As countries debate over what needs to change post-pandemic, Germany says the challenge is whether member states of the World Health Organization are ready to make the needed changes to avoid another global health crisis like COVID-19.
“Colleagues, we do not have a lack of recommendations to make the world less vulnerable to global health crises. We do have a lack of common political will among 194 member states to learn from past mistakes and to implement these recommendations,” said Björn Kümmel, deputy head of the global health division in Germany’s health ministry on Tuesday’s session of the WHO executive board.
“The Independent Panel does not want to present yet another report to sit on the shelves, leaving historians to ask what if its recommendations had been heeded.”— January report from the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board
A wide range of experts have for years identified gaps and challenges in national and international capacities in responding to global health outbreaks. They have made recommendations on where WHO needs to improve, and where countries should invest in to help them prepare for and respond to future health emergencies.
Some of the recommendations were acted upon, such as the birth of the WHO Health Emergencies Programme, post-Ebola outbreak in West Africa in 2014-2016, but not all. Experts worry that current reviews expected to make final recommendations to the World Health Assembly in May on how the world can be better prepared and respond to the next health emergency post-COVID-19 will fall in the same pattern.
“I can imagine that all these bodies will generate a long list of recommendations, many of which will be consistent with each other,” said Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, referring to the three review committees comprised of the Independent Panel for Preparedness and Response, the International Health Regulations Review Committee, and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.
But it’s likely only a few of those recommendations will be implemented.
“If history is any guide, only a few will actually be implemented — the key question is which ones? Will Member States choose to implement the most important, yet politically or financially difficult ones, or go for the low-hanging fruit? Too early to say. I hope Member States will be ambitious and go big, but that depends on political leadership,” she told Devex over email.
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The Independent Panel for Preparedness and Response, set up to review the response to COVID-19, identified some early failings of the international and national response to COVID-19. This included the failure of available assessment tools to predict how well countries would be able to contain the spread of COVID-19.
The report also identified some shortcomings on the part of authorities in China and other countries to forcefully apply public health measures to contain the spread of COVID-19 early on in the pandemic when there were still few cases found in a few countries, and of WHO and national and local authorities to take a precautionary approach in the early days of the pandemic.
“If the precautionary principle had been applied in relation to the earliest indicative but unconfirmed evidence of human-to-human and asymptomatic transmission, more timely and stronger warnings of the potential for human-to-human transmission could have been issued by both WHO and national and local authorities," the report stated.
It also highlighted how the international community’s failure to act on reforms as recommended by numerous expert panels and committees in the past decade “has left the world dangerously exposed, as the COVID-19 pandemic proves.”
“Many of the previous panels produced good ideas and some of them were implemented …. Yet, overall, there has been a failure to undertake comprehensive reforms and to address leadership, funding, and governance issues at the highest international level,” according to the panel report.
“The Independent Panel does not want to present yet another report to sit on the shelves, leaving historians to ask what if its recommendations had been heeded,” it added.
WHO member states have been particularly interested in making changes to the International Health Regulations, an internationally binding treaty outlining the obligations of WHO and member states in a public health emergency. The IHR is seen as a critical global governance structure for infectious disease outbreaks and has undergone revisions throughout its history.
But experts tasked to review the International Health Regulations emphasized how the global response could improve if member states effectively implement the existing provisions of the IHR.
“While we have not finalized our article by article assessment [of the IHR], there is a growing belief in the Committee that most of the necessary improvements can be achieved through a more effective implementation of the existing provisions of the IHR, and do not require at this point changes to the design of the IHR,” said Lothar Wieler, president of the Robert Koch Institute in Germany and chair of the IHR review committee, on Tuesday’s WHO executive board session.
He added that recommendations for an intermediate level of alert system for international health emergencies were already made previously by a review committee post-Ebola outbreak in West Africa, but this was not endorsed by member states.
“It is clear that global preparedness, alert and response actions need to start much earlier, and more decisively than they did during COVID-19. But it is far from certain that introduction of an intermediate level of alert would result in such earlier action,” he said.
Gro Harlem Brundtland, former prime minister of Norway and co-chair of the Global Preparedness Monitoring Board, warned that reviews don’t always lead to improvements.
“We should all be aware that a review does not necessarily lead to improvement. It may in fact lead to the opposite, especially when urgent actions are required. For example, the last review of the International Health Regulations, a process we initiated during my time as director general of WHO, may actually have weakened the authority of the director general,” she said in the same event.
But Germany’s Kümmel asked the review panel and committees to push member states to make the needed changes in global health preparedness, saying “the world cannot afford to experience such a global health crisis again in the future.”