As it praised Beijing, the World Health Organisation concealed concessions to China and may have sacrificed the best chance to unravel the virus's origins. Now it's a favourite Trump attack line.
On a cold weekend in mid-February, when the world still harboured false hope that the new coronavirus could be contained, a World Health Organisation team arrived in Beijing to study the outbreak and investigate a critical question: How did the virus jump from animals to humans?
At that point, there were only three confirmed deaths from Covid-19 outside China and scientists hoped that finding an animal source for the coronavirus would unlock clues about how to stop it, treat it and prevent similar outbreaks.
"If we don't know the source then we're equally vulnerable in the future to a similar outbreak," Michael Ryan, the World Health Organisation's emergency director, had said that week in Geneva. "Understanding that source is a very important next step."
What the team members did not know was that they would not be allowed to investigate the source at all. Despite Ryan's pronouncements, and over the advice of its emergency committee, the organisation's leadership had quietly negotiated terms that sidelined its own experts. They would not question China's initial response or even visit the live-animal market in the city of Wuhan where the outbreak seemed to have originated.
Nine months and more than 1.1 million deaths later, there is still no transparent, independent investigation into the source of the virus. Notoriously allergic to outside scrutiny, China has impeded the effort, while leaders of the World Health Organisation, if privately frustrated, have largely ceded control, even as the Trump administration has fumed.
From the earliest days of the outbreak, the World Health Organisation — the only public health body with a global remit — has been both indispensable and impotent. The Geneva-based agency has delivered key information about testing, treatment and vaccine science. When the Trump administration decided to develop its own test kits, rather than rely on the WHO blueprint, the botched result led to delays.
At the same time, the health organisation pushed misleading and contradictory information about the risk of spread from symptomless carriers. Its experts were slow to accept that the virus could be airborne. Top health officials encouraged travel as usual, advice that was based on politics and economics, not science.
The WHO's staunchest defenders note that, by the nature of its constitution, it is beholden to the countries that finance it. And it is hardly the only international body bending to China's might. But even many of its supporters have been frustrated by the organisation's secrecy, its public praise for China and its quiet concessions. Those decisions have indirectly helped Beijing to whitewash its early failures in handling the outbreak.
Now, as a new Covid-19 wave engulfs Europe and the United States, the organisation is in the middle of a geopolitical standoff.
China's authoritarian leaders want to constrain the organisation; President Donald Trump, who formally withdrew the US from the body in July, now seems intent on destroying it; and European leaders are scrambling to reform and empower it.
The search for the virus's origins is a study in the compromises the WHO has made.
On the surface, an investigation into the virus's origin is progressing. Beijing recently approved a list of outside investigators. The health organisation has agreed that key parts of the inquiry — about the first patients in China and the market's role in the outbreak — will be led by Chinese scientists, according to documents obtained by The New York Times. The documents, which have never been made public, show that WHO experts will review and "augment, rather than duplicate," studies undertaken by China.
Even as it has heaped praise on the Chinese government, the organisation has refused to disclose details of its negotiations with Beijing and hasn't shared documents with member states outlining the terms of its investigations.
"The WHO prioritises access to the country," said Gian Luca Burci, a former legal counsel for the agency. "But if you do that to the bitter end, you lose soft power."
The question of the virus's origin remains a critical mystery that, if solved, could help prevent another pandemic and help scientists create vaccines and treatments. When the first severe acute respiratory syndrome outbreak began spreading in China in late 2002, officials hid the epidemic for months. But when they finally acknowledged it, they soon allowed in international teams to investigate the animal source.
This time, the hunt for a source has been shrouded in secrecy.
Internal documents and interviews with more than 50 public-health officials, scientists and diplomats provide an inside look at how a disempowered WHO, eager to win access and cooperation from China, has struggled to achieve either. Its solicitous approach has given space for Trump and his allies to push speculation and unfounded conspiracy theories, and deflect blame for their own mistakes.
The prospect of an apolitical inquiry into the virus's origins is dwindling. China has extracted concessions from the health organisation that have helped the country delay important research and spared its government a potentially embarrassing review of its early response to the outbreak.
"Unfortunately, this has become a political investigation," said Wang Linfa, an Australian virus expert in Singapore who helped identify bats as the hosts of the first SARS coronavirus. "Whatever they do is symbolic."
The organisation said it was committed to a full-scale investigation irrespective of political distractions.
"Divisions between and within countries have provided fertile ground for this fast-moving virus to grow and gain the upper hand," the WHO's director general, Tedros Adhanom Ghebreyesus, said in a statement to the Times. He said political attacks had undermined the world's response. "Leadership in a crisis such as this requires listening, understanding, trust and moving forward together."
The question of where Covid-19 began is especially intriguing because the initial theory, centered on illegal wildlife sales at the Wuhan market, is now in doubt.
There is powerful evidence that the new coronavirus passed naturally from an animal into humans. Scientists have found a virus in bats that is a close relative, and they suspect that it may have infected another animal species before it reached people.
But though they agree that many cases were linked to the market in Wuhan, many scientists no longer believe it is where the outbreak began.
For now, however, it's still where the trail goes cold.
A contaminated market
On the night of December 30, 2019, according to local reports, workers in protective gear began scrubbing the Huanan Seafood Wholesale Market in Wuhan, a warren of vendors selling produce, meats and wild animals. They scoured the market, going stall to stall, and spraying disinfectant to stop an outbreak that officials believed originated there.
A day or so later, another team arrived from China's Center for Disease Control and Prevention. According to one official account, the experts took samples both from products sold at the market and the environment.
But three weeks later, George F. Gao, the chief scientist at China's CDC, indicated to a reporter that the market had been closed before his team could conduct a thorough search for the animal source.
This is a key moment. The discrepancy in the accounts leaves open two possibilities. If researchers tested samples from live animals, then they may be concealing potentially important clues about the origins of the virus.
But if they arrived after the market had been closed and disinfected, they may only have taken samples from places like door handles, counters and sewage runoff. Many outside experts consider this the most likely scenario. They said it was understandable that local officials, focused on preventing human illness, would rush to clean the market rather than pause to preserve evidence.
Yet that would mean that Chinese officials probably missed a chance to confirm where the outbreak did, or did not, originate.
The WHO has repeatedly said that investigations are underway but has done little to clarify the uncertainty. Chinese health and diplomatic officials did not respond to repeated interview requests and have been publicly silent on what happened.
"This is part of the Chinese psyche — to demonstrate to the world that they do the very best science," said Peter Daszak, a disease ecologist and president of EcoHealth Alliance in New York. "But in this case, it didn't work. And I think that is the reason why we don't know much more."
Identifying the source of a virus is not an armchair exercise. After the 2012 outbreak of the Middle East respiratory syndrome coronavirus, scientists found evidence that it was carried by camels. But it took researchers like Ghazi Kayali, who drew blood samples from Egyptian slaughterhouses, to confirm that. Now he and other researchers are eagerly awaiting details on China's early tests.
"What did they actually find?" Kayali said. "Was it a live virus, or just fragments of RNA? Did they sample animals that were present there?"
The closest the Chinese government has come to publishing findings was a January 22 news release, which declared that scientists had found the coronavirus in 15 samples from the market. But it is unclear whether that virus was shed by humans or animals. Chinese scientists published the genetic sequence from some samples, but the information provided no clues to the virus's origins.
The WHO may be in a position to answer some of these questions. In mid-January, China's National Health Commission briefed the organisation's local office on its market investigation, according to an official with direct knowledge of the briefing.
Chinese officials said in January that the outbreak began at the market. Gao, at the Chinese CDC, blamed illegal wildlife sales.
In private conversations, he shared a more specific hypothesis. W. Ian Lipkin, a Columbia University virus expert, recalled how, over dinner in Beijing in early February, Gao pulled out his phone and showed him pictures of dead rodents found at the market.
"George Gao was convinced we were going to implicate a cane rat," Lipkin said.
Yet, even then, Gao was seeing evidence that undermined his theory.
In late January, Gao co-wrote one of the earliest epidemiological studies about the virus. The study highlights the market's links to the outbreak. But a close look at the data reveals something significant: Four of the first five coronavirus patients had no clear links to the market.
They had apparently been infected elsewhere.
The diplomacy of effusive praise
In late January, Tedros met with China's leader, Xi Jinping, in Beijing. The outbreak was gathering speed, if still largely confined to China, as the two men sat in front of a bucolic mural in the Great Hall of the People and carved out an agreement.
Tedros had rushed to Beijing to lobby Xi to allow in a large team of international experts. A small WHO team had traveled to Wuhan a week before but had not gone to the market or to the largest hospital for infectious diseases.
Xi did not welcome the suggestion that China needed help. But he agreed to let a WHO mission evaluate the situation "objectively, fairly, calmly and rationally."
"The epidemic is the devil, and we cannot let the devil hide," Xi said, according to local media reports.
The agreement was critical for Tedros, who the previous week had decided against declaring an international emergency after convening a committee to advise him.
What was not publicly known, though, was that the committee's January 23 decision followed intense lobbying, notably by China, according to diplomats and health officials. Committee members are international experts largely insulated from influence. But in Geneva, China's ambassador made it clear that his country would view an emergency declaration as a vote of no confidence.
China also presented data to the committee, portraying a situation under relative control.
Half the committee said it was too early to declare an emergency. The outcome surprised many countries, as did Tedros when he publicly praised both Xi and China's pneumonia surveillance system.
"It was that system that caught this event," he said during a news conference.
That was wrong. China's surveillance system had failed to spot the outbreak, a failure that experts now say allowed its spread to accelerate. Asked to explain the discrepancy, the WHO referred questions to China.
Praising China, though, has been Tedros' trademark refrain.
Tedros is a politically minded public health researcher who has served as health minister and foreign minister of Ethiopia. He is affable and calls leaders and diplomats "my brother." Critics and supporters agree that he dislikes criticizing countries publicly.
His supporters say soft diplomacy is necessary for any leader of the WHO, a badly underfunded United Nations agency founded after World War II that relies on donations for about 80 per cent of its budget.
When Tedros took over in 2017, the organisation was undergoing an overhaul after criticism for its earlier botched response to the Ebola outbreak in West Africa.
But the agency still has no guaranteed budget and no authority to make demands or enforce international regulations. For the sake of public health, it often chooses to work with countries even after other UN agencies have placed sanctions on them.
When SARS emerged in late 2002, China hid the outbreak for months and ignored calls from Gro Harlem Brundtland, who was then leading the WHO. Only when she publicly shamed the country did China cooperate.
This time, things seemed to start off better. Chinese leaders communicated regularly with Tedros. Beijing had also shared the genomic sequence of the virus with the WHO relatively quickly, although only after Chinese scientists beat it to the task. Xi's decision to allow a WHO mission seemed to vindicate Tedros' approach.
"I will praise China again and again because its actions actually helped in reducing the spread of coronavirus to other countries," Tedros said after he left Beijing. "We should tell the truth."
Back in Geneva, the US ambassador, Andrew Bremberg, urged Tedros to dial back praise of China.
"You're risking your personal and organisational reputation," he told Tedros, according to several Western diplomats briefed on that conversation.
In the end, Tedros declared an emergency on Jan. 30, on the advice of nearly every member of the committee, save for the Chinese delegate. The committee also advised that the upcoming WHO mission to China should "review and support efforts to investigate the animal source."
About a week later, in early February, two top experts from the organization went to Beijing to negotiate the mission's agenda. That same week, the world's leading health experts ranked finding the animal host as one of the top tasks.
Yet, even before the full team gathered in Beijing on February 16, the WHO had ceded ground, according to two people who were on the mission, diplomats and others. It agreed not to examine China's early response or begin investigating the animal source, they said. It could not even secure a visit to Wuhan.
"We weren't there to look at the animal origins," said Dale Fisher, a National University of Singapore medical professor who took part in the mission.
In response to questions, the WHO said that it had focused on "understanding the outbreak in China in order to help all countries to prepare and protect populations."
Once in China, team members agreed the mission would not be credible unless they went to Wuhan, said H. Clifford Lane, a clinical director at the National Institute of Allergy and Infectious Diseases.
Wuhan was sealed, so six members — three Chinese and three international experts — took a special train to the city. They stayed for about a day and visited two hospitals. They did not go to the market.
When the team gathered to write its report, the 25 members parsed every word for nearly three days.
"They would get stuck on a word," Fisher said about his Chinese colleagues.
The mission produced valuable information on the disease, its transmission, and China's successful, if draconian, response. Its report also credited Xi, whom it said "personally directed and deployed the prevention and control work" — a statement not corroborated by early reports on the outbreak.
On the origins of the virus, the experts mostly shifted the onus to China, asking the government to prioritise a "rigorous investigation." But they also assured people that numerous investigations were underway.
"It was an absolute whitewash," said Lawrence O. Gostin, a professor of global health law at Georgetown University. "But the answer was, that was the best they could negotiate with Xi Jinping."
American fury
In Washington, the US health secretary, Alex M. Azar II, gathered advisers inside a conference room of the Department of Health and Human Services to hear from two government scientists who had participated in the WHO mission to China.
The scientists, still in quarantine, described by videoconference the seemingly unimaginable lockdown that China had imposed. When questions turned to the origins of the virus, however, answers stopped.
"You'd have to look at the terms of reference," one of the scientists replied, a senior US health official recalled. The "terms of reference" was a document spelling out the mission's rules. The Americans had never seen it.
The health organisation's public statements suggested that the animal-source investigation was well underway.
If that was true, the Americans realized that they were on the outside, blocked from the investigation by China.
Tedros was already a lightning rod inside the Trump administration — even with some career health officials — because of his unstinting praise of China. What his supporters saw as diplomacy, the Americans viewed as a refusal to use his organization's moral authority to demand transparency.
And he did not always deliver. In January, Tedros had announced that China had agreed to share biological samples. Nothing ever came of it.
Then the thesis about the origin of the outbreak suddenly pivoted.
Gao, the director of China's CDC, told the journal Science in March that the virus may not have originated at the market. Maybe, he said, it "could be a place where the virus was amplified," meaning it began elsewhere but spread wildly there.
Then Gao told a local TV station that animal samples from the market did not contain the virus. That indicated at least that samples had been taken from animals. Yet the details remained concealed.
"To the best of our knowledge, no information has been shared with HHS, nor published in peer-reviewed journals," the US agency said in a statement to the Times.
In the United States, where the pandemic was starting to take root, Trump and his allies began to talk about the "China virus."
Rumors and conspiracy theories, particularly among far-right and anti-China news sources, pushed the idea that Covid-19 had been manufactured in a Chinese laboratory. Scientists and intelligence officials say there is no evidence for such a theory, but some of Trump's closest allies gave it credence.
On April 7, Trump accused the WHO of being too close to China.
"They seem to be very China centric. That's a nice way of saying it," he told reporters.
In May, under sharp criticism for his administration's response to the outbreak, Trump announced the US would soon withdraw from the international organiation. Doing so isolated him from allies who shared some of his frustrations but wanted to strengthen, not abandon, the WHO.
Highlighting just how deeply the anti-Chinese conspiracy theory had seeped into government policy, the National Institutes of Health said they would not fund a project by EcoHealth Alliance, a nonprofit that studies emerging diseases, unless it agreed to investigate online conspiracy claims and ferry viral samples out of China, according to a letter seen by the Times.
The US withdrawal from the WHO, and the world's failure to stop the pandemic, have jump-started negotiations to overhaul the organisation. The European Union and other countries are seeking to give it more money and authority to hold countries accountable.
The Trump administration has continued to try to guide reform talks after withdrawing from the organisation — much to the frustration of allies. The US has privately endorsed giving the WHO the authority to demand access to countries, akin to the power that nuclear inspectors have, according to diplomatic documents.
As the virus has spread unabated across the US, Trump has continued to lash out at the WHO and China to deflect criticism of his own missteps.
If Trump thought Tedros would buckle, he was mistaken. Publicly, Tedros has stuck to his message of solidarity. "Governments should focus on tackling the virus and avoid politicization," he said last Friday.
Privately, Tedros told colleagues and others that he felt stuck between China and the US He compared them to two playground bullies.
Bottlenecks
The WHO found new support in May for its stalled effort to investigate the virus's origins. A resolution, sponsored by more than 140 countries, included a clause directing the agency to search for the animal source.
By the summer, even the WHO was frustrated. Two experts who went to China in July to define the terms of the investigation spent two weeks in quarantine. They interviewed experts by phone but did not go to Wuhan.
Chinese officials then said that the organisation should start investigating in Europe, pointing to reports that the virus had been discovered in sewage systems there last year.
In a letter to Chinese officials described to the Times, the health organization expressed frustration at China's delays and insisted that the investigation begin in Wuhan, if only because the first infections were found there.
None of these frustrations spilled into public. The organisation described only progress. Yet it repeatedly declined requests by multiple governments to disclose the investigation terms it had negotiated with China. On Friday, the organisation told the Times that it would soon make the documents public.
An executive summary of the documents, obtained by the Times, shows that the health organisation's virus origin studies will unfold in two phases. One will look for the first patients by reviewing hospital records and interviewing people who were treated for the virus in December. The team will also investigate what wildlife was sold at the Wuhan market and follow the supply chain, according to the summary.
The WHO has agreed this phase will be led by Chinese scientists, with outsiders reviewing their work remotely.
In the second phase, international experts will work with Chinese colleagues to find the virus among animal hosts and a possible intermediate host.
No date has been set for a visit, though diplomats say China and the health organization appear eager to pause until after the US election. Joe Biden, the Democratic nominee, has said he will keep the US in the organisation if he wins.
The organization solicited experts for the mission and the US recommended three government scientists. None made the team, a senior US official said. But the WHO has not made the list public. It said Monday morning that an independent American scientist was on the list.
On Friday, the team finally held its first virtual meeting.
"It is difficult to do this work in a politically intoxicated environment," Ryan, the organization's emergency director, said at a news conference later that day.
"It is hard for scientists to do what they have to do and want to do in situations like this," he said.
Written by: Selam Gebrekidan, Matt Apuzzo, Amy Qin and Javier C. Hernández
Photographs by: Doug Mills
© 2020 THE NEW YORK TIMES
