Emails raise questions about China’s sway over first WHO mission on COVID-19

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A WHO mission to China led by Bruce Aylward offered the world a first glimpse at COVID-19, but the picture may have been distorted by politics. (Photo credit: WHO)

An early World Health Organization report about the COVID-19 pandemic was influenced by political considerations in China, emails obtained through the Freedom of Information Act show.

A World Health Organization mission of 13 international experts and 12 Chinese experts ⁠— led by Bruce Aylward, a senior advisor at the World Health Organization, and Wannian Liang, an epidemiologist representing the People’s Republic of China ⁠— was influential to the globe’s understanding of the novel coronavirus. The report was prepared in Feb. 2020, when the rest of the world knew little about SARS-CoV-2.

The new emails follow reports that Chinese authorities exerted tight control over a second WHO mission in January 2021. Liang served on both missions. 

China insisted that the WHO’s first mission meet China’s need for an admiring assessment of its COVID-19 response and plans. 

“In an excellent and encouraging discussion with Liang on the train we agreed that the best way to ensure we meet China’s need for a strong assessment of its response and where it plans to go next, would be to add [REDACTED],” Aylward wrote

The report is a glowing paean of China’s mitigation measures and its data sharing. 

“In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history,” the report’s number one takeaway reads.

Aylward’s email suggests this section – the report’s “major conclusions” – may have been added to “accommodate” the Chinese scientists.

Other international members of the mission recommended that Aylward “dial it back a bit for a public audience and at least hint at shortcomings.”

Alyward may have anticipated pushback on the laudatory section, saying “it is the opinions of the Internationals that matter most here.”

Aylward, who remains a senior advisor to WHO Director-General Tedros Adhanom Ghebreyesus, did not respond to a request for comment.

The email also suggests that Wang Bin, deputy director general of China’s Disease Prevention and Control Bureau of the National Health Commission, sought to nix certain recommendations in a section dedicated to the public, but they are not specified. 

In communications with the CDC, Aylward and mission member and infectious-diseases physician at the National University Hospital in Singapore Dale Fisher were “highly complementary” and “did not question the data coming from China,” Director of the CDC’s Global Disease Detection Operations Center Ray Arthur told colleagues. 

Some concerns about China’s response or data were flagged to CDC by Aylward and Fisher, but the nature of those concerns are redacted. 

They were not discussed publicly by Aylward at the press conference that followed the report’s release, during which Aylward repeatedly applauded China’s response to the pandemic.

“It’s the opinion of the joint mission, after looking at it very closely and in different ways, that there is no question that China’s bold approach to the rapid spread of this new respiratory pathogen has changed the course of what was a rapidly escalating and continues to be deadly epidemic,” Aylward said

The pressure to appease Chinese authorities may have impacted the mission’s report in other ways.

For example, Aylward refused to sign his name to the report unless references to “SARS-CoV-2” were removed.

“Definitely do not use SARS-COV2 – I’m not signing anything with that in it,” Aylward wrote. “I’m not going to be part of that mess.”

Aylward said that his concerns surrounded the “deep history of this country with SARS.”

SARS-CoV-2, the now widely accepted name for the virus that causes COVID-19, was initially resisted by Chinese virologists and the WHO because it tied COVID-19 to the 2003 SARS outbreak and therefore to China.

Wuhan Institute of Virology coronavirus researcher Shi Zhengli appealed to the International Committee on Taxonomy of Viruses for the virus to be renamed to something like TARS-CoV or HARS-CoV, U.S. Right to Know reported last year.

Premature conclusions

Other key details that could shed a light on the impact of China’s influence are redacted.

But it is clear that some of the report’s takeaways were premature. The report concluded that the pandemic had a zoonotic origin, stating it in at least three places. 

WHO Chief Dr. Tedros indicated in a recent interview with U.S. Right to Know that he considers both a natural spillover and a lab accident to be possible scenarios. 

“COVID-19 is a zoonotic virus,” the Feb. 2020 report states. “The intermediate host(s) has not yet been identified. However, three important areas of work are already underway in China to inform our understanding of the zoonotic origin of this outbreak,” namely sampling at the city’s wet market and an investigation into the species sold there.

The report states that “early cases identified in Wuhan are believed to be have [sic] acquired infection from a zoonotic source as many reported visiting or working in the Huanan Wholesale Seafood Market.”

“Wet markets were closed, and efforts were made to identify the zoonotic source,” the report states a third time.

One of the “knowledge gaps” identified by the WHO mission was the “animal original source and natural reservoir” of the virus. 

The report does not mention a lab accident at the Wuhan Institute of Virology or China CDC lab in Wuhan as a possible origin of Covid-19.

“It seems quite clear that China exerted some influence over the WHO-China joint mission. It certainly has handicapped WHO in its investigation of the origins of SARS-CoV-2,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law.

China’s eagerness to suppress questions about Wuhan labs as a possible origin of SARS-CoV-2 has been previously reported.

For example, second WHO mission to China in January 2021 concluded that the lab accident hypothesis was an “extremely unlikely pathway.” WHO mission head Peter Ben Embarek later said that language was the result of a compromise with Chinese experts, who initially pushed to exclude any mention of a lab accident from the report altogether. The White House expressed “deep concerns” about China strong-arming its work.

The Feb. 2020 mission report was circulated with CDC experts responding to the rapidly unfolding pandemic in the U.S., another email obtained by U.S. Right to Know shows. 

The report was shared with dozens of U.S. CDC offices and employees – including Global Disease Detection Operations Center, the head of the division of high consequence pathogens and pathology, the head of the division of global health protection, and leaders of the agency’s COVID-19 response in Rwanda, South Sudan, the Congo and Uganda. 

The report was produced over a 9-day period from February 16 to February 24, 2020. The team visited Beijing, Shenzhen, Guangdong, Chengdu and Sichuan. “Select team members only” visited Wuhan for two days.

U.S. Right to Know obtained the emails reported on in this article from a Freedom of Information Act submitted to the Centers for Disease Control and Prevention as part of an investigation into the origins of COVID-19 and risky research funded with taxpayer dollars.

Written by Emily Kopp 

Conversations Between Coca-Cola and the CDC

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Milbank Quarterly: Public Meets Private: Conversations Between Coca-Cola and the CDC, by Nason Maani Hessari, Gary Ruskin, Martin McKee and David Stuckler (1.29.19)

Conclusion: “The emails we obtained using FOIA requests reveal efforts by Coca-Cola to lobby the CDC to advance corporate objectives rather than health, including to influence the World Health Organization. Our findings provide a rare example of the ways in which corporate interests attempt to influence public health practitioners ‘in their own words,’ and they demonstrate a need for clearer policies on avoiding partnerships with manufacturers of harmful products.”

USRTK News Release: Study Shows Coca-Cola’s Efforts to Influence CDC on Diet and Obesity (1.29.19)

The U.S. Right to Know Food Industry Collection, containing Coca-Cola emails with the CDC, is posted in the free, searchable UCSF Food Industry Documents Archive.

Congresswomen call for investigation

News Release: Pingree, DeLauro to HHS Inspector General: Investigate Coca-Cola’s Lobbying of CDC (2.4.19)

Letter to HHS Inspector General Daniel Levinson (2.4.19)

Salon: Two congresswomen want an investigation into CDC’s crooked relationship with Coca-Cola, by Nicole Karlis (2.5.19)

News coverage of Milbank Quarterly study

Washington Post: Coca-Cola Emails Reveal How Soda Industry Tries to Influence Health Officials, by Paige Winfield Cunningham (1.29.19)

Associated Press: Food industry sway over public health gets new scrutiny, by Candace Choi (1.29.19)

Politico: Coca-Cola Tried to Influence CDC on Research and Policy, New Report States, by Jesse Chase-Lubitz (1.29.19)

CNN: Old emails hold new clues to Coca-Cola and CDC’s controversial relationship, by Jacqueline Howard (1.29.19)

BMJ: Coca-Cola and obesity: study shows efforts to influence US Centers for Disease Control, by Gareth Iacobucci (1.30.19)

Salon: New emails reveal CDC employees were doing the bidding of Coca-Cola, by Nicole Karlis (2.1.19)

Mother Jones: Study: Emails Show How Coca-Cola Tried to Influence Global Health Policy, by Kari Sonde (2.1.19)

Atlanta Constitution Journal: Coke and CDC, Atlanta icons, share cozy relationship, emails show, by Alan Judd (2.6.19)

Related journal and news articles

BMJ: Conflicts of interest compromise US public health agency’s mission, say scientists, by Jeanne Lenzer (10.24.16)

Science: U.S. lawmakers want NIH and CDC foundations to say more about donors, by Jeffrey Mervis (6.29.18)

BMJ: Centers for Disease Control and Prevention: Protecting the Private Good? By Jeanne Lenzer (5.15.15)

Type Investigations: Firm Pays Government to Challenge Pesticide Research, by Sheila Kaplan (3.1.11)

BMJ: US public health agency sued over failure to release emails from Coca-Cola, by Martha Rosenberg (2.28.18)

San Diego Union Tribune: UCSD hires Coke-funded health researcher, by Morgan Cook (9.29.16)

More reporting on Coca-Cola’s influence

Journal of Epidemiology and Community Health: Science organisations and Coca-Cola’s ‘war’ with the public health community: insights from an internal industry document, by Pepita Barlow, Paulo Serôdio, Gary Ruskin, Martin McKee and David Stuckler (3.14.18)

Critical Public Health: How food companies influence evidence and opinion — straight from the horse’s mouth, by Gary Sacks, Boyd A. Swinburn, Adrian J. Cameron and Gary Ruskin (9.13.17)

Environmental Health News: Coca-Cola’s “war” with the public health community, by Gary Ruskin (4.3.18)

BMJ: Coca-Cola’s secret influence on medical and science journalists, by Paul Thacker (4.5.17)

Politico: Trump’s top health official traded tobacco stock while leading anti-smoking efforts, by Sarah Karlin-Smith and Brianna Ehley (1.30.18)

New York Times: New C.D.C. Chief Saw Coca-Cola as Ally in Obesity Fight, by Sheila Kaplan (7.22.17)

Associated Press: Emails reveal Coke’s role in anti-obesity group, by Candice Choi (11.24.15) and Excerpts from emails between Coke and Global Energy Balance Network

New York Times: Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets, by Anahad O’Connor (8.9.15)

News articles by U.S. Right to Know staff

The Hill: What is going on at the CDC? Health agency ethics need scrutiny, by Carey Gillam (8.27.16)

Huffington Post: More Coca-Cola Ties Seen Inside U.S. Centers For Disease Control, by Carey Gillam (8.1.16)

Huffington Post: CDC Official Exits Agency After Coca-Cola Connections Come to Light, by Carey Gillam (6.30.16)

Huffington Post: Beverage Industry Finds Friend Inside U.S. Health Agency, by Carey Gillam (6.28.16)

Forbes: The Coca-Cola Network: Soda Giant Mines Connections With Officials And Scientists To Wield Influence, by Rob Waters (7.11.17)

Forbes: Trump’s Pick To Head CDC Partnered With Coke, Boosting Agency’s Longstanding Ties To Soda Giant, by Rob Waters (7.10.17)

U.S. Right to Know is a plaintiff in a FOIA lawsuit regarding CDC

CrossFit and U.S. Right to Know are suing the Department of Health and Human Services seeking records about why the Foundation for the National Centers for Disease Control and Prevention (CDC Foundation) and the Foundation for the National Institutes of Health (NIH Foundation) have not disclosed donor information as required by law. (10.4.18)

Coca-Cola/ILSI influence on CDC in China

New York Times: How Chummy Are Junk Food Giants and China’s Health Officials? They Share Offices, by Andrew Jacobs (1.9.19)

Journal of Public Health Policy: Soda industry influence on obesity science and policy in China, by Susan Greenhalgh (1.9.19)

BMJ: Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China, by Susan Greenhalgh (1.9.19)

BMJ: The hidden power of corporations, by Martin McKee, Sarah Steele and David Stuckler (1.9.19)

CDC FOIA document batches

(1) CDC Bowman Malaspina

(2) CDC Janet Collins

(3) CDC Culbertson Ryan Liburd Galuska

(4) CDC Bowman Stokes 2018

Additional documents

(1) CDC SPIDER letter

(2) Three Barbara Bowman emails

Study Shows Coca-Cola’s Efforts to Influence CDC on Diet and Obesity

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News Release: Tuesday, January 29, 2019
Documents posted here
Contact: Gary Ruskin (415) 944-7350 or Nason Maani Hessari (+44) 020 7927 2879 or David Stuckler (+39) 347 563 4391 

Emails between The Coca-Cola Company and the Centers for Disease Control and Prevention (CDC) demonstrate the company’s efforts to influence the CDC for its own benefit, according to a study published today in The Milbank Quarterly. Coca-Cola’s contact with the CDC shows the company’s interest in gaining access to CDC employees, to lobby policymakers, and to frame the obesity debate by shifting attention and blame away from sugar-sweetened beverages.

The study is based on emails and documents obtained via the Freedom of Information Act by U.S. Right to Know, a nonprofit consumer and public health research group. The investigation into Coca-Cola is of particular relevance because the CDC has recently faced criticism for its links to manufacturers of unhealthy products, including those of sugar-sweetened beverages. The emails demonstrate Coca-Cola’s efforts to “advance corporate objectives, rather than health, including to influence the World Health Organization,” the study says.

“It is not the proper role of the CDC to abet companies that manufacture harmful products,” said Gary Ruskin, co-director of U.S. Right to Know. “Congress should investigate whether Coca-Cola and other companies that harm public health are unethically influencing the CDC, and subverting its efforts to protect the health of all Americans.”

“Once again we see the grave risks that arise when public health organisations partner with manufacturers of products that pose a threat to health,” said Martin McKee, professor of European public health at the London School of Hygiene & Tropical Medicine. “Sadly, as this example, and more recent ones in the United Kingdom show, these risks are not always appreciated by those who should know better.”

The paper concludes: “It is unacceptable for public health organizations to engage in partnerships with companies that have such a clear conflict of interest. The obvious parallel would be to consider the CDC working with cigarette companies and the dangers that such a partnership would pose. Our analysis has highlighted the need for organizations like the CDC to ensure that they refrain from engaging in partnerships with harmful product manufacturers lest they undermine the health of the public they serve.”

The Milbank Quarterly study was co-authored by Nason Maani Hessari, research fellow at the London School of Hygiene & Tropical Medicine; Gary Ruskin, co-director of U.S. Right to Know; Martin McKee, professor at the London School of Hygiene & Tropical Medicine; and, David Stuckler, professor at Bocconi University.

U.S. Right to Know is currently litigating two FOIA cases to obtain more documents from the CDC. In February 2018, U.S. Right to Know sued the CDC over its failure to comply with its duty under FOIA to provide records in response to six requests about its interactions with The Coca-Cola Company. In October 2018, CrossFit and U.S. Right to Know sued the Department of Health and Human Services seeking records about why the Foundation for the National Centers for Disease Control and Prevention (CDC Foundation) and the Foundation for the National Institutes of Health (NIH Foundation) have not disclosed donor information as required by law.

The U.S. Right to Know Food Industry Collection, containing documents from today’s study, is posted in the free, searchable Food Industry Documents Archive hosted by the University of California, San Francisco. For more background about USRTK’s work regarding the CDC and Coca-Cola, see: https://usrtk.org/our-investigations/#coca-cola.

U.S. Right to Know is a nonprofit consumer and public health research group that investigates the risks associated with the corporate food system, and the food industry’s practices and influence on public policy. For more information, see usrtk.org.

The London School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research, postgraduate studies and continuing education in public and global health. LSHTM has a strong international presence with 3,000 staff and 4,000 students working in the UK and countries around the world, and an annual research income of £140 million. LSHTM is one of the highest-rated research institutions in the UK, is partnered with two MRC University Units in The Gambia and Uganda, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice http://www.lshtm.ac.uk

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