In the spotlight: Director General of the World Health Organization Tedros Adhanom Ghebreyesus. Image: Associated Press / Alamy
As the UK’s Covid inquiry got underway in London, negotiations on a future Pandemic Treaty and International Health Regulations were happening in Geneva. What form might such international measures take, and in whose interests?
Three years on from the declaration of a global pandemic by the World Health Organisation, the UK’s long-awaited Covid-19 inquiry has gotten underway. Some just want to forget and move on, but the issue remains divisive.
Pro-restriction voices gained much satisfaction from former Prime Minister Boris Johnson’s ‘Partygate’-induced downfall. Long before these events came to light there were others who saw Covid restrictions as wrong, either in whole or in part. Perspectives on the Covid period have evolved. In the UK, we were once counselled that ‘lockdown scepticism’ was the preserve of Covidiots, but such views now seem more mainstream. Root-and-branch critiques have emerged from both the political right and the left, and from both the Global North and South. Evidence that the period’s more damaging restrictions were ineffective and harmful has built up. According to recent data, Sweden, one of the least locked down countries in the world, fared better overall than more restrictive jurisdictions.
Across the developed world, there are now many examples of health policies and reputations going into reverse. In Brussels, Ursula von der Leyen has apparently mislaid her text messages with Pfizer’s CEO in what was politely termed ‘maladministration’. And the emerging critiques and policy U-turns are not only about corruption. The German government once led a zealous Covid regime that included multiple lockdowns, compulsory testing, masking and vaccine mandates. German Health Minister Karl Lauterbach is now critical of his own policies. To top it off, he is facing a slew of vaccine-harm lawsuits. In the US, departing Chief Medical Advisor Anthony Fauci faced bitter interrogations before the US Congress over alleged ‘gain of function’ funding that some consider to have triggered the pandemic. Jacinda Ardern’s resignation as New Zealand’s prime minister seems not unconnected to her government’s violent suppression of protests and the stigmatising of political opponents.
In much of the developing world, Covid restrictions were seen as a cruel imposition from the get-go. In Spring 2023, King’s College London convened scholars and activists from 14 mainly Asian, Latin American and African countries to discuss the impacts of Covid restrictions in Low and Middle Income Countries (LMICs). Their conclusions and recommendations make for stark reading, amply illustrating the costs that policies dreamed up in the halls of Geneva can have elsewhere.
In much of the developing world, Covid restrictions were seen as a cruel imposition from the get-go
As research by the charity Collateral Global has shown, between 2020 and 2022, millions worldwide suffered from food insecurity and loss of education or livelihoods. Others were imprisoned in slum housing or beaten by panicked police. Escalating levels of national debt and global inflation eventually led to half of low and lower middle-income countries cutting health budgets during the pandemic while two-thirds of low and lower-middle income countries cut education spend. Subsidies on food and fuel that acted as a lifeline for the poor were cut back in the face of blooming debt repayments. For countries such as Sudan, austerity proved to be fateful.
Faced with such evidence, it is hard to maintain the once-popular refrain that we were all ‘in it together’. One suspects that the Covid era’s 500 new billionaires experienced the past three years differently from the 228,000 South Asian children estimated by the UN to have died due to withdrawal of health services. For some this amounts to ‘health colonialism’ and yet another imposition of austerity on the world’s poor. From India to Kenya and from Argentina to Senegal, LMICs also saw Covid-related corruption scandals. In many LMICs, there is understandably simmering public anger.
Meet the WHO … Again
It was in this fevered atmosphere that the World Health Assembly, a decision-making body of the World Health Organisation (WHO), held its annual meeting in May 2023. Many will recall that the restrictive measures introduced from 2020 onwards received strong endorsement from the WHO. Two major items sit in the organisation’s in-tray at present.
Newly proposed amendments to the IHR would further expand the WHO’s resources and powers
First up are proposed amendments to the so-called International Health Regulations (IHR). Dating from 2005, these provided new powers to the WHO in the wake of the SARS-CoV-1 scare. WHO member countries (State Parties) were to notify the WHO of any events that might constitute a public health emergency of international concern (PHEIC). State Parties also agreed to new capacities to detect, assess, report and respond to PHEICs. Yet all such provisions remained non-binding.
Newly proposed amendments to the IHR would further expand the WHO’s resources and powers, particularly those of the director-general, who could independently declare emergencies. Definitions of pandemics and health emergencies would change to include those with the potential to cause harm, rather than those causing actual harm. The amendments under consideration include border closures, quarantines and medical examinations of citizens. The WHO would also be able to share country data without explicit consent. Compulsory surveillance processes would be required in all member states. Proposed amendments also call for the WHO to strengthen its capacities on a global scale to ‘counter misinformation and disinformation’. All such measures would for the first time become binding on State Parties.
The second item under discussion is a new Pandemic Treaty, referred to as the ‘WHO CA+’. First proposed publicly in December 2020 by European Council President Charles Michel, a zero draft of this was published for consultation in February 2023 and discussed by the WHO’s Intergovernmental Negotiating Body from 27 February to 3 March 2023.
Similar content to the proposed IHR amendments is on offer in the treaty draft, from travel restrictions to business closures, and from data gathering by governments and the private sector to combatting ‘mis-’ or ‘dis-’ information (as defined by the WHO). Controversially, the draft treaty also endorses so-called ‘gain of function’ research. The draft text states that the safety standards regulating research to ‘genetically alter organisms to increase their pathogenicity and transmissibility’ should ‘not create any unnecessary administrative hurdles for research’. For some, this language is alarmingly permissive, given the possibility that Covid-19 originated from a lab leak.
Many supporters of global cooperation on health issues welcome the IHR revamp and treaty proposals. There are also critics. These include hardcore sceptics who interpret moves by the WHO as part of a wider ‘globalist’ plot against democracy. But those merely critical of either recent Covid-19 policies or the WHO’s overall track record are also not impressed.
Many supporters of global cooperation on health issues welcome the IHR revamp and treaty proposals
In fact, opponents of enhanced WHO powers have global reach. States’ positions on these issues were revealed at the 75th World Health Assembly meeting in 2022, where the Joe Biden administration tabled 13 proposed amendments to the IHR. A grouping of LMICs that included many African states, Malaysia and Iran blocked the move. Botswana led 47 African countries to oppose ‘fast-tracking’ both the proposed IHR amendments and the development of a new pandemic treaty.
A range of civil society campaigners, many from the Global South, are also concerned. Some have been raising concerns about rushed negotiations for years. To quote the co-chair of the Society for International Development and the Geneva Global Health Hub, ‘The treaty discussion is full of good intentions, but lacks evidence’.
The World Health Assembly has set a deadline of May 2024 for amendments to the IHR and the Pandemic Treaty to be voted upon. Those favouring hard and rapid pandemic responses might be comforted by the speed of action, but critics accuse the WHO of everything from incompetence to corporate capture, authoritarianism and health colonialism.
WHO to Blame?
The WHO’s major calls on Covid-19 do appear to have been erratic and susceptible to influence. For example, despite convincing evidence, it refused to state that Covid-19 was airborne until April 2021. In keeping with available evidence, it started out by dismissing universal masking as ineffective, only to provide an endorsement when powerful member states began introducing the requirement. It exaggerated fatality rates and ignored evidence of age-stratified risk, moves that increased fear. Having once ruled out ‘test and trace’ systems as unethical and ineffective, it ended up endorsing them when the politics changed. It dismissed the benefits of natural immunity. Moreover, against previous pandemic plans, its staff gave a full-throated endorsement of lockdowns following an early visit to China, showing little concern for human rights protections and in the absence of any risk assessment. When challenged on its decision-making, it seems to have stifled dissent rather than debating the evidence.
Campaigners also argue that non-state actors have come to exert undue influence over the WHO. Third World Network, for example, claims that the WHO effectively outsourced its Covid-19 vaccine response, marginalising member states in favour of private funders. It points out that State Parties’ funding (assessed contributions) has accounted for progressively less of the organisation’s budget over the past three decades. 80% of the budget now comes from voluntary contributions, the bulk it from private foundations and pharmaceutical companies.
The world needs ongoing collaboration on health issues and the sharing of information and expertise, both to prevent and to respond to health emergencies. Yet the draft WHO Pandemic Treaty and proposed IHR amendments are raising concerns in different quarters
One former WHO staff member has spoken out strongly, decrying a gradual retreat from preventative and community-centred care in favour of expensive, top-down solutions – and particularly pharmaceutical ones. Perhaps it is a coincidence that the priorities of the WHO have evolved over time in line with special interests. However, campaigners for global health equity are concerned enough to have established a rolling ‘watch’ of WHO decision-making.
The world needs ongoing collaboration on health issues and the sharing of information and expertise, both to prevent and to respond to health emergencies. Yet the draft WHO Pandemic Treaty and proposed IHR amendments are raising concerns in different quarters. With the role of the WHO also under scrutiny and with evidence and narratives in flux, moves to strengthen international law and regulation in this area should not be rushed.
In the past, dark money, nationalism and populism have all been blamed when countries and populations diverged from ‘approved’ Covid norms. But given the lives and livelihoods destroyed in the Global South by Covid-era policies, one does not need a conspiracy theorist to ask searching questions at home or abroad. More scrutiny is needed over future pandemic laws and policies, at both the national and the supranational level. Unless searching debate takes place and a diversity of perspectives and evidence is brought to bear, there is a risk that future pandemic handling might worsen rather than improve the lives of many worldwide.
The views expressed in this Commentary are the author’s, and do not represent those of RUSI or any other institution.
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Senior Research Fellow, African Security