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.
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.As is often the case, those with the least are suffering the most.
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.
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.
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.”
Questions to the WHO’s Negotiating Body
With this in mind, the following open letter to the WHO has been written by Pandata.org.- What is the true frequency of pandemics?
- Is the proposed expenditure proportionate to the health burden from pandemics?
- Does the response fit with the WHO principles regarding community empowerment and control?
- Should non-state actors with conflicts of interest be excluded from interim negotiation processes?
- Did the response to COVID-19 reduce the overall disease burden, or increase it?
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.