You could even sense some fear in his voice. The idea that he should take more personal responsibility had been forced in his mind, and it was scary. Too scary. No, there would be no independent thinking. We would follow. We must follow. The government would do exactly as it was told.
Coming from a Fine Gaeler, you would have had good reason to believe him. What is Fine Gael if not an authority structure? This is the party of the goody good boys, and goody good boys always do what they are told. The better they are doing what they’re told, the higher they rise in the party structure. That’s how they play the game.
So, did the goody good boys of Fine Gael follow the WHO’s advice? More to the point, what was the WHO’s advice?
The Strategic Preparedness and Response Plan
On the 3rd of February, the WHO published its Strategic Preparedness and Response Plan. The WHO publishes a great many updates, articles, statements etc, but this one was significant. This was the WHO’s ‘how to’ guide to the Covid-19 outbreak. In its own words:
“The document takes what we have learned so far about the virus and translates that knowledge into strategic action that can guide the efforts of all national and international partners when developing context-specific national and regional operational plans”
Were you a policy-maker responsible for managing the national response to the unfolding crisis, you would have studied this document in detail. Had you done so, you would have paid special attention to the following paragraph:
“…in certain specific circumstances, such as uncertainty about the severity of a disease and its transmissibility, measures that restrict the movement of people may prove temporarily useful at the beginning of an outbreak to allow time to implement preparedness activities, and to limit the international spread of potentially highly infectious cases.”
Was there uncertainty about the severity and transmissibility of the coronavirus at the time? There was plenty. Were we at the beginning of the outbreak? In Ireland, we were. Did we want time to implement preparedness activities, and to limit the international spread of potentially highly infectious cases? Yes and yes.
The WHO was telling us that international travel restrictions could help us fight the outbreak. We needed to act.
First World Problems Need First World Solutions
It was a remarkable change in policy from the WHO. Throughout January, it had been steadfast in its refusal to consider any international travel restrictions. It had issued the same statement when the virus was discovered, and again on each of the many occasions when the virus had spread to a new country:
“WHO advises against the application of any travel or trade restrictions based on the information available.”
This wasn’t just about keeping China happy; the WHO really believed what it was saying. The WHO was advising the world in line with its best understanding of the situation, and it genuinely believed that travel restrictions could do more harm than good.
But with the publication of this report, that clear and consistent (though desperately flawed) advice had been thrown out of the window. What caused the WHO’s change of heart? And how had it come to such a baffling position in the first place?
In short: first world problems.
Many of the WHO’s experts cut their teeth managing outbreaks in regions like west Africa. Imagine trying to contain the spread of a disease in countries with long, unmanned land borders, weak civic infrastructure, and small, informal economies. International travel restrictions are ineffective in that environment, as there is little ability to enforce them. They may even cause harm by pushing people outside of the official channels.
The WHO was correct in its analysis; the mistake was to blindly copy and paste policies from the disorganised developing world, to the hyper-connected developed world. It took a month, but eventually the Who realised that first world problems needed first world solutions.
International travel restrictions protect us by limiting the virus’ international spread, just as social distancing does at the societal level. If nothing gets in, the domestic population is protected. If nothing gets out, foreign populations are protected. If countries are no longer infecting each other, then the international R0 goes to 0, and the problem is easier to solve. In the developed world, international travel restrictions are an essential policy tool.
The fact that the WHO included the new advice in its Strategic Preparedness and Response Plan underlined its conviction. This was not the opinion of a senior official, nor was it a knee-jerk reaction to bad publicity. This was the WHO’s official advice, and it wanted the world to know.
Did The Goody Good Boys Do What They Were Told?
For the expert-following policy-maker (i.e. a policy-taker), the publication of this report would have been a landmark moment. This was a significant change to a key component of the experts’ advice, and on a matter that necessitated both domestic and international discussions. It would also require, in the WHO’s opinion, a cost-benefit analysis.
“In such situations, countries should perform risk and cost-benefit analyses before implementing such restrictions, to assess whether the benefits outweigh the drawbacks.”
Did the government perform a cost-benefit analysis of international travel restrictions? Is that analysis publicly available? Did the government engage the WHO for clarity and / or guidance on implementation? Did the government discuss the updated advice with their partners in the UK and the EU?
These questions must be answered. It could be that the government went to great lengths to explore travel restrictions, and somehow came to the conclusion that they posed a grave threat to public health. Alternatively, it could be that the government never had any interest in travel restrictions and just quoted the WHO out of convenience. We don’t know.
What we do know, is that when the WHO changed its position on travel restrictions, the goody good boys did not follow them. They said they would do what they were told, but they did not. On the same day that the report was published, Australia and New Zealand announced a coordinated travel restriction on passengers from China. South Korea would follow a day later. Taiwan, Singapore, Vietnam, Sri Lanka, Israel, and Italy had implemented travel restrictions at the end of January.
But Ireland remained open to the world, as it would throughout the crisis. Ireland was the only country in the EU that didn’t try to prevent the virus infecting the population. In the whole of Europe, only Boris Johnson and Alexander Lukashenko took the same approach to protecting their peoples’ health.
The WHO Finally Gets It
If there were any doubts about the WHO’s change of heart, the Updated Strategic Preparedness and Response Plan (14th of April) made it clear.
“The global strategic objectives are as follows… Suppress community transmission through context-appropriate infection prevention and control measures, population level physical distancing measures, and appropriate and proportionate restrictions on non-essential domestic and international travel.”
The report goes on to emphasise the importance of:
“Measures to reduce the risk of importation or reintroduction of the virus from high-transmission areas, such as limits on national and international travel, enhanced screening and quarantine”.
“Targeted and time-limited implementation of these measures will potentially reduce mortality by flattening the trajectory of the epidemic and relieving some pressure on clinical care services.”
In other words, international travel restrictions could reduce the spread of the disease, limit the potential for community transmission, protect the national health services, and flatten the global curve. The WHO had had come full circle: international travel restrictions were now an essential component of its outbreak response planning. It only served to underline the Irish government’s failure.
How Did The Government Get It So Badly Wrong?
I don’t intend to whitewash the WHO’s record. The WHO as an institution is fundamentally flawed, and its leadership is complicit in this global catastrophe. It shouldn’t have taken so long to realise that international travel restrictions would save lives – not least because the WHO had used them to fight the SARS outbreak in 2003.
Regardless, had the Irish government followed the WHO’s advice in February (as it repeatedly assured us it would) Ireland’s death toll would have been significantly lower, our health care workers and our care homes would have been protected, the lockdown would have been less severe, and the mental health of the country would not have been tested so.
No, the government did not follow the WHO’s advice. The WHO had given them the tools they needed to protect the nation’s health, but for some reason, they didn’t use them. Why? We won’t know until the inevitable inquiry into their mishandling of the crisis. Until then, we can expect to see many more anti-government protests in the streets.