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A drone view of a Liberian-flagged cargo ship anchored after Argentine authorities quarantined it on the Parana River over a suspected case of mpox onboard, according to the government, in San Lorenzo, Argentina August 21, 2024.
“Not COVID,” but caution: WHO on high alert as new mpox strain spreads
Thailand confirmed on Thursday that the country has its first case of the new, more dangerous strain of mpox, and Argentina has quarantined a cargo ship in the Parana River over a suspected case onboard.
The news comes as global public health authorities raise the alarm about the fast-spreading variant of the virus, which has already surged in central and eastern Africa. So far in 2024, those regions have recorded over 17,000 infections, and while cases are usually mild, more than 500 people have died.
Mpox is a viral infection that causes pus-filled lesions and flu-like symptoms. It is typically transmitted through intimate physical contact, face-to-face breathing, infected skin lesions, or contaminated objects.
Why is this strain different? The new clade 1b strain has caused concern because it seems to spread more easily through routine close contact, and it is affecting women and children in larger numbers. It is fatal in about 3.6% of cases, especially for children.
Although the World Health Organization has issued a global public health emergency warning, it insists this “is not the new COVID,” and that the spread can be controlled through public health efforts — like enhanced surveillance and tracing, as well as isolating those infected — while the new strain is studied.
World Health Organization (WHO) displayed on screen with pharmacy medical syringe and vaccine vial. Seen in this photo illustration, in Brussels, Belgium, on September 24, 2023.
WHO can succeed at AI?
The World Health Organization recently released Smart AI Resource Assistant for Health — or SARAH — an AI chatbot that’s able to answer basic health questions. SARAH is able to answer health questions in eight different languages, and the organization says she’s a tool to fight misinformation about mental health, cancer, and COVID, among other things.
The WHO bills SARAH, which appears as a female avatar with a voice and facial expressions, as a digital health “promoter” — not a provider — and, though SARAH hasn’t taken the Hippocratic Oath, it’s meant to fill in the gaps for people searching for health questions without access to proper health care providers. (They’ll still need a broadband connection.) You can speak through a microphone, and SARAH will respond, or you can type your answers to a similar effect.
But SARAH still struggles with plenty of basic queries, according to independent researchers who spoke to Bloomberg.
SARAH is trained on GPT-3.5, the model that OpenAI powers its free version of ChatGPT with, not the updated premium version (that’s GPT-4). Bloomberg found that SARAH repeatedly hallucinated — giving false and outdated medical information about drugs, medical advisories, or WHO’s own data. It incorrectly said that an Alzheimer’s drug was not approved, couldn’t provide details on where to get a mammogram, and couldn’t even recount the WHO’s finding about hepatitis cases worldwide.
When GZERO tested SARAH, it didn’t make any noticeable mistakes, but it basically refused to answer any questions, including a query about whether COVID is still dangerous. It responded, “I’m here to encourage you to live a healthy lifestyle, so I can't respond to that. Is there anything else health-related you'd like to discuss or any other questions I can help answer for you today?”
So maybe don’t cancel that appointment with your doctor just yet.
How can the world build back better public health after COVID?
Every year, over ten million people globally die from high blood pressure, more than all infectious diseases combined. Dr. Tom Frieden, former director of the Centers for Disease Control, is tackling this massive problem in public health, among many others, as CEO of Resolve to Save Lives.
He told GZERO’s Tony Maciulis that ensuring easy access to three drugs — amlodipine for blood pressure, metformin for blood sugar, and atorvastatin for cholesterol — could save tens of millions of lives over the next quarter century for just a penny per pill.
It’s part of a set of goals Frieden calls the three Rs: Renaissance in public health, robust primary healthcare and resilient populations. But as the developing world takes on more and more public debt, where will the money come from?
See more from Global Stage.
“Health is a human right”: How the world can make up progress lost to COVID
The state of public health in the developing world bears some deep scars from the COVID-19 pandemic. Over the past three years, immunization rates have dropped to levels not seen in three decades. 2 billion people are facing "catastrophic or impoverishing" health spending worldwide according to the World Health Organization. And governments in the Global South are taking on more and more debt at the expense of investment in health and social services.
Kate Dodson, the Vice President of Global Health Strategy at the UN Foundation, is on the frontlines of the fight to give the most vulnerable people in the world access to proper healthcare. She works to connect experts and innovators with the UN, and find resources to support their work.
She’s calling on governments to invest in basic elements of public health, including primary care access, and properly remunerating healthcare workers — the majority of whom are women, worldwide. And more fundamentally, she wants leaders to treat health as a human right that all deserve to enjoy.
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What’s next for the WHO?
As the World Health Organization celebrates its 75th anniversary on April 7, it is preparing to put the COVID-19 pandemic behind it by declaring an end to the public health emergency sometime later this year. Yet it won’t be easy for the UN agency to rehabilitate its reputation after the criticism received for its handling of the world’s worst health crisis in 100 years.
We asked Eurasia Group public health expert Laura Yasaitis to provide some perspective on the WHO’s long history and where it goes after COVID.
As it turns 75, what are the WHO's main accomplishments?
Probably the most outstanding was the complete eradication of smallpox, a remarkable example of international coordination to achieve a public health goal. WHO officials worked with countries to encourage widespread vaccination, as well as donations of the vaccine, and the US and the Soviet Union were both major donors. WHO consultants were dispatched around the world to identify and respond to outbreaks quickly, even in war-torn and poverty-stricken locations such as Somalia, which saw the last natural case in 1977.
The WHO’s efforts to improve childhood vaccination around the globe have also brought about the near eradication of polio, while efforts to prevent and treat malaria have helped dramatically reduce the range of the disease and improve outcomes for those infected.
And failures?
As the organization has grown and taken on an expanded mission, it has become overstretched and overly bureaucratic. These shortcomings were blamed for the slow response to the Ebola outbreak that began in West Africa in 2014 and lasted until 2016.
Yet many of the organization’s perceived failures can be traced to the constraints within which it operates. Only 16% of its budget comes in the form of dues. The rest comes from large donors and is earmarked for specific causes, which means the WHO is limited in pursuing its own priorities. Furthermore, it relies on the goodwill of countries to follow its recommendations; even the legally binding International Health Regulations, which require reporting of specific diseases and public health events, are essentially unenforceable.
What did the WHO do well during the pandemic?
The WHO helped coordinate data sharing among countries, providing invaluable information that helped experts to track and better understand the novel virus. Without a central source of trusted scientific information, it may have taken the world far longer to understand what it was up against. The WHO also co-led COVAX, which aimed to equitably distribute COVID vaccines to all countries, rich or poor. While the group fell far short of this goal – largely because wealthy nations hoarded the initial production of most vaccines – the framework it established may provide a model for future pandemics.
What did it not do so well?
The WHO has been faulted – including by an independent committee it established to review its response – for waiting an extra week before declaring a Public Health Emergency of International Concern, the highest level of emergency. Much of the delay was attributed to its regulations on reporting of public health incidents, which forced slow consideration of the data. These regulations also recommend against declarations that could hurt a country’s economic activity. Furthermore, the organization’s messaging – it does not officially define the term “pandemic” and didn’t use the term until two months after a PHEIC was declared – was faulted for its lack of urgency. That may have contributed to inconsistent and ineffective responses at the national level.
What about its relationship with China?
The WHO was accused of unwarranted deference to China early in the pandemic, both in delaying its PHEIC declaration, and in the public praise lavished on the country for its initial response. The most prominent criticism came from Donald Trump, who in July 2020 declared that the US would withdraw from the organization (though US President Joe Biden reversed the decision when he took office). The WHO-China relationship soured somewhat after the first phase of an investigation into the virus’s origins, which included the lab leak theory, even if “extremely unlikely”; China vehemently opposed any mention of the possibility. Then, earlier this year, China refused to release data revealing the scale of a massive outbreak, despite its legally binding commitments to do so. Yet WHO officials praised the limited releases of data, and largely avoided criticizing the country despite what international experts asserted were highly inaccurate official infection and mortality rates.
Will we ever know where the virus came from?
At this point, it’s unlikely, at least with enough certainty to convince the vast majority of skeptics given that the science has become highly politicized. China has stonewalled further WHO-led investigations after the lab-leak theory was included in the phase one report, forcing the WHO to quietly abandon plans for additional study. Other independent research continues; for example, data released last month supported animal-human transmission as the original source. However, given the length of time that has passed, and the many people who have made up their minds on both sides, it’s far more likely that the issue will continue to be a political football.
In light of all this, how is the WHO reforming itself?
There have been many calls for reforming the WHO and its powers to grant it more authority to investigate and respond to disease outbreaks. However, given the importance of assuring member states’ sovereignty, and the political and economic implications of being named the source of a major disease outbreak, establishing an independent, powerful, WHO remains an uphill battle. Nonetheless, some reforms are being pursued that will allow increased independence. It was recently announced that sources of the organization’s funding would shift over time to be at least 50% comprised of membership dues by 2030-2031.
What is the WHO doing to ensure it's better prepared for the next pandemic?
The WHO is trying to learn from the mistakes of the past few years. The most ambitious effort may come in the form of a new legally binding pandemic prevention, preparedness, and response treaty. A draft presented in February lays out a framework to ensure equitable distribution of vaccines and treatments and provide incentives for poor countries to participate in the data sharing that is needed. However, a big question is whether the provisions will be backed by adequate enforcement mechanisms. The WHO’s authority and credibility has been badly damaged by the pandemic, a situation that will need to be rectified if it is to lead a global health response to the next pandemic.
Edited by Jonathan House, Senior Editor, Eurasia Group.
Russia cutting Nord Stream 1 gas to undermine European leaders
Ian Bremmer shares his insights on global politics this week on World In :60:
Is Russia waging a gas war with Europe?
They certainly are. You have Nord Stream 1 back online after scheduled maintenance, and first was 40%, now 20% of normal volumes. Technical problem, that's what the Russians say. But of course, in reality it is because they know that the Europeans are moving to diversify away from Russian energy as fast as possible and the Russians are not letting them do it on their timeframe. Winter's coming and Russia's best opportunity to undermine European leaders and get a whole bunch of Europeans saying, "What are you doing? Why are you sanctioning the Russians, you're hurting us. We are the ones that are facing the economic pain as a consequence. We don't want you to." A bigger peace movement is if they make life impossible for the Europeans during winter this year. So, I mean, frankly, I'd be surprised if you have any Russian gas go into Germany, come winter this year. The Germans are aware of that possibility and they are very concerned about it. By the way, if the worse comes to worst you're talking about a 2a to 3% contraction of the EU economy. It's a big deal, but it's not a disaster. Next year will be easier for the Europeans.
Is the world prepared to combat the growing global monkeypox outbreak?
I wish we weren't talking about another major outbreak. We're talking about tens of thousands of cases already around the world, and we don't have enough vaccines, even though we do have vaccines for it. We don't have enough monitoring, even though we've just been through a global pandemic. The good news is the vaccine works. The good news is it's very rarely lethal, and it's not leading to huge numbers of hospitalization. So I'm not anywhere close to as worried about monkeypox as we have been about COVID. But still this is absolutely a serious disease and it is not one we are anywhere close to containing, hence the World Health Organization's statement over this week.
How is the UK race going to become the next prime minister?
Well, I mean, it's going in orderly fashion. No one is going to claim that it was rigged or that it's unfair or that you should stop the steal. No, one's saying that in the United Kingdom; no one said that in France during parliament elections. No one said that in Germany, when Scholz became chancellor. Only the United States among advanced industrial democracies; maybe we should learn something from that. But more importantly, we've got two serious contenders, Rishi Sunak and Liz Truss. Rishi kind of more the technocrat and Liz Truss more the populist. She certainly would not be the favorite in terms of EU-UK relations, though she does have more of the conservative base on her side. Look, it's going to be a closely run event. Could go either way from my perspective at this point. But what we do know is that Boris Johnson very soon will be no more.
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Shen goes down to the courtyard of her residential complex at dawn to swipe cherries from the trees in the garden to make bread and jams.
Birdsong and stolen cherries: Lockdown life in Shanghai
Yang Shen has lived in Shanghai for more than 10 years, but it wasn’t until recently that the 36-year-old writer noticed something very particular about the city: the birds.
While they sing freely outside Shen’s window, Shanghai’s 26 million human residents are still cooped up in their homes, part of the world’s largest COVID lockdown.
Most governments around the world have already relaxed their pandemic restrictions, but China has doubled down on its zero-COVID policy, using harsh lockdowns and quarantines to stifle even the smallest outbreaks. Dozens of Chinese cities are now under lockdown as omicron variants circulate. By some estimates, nearly half of China’s GDP is currently affected by some form of restriction.
That has sent shockwaves through the global economy, further tangling snarled global supply chains. But the effects are felt most keenly in China itself.
In Shanghai, the recent lockdown began in early April. At first Shen was optimistic.
“As a writer you have to stay at home and focus,” she says, “you need isolation. But it turns out there's a big difference between ‘I don't wanna go out’ and ‘I can't go out’.”
Most Shanghainese are permitted to leave their homes these days only for mandatory COVID tests, and those who test positive are whisked off to quarantine centers. Throughout China’s most populous city, residents compete for deliveries of food and other staples via wholesaler apps that only serve groups of 50 households or more.
The local economy, meanwhile, has been crushed. By one measure in April, a grand total of zero cars were sold — more than 26,000 fewer than in the same month last year. Across China, retail sales have plummeted, and factories have ground to a halt.
After more than six weeks of this, Shen says she and her husband’s biggest fear is something worse than getting sick.
“We're not scared of COVID, we're scared of starvation.”
That concern is shared by millions across the city, particularly in poorer neighborhoods that can’t compete with large residential compounds like Shen’s to buy food in bulk.
Even Shen and her husband have had to cut back on daily meals, and they’ve gone to daring lengths just to find little variety in what they eat. Every few days, Shen says, they steal down to the courtyard of their residential complex at dawn to swipe cherries from the trees in the garden. They use them to make bread and jams.
But flouting lockdown rules can cause trouble with nosy neighbors and the local Communist Party committees.
Birdsong and Stolen Cherries: Lockdown Life in Shanghai | GZERO Worldyoutu.be
Camilo Cadena, 33, a Colombian-American artist who has lived in Shanghai with his partner for the past five years, recently took a stroll in his compound’s courtyard during a brief period of looser restrictions. Within minutes, a neighbor had sent his partner a grainy photograph of him from a high-rise balcony, with a message: “Isn’t this your fiancé?”
Cadena, who works as a consultant for public art projects in Shanghai, has decided to leave the city. Doing so requires signing a pledge that he will not return to the compound where he lives. It also means saying goodbye to close friends remotely.
“There is a bit of survivor’s guilt,” he says, “knowing that leaving is not an option for many people.”
That’s because the government has recently banned foreign travel for most Chinese nationals in a bid to control the spread of the virus.
Public health experts question whether zero-COVID can even work. World Health Organization chief Tedros Ghebreyesus recently said the policy simply isn’t sustainable given how contagious omicron is.
So why is the Chinese government sticking to it, despite such immense social and economic costs?
Public health is one part of the story. Vaccination rates among the elderly — the most vulnerable to the disease — are low. Fewer than half of Chinese over the age of 70 have been fully vaccinated and boosted. And even for those who have, there are doubts about the effectiveness of China’s homegrown vaccines, which are the only option for most people.
A recent study in the journal Naturewarned that without any restrictions in place, China could run the risk of more than 1.5 million COVID deaths in the coming months.
So far, the government reports a grand total of fewer than 15,000 for the entire pandemic. That’s certainly an undercount, but it’s still far below the death rates in most Western countries.
But politics are also at play, according to Yanzhong Huang, a global health expert at the Council on Foreign Relations.
He says that President Xi Jinping has a personal stake in ensuring the success of zero-COVID, especially as he prepares to be elected to an unprecedented third term as Communist Party boss this fall. That means local and regional officials all the way down the chain of command have an incentive to follow suit as well.
To back away from zero-COVID now, says Huang, “would be admitting policy failure” not only at home but globally. Beijing’s authoritarian approach is meant to compare favorably with the more disjointed strategies of Western democracies.
In recent days, Shanghai officials have said they aim to end the lockdown by June, now that the official case count has fallen to zero outside of the official quarantine centers.
It’s anyone’s guess whether the city will be able to hit that target, as even a brief resurgence of cases could lead to fresh lockdowns.
But for Shen Yang and her fellow Shanghainese, June can’t come soon enough.
“Every time I post anything on my social media, I say something like, ‘Okay, summer is coming. When can I get out of this prison?’"
Additional reporting by Sarah Kneezle.
Chinese medical workers in protective suits wave at residents during a farewell ceremony in Changchun.
China is in a tough spot
This week, the head of the World Health Organization warned that China’s “zero-COVID” policy, which has left tens of millions of people locked inside their homes, is not “sustainable.” The Omicron variant is too transmissible to effectively isolate, and the cost of China’s lockdown strategy, for the country’s economy and the mental health of its people, is too high, warns the WHO.
But … also this week, a report from the peer-reviewed international scientific journal Nature Medicine warned that lifting the zero-COVID policy without taking a series of specific steps to mitigate the damage could create a COVID emergency on a scale the world hasn’t yet seen. More than 1.5 million would die within six months, according to the study, and demand for intensive care would be nearly 16 times greater than China’s hospitals can handle.
Limiting damage from a lifting of restrictions, according to the report, would demand the widespread availability of recently approved antivirals, more accurate testing, a lot more booster doses, and the vaccination of many more elderly people.
Analysts say a change in approach is highly unlikely. According to Michael Hirson, a China expert at Eurasia Group, China isn’t likely to take any major step away from a “dynamic zero-COVID” strategy of mass testing and strict quarantines to contain any outbreak of the virus. “For now, they’re more likely to tighten than to loosen,” says Hirson.
The stakes are growing, and not just for China. The uncertainty weighing on the entire global economy has many sources. Post-COVID damage to global supply chains and the impact of Russia’s war on Ukraine on food and fuel prices are major contributors. But the effect of COVID lockdowns on the world’s second-largest economy, including on the more than 26 million people who live in Shanghai, the world’s busiest port, is also depressing growth expectations and stoking global inflation. By one estimate, dozens of cities responsible for about 30% of China’s economic output and a combined 290 million people (88% of the total US population) are currently under full or partial lockdown.
When measured strictly by the number of COVID deaths, China’s policy has been a big success. It has reported fewer than 14,000 COVID-related deaths. Even if the true number is significantly higher, that compares very well with the one million deaths that have now been reported in the US, a country with less than a quarter of China’s population. But the speed with which Omicron can move through a society that has no access to the world’s most effective vaccines and boosters – and little of the immunity that comes with much greater exposure to the virus – could generate an unprecedented emergency inside China over the next few months.
The economic, mental health, and potential political downside to sticking with an uncompromising lockdown strategy, however, comes at a cost. China’s government is encouraging already deeply indebted companies to continue borrowing to boost sagging economic growth, compounding a problem that can inflict long-lasting damage to China’s economy. The stresses of isolation are flooding mental health hotlines with calls. Angry messages are lighting up Chinese social media.
It’s all happening at a moment of historic political sensitivity in China. This fall, President Xi Jinping hopes to choreograph a Communist Party Congress that will set aside practices of the past to grant him an unprecedented third term as China’s leader. This week’s warnings make clear that Xi faces tough choices: stick with a policy that imposes pain on tens of millions of people and takes a large bite out of China’s economy or publicly shift course and adopt an uncertain new strategy.
China’s president is well aware that neither choice can guarantee that China avoids a health and economic crisis at the worst possible political moment.