“It was not just the SARS-cov-2 virus. That was just the jumping off point – and jump we did, a world in perfect synchronicity. The frantic response knew no bounds: there was the shifting target of the virus, and the new genetic therapeutics hailed as traditional vaccines. And what of the failure to approve cheap and effective off-patent therapeutics? The register continues – several lockdowns, denial of early lifesaving treatment, and the fever pitch censoring – and censuring – of intelligent dissent. We would do well to recognise and address these well-documented shortcomings and exercise extreme caution before a repeat spells disaster for every WHO partner state.” A Pandemic Reflection
During the 77th World Health Assembly (WHA) in Geneva, Switzerland from 27 May to 1 June 2024, Ministers of Health the world over convened to consider amendments to the International Health Regulations (IHR) that were last amended in 2005, as well as to establish a new Pandemic Agreement (Treaty). While this could sound innocuous, if not cooperative, the potential meaning and impact of these two instruments could be staggering for international public health. In effect, these drafts were intended to set up legally binding commitments under which the WHO’s 194 Member States would undertake to follow WHO recommendations regarding the management of health emergencies. Strengthened with centralised power, the WHO’s Director-General (DG) would have enhanced authority to unilaterally declare Public Health Emergencies of International Concern (PHEIC), and during such emergencies, exercise increasing powers over member nations. This would radically change how pandemics or threats thereof are managed, further shifting public health policy away from sovereign nations to a global, untempered body.
This important role ought not to be vested in a single individual. Instead, it ought to be entrusted to a body free from conflicts of interest and adequately representing a cross-section of regions, cultures and disciplines, to assess the transmissibility, morbidity and mortality caused by a disease, and to determine response mechanisms appropriate for specific settings and diverse cultures in a bid to promote the highest possible holistic health outcomes (physical, social, psychological, economic, etc.) for everyone. What is perhaps most concerning is that much of the global population and its leaders remain largely unaware of these proposed radical changes and potential impact on their national systems and populations.
Reportedly crafted with the intention of learning from failures in the management of the COVID-19 crisis and building upon its successes, had the two instruments been adopted as proposed prior to tabling at the 77th WHA, they would have accomplished the opposite. The WHO’s failures during the pandemic and its now-discredited exaggeration of disease outbreaks and risk (both of which have trended downward in recent years) are well documented. Nevertheless, the Working Group on Amendments to the International Health Regulations (2005) (WGIHR) and the International Negotiating Body (INB) responsible for the preparation of the Pandemic Agreement both pressed forward with unusual haste to complete negotiations on the two documents to be voted on at the 77th WHA.
In the process, the WHO contravened its own legal requirements for voting by disregarding Article 55(2) of the current IHR that reads: “The text of any proposed amendment shall be communicated to all States Parties by the Director-General at least four months before the Health Assembly at which it is proposed for consideration.” In like manner, the Pandemic Agreement was intended to be delivered by 29 March 2024, for a similar intent of providing time for reflection prior to commitment to vote. But it was also under negotiation right up until the opening of the 77th WHA. In the end, the 77th WHA adopted significantly diluted amendments to the International Health Regulations and shelved a vote on the Pandemic Agreement. Dr Meryl Nass has written a helpful “Complete Article-by-Article Analysis of the Adopted IHR and How it Differs from what was Proposed by WHO in February 2023”.
A sizeable number of scholars, health practitioners and health freedom advocates around the world have pointed out that efforts to universalise public health through the draft Pandemic Agreement and amendments to the IHR are rife with the kind of opportunities that unchecked power affords. Recalling failed WHO-driven pandemic countermeasures that compelled much of the world to move in lockstep – enduring restricted movement, mass testing, censored speech, disrupted education and economies, and, in some cases, breaches of bodily autonomy through vaccine mandates – they contend that the unelected WHO needs restraint, not supercharging. They further point out that nations with their local leaders, experts and systems are best suited to make public health decisions and develop context-relevant policies. In this way, sovereignty, with the human dignity and freedoms it upholds, is preserved, contextual nuance is rightly considered, and collateral harm that disproportionately impacts low income countries better mitigated, if not avoided.
In sum, this expanding global group of scholars, practitioners and advocates hold that adopting these two instruments as they were tabled at the 77th WHA would have, far from helping effectively handle any future global health emergency, instead awarded an ambitious WHO with binding agreements, potentially granting it de facto global government powers under the guise of public health and safety.
It is against this backdrop that five scholars with varying expertise and unique perspectives – two from the Global North and three from the Global South – are unified in their conviction that it was impossible to adopt the Pandemic Agreement and amendments to the IHR at the 77th WHA in a lawful manner and with any measure of integrity. Further, they hold that these instruments lack scientific rigour; they lack the twin guardrails of evidence and transparency, which together engender trust and help legitimise global public health instruments and practices. They also are in agreement that the instruments were being negotiated in opaque haste without genuine public participation.
Dr David Bell, former medical officer and scientist at the WHO and currently a consultant at the University of Leeds, maintains that the negative impact of COVID-19 measures was widely felt, affecting not only disease burden and outcomes, but also access to care for other medical conditions. He notes the crushing impact of those protocols on the world economy, and particularly how that played out in low-income countries at most risk from such measures. Bell is of the view that a rigorous scientific inquest on the response to COVID-19 must be carried out. Contrary to claims by the WHO and its partners, he observes that there is presently no reliable empirical evidence showing that humanity is facing increased risk of new and emerging infectious diseases from spillovers of pathogens from animals due to climate change. Rather, he says, available data actually used by WHO, the World Bank and the G20 suggests that an increase in recorded natural outbreaks could be mostly explained by technological advancements in diagnostic testing over the past 60 years, while current surveillance, response mechanisms and other public health interventions have successfully reduced such disease burdens over the past 10 to 20 years.
For Bell, the requirement for financial contributions from all states parties to finance the obligations stipulated by the two documents is likely to cause low- and middle-income countries (LMICs) to divert their meagre resources from their own health priorities, thereby reversing the economic and health gains they had made. He is therefore not convinced by the language of equitable contributions by signatory countries. Regarding the proposed budget for implementing the two instruments, Dr Bell holds that it seems concocted, with no indication of the methods by which the total annual figure of over US$30 billion was derived. For him, both treaty documents tabled at the 77th WHA were clearly incomplete and poorly thought through, such that to vote on one or both of them without time for reflection constituted a violation of the principles of public health and a travesty of the rule of law.
From Kenya, University of Nairobi’s philosophy professor Reginald M. J. Oduor, a member of the Pan-African Epidemic and Pandemic Working Group (PEPWG), is deeply concerned about both the content of the draft Pandemic Agreement and amendments to the International Health Regulations (IHR) and the process through which they were being negotiated. Oduor observes that, in the forms in which they were tabled at the 77th WHA, the documents threatened the well-being of humanity in several respects.
First, negotiations on the documents were conducted in a covert and rushed manner. They were obscured to experts and the public alike, thus violating the democratic principle of public participation. Second, the provisions of the documents espoused a top-down and highly centralised decision-making architecture for mitigating real and alleged global health crises. This is contrary to the provisions of the WHO’s own Alma-Ata Declaration with its emphasis on the need for primary health care, which, by definition, is context-sensitive. Oduor explains that the centralised, top-down approach to global public health threatens to undermine the sovereignty of member states. Third, he says the two instruments put inordinate emphasis on vaccines, therapeutics, and devices under emergency use authorisation, thereby promoting the financial interests of the pharmaceutical industry above human safety by protecting them against liability for any adverse events arising from such products. Fourth, Oduor continues, the two instruments frame public health in a Eurocentric manner, privileging Western medicine over the health systems of other cultures, thus perpetuating neocolonialism. Fifth, the determination to pursue a One Health approach overlooks the uniqueness and nuances of human, animal, plant and environmental health, and most crucially, devalues human life by equating it to lower life forms. Finally, Oduor points out that the instruments promote private-public partnerships that have almost invariably benefited the private at the expense of the public. Overall, he says, given its poor track record in the management of COVID-19, the WHO needs more accountability and comprehensive reforms, not increased powers.
Dr Janci Lindsay, a US-based toxicologist and molecular biologist with previous vaccine development experience, applauds Oduor and the Pan-African Epidemic and Pandemic Working Group (PEPWG) for defending their right to determine a public health framework suitable for African contexts. Lindsay also warns of several serious problems with the genetic vaccine platform that has been framed by the WHO as their desired, singular approach to combatting future pandemics. Among other issues, she notes that the “self” production of foreign antigens is leading to both autoimmune reactions and inducing tolerance to the virus. For Lindsay, these reactions may explain in part the lacklustre performance of the mRNA vaccines. She also highlights findings of persistent, rather than transient, expression of the spike protein and off-target protein production, as well as the inability to cheaply and effectively remove DNA plasmid contamination from the mRNA vaccines, and yet this contamination increases the risk of insertional mutagenesis. Consequently, Lindsay is of the view that for the WHO to hastily approve the emergency use of the novel genetic vaccine platforms and even expand them as the preferred “tools” to combat emerging global pandemics is illogical from the viewpoint of their performance to date. Further, it is not in line with the WHO’s previous approach of using existing cheap and time-tested drugs (“repurposing”).
On the other hand, Dr Henry Kyobe Bosa, a physician epidemiologist in Uganda’s Ministry of Health and a Senior Research Scientist at Makerere University’s Lung Institute in Uganda, holds that the WHO should not be condemned for its failures during COVID-19 since the impact of the pandemic exceeded its mandate. Under these conditions, Kyobe says, the United Nations (UN), of which the WHO is a specialised agency, should have stepped up and carried on to close gaps. However, even as the pandemic entered into the recovery phase, the UN failed to provide global leadership on a complex public health phenomenon. He had hoped that a UN emergency committee would have come in to address other gaps that stretched beyond the mandate of WHO.
Therefore, for him, what is problematic is not the idea of amending the IHR (2005) and drafting a Pandemic Agreement, but rather how the process has been handled thus far. The review of the IHR and proposition of any new binding global treaty should entail internal country-level reflection, Kyobe explains, akin to an enquiry in each country. This would allow for widened consultations and increased transparency. As it presently stands, only headquarter-level individuals have been sent to Geneva for the last two years to contribute to or sanitise a process that has possibly been synthesised elsewhere. He asks: “Where is the voice of the communities, of the business sector, of academicians and human rights activists and ethics actors?” He emphasises, “We cannot leave everyone behind when we are defining any global response to ultimately local challenges.” He takes serious issue with the much-touted One Health approach which, according to the One Health High-Level Expert Panel, “aims to sustainably balance and optimise the health of people, animals and ecosystems”.
For Kyobe, premising the two documents on One Health is the lowest we could have gone to: “Animals are animals, environment is environment, and humans are humans. The poorly defined, and multifaceted interaction of the three, which in essence varies in every context, if it is to be solely used as a basis to define a new world is a big mistake. We are taking away human dignity and civil liberties and marrying them with animals. This must be resisted from the very start.”
Furthermore, physician scientist and assistant professor of human and pathogen genetics and genomics at Makerere University in Uganda, Dr Misaki Wayengera believes that whatever went wrong with COVID-19 emanated from lack of institutional memory, given that pandemics of influenza and smallpox happened over 100 years back: “Basically, the global response to COVID-19 pandemic represented something reminiscent of a knee-jerk reflex, more reactionary than planned.” Thus, he believes having more exercises and drills, if not experience with natural emergencies and disasters, might offer better preparation than reliance on a largely theoretical treaty. He says the world needs to synthesise an evidence-based plan on how to effectively respond to a global health emergency, and this cannot be hurried; it must be comprehensive in experience and consultation.
For Wayengera, the COVID-19 pandemic introduced uncertainties and complexities often unaccounted for by today’s modellers of simple, linear disease outbreaks. He points out that many aspects and countermeasures of the pandemic kept shifting across the globe as the virus continued to mutate. This, he suggests, often introduced actual, but mostly incorrectly contextualised narratives and comparisons across the world, even within the scientific community. Therefore, Wayengera observes, COVID-19 offers an opportunity to rethink preconceived ideas of global health security. Thus, for Wayengera, whatever comes next in revisiting the IHR and pursuing a new pandemic treaty, the inequity suffered by countries of the developing world must be addressed.
Yet, despite their divergent views, all scholars engaged in the foregoing discourse agreed in their passionate appeal to the WHO to postpone votes on the Pandemic Agreement and amendments to the WHO’s International Health Regulations to afford countries more time to review and contribute to them. They are convinced this would have provided an opportunity to address many of the gaps and concerns raised above. In their appeal, they pointed out that final drafts of the Pandemic Agreement and amendments to the IHR should address the following issues: Negotiations that facilitate effective public participation; respect for statutory deadlines to enable countries to interrogate the documents; recognition of the unique health needs of different regions in theory and practice; commitment to the recognition and protection of human rights, including freedom of thought and expression that were grossly violated at the height of the COVID-19 crisis;
The scholars also called for the respect for the principles of medical ethics, including beneficence, non-maleficence, voluntary informed consent, patient confidentiality, and adherence to research ethics; adherence to the principles of public health ethics, including balancing individual liberty and well-being with the public good, fairness in the distribution of burdens, and public participation in the formulation of mitigating measures; protection of humanity from poorly tested vaccines, therapeutics and devices by discouraging emergency use authorisation of those, and refraining from providing legal protections for pharmaceutical corporations from liability in events of injuries arising from such products; commitment to respect and uphold the multidimensional sovereignty of state parties, health sovereignty and financial sovereignty included; promotion of the scientific impartiality of WHO by eliminating the influence of corporates and individuals on its governance and funding framework.
