US President Donald Trump has raised the world’s hackles by announcing that the US will withhold its contributions to the World Health Organisation (WHO), alleging that WHO has mishandled the COVID-19 crisis.
For its part, WHO has the unenviable task of announcing to the world’s people that they’re facing a pandemic while trying to walk a fine line between not causing a panic and not appearing to be blaming any one country. The organisation has been at the forefront of several outbreaks since its inception, often in this manner.
WHO’s constitution was ratified on April 7, 1948, under the UN; April 7 has since been celebrated as ‘World Health Day’. According to the organisation, health is a state of complete physical, mental and social wellbeing, and not just the absence of disease or infirmity, health equity and security are two of its loftier goals. It also assists governments with their health services before and during a crisis, whether as a result of disasters, conflicts or pathogens.
The organisation acquires operational responsibilities through ‘health emergency program’ during emergencies. The Pandemic Influenza Preparedness framework is set up under this program. In addition, it coordinates many aspects of health data, research, access to vaccines, etc.
WHO continues to play an indispensable role during the current COVID-19 outbreak itself. In November 2018, the US National Academies of Sciences, Engineering and Medicine organised a workshop to explore lessons from past influenza outbreaks and so develop recommendations for pandemic preparedness for 2030. The salient findings serve well to underscore the critical role of WHO for humankind.
The world’s influenza burden has only increased in the last two decades, a period in which there have also been 30 new zoonotic diseases. A warming world with increasing humidity, lost habitats and industrial livestock/poultry farming has many opportunities for pathogens to move from animals and birds to humans. Increasing global connectivity simply catalyses this process, as much as it catalyses economic growth.
How WHO discharges its duties
WHO coordinates health research, clinical trials, drug safety, vaccine development, surveillance, virus sharing, etc. The importance of WHO’s work on immunisation across the globe, especially with HIV, can hardly be overstated. It has a rich track record of collaborating with private-sector organisations to advance research and development of health solutions and improving their access in the global south.
It discharges its duties while maintaining a dynamic equilibrium between such diverse and powerful forces as national securities, economic interests, human rights and ethics. COVID-19 has highlighted how political calculations can hamper data-sharing and mitigation efforts within and across national borders, and WHO often simply becomes a convenient political scapegoat in such situations.
International Health Regulations, a 2005 agreement between 196 countries to work together for global health security, focuses on detection, assessment and reporting of public health events, and also includes non-pharmaceutical interventions such as travel and trade restrictions. WHO coordinates and helps build capacity to implement IHR.
As a part of the Pandemic Influenza Preparedness program, WHO officials help the world’s protection against flu via the Global Influenza Surveillance and Response System (GISRS). The objective of GISPRS is to deliver a fair, transparent and equitable sharing of information and vaccines.
These various frameworks are combined into a One Health initiative to account for the intimate interactions between people, animals, and plants in their shared environment. Effective responses are possible with this integrated trans-disciplinary approach to facilitate early detection, behavioural interventions, vaccinations, and better approaches to vaccine development.
To be better prepared for 2030
COVID-19 is the first global pandemic since the 1918 flu, which killed an estimated 20-100 million people. Many deficiencies have been identified in WHO’s functionality and performance during outbreaks. The US academy report quoted above identifies a few areas for building readiness, with 2030 as a deadline.
The workshop focused on different types of influenza outbreaks, in 1918, 1957, 1968, 2003, 2009, 2012-2015 and the 2014-2016 Ebola outbreak, and concluded that several limitations exist in the international healthcare system. These range from limited potential for improved respiratory care to insufficient hospital beds and ventilators – familiar to us because they’re also playing out in the ongoing COVID-19 pandemic.
In effect, WHO needs strong and distributed leadership at the national, regional and global levels. The pandemic response shouldn’t peter away after an outbreak but implement end-to-end solutions to reduce future response time and hasten recovery. The WHO network of healthcare facilities should also assist with preparedness exercises at local, community and hospital levels.
Public health capacities can only be strengthened by research and development, and with risk maps that account for socioeconomic vulnerabilities to drive financing. WHO has in fact established a ‘Global Pandemic Monitoring Board’ to facilitate this process.
Many concerns remain about the decline in sharing of viruses and WHO’s access to vaccines and products needed for pandemic response. Preparedness for 2030 will need more public awareness as well as resources and technologies. The US academy report filters down the vast literature on related issues to three categories of recommendations for preparedness 2030: country-level core capacities; research, development and knowledge sharing; and the place and role of WHO in the global system.
Specific recommendations in the first category are related to detection, prevention, and pandemic response. Each country needs to build capacity and be ready with plans for different outbreak scenarios. Better local surveillance and data gathering and management are critical to build resilience to risk. Increasing the capacity to respond requires training, funding and protecting healthcare workers.
Global pandemic readiness should follow the old adage of a chain being only as strong as its weakest link. WHO is the only entity with the credibility to provide a template for global pandemic preparedness, and only WHO can build the capacity to ensure conformity across the globe.
The structure and protocol of communications must ensure that public health events of international concern are reported at the earliest stage possible. Incentives and assurances will be needed to avoid reporting being seen as a risk.
As for R&D and sharing knowledge, the recommendations argue for reducing impact of pandemics, speeding up commercial production of vaccines, increasing investment in medical R&D and building capacity to deliver medical and pharmaceutical goods. Understanding feedback loops between human and animal health are essential for advancing pandemic knowledge. ‘One health’ research programmes – which treat human, environmental and animal health together – must focus on understanding the emergence, prevention, detection and control of pandemics.
And as for WHO’s role – the organisation’s capacity to support the Global South must be increased, as well as its relations with non-state entities. WHO’s brandname as a ‘broker’ of knowledge needs to be protected. Transparency of WHO’s management, training and constitution of the healthcare workforce, are essential to maintain credibility. Partnerships with humanitarian organisations are imperative during health crises, and WHO’s accountability will be improved with regular independent assessments.
Humanity cannot escape pandemics but it can escape failures to manage them in effective, efficient and humane ways. The US already has an on-again off-again relationship with UNESCO, but the consequences will be more dire if its relationship with WHO deteriorates as well. The world must unite to stand by WHO because the world is only as safe as the sickest nation.