THE WORLD HEALTH Organisation’s position on lockdowns has been misrepresented in the media and by politicians in recent weeks.
It is a much-debated subject in Ireland and across other parts of Europe as countries consider tighter restrictions to counter a second wave of Covid-19.
Some governments – like our own – have hesitated before making this call, citing economic and other societal concerns, with some Covid hawks advocating for continued light-touch restrictions over a more heavy-handed lockdown.
This has led to a questioning of whether lockdowns are the right approach, but confusion over the WHO’s position on this has led to a significant muddying of the debate.
What is and what isn’t a lockdown is subjective. WHO officials often call them “so-called lockdowns”.
It’s sometimes argued that Ireland never had a full lockdown; while the Irish government introduced many restrictions impacting the opening of businesses such as hospitality and non-essential retail, personal freedoms were left largely intact, and the restrictions on those – limits on movement and household interaction – were lightly enforced.
Something closer to a true lockdown might be found back in spring or summer, when parts of Italy were sealed off by military and police checkpoints, France required residents to fill in a form to just to leave your home, or in China, where under some lockdowns just one member of the household could leave for two hours per day to pick up essentials.
Whatever the level of severity, it can be seen that there are different levels of lockdowns and there were different approaches in different countries.
New restrictions are now being introduced again, but at a slower pace and in a less blunt manner: Brussels has imposed a curfew and closed bars and restaurants, and France again requires people in certain cities to fill out paperwork to leave their home.
The concept of a ‘circuit breaker’ lockdown has also been popularised, particularly in the United Kingdom and New Zealand: a short, sharp period of tight restrictions which allows contact tracers to root out the chains of transmission.
Other countries, like Ireland, are heading into what could be described as lockdown again.
Italy is a couple of weeks behind Ireland and is imposing measures somewhat equivalent to our own Level 3 in the hope of avoiding lockdown, while officials in Czechia plan to wait another two weeks to decide whether more severe restrictions are required.
Back to the matter at hand: Did the World Health Organisation change its position on lockdowns?
Before we look at recent comments that sparked accusation of a changed stance, let’s look back at what its stance was to begin with.
WHO was never a big proponent of lockdowns, painting them as a sometimes unavoidable last resort.
Since the start of the pandemic, the advice from the WHO has been consistent: Lockdowns are not the best way of controlling the virus, but are sometimes necessary to bring the number of cases under control again and within the reach of a country’s health service and contact tracing capabilities.
A robust regime of identifying and isolating new cases is key to avoiding lockdowns, WHO advises, and a preferable way of controlling an infectious disease in the longer term.
“If we’re going to move away from that approach as a means of suppressing the virus we have got to put in place the public health surveillance, the isolation, the quarantine, the case finding, the detection,” Dr Mike Ryan, the World Health Organisation’s executive director for health emergencies, said on 30 March.
We have got to be able to show that we can go after the virus because lockdowns alone will not work.
The following month, WHO’s director-general Tedros Adhanom Ghebreyesus said:
So-called lockdowns can help to take the heat out of a country’s epidemic, but they cannot end it alone. Countries must now ensure they can detect, test, isolate and care for every case, and trace every contact.
Now, onto the current stance. Where WHO stands on lockdowns is in the spotlight after an interview with Dr David Nabarro.
Nabarro, previously a candidate for the role of WHO director-general, is one of the seven special envoys on Covid-19. As such he makes regular appearances in Irish and UK media and has also addressed the special Oireachtas committee on Covid-19 response.
His comments were made to The Spectator’s The Week in 60 Minutes programme in the UK on 8 October – you can watch the exact clip here and the full episode here.
Presenter Andrew Neil puts this point to him:
We had Professor Sunetra Gupta from Oxford University on, and she was implying – and I mention you because you have a global mandate, a global view – was that a problem we don’t think about in lockdowns is that they’re very nationalistic, that if we lock down our economy, then it hits our economy, but it also means we’re not buying stuff, we’re not trading with weaker economies, we’re not just destroying our own jobs, we’re destroying the jobs of all those in the poorer parts of the world that export to us. That seemed to me to be a reasonable point?
David Nabarro answers:
Really important point by Professor Gupta. I want to say it again: we in the World Health Organisation do not advocate lockdowns as a primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to re-organise, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large, we’d rather not do it.
He then gives examples of impacts of restrictive measures taken during the pandemic, on the tourism industry and smallholder farmers, but also on poverty levels and child malnutrition, before concluding:
We really do appeal to all world leaders: stop using lockdown as your primary control method. Develop better systems for doing it. Work together, and learn from each other, but remember, lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer.
Nabarro’s comments and phrasing here is quite clear – and in line with WHO’s previous narrative on this – saying that lockdowns shouldn’t be used as the primary control method of the disease.
The implication here is that other measures are needed before lockdown – as is the case in most countries, including Ireland. Hygiene and social distancing count as the primary defence.
It can be argued that contact tracing and light restrictions are the secondary defence, and heavy restrictions the tertiary defence.
However, this has been taken out of context numerous times - most notably by the president of the United States of America as well as by people commenting on social media - as meaning either WHO does not advocate for lockdowns or that countries should avoid them completely.
Nabarro’s comments have also been included in a video which has been shared widely on Facebook and YouTube in Ireland in recent days.
The Poynter Institute’s factchecking website PolitiFact followed up with Nabarro on how his comments were being championed by those who oppose lockdowns. His reply in a piece published 15 October:
My comments were taken totally out of context.
We’re saying we really do have to learn how to coexist with this virus in a way that doesn’t require constant closing down of economies, but at the same time in a way that is not associated with high levels of suffering and death.
He again reiterated that more broad-strokes public health measures are needed as the primary defence against Covid-19.
PolitiFact also sought a comment directly from WHO. The organisation said yes, lockdowns shouldn’t be used as the primary control method due to their highly damaging impact on society, “but may need to be used if Covid-19 transmission is out of control”.
Dr Hans Henri P. Kluge, the WHO’s regional director for Europe, made it clear in remarks on 15 October that the organisation sees the tightening of restrictions as a proportionate response to the situation unfolding in many EU countries.
“Our message is that any nationwide tightening-up decision must consider both the direct risks and the collateral damage associated with the pandemic,” he said, highlighting areas such as mental health, domestic violence, education, routine healthcare, the economy, and the ability of frontline workers to cope.
In March, lockdown was the default option because we were caught off guard. Today, lockdown means a very different thing. It means a stepwise escalation of proportionate, targeted and time-limited measures. Measures in which all of us are engaged both as individuals and as a society together in order to minimise collateral damage to our health, our economy and our society.
Mike Ryan says similar comments he made regarding lockdowns were also taken out of context. “I didn’t state that lock-downs were not necessary,” Ryan told a press conference on 9 October, “I said that lock-downs were not the absolute and only consequence of new cases.”
Again, like Nabarro, he highlighted the importance of early and aggressive contact tracing, focusing on how South Korea and Japan used this method to break chains of transmission effectively, but that other countries are not maintaining a tracing regime that has the necessary focus and speed.
[Countries struggling to stay on top of cases are] getting themselves into situations where the disease is very, very established and very, very intense and then there are no options but to shut down and lock down in many situations, particularly at a municipality or a city level because it becomes very, very hard to stop the virus unless you separate people from other people and that is a very difficult thing for everyone to accept.
The view of the chief medical officer Tony Holohan is that this is the situation we’re facing in Ireland.
He told a National Public Health Emergency Team briefing on 15 October that “it’s clear that the disease is not in control”.
In an interview with Newstalk Breakfast on 12 October, Nabarro spoke about “the middle path” that can be followed up until this point, where the spread of the disease outstrips our ability to keep a lid on it, referring to “people measures” – wearing masks, isolating when you’re sick, maintaining social distancing – and government services – mainly contact tracing.
Nabarro is clear that a strong approach here is key to being able to avoid lockdowns, and that’s what the World Health Organisation advises countries to do, as it has proven successful.
However, he again stressed that if outbreaks overwhelm this capacity, lockdowns may be needed:
The only time when you need to really restrict movements is when outbreaks are building up and you do that – the movement restrictions – locally. It’s not necessarily got to be a nationwide restriction.
So, in summary, we’re saying please put these defence mechanisms in place, they’ll be how you’ll be able to get on, and then only use nationwide-wide, major lockdowns in really extreme circumstances when things are very bad.
This has been the World Health Organisation’s consistent position: Lockdowns may be needed, but only when the spread of the disease is out of control, as up until that point other methods of controlling the disease are more effective and beneficial from both an epidemiological and economic standpoint.
But is that approach being taken by Irish authorities? Yes, according to the chief medical officer.
He and other members of NPHET are loathed to use the term lockdown. Holohan prefers the term “population-level measures”.
“Of course we agree,” he said when he was asked by RTÉ reporter Fergal Bowers for his thoughts on Nabarro’s comments at a NPHET briefing on 12 October.
“The first instrument that we reach for in terms of our management of this isn’t to close down important parts of our functioning as a society, as an economy.
“When we get to the conditions that allowed it – we’ve already done this – we’ve opened up parts of the economy that we think are appropriate, we’ve opened up parts of society that we think are appropriate, and government has made all of those decisions, and you’re well familiar with what those are.
“The position and the advice of the WHO is around public health measures of the kind that we’re advocating, and the importance of building public health systems that have the capacity, the scale, the connectedness between the different components of them, and the speed to enable us to maintain sufficient control of the virus.”
Holohan was also keen to stress that Nabarro and others in WHO were talking more broadly about this, and not just about Ireland.
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