By Tsung-Ling Lee
Despite the World Health Organization’s (WHO) recent efforts to broaden participation, the international infectious disease control regime remains state-centric.
As such, the state-centric infectious disease regime violates the fundamental principle of how contagious diseases spread within and across countries — the virus recognizes no national borders, nor does the virus discriminate. The longstanding global health mantra — no country is safe until all countries are safe; no one is safe until everyone is safe — should guide global pandemic preparedness.
Under the WHO’s 2005 International Health Regulations (IHR), State Parties are primarily responsible for strengthening their respective public health core capabilities.
Article 54 of the IHR stipulates the annual reporting obligation: member countries are required to report their IHR implementation progress at the annual World Health Assembly (WHA).
Voluntary commitments include Joint External Evaluations (JEE), After Action Review, and Simulation Exercises, which together form the IHR Monitoring and Evaluation Framework, introduced by the WHO to ensure accountability and transparency in 2015.
In particular, the JEE is a voluntary collaborative process which seeks to provide independent and external expert review of member countries’ core capacities in 19 technical areas, initiated at the request of the member state. The JEE process plays an essential role in identifying public health strengths, weaknesses, best practices and challenges in countries’ IHR core capacities.
Yet, neither the JEE nor the annual IHR reporting processes are open to the relevant stakeholders.
The JEE process remains a technical exercise between the WHO and requested member states. Civil societies, academic institutions, private sectors are rarely involved in the evaluation process. As the JEE assessment often informs national pandemic action plans, accounting for local capacities and inputs from diverse viewpoints can enhance the quality of policymaking.
Likewise, there is no shadow reporting of State Parties’ IHR implementation during the WHA.
Rethinking the public health monitoring framework from a good governance perspective is integral to mitigate the scale and magnitude of social and economic disruptions that pandemics can cause. As we have seen, the pandemic’s rippling impacts go far beyond public health, penetrating economic and social spheres. Sustained dialogues on pandemic preparedness, including a broad array of actors, can cement shared interests and responsibilities.
The gaps revealed by the COVID-19 pandemic in terms of preparedness and real-world responses should guide institutional arrangement reforms at national and international levels.
The Independent Panel for Pandemic Preparedness and Response points out that the world was unprepared for the COVID-19 pandemic: the existing preparedness measures “failed to account sufficiently for the impact on responses of political leadership, trust in government institutions and country ability to mount fast and adaptable responses.”
This remark offers a starting point for reorienting our thinking towards pandemic preparedness planning. Successful pandemic responses require the public’s buy-in. Public inputs in preparedness planning can help increase that buy-in. Evaluating pandemic preparedness should involve collaborative multi-sectoral efforts at various levels of governance.
Experience from the 2014 Ebola outbreak demonstrates that successful infectious outbreak control response necessitates engagement with non-state actors, such as faith-based organizations. Likewise, as the COVID-19 pandemic shows, community health workers are most familiar with local contexts and challenges, and should be part of pandemic preparedness planning. Diversifying viewpoints can engender better quality policymaking and more accurately reflect the needs and demands in local, regional, and global contexts.
The COVID-19 pandemic has shown that to enhance societies’ capacities to respond to uncertainties and risks, and to sustain changes in behavioral and social norms, building trust is paramount. Establishing prior channels of cooperation before the eruption of a pandemic can yield social dividends during global health crises. Regular meetings, exchanges, and reporting on IHR implementation progress among stakeholders can cement shared responsibilities and interests in a more equitable world by creating multiple public spaces for solidarity.
Thus, the state-centric pandemic preparedness regime is deeply problematic for two reasons.
First, the regime has partly reinforced nationalistic mindsets to the world’s detriment. For instance, during the COVID-19 pandemic, countries first competed for essential medical supplies, then for vaccines.
Second, the state-centric regime tends to neglect the health inequalities within countries when evaluating preparedness. Rising disparities in impacts of the pandemic on communities reveals structural injustice pertaining to race, gender and socio-economic status within countries. For instance, child marriage may be on the rise in India, as the pandemic has caused disruption to schooling. In Asia and the Pacific region, young adults will bear higher long-term economic and social costs because of disruption in employment. Elsewhere, minorities, migrant workers, refugees also bear disproportionate impacts from the pandemic.
It is imperative that we engage and empower individuals to ensure governments worldwide are held accountable for strengthening their respective public health core capacities.
Likewise, it is also essential to create institutionalized processes at the national and international levels to enable currently unrepresented and unheard voices to participate in decision-making processes that affect them.
Pandemic preparedness is a global public good, where everyone benefits when the world is better prepared. Until individuals around the world recognize global health vulnerabilities elsewhere as their own, global pandemic response and preparedness is likely to continue as fragmented, nationalistic, and fractured.
Tsung-Ling Lee is an Assistant Professor of Law at Taipei Medical University.