Against the World Health Organization

During the COVID-19 crisis, World Health Organization (WHO) has failed us in a truly spectacular manner. Throughout the crisis, the WHO has repeatedly published misleading information that has at-best generated confusion that reduces people’s faith in experts and at worst actively driven people to avoid common-sense safety measures. From initially recommending against the obviously common-sense policy of wearing a mask (up until JUNE 8) to repeatedly publishing misleading statements for public consumption I believe there’s a strong case to be made that the WHO has done more harm than good during this crisis.

Here’s a brief timeline of the most egregious errors that jump out in my mind:

The recommendation against mask-wearing is clearly the most egregious. Unfortunately, the best discussion of this failure that I had read on (Slate Star Codex) has been taken down, so I’ll summarize: the principal issue here is that the WHO has become too hampered by its reliance on peer-reviewed studies to be able to make recommendations during a fast-moving pandemic. Similar to the study that (correctly) claims that there is no evidence that wearing a parachute helps to protect humans falling from aircraft (because, as the authors note, there have been no randomized control trials (RCT) testing the assertion), the WHO noted that there were no RCT studies about wearing masks around COVID-19, so clearly there is no evidence that wearing masks helps prevent the spread of COVID-19.

While this approach makes sense for evaluating lots of different novel medical treatments, this approach is clearly wrong in this context! And it’s especially wrong for an organization as visible as the World Health Organization to recommend against such common-sense measures that many doctors and public health policy experts were advocating for. I believe that there is a role for scientists to make subtle points about to what extent certain policies and treatments have been tested (though I believe the rule should be that they can only communicate through PDFs, never through a medium that the general public will be consuming), that is most definitely not the role of the WHO in a crisis like this! By confusing a subtle scientific point (no RCT) with common-sense public health policy, the WHO mudddied the waters and reduced the general public’s receptiveness to public health policies that could have slowed the spread of the virus.

The WHO makes this error repeatedly — roughly all of the links I posted above are variations of this. The WHO seems not to understand that it is a public health organization and that people look to it for it clear policy recommendations. When the WHO attempts to make subtle scientific points, especially by using phrases like “no evidence for” the general public routinely does not interpret these statements in the way that scientists do. I don’t want to say that the public “misinterprets” these phrases because it should be obvious how any non-scientist is going to interpret this sentence:

There is currently no evidence that people who have recovered from #COVID19 and have antibodies are protected from a second infection

I personally talked with at least two smart people who saw this tweet and it interpreted the way it’s written — they interpreted this to mean that it’s there isn’t any immunity after having COVID-191When the general public sees “no evidence for” they understand “it is false that”. Always.. That is not correct! And while that’s not the point the WHO was trying to make, it should have been obvious to them that that’s not how the general public would interpret this! And the WHO makes this mistake again and again. People are looking to the WHO as a source of information on public health policy, not for subtle scientific points about what has or hasn’t been studied using a randomized control trial.

The WHO needs to clarify its mission and get serious about how it communicates. If it wants to be a scientific organization, that’s great but it should delete its Twitter account and emphasize coordinating the work of researchers. It should avoid communicating with the general public and should rely on other organizations to communicate and disseminate public health policy advice. If it’s going to be a public health policy organization, then it needs to think much harder about how it responds to fast-moving situations like a pandemic where there will never be RCTs (because by the time you’ve done the RCT and published the results, millions of people have died!) and how it communicates to the public. The WHO needs to recognize that nuanced scientific proclamations tend to confuse people and sew doubts about the recommended public health policies that we need people to be following.

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By michael