It was the scenario the public health community had feared for decades. A dangerous virus emerges. It spreads rapidly around the world.
COVID-19 infects people when they come together, but coming together is also how we will beat it. 2020 saw the world unite against the virus, from small personal gestures to protect others, to international collaboration on research and innovation. The year ends with COVID-19 vaccines rolling out — an extraordinary feat.
Science, solutions and solidarity have been WHO’s tools for addressing the biggest health threat of the past century — this is the story of the response we built with them.
Guidance, coordination and leadership
This isn’t the first time WHO has responded to a pandemic, and it won’t be the last — but COVID-19 is the most challenging crisis we have ever faced.
On 30 January 2020, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the COVID-19 outbreak a Public Health Emergency of International Concern. The declaration is WHO’s highest level of alarm — a rallying call to all countries to immediately take notice, and take action.
Countries looked to WHO for guidance on how to confront an unknown virus and WHO answered the call. Within two weeks of first learning of this new disease, WHO published its first set of advice to countries on how to test for the virus, treat patients, keep the public informed and prepare for more cases.
WHO also leveraged well-established scientific relationships and connections to facilitate the rapid development of vaccines, treatments, diagnostics and other tools. The first lab test for COVID-19 was developed just days after scientists shared the genetic sequence, and the first test kits were shipped out to labs around the world within weeks.
Delivering knowledge and supplies
In 2020, WHO sent lifesaving supplies and equipment around the world and reached billions of people with critical information about the evolving nature of the virus, and how to protect themselves.
The COVID-19 Partners’ Platform heralded a new model of health crisis engagement, by enabling over 150 countries, UN entities and 900 partners to coordinate actions and resources together in real time.
Ensuring access to vital resources
Protecting health workers who risked their lives to fight the pandemic was one of WHO’s biggest priorities. The pandemic caused an acute shortage of essential supplies, so a COVID-19 Supply Chain System was established to fill gaps, ensure quality and help countries navigate supply chains.
Travel restrictions and reduced flights put immense pressure on global supply chains in 2020. Logistics teams worked around the clock to get response supplies to those who needed them most.
While the need for masks is well known, a less publicized but equally vital resource is medical oxygen, which helps severely ill patients breathe and potentially avoid intubation.
The production and delivery of medical oxygen was a challenge worldwide even before the pandemic, as it is often left out of hospital budgets because demand can be difficult to predict.
In responding to COVID-19, WHO has procured and distributed oxygen supplies for vulnerable countries. By December 2020, WHO had sent more than 16 500 oxygen concentrators and 40 000 pulse oximeters and oxygen monitors to 121 countries. These devices will bring broader health benefits, for example to children with severe pneumonia, people undergoing surgery, and pregnant women.
WHO is also working with countries such as Papua New Guinea, Ukraine, Somalia and South Sudan on a more sustainable solution to rising demand: oxygen generation plants.
Getting the message out
Around the world, people were hungry for clear, accurate and useful information. Starting with our first Disease Outbreak News at the beginning of January, WHO has met the demand, releasing over 200 daily situation reports, followed by nearly 40 weekly epidemiological and operational updates. WHO updates its COVID-19 dashboard daily to provide a real-time snapshot of the pandemic.
Committed to helping frontline responders safely take on the pandemic, we provided free online training courses through our OpenWHO platform.
WHO hosted 38 Member State information sessions, during which a total of 79 countries — including health ministers and other leaders — shared their experiences with COVID-19 in the spirit of solidarity.
The media have also been a key audience and partner. WHO shared the latest developments on COVID-19 during over 130 briefings for journalists. WHO leadership also participated in other public forums, including over 50 weekly #AskWHO Q&A sessions on social media, and 19 podcasts and videos in our Science in 5 series explaining the science related to COVID-19 to the public.
WHO is also engaging new audiences with key partners including the Wikimedia Foundation, companies like Facebook (Instagram, Messenger and WhatsApp), Google, LinkedIn, Pinterest, Snapchat, TikTok, Twitter and Viber. We’ve also linked up with the creative talents behind beloved characters, including the Minions and Peppa Pig.
Increased outreach was especially vital given the infodemic — the flood of information on the COVID-19 pandemic. Not all of it was reliable, with harmful rumours and misinformation about the virus.
Helping countries directly
In early February, WHO launched its Strategic Preparedness and Response Plan, which outlined key public health measures, to guide the efforts of national and international partners.
Through our 150 country offices and six regional offices, WHO has worked hand in hand with politicians, health workers, hospital directors, communicators, logisticians, lab technicians and more. We sent virtual and in-person missions of experts at the request of countries around the globe.
The heat of a response is the best time to judge performance and course correct. Over 30 countries invited WHO to do just that, in a process called intra-action reviews: determine what went well, then figure out what to fix now and how to better prepare for next time.
WHO also supported the deployment of 70 Emergency Medical Teams (EMTs) to countries, while 840 national teams were mobilized using the EMT methodology.
But health workers remain the backbone of the COVID-19 response around the world. In some places they had to temporarily shift their focus from responding to other diseases, such as polio. Over 30 000 polio personnel in countries including Afghanistan, Pakistan, Somalia and South Sudan tracked potential COVID-19 cases, traced contacts and shared information with communities. In Pakistan, polio data management systems enabled better case detection and were used to help fight COVID-19 misinformation.
WHO provided technical support, virtual training, equipment and supplies to boost testing capacity around the world. For example, when COVID-19 first emerged, Somalia did not have molecular testing capacity — but by the end of 2020, six labs in Somalia could do this kind of testing.
Leaving no one behind
WHO leads a COVID-19 crisis management team that works with 23 UN partners. WHO has also collaborated closely with the wider UN family on the Global Humanitarian Response Plan, to address needs in over 60 countries contending with humanitarian crises exacerbated by the pandemic.
WHO has helped drive the agendas of the UN framework for the immediate socio-economic response to COVID-19 and the Inter-Agency Standing Committee.
In the most challenging settings, WHO works hard to keep essential health services running. Throughout the pandemic, we have worked with countries to keep hospitals and clinics open to patients suffering from other diseases. WHO has also supported countries to keep routine childhood immunization going and help mothers give birth safely.
We’ve also stepped in when other emergencies strike. A day after an explosion devastated the port in Lebanon’s capital of Beirut, a plane carrying 20 tonnes of WHO health supplies landed in the country. WHO also set up an appeal and collaborated with partners to provide follow-up care for the injured and mental health support for health workers, as well as expanding COVID-19 testing and treatment.
How the COVID-19 response looked in three different settings
Putting science and research at the heart of the pandemic response
In 2020, the WHO R&D Blueprint created the go-to platform for international scientific collaboration between scientists, developers, regulators and funders to accelerate critical research on the pandemic, covering tests, vaccines, treatments and more.
Early on, over 130 scientists, funders and manufacturers from across the globe committed to working with WHO to speed the development of a vaccine against COVID-19.
WHO has arranged for the world’s best scientific minds to analyze data — even before they are published — to rapidly understand this virus, how disease develops, the immune responses needed to control it and the tools required to evaluate would-be vaccines.
In February 2020, WHO hosted an agenda-setting Global Research and Innovation Forum on this new virus, attended by nearly 900 experts and funders from more than 40 countries, who took stock of what was known so far and set the agenda going forward.
The Forum catalyzed research into the spread of the virus, how to control it, its severity and who is most susceptible. Priorities were set: assessing approaches to care, making optimum use of PPE and identifying animal hosts to prevent spill-over.
On testing, the Forum established the use of rapid tests at a community level as a key area for follow-up. On treatments and vaccines, the evaluation of investigational therapeutics and vaccines was to be accelerated using ‘core protocols’ and platform trials.
The Forum also set the stage for: mobilizing funders; integrating the social sciences into the outbreak response; and sharing virus materials, clinical samples and data across borders.
On vaccines, WHO set the bar for success. We identified the key attributes vaccines would need, using them to promote clinical trial designs for generating the efficacy and safety data vital to making the best decisions about policies, regulation and deployment.
WHO has provided the world with a reliable and authoritative guide to candidate vaccines, tracking each one as they progress through the preclinical and clinical phases.
On treatments, in June, WHO welcomed clinical results from the UK that showed dexamethasone, a corticosteroid, could be lifesaving for patients critically ill with COVID-19.
WHO’s international collaborative efforts led the world in implementing a global trial for rapidly finding the right therapeutics.
Launched in March, WHO’s Solidarity trial became one of the largest clinical trials for COVID-19 therapeutics in the world and the largest looking at remdesivir and interferon beta 1a as potential treatments.
At its peak, the trial has involved more than 30 countries, over 14 000 patients and nearly 500 hospitals. An independent group of experts is reviewing potential drugs — including monoclonal antibodies — for the next stage of the trial, after an initial four drugs were found to have little or no effect on: mortality, the need for ventilation, or duration of hospital stay.
Since the start of the pandemic, WHO has worked with partners to facilitate timely, fair and affordable access to the tools needed to beat COVID-19.
Launched in April 2020 by WHO and partners, the Access to COVID-19 Tools (ACT) Accelerator partnership has led the fastest and most coordinated global effort in history to develop tools to fight a disease.
The ACT-Accelerator aims to ensure equitable access to COVID-19 diagnostic tests, therapeutics and vaccines, underpinned by a commitment to strengthening health systems.
- Reserved 120 million rapid antigen tests for low- and middle-income countries
- Procured over 27 million molecular tests and 12 million rapid antigen tests for low- and middle-income countries
- Provided training for over 23 000 people in over 190 countries
- 2021 aim: 500 million tests by mid-year
- Procured 2.9 million doses of dexamethasone — the only WHO-approved treatment for COVID-19
- Supported 15 clinical trials, investigating 21 therapies in 47 countries, with 85 000 patients enrolled
- 2021 aim: 245 million courses of treatment throughout the year
- 190 countries signed up to the COVAX Facility
- US$ 2.4 billion raised for the Advance Market Commitment: more funds needed
- 2021 aim: 2 billion safe and effective doses aimed for by the end of the year
A deep dive on vaccines
One of the ACT-Accelerator’s key goals is to speed up the safe development and manufacturing of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world. The COVAX facility plays a vital role in achieving that goal.
At the end of 2020, economies representing 90% of the global population are eligible to receive vaccines through COVAX. US$ 2.4 billion had been raised for the Advance Market Commitment (AMC), the innovative financial mechanism that will secure access to COVID-19 vaccines for the world’s poorest countries. Yet despite this success, US$ 4.6 billion is still needed for the AMC in 2021 alone.
Rising to the challenges of 2021
WHO’s COVID-19 response built on lessons learned from previous outbreaks.
Our early guidance on COVID-19 was adapted from documents on Middle East Respiratory Syndrome (MERS). Reforms pursued since the 2014 Ebola outbreak in West Africa — such as ways to help countries prepare for emergencies and accelerate research when new diseases emerge — underpinned the speed, flexibility and effectiveness of the COVID-19 response.
But there is much more to do in 2021. The pandemic still rages in large parts of the world. There are massive funding gaps.
There is a real risk of vaccine nationalism, and the best tools against COVID-19 not being shared fairly among countries. Many health systems will struggle to roll out COVID-19 vaccines, tests and treatments while managing all other areas of health.
Overcoming these challenges to ensure COVID-19 releases its grip on our lives in 2021 will require us all to come together with humility, humanity and generosity.