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WHO's suppression of report on Italy's pandemic response set dangerous precedent, critics say

An empty street in Rome, March 2020. Credit: AP Photo / Andrew Medichini.

The World Health Organization’s suppression of an independent report that critically examined Italy’s Covid-19 pandemic response – sets a dangerous precedent, WHO observers in Geneva and Italy are saying.

The World Health Organization’s suppression of an independent report that critically examined both the strengths and weaknesses of Italy’s Covid-19 pandemic response – sets a dangerous precedent that could further compromise the international organization’s technical credibility, longtime WHO observers are saying.

Why is this important? The controversy over WHO’s removal of the report, An unprecedented challenge – Italy’s first response to Covid-19, has in fact been simmering inside the organisation since May when the report was first issued and then abruptly withdrawn.

But it has erupted publicly at a time when the Italian national pandemic response is also under intense legal scrutiny by communities around the northern Italian city of Bergamo, which were the hardest hit in the country by the pandemic. Internationally, WHO’s recall of the report has hit another sensitive nerve - reviving the debate over WHO’s credibility and independence, as it leads a series of other sensitive investigations into the global pandemic response and the origins of the SARS-Cov2 virus.

What happened? The WHO report An unprecedented challenge, which was supposed to be an independent assessment of Italy’s pandemic response, was published in mid-May, and then abruptly deleted a day later. The sudden withdrawal of the document was due to what critics describe as politically tainted objections by a single member of WHO’s senior management team who is also a former high-ranking Italian government official, according to a series of Health Policy Watch interviews with knowledgeable insiders, supported by a trail of leaked emails.

After formal WHO publication approval had been granted, and days before the report’s publication, Ranieri Guerra, WHO assistant director-general and former head of prevention activities in Italy’s Ministry of Health, attempted to revise key sections of text, according to the email correspondence and testimony. The revisions were rejected as unnecessary and factually untrue by the report’s senior professional, Francesco Zambon, coordinator of WHO’s Venice office, and the finalised, copyrighted report was posted online by WHO’s European Regional Office on 13 May - only to be removed the following day, without any explanation.

The emails and insider testimonies suggest that Guerra tried to alter the WHO report to protect himself and other Italian officials from scrutiny over the Ministry of Health’s failure to update the country’s pandemic preparedness plan during the period 2014-2017 - when Guerra himself was in charge of the ministry’s prevention team.

Specifically, Guerra demanded that references to Italy’s 2006 pandemic preparedness plan state that the plan been “updated in 2016” - when in fact the plan had not been significantly changed in a decade.

In fact, well-placed sources say, Guerra himself should have initiated an update of Italy’s preparedness plan in the period when he headed the ministry’s prevention team – as per a 2013 European Commission request to EU member states. His interventions in the WHO report text sought to blur the record over his own omissions.

WHO Responses. WHO has explained the report’s removal saying that it contained “inaccuracies”.  But asked on Tuesday what the errors were, a WHO spokesperson refused to elaborate, stating, “We are not going to discuss factual inaccuracies.”

The leaked email correspondence, including direct exchanges between Guerra and Zambon, coordinator of the Venice-based WHO European Office for Investment for Health and Development, is very clear, however, about the facts Guerra sought to change.

In one email, rife with expletives, Guerra demanded that Zambon falsify the sentence referring to Italy’s preparedness plan to state that the plan had an “update” in 2016:

“You need to correct the text immediately: national influenza pandemic preparedness and response plan; Ministry of Health; 2006 (…) And report what is available on the Ministry of Health website (…) last update in December 2016. Don’t mess me up on this one. …I begged you to let me read the draft before printing… damn it…Now I’m blocking everything with Soumya,” it states – a reference to WHO Chief Scientist Soumya Swaminathan.

“Get me the modified version as soon as you can. It simply can’t come out this way. Please no bullshit. Thank you and excuse the tone, Ranieri.”

In another email, Guerra admitted to Zambon that the report’s factual content was solid – but he said the report would prove embarrassing to the Italian government: .

“There are no doubts or criticisms about a work that is certainly valuable from the point of view of content,… but I don’t think you fully realise what political issues are overlapping at the moment.”

Guerra went on to say that a critical WHO account of Italy’s pandemic response would be perceived as undermining the current minister of H=health, Robert Speranza, and thus not be “doing the country a good service” - just after Italy had given WHO a major new contribution of  €10m. Although the report’s overall tone was not aggressive or harsh, Guerra also objected to another phrase, which described the initial Italian response as “improvised, chaotic and creative”, reportedly asking Zambon to strike that from the text as well.

In a follow-up email on 27 May from Zambon to WHO’s European regional director, Hans Kluge, obtained this week by Health Policy Watch, Zambon told Kluge that Guerra’s last-minute attempts to make changes were largely motivated by his desire to blur the record over his own performance in the Italian government.

“On 11 May, before seeing the sentence about lack of pandemic plan [which is a mere fact] Guerra emailed me saying that the publication is fantastic, ordering 50 copies to be distributed to all ministers… Then he saw the sentence about pandemic plan (first sentence 2.1 chapter), he first intimidated me to remove it [email proving that] and then calling saying that if I had not removed it, he was already on the doorstep of the DG….”

Censorship of the report, Zambon warned Kluge, would harm WHO’s professional credibility and its reputation for transparency - precisely at a time when other larger investigations have been mandated by the World Health Assembly into the pandemic response and the origins of the SARS-CoV-2 virus. Zambon concluded with a passionate plea focused on the dedicated team that had been involved in developing the report and its ultimate purpose:

“A large team of experts worked literally days and nights with one motivation, making sure that what happened in Italy is not repeated in those countries behind in time in the epidemic curve… The report contains important messages, extrapolated from facts on what worked (many things) and the blind spots of the system. No accusatory tone at all is used in the publication. Furthermore it contains a wealth of subnational practices with the unique regional profiles….

“I find it difficult to understand how an ad hoc created diplomatic incident (with a specific purpose as mentioned above) can withhold what could surely be of benefit to a large number of MSs [member states].”

In the wake of an expanding series of media stories in Italy and internationally around the report’s suppression, WHO on Tuesday issued a brief press release about the report’s removal, stating it was due to “factual inaccuracies” in the text. That was followed by an internal memo circulated to staff, which provided them with a playbook of responses to media queries.

The WHO memo Reactive Q&A in case of media questions , obtained by Health Policy Watch, effectively supports the narrative of Guerra, who was personally appointed by WHO director-general Dr Tedros Adhanom Ghebreyesus in 2017 - against that of Zambon and other career professionals who developed the report. The WHO responses go so far as to justify Guerra’s reported attempts to amend or delete the very texts, with which he took issue.

For instance, one mock media question in the WHO Q&A asks:  “Is it true that Italy’s pandemic plan had not been updated since 2006, and the initial response from hospitals was “improvised, chaotic and creative?  WHO’s reply:

“The Covid-19 pandemic has been unprecedented and many countries have faced huge challenges, including Italy. Italy was the first country in the European region to be hard-hit, with the situation escalating in a matter of days. The initial response was particularly complex.  However, words like ‘improvised, chaotic and creative’ do not do justice to the tremendous efforts of the government and the regions.

-Nicoletta Dentico contributed to this article.

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Health Policy Watch - World Health Organization's censorship of report on Italy's pandemic response sets dangerous international precedent - critics say