Problems of world and European governance in relation to health security and the COVID-19 pandemic

2020

Daniel López Acuña
Doctor. Epidemiologist. Former Director of Health Assistance in Crisis Situations at the World Health Organisation. Associate Professor at the Andalusian School for Public Health

Since the start of the COVID-19 pandemic in Wuhan, China, in December 2019, the governance mechanisms of global health security, based primarily on the International Health Regulations approved in 2005 by the World Health Organisation’s (WHO) Member States, have revealed major weaknesses that have affected the world’s management of the pandemic. These weaknesses must be resolved in order for us to rely upon more robust mechanisms of globally coordinated action when facing phenomena of this nature.  

This has been followed by a frailty and deficiency in European governance mechanisms concerning health security to cope with the COVID-19 pandemic — neither the European Centre for Disease Prevention and Control (ECDC) nor the European Commission’s health policies have managed to attain suitable coordination actions, nor has there been an effective convergence of public health measures.  

Information has been gathered and disseminated, guidelines and recommendations have been drawn up — some very late and subject to change — multi-centre studies to evaluate the effectiveness of different treatments have been coordinated and there have been attempts to drive forward multi-lateral solidarity mechanisms for effective access to the vaccines being developed. However, there has been a lack of coordinated actions that are pre-emptive enough to slow down the pandemic, to establish restrictive measures, travel regulations and border closures, to make emphatic recommendations and to hold to account countries that have gone their own way. In essence, there has been a weakness in exercising the constitutional mandate of world health authority by the World Health Organisation (WHO) and a total lack of health authority on a European level with regard to the health problem affecting multiple countries simultaneously.     

The problems to highlight are large in number, but, essentially, on a global and European level, the powerlessness to exercise supranational authority in health has become apparent and, in the case of a pandemic, this goes beyond the limits of sovereignties based on a political concept of Nation State, when the global and Pan-European epidemiological reality does not distinguish between borders and must transcend them.

In addition, 65% of the world’s countries do not have the basic capacities they should have in place to fulfil the compulsory legal provisions of the International Health Regulations and do not take sufficient coercive or support measures for their development. This became abundantly clear during the Ebola epidemic in West Africa and has been a global weakness, impeding the availability of necessary devices and infrastructures to undertake essential public health operations that national, regional and local governments must put into practice to ensure fundamental health security.     

In short, we face a situation without a true global public asset (and for these purposes, European) which cogently guarantees not simply an alert but also the capacity for a multi-lateral response to problems such as the pandemic, which affects all countries.  

As a result, it will be particularly important to have a detailed report from the Independent Panel, which is carrying out an evaluation of the WHO’s management of the pandemic and which includes a review of the pertinence and need to reform the International Health Regulations. This was mandated by the World Health Assembly in May 2020 and the results must be submitted by May 2021.