On 30 March 2021, 25 government leaders and the WHO’s director-general called for the negotiation of a pandemics treaty that would allow countries across the world to strengthen national, regional and global capacities and resilience to deal with future pandemics. The idea was rooted in experiences of COVID-19, where no government or multilateral organisation had managed to tackle the problem individually. From this juncture, discussions have got under way on what must and must not be accepted in this new pandemic treaty, but at the very least there is a need to define the actors, road map and processes in developing it.
Perhaps the first thing to do would be to define the values underpinning it. Equal access to possible solutions resulting from its development should be at the heart of discussions, above any commercial or political interests, because we cannot and must not repeat the situation of inequality witnessed in the pandemic caused by SARS-CoV-2. Another important issue to clarify is whether the treaty must be compulsory or voluntary -there are already too many voluntary world commitments which have proved ineffective, and it is important for the agreements stemming from this treaty to be binding, although major problems would also have to be overcome-. The first thing to make clear is whether all countries would be on board, since it would make them relinquish part of their independence for the common good, with too many recent examples to the contrary, particularly among the world’s major powers.
If the aim is for an effective pandemic treaty, then a decision must be made on who will be entrusted with controlling and monitoring it -it should be the WHO, given that the management, globally, of actions to avoid the international spread of diseases has historically fallen under the responsibility of this institution-. Yet at the present time it lacks the capacity and resources to do so, which means that countries should strengthen it and not repeat what has been done in this and previous pandemics, where they assigned legal powers and funding to structures outside WHO, weakening its role as a guarantor of world health. This would be the only way for all regions to be in an equal situation, despite the different starting points found at the present time.
Part of the content of this pandemic treaty should include established mechanisms needed for a swift exchange of R+D+I in the world, allowing for the best preventive, diagnostic and therapeutic solutions to be developed, and putting the right to health ahead of any other interests, as well as looking at who is going to fund potential needs that arise and how. Finally, there must be individual responsibility for each country to develop mechanisms of prevention, protection (including measures of social protection) and alarm that can be decided in the treaty.
In addition to reflecting on global health measures to be implemented, we also need to take a multi-dimensional approach to the problem. An analysis of human health must be joined by an analysis of animal and planetary health given that zoonoses causing pandemics are heavily related to both, and these are also related to other fields such as the economy and the environment.
There is some anticipation over whether we are moving towards an effective pandemic treaty capable of responding to future world needs. The conclusions that have appeared from the evaluation of the International Health Regulations (IHR), which would be a tool for developing this treaty, have yielded mixed results.
The IHR is a tool which, since 2005, should be used by all countries to prevent, detect, respond to and inform of pandemics such as COVID-19. In 2011, after the H1N1 virus pandemic, there were already warning signs: “the world is not prepared to respond to a serious flu pandemic or any other similar emergency that is a threat to global public health”. Furthermore, countries that seemed better prepared to fight against this type of health problem have been unable to contain the pandemic-related consequences. In September 2020, an Independent Committee was set up with 20 experts, and with the mandate of reviewing the operations of IHR on a global scale during the response to COVID-19, particularly in the following areas:
The results of this review were presented in the World Health Assembly in May 2021 and have highlighted something obvious: too many countries still lack public health capacity to be able to protect their populations, and to alert other countries and the WHO of potential problems that could result in pandemics. In addition, IHR had not been implemented in many countries. WHO, and other international organisations also lack the capacities and resources to handle the leadership response to a pandemic.
There are many aspects to improve in the IHR. A monitoring mechanism has not been created to gain some idea of how the key aspects of the IHR are developing in countries, including those covering human rights, in relation to improvement and accountability. The Emergency Committee must be more operative and unforeseen new elements must be incorporated, such as the importance of sharing samples of pathogens and genetic sequences, digitisation, and the impact of social networks on alert systems, including the mechanisms to approve recommendations by countries.
Most notable among the conclusions of this review is the need for responsibility in implementing the IHR found at the highest level of government, and work must be carried out on an adequate evaluation system and greater collaboration between countries, as well as sufficient financing for the IHR.
However, this review is particularly limited in relation to the operative part of the IHR and no discussions have taken place around the economic, political and social roots causing the mass spread and consequences of this pandemic. Nor has much emphasis been placed on detailing how a health emergency has been used to violate other human rights in some countries, where they have been used to limit the freedom of expression. The Regulations must explicitly reference the Siracusa Principles on the limitation and derogation principles in the International Covenant on Civil and Political Rights, which advise on how and when to restrict civil and political rights in a crisis like the present one. These restrictions must be necessary and provided for a legitimate purpose and must be prescribed by law and applied as a last resort, using the least restrictive resources available.
Therefore, the improvement of the IHR is a positive step forward in upgrading the technical capacity of preparing for future pandemics, but is insufficient if it truly wants to prevent the catastrophic effects of another pandemic like COVID-19 in the world. We must strengthen world health governance and a pandemic treaty could help with that; nevertheless, we can’t expect such a treaty to be a miracle cure that solves every challenge affecting people’s right to health. There are numerous health issues and factors that have an effect and would remain outside this possible pandemic treaty -for instance, problems of sexual and reproductive health and non-communicable diseases-. Therefore, the treaty must be part of a broader strategy, where the prime concerns would be to bolster global public health governance and public health systems as a whole, prioritising the work of Primary Health Care and working for health in all policies.