The Covid-19 crisis illustrates how the source and scope of many critical problems are global and require multilateral solutions, but the policy authority and requisite resources for tackling them are vested in states. An efficient architecture of global health governance would have detected the emerging epidemiological threat early, sounded the alarm and coordinated the delivery of essential equipment and medicines to population clusters in the most need. The World Health Organisation is at the centre of the existing architecture. It works worldwide to promote universal health care, monitor public health risks, prepare for emerging epidemiological emergencies and coordinate responses. It sets international health standards and guidelines and provides technical assistance to countries in need. It’s credited with eradicating smallpox and coordinating the response to Sars. Its Covid performance, however, was somewhere between underwhelming and disgraceful. Its credibility was badly damaged by tardiness in raising the alarm; by shabby treatment of Taiwan at China’s behest despite the potential lessons to be learnt from its prompt and effective measures to check Covid; by the initial investigation that whitewashed the origins of the virus; and by flip-flops on masks and lockdowns. For problems without passports, in Kofi Annan’s evocative phrase, we need solutions without passports. Instead, international and domestic border closures, wholesale quarantine of healthy populations and mandatory vaccine requirements insinuated passport requirements into daily activities.
Health includes mental health and wellbeing and is highly dependent on a robust economy, yet the WHO-backed package of measures to fight Covid has been damaging to health, children’s immunisation programs in developing countries, mental health, food security, economies, poverty reduction, social and educational wellbeing of peoples. Their worst effects were grievous assaults on human rights, civil liberties, individual autonomy and bodily integrity. To make it worse, in promoting these policies the WHO violated, without providing any justification beyond China’s example, (1) the guidance from its own report in October 2019 that summarised a century’s worth of worldwide experience and science; and (2) its own constitution which defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. The vaccine push has similarly ignored accumulating safety signals about the scale of adverse reactions, on the one hand, and rapidly dwindling efficacy after successive doses, on the other.
Euro-US efforts, backed by Australia, to amend legally binding international health regulations and adopt a new pandemic convention would confer extraordinary powers on the WHO to declare public health emergencies of international/regional concern and command governments to implement their recommendations. WHO inspectors would have the right to enter countries without consent and check compliance with their directives. They would lock in the lockdowns-vaccines narrative and preempt rigorous independent retrospective reviews of their costs and efficacy. The ‘reforms’ amount to a WHO power grab at the behest of Big Pharma and Big Donors. Whether approved as two separate instruments or folded into one overarching new treaty, the changed architecture will greatly strengthen the WHO’s core capabilities on public health surveillance, monitoring, reporting, notification, verification and response. The rush to amend the existing international health regulations encountered significant pushback last month from developing countries, China and Russia but will come up again for discussion and approval shortly. The new treaty under negotiation will be presented to the World Health Assembly in 2024.
Remarkably, there’s been virtually no public debate on the ramifications of such far-reaching encroachments on national autonomy, state sovereignty and human rights. The Spectator Australia has been an honourable exception. Well-capacitated, technically proficient and democratically legitimate states should be wary of ceding control of the policy agenda, decision making authority and enforcement powers to inefficient, cumbersome and unaccountable international bureaucracies. Many governments argue that other issues like climate change, gun violence and racism also constitute public health emergencies which would expand the WHO’s remit even more.
The two new instruments would give pride of place to pandemics above all else. Yet pandemics are rare events. The WHO listed only four in the 120 years before Covid-19: the Spanish flu 1918–19, Asian flu 1957–58, Hong Kong flu 1968–69 and swine flu 2009–10. They impose a low disease burden compared to the endemic infectious and chronic diseases. According to the World Life Expectancy, from 1 March 2020 to 9 June 2022, heart diseases, cancers, strokes, lung diseases and influenza and pneumonia killed more people around the word than Covid 19. Moreover, as is well known and unlike the earlier pandemics, about three-quarters of the 6.3 million Covid deaths were in people with comorbidities at or above average life expectancy. Florida and Sweden resisted the lockdown groupthink and have come out markedly better on the balance of benefits versus harms. Yet the new regulatory framework would strip away their right to chart their own independent paths, just like lockdowns removed responsibility and agency from individuals to the public health clerisy.
On 24 January, Director-General Tedros Adhanom Ghebreyesus said an urgent priority was to ‘strengthen WHO as the leading and directing authority on global health’, for: ‘We are one world, we have one health, we are one WHO’. On 12 April, he said the Covid crisis had ‘exposed serious gaps in the global health security architecture’; the new treaty would be ‘a generational agreement’ and ‘a gamechanger’ for global health security. If adopted, it will consolidate the gains of those who have benefitted from Covid 19, concentrating private wealth, increasing national debts and decelerating poverty reduction; expand the international health bureaucracy under the WHO; shift the centre of gravity from common endemic diseases to relatively rare pandemic outbreaks; create a self-perpetuating global biopharmaceutical complex; shift the locus of health policy authority, decision-making and resources from the state to an enlarged corps of international technocrats, creating and empowering an international analogue of the administrative state that has already thinned national democracies. It will create a perverse incentive: the rise of an international bureaucracy whose defining purpose, existence, powers and budgets will depend on outbreaks of pandemics, the more the better. Deeply held differences – over whether vaccination should be legally binding or voluntary, on equitable vaccine access vs vaccine nationalism where rich countries can price out the poor, strengthened information sharing requirements, etc. – will likely make the negotiations protracted and contentious and may yet scupper the initiative.
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