Conclusions
Lipsitch predicts that some 40%-70% of the worldʼs population will be infected this year.78 Despite political claims, a vaccine is more likely seen within a year or two at best.79 It is no longer realistic to expect the management of these gaps in infectious disease outbreaks, especially those that threaten to be epidemics and pandemics, are to be capably managed in their present state of willful denial and offenses by many countries, especially those that are ruled by authoritarian regimes.80
Despite resistance to globalizationʼs health benefits that would markedly benefit the global community during these crises by authoritarian regimes, in 2015, I called for a new WHO leadership granted by the International Health Regulations Treaty that has consequences if violated. I stated:The intent of a legally binding Treaty to improve the capacity of all countries to detect, assess, notify, and respond to public health threats are being ignored. While there is a current rush to admonish globalization in favor of populism, epidemic and pandemics deserve better than decisions being made by incapable autocrats. During Ebola, a rush by the Global Health Security Agenda partners to fill critical gaps in administrative and operational areas was crucial in the short term, but questions remain as to the real priorities of the global leadership as time elapses and critical gaps in public health protections and infrastructure take precedence over the economic and security needs of the developed world. The response from the Global Outbreak Alert and Response Network and foreign medical teams to Ebola proved indispensable to global health security, but both deserve stronger strategic capacity support and institutional status under the WHO leadership granted by the [International Health Regulations] Treaty. Treaties are the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world. Other options are not sustainable. Given the gravity of on-going failed treaty management, the slow and incomplete process of reform, the magnitude and complexity of infectious disease outbreaks, and the rising severity of public health emergencies, a recommitment must be made to complete and restore the original mandates as a collaborative and coordinated global network responsibility, not one left to the actions of individual countries. The bottom line is that the global community can no longer tolerate an ineffectual and passive international response system. As such, this Treaty has the potential to become one of the most effective treaties for crisis response and risk reduction world-wide. Practitioners and health decision-makers world-wide must break their silence and advocate for a stronger Treaty and a return of WHO authority. Health practitioners and health decision-makers world-wide must break their silence and advocate for a stronger Treaty and a return of WHOʼs undisputed global authority.81
Will Chinaʼs unilateral decisions just be a temporary stay as it was post-SARS, or is China capable of adopting, without conditions, the WHO public health requirements they have so far ignored?
Autocratic leaders in history have a direct impact on health security. Dictatorships, with direct knowledge of the negative impact on health, create adverse political and economic conditions that only complicate the problem further. This is more evident in autocratic regimes where health protections have been seriously and purposely curtailed. This summary acknowledges that autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or their impact on their population. They will universally accelerate defenses indigenous to their personality traits when faced with contrary facts, double down against or deny accurate science to the contrary, delay timely precautions, and fail to meet health expectations required of nations under existing International Health Regulations, laws, and Epidemic Control surveillance.82
Kavanaughʼs Lancet editorial initially praised Chinese tactics that reflected a level of control only available to authoritarian regimes. As days and weeks passed, it revealed a government that inherently became victims of their own propaganda based on “need to avoid sharing bad news.” He concluded that authoritarian politics inhibited an effective response, and that openness and competitive politics favor a strategically fair public health strategy.83 Democratic nations in comparison to autocratic regimes recognize that public health fundamentally depends on public trust.84 The WHOʼs China Joint Mission on Coronavirus Disease report has applauded Chinaʼs eventual response capability and capacity with strict measures to interrupt or minimize transmission chains with extremely proactive surveillance, rapid diagnosis, isolation tracking, quarantine, and population acceptance of these measures, to implement the measures to contain COVID-19 within the country.85 It must not be forgotten that Chinaʼs authoritarian rule “put secrecy and order ahead of openly confronting the growing crisis and risking alarm or political embarrassment,”86 arrested and compelled Dr. Li Wenliang to sign a statement that his warning constituted “illegal behavior,” all of which delayed a concerted public health offensive that led to his death.86 This was an “issue of inaction” that would have contained COVID-19 within China and remains a potent symbol of Chinaʼs failures.86 There is no evidence that the authoritarian regime has or will change to prevent this from happening again.87 I suspect Chinaʼs sophisticated censorship and propaganda systems will outlast any public health improvements.