The failings of Public Health England and the WHO

Having spent years saying Public Health England should be closed down and the WHO should be defunded, it's pleasing to see so many people coming round to my point of view. All it took was for these organisations to get a bit of scrutiny.

There's a damning article in the Economist this week about PHE... 

The pandemic has exposed flaws in Public Health England

After the pandemic, the government is likely to rethink the executive agency’s role

Let's hope so.

While the failure to raise [Covid testing] capacity spreads well beyond PHE, there is concern across the health system—in the NHS, government and local authorities—that PHE has failed to rise to the challenge. 

It's difficult to keep up with all of PHE's shortcomings this year, but they include failing to work with the private sector to ramp up testing capacity, advising people against wearing face masks, assuring the public that it is 'very unlikely that people receiving care in a care home or the community will become infected' and failing to use local public health teams in contact tracing. It has now emerged that PHE knew about an outbreak of the virus at a Nike conference in February and did not tell the public.

Still, menthol cigarettes are being banned this week, so at least PHE's fat cats have got one thing to celebrate.

Before the pandemic, PHE was well regarded. 

By other people in the 'public health' racket, perhaps.

A review by the international association of public-health bodies concluded that it rivalled any in the world. 

It might be time to revise that now.

Created as part of controversial reforms to the health system in 2013, it emerged from 129 organisations, including those responsible for health protection (watching for infectious diseases) and for health promotion (campaigning against smoking). The inspiration was America’s Centres for Disease Control and Prevention. In Britain the model seems unlikely to survive the crisis.

Good.

The fragmented system that has resulted has its own problems, particularly in data collection. The health department has brought in Dido Harding, the head of an NHS regulator, to sort things out, and to link the testing programme with contact tracing, which is still run by PHE. The Office for National Statistics is leading serological studies to see how widespread covid-19 is in the British population. It is an all-hands-on-deck-situation for the government. Yet effective organisations tend to accumulate responsibilities. Instead, some in the NHS joke that PHE is enjoying a period of “self-isolation”.

One of the problems, as Matthew Syed argued in the Sunday Times yesterday, is that PHE had been preparing for an influenza outbreak, not a coronavirus outbreak, despite two near-misses in the recent past - SARS and MERS - being coronaviruses.

Once country that did not make that mistake is Taiwan, whose response to the epidemic has been exemplary. Alas, the WHO is not likely to learn many lessons from Taiwan because it barely acknowledges its existence. The reason is China. The video below has become an infamous reminder of the WHO's attitude towards Taiwan, and the Economist, in a different article, looks at how China keeps the Taiwanese out of the room. Worth a read.

It is an embarrassing scene. @WHO Director General, Bruce Aylward, hangs up in an interview with RTHK when he is asked about reconsidering Taiwan’s membership. Ironically, despite being so close to China, Taiwan manages to keep the #coronavirus infection and fatality rate low. pic.twitter.com/bFWRXpCyHN

— Ezra Cheung (@ezracheungtoto) March 28, 2020