Essential Questions to the WHO on Pandemic Preparedness, Response

The logo of the World Health Organization is seen at the WHO headquarters in Geneva, on June 11, 2009. Anja Niedringhaus/AP Photo

Commentary

The World Health Organization (WHO) is seeking public input on the scope of a planned internationally binding pandemic agreement. Before proceeding, however, fundamental questions should be answered on the underlying justification for such an agreement, its potential benefits and harms, and the WHO’s competence for the guiding role.

Rather than rushing to address the “next” pandemic, we suggest that the world requires a return to calm, rational thought, and a transparent discussion based upon the public health principles embedded within the WHO’s constitution (pdf).

The Example of COVID-19

The response to COVID-19 has exposed many flaws in the systems of global public health. Economies have been left struggling and inequality has increased, as the wealth of low- and middle-income earners is transferred to the wealthiest members of society.

National debt has risen while gross domestic product (GDP) has fallen, cementing future poverty. The education of a generation of children has been severely disrupted, even though it was known from the beginning that they were at little risk from COVID-19 itself. Global food security is declining because of continuing supply chain disruption, most notable in low-income counties.

As is often the case, those with the least are suffering the most.

Governments and the WHO have rightly stated that pandemic prevention, preparedness, and response (PPR) needs an overhaul. Consequently, in December 2021, the World Health Assembly established an intergovernmental negotiating body (INB) to draft a new international PPR agreement under the Constitution of the World Health Organization—referred to as the “WHO CAII” (pdf). The aim is to have the WHO CAII agreed upon by May 2024, and for it to become binding under international law.

The proposed agreement risks codifying the WHO’s ability to replicate the response to COVID-19 for any future outbreak. The organization is seeking greater powers to control the response to pandemics and to declare public health emergencies more easily. Increased disease surveillance will identify disease outbreaks more frequently, before the severity is known.

The WHO CAII will ultimately give the WHO the ability to dictate, and drive, national and global responses to outbreaks that it classifies as “threats.”

A Time for Reflection

Before proceeding, it would seem pertinent to stop and ask whether more centralized control of global public health is the right solution. It’s essential to determine whether the COVID-19 response was better than preexisting, evidence-based approaches, described in the WHO 2019 pandemic influenza guidelines (pdf), intended to be adapted to local and regional needs.

It must also be determined whether the pandemic preparedness bureaucracy that the WHO plans to build is the best use of available resources, given competing health priorities and the historical rarity of severe pandemics. Giving unelected individuals power over the lives, future, and freedom of others may not be consistent with human rights norms, ethics, or the WHO’s own mandate to promote global public health.

While the core business of the WHO is to seek answers to such questions, the organization has failed to do this. It resorts instead to vacuous soundbites and slogans such as “No one is safe unless all are safe” and “vaccine equity,” which won’t provide answers to these fundamental questions.

The WHO’s basis for funding increased pandemic preparedness—that pandemics are becoming more frequent—doesn’t appear to stand up to scrutiny. The organization lists only five “pandemics” in the past 120 years, most causing fewer deaths than expected every year from tuberculosis. What’s more, the WHO’s definition of a pandemic is unclear, with the organization failing to define any degree of severity that would trigger its response.

The WHO also asserts that pandemic risk is increasing because of increased wildlife contact, despite a steady decline in wild animal populations and humanity’s long history of living closely with animals.

The WHO 2019 pandemic influenza guidelines (pdf) emphasize the dangers posed by border closures, disruptive social distancing measures, and travel restrictions, particularly on the poorest populations; the WHO hasn’t explained why that ceased to be a concern in 2020. The costs of lockdowns, characterized by the WHO as costs of COVID-19, are used as justification for increasing global disease surveillance. But does the data even back this up?

Why were such downturns not seen in previous pandemics (1957–58, 1968–69), which were skewed toward younger, working-aged people? Are disease outbreaks really increasing, or is this a classic case of seek and ye shall find?

Attempts to reduce the risk of death from pandemics are generally considered a public good, although mass malnutrition, increasing inequality, increased overall mortality, discrimination, and entrenched poverty are not. Public health interventions are supposed to be proportional to the level of threat, to ensure that resources aren’t diverted from areas of greater need. Fundamental human rights should be upheld.

However, the disproportionate diversion of resources, and widespread abuse of human rights, is precisely what occurred in the response to COVID-19; the WHO CAII risks entrenching these abuses and misallocations as a permanent feature of global public health. The WHO is pursuing a policy agenda that runs counter to its founding principles.

Who Is the WHO’s Priority?

Throughout most of its history, the WHO was largely funded by member states. This public funding model reduced the likelihood that major conflicts of interest would influence policy development. The WHO was formed to represent the needs of the populations of the world, rather than private foundations and corporations in the health field.

Obvious challenges have arisen now that a significant part of the WHO’s funding, including in pandemic prevention, preparedness, and response, is provided by private entities with direct commercial interest in this field.

The people of the world may benefit more if the WHO returned to its founding principles and focused on benefitting all people, irrespective of the needs of its corporate partners. It must also reestablish its rigorous approach to evidence and urgently address growing conflicts of interest.

The draft WHO CAII states that “policies and interventions on pandemic prevention, preparedness and response should be supported by the best-available scientific evidence and adapted to take into account resources and capacities at subnational and national levels.”

We completely agree.

Questions to the WHO’s Negotiating Body

With this in mind, the following open letter to the WHO has been written by Pandata.org.

Pandemic preparedness must be evidence-based and proportionate, balancing potential benefits with costs, including collateral costs to health and wider society. Therefore, PANDA [Pandemics Data & Analytics], an organization of multi-disciplinary professionals, suggests the following questions must first be addressed:

• What is the true frequency of pandemics?

The WHO lists only five pandemics in the past 120 years, with the highest mortality before antibiotics and modern medicine.

• Is the proposed expenditure proportionate to the health burden from pandemics?

Other infectious diseases, including malaria, tuberculosis, HIV/AIDS, non-communicable diseases, and malnutrition, have exacted higher burdens than COVID-19 in the past two years (based on life years lost). The WHO also considers mental and societal well-being within “health.”

• Does the response fit with the WHO principles regarding community empowerment and control?

These principles of horizontal over vertical approaches were reiterated by the WHO at Astana, Kazakhstan, in 2018.

• Should non-state actors with conflicts of interest be excluded from interim negotiation processes?

The pandemic “treaty” zero-draft includes a role for private and corporate entities, who fund the WHO directly and through partners in pandemic response. Such conflicts of interest were formerly avoided.

• Did the response to COVID-19 reduce the overall disease burden, or increase it?

Previous WHO recommendations cautioned against measures used against COVID-19. WHO partners report high collateral mortality, including among children.

A full, transparent, and inclusive review process is required, utilizing the WHO’s established evidence-based guideline approach, and incorporating assessed strength of evidence. This review should occur prior to considering further application of these new approaches to pandemic management.

What Next?

If these questions are taken seriously by the WHO, it’s unlikely that the WHO CAII would proceed in anything like its currently projected form. Admitting the low frequency and very low burden of pandemics over the past century—and the growing burden of other diseases—would underline the unethical nature of diverting resources and attention away from areas of far greater need. However, admitting this would remove a potentially extremely lucrative future for the international public health “community,” and these people know where their bread is buttered.

As the draft WHO CAII suggests, the global public health community should be “reflecting on the lessons learned from coronavirus disease (COVID-19)” and “reiterating the determination to achieve health equity through action on social determinants of health and well-being by a comprehensive intersectoral approach.”

Instead, the WHO appears to have abandoned the social determinants of health, and is seeking to entrench the mistakes made in the response to COVID-19—under the banner of equity, inclusivity, sustainability, and diversity. If it achieves its aim, global public health will continue to impoverish and harm the world’s poor, while driving a historic wealth transfer to the wealthiest in society, for whom the COVID-19 response has proven so rewarding.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.