Do we need stricter international health rules to end the pandemic?


Meeting of the Executive Board of the World Health Organization in Geneva in February 2020. Keystone / Salvatore Di Nolfi

Most countries were not prepared for the Covid-19 pandemic and only sporadically implemented the recommendations of the World Health Organization (WHO). As the virus is at risk of becoming endemic, what are the next steps? Some world leaders and the WHO have suggested an international pandemic treaty. Experts and WHO disagree on the realistic nature of the approach.

This content was published on May 22, 2021 – 10: 00

Last March, WHO Director-General Tedros Adhanom Ghebreyesus, along with several world leaders and international agencies, called for an international treaty on the pandemic.External link to encourage collaborative action.

Among those who supported the call were French President Emmanuel Macron and German Chancellor Angela Merkel.

The new agreement, titled “Treaty on Pandemic Preparedness and Response”, would call on states to cooperate in combating pandemics at the national, regional and global levels. treatments.

The Swiss Federal Office of Public Health (OFSP) told SWI that “Switzerland is participating in the first reflection.” Some countries like the United States, Russia and China were absent from the initiative.

The call follows an apparent lack of leadership linked to the Covid-19 pandemic, with the WHO recommendation being systematically ignored by national states.

The Independent Pandemic Preparedness and Response Group (IPPPR), established by the WHO in 2020, said the pandemic was “preventable.” To date, the pandemic has spread to 200 countries, infected more than 159 million people and caused more than 3.3 million deaths.

In its final reportExternal link, the IPPPR points the finger at the countries which have been slow to put in place containment measures and which have not succeeded in anticipating the pandemic. But they are only part of the problem. The report also states that WHO is taking its share of the responsibility. The WHO International Health Regulations (IHR) also delayed the early response, the IPPPR said. The panel added that the IHR is “a conservative instrument as it is currently constructed and serves to constrain rather than facilitate rapid action and that the precautionary principle has not been applied to early warning evidence so than it should have been ”.

The International Health Regulations (IHR)

RSIExternal link Was the existing legally binding framework last revised in 2005 by WHO Member States? It addresses public health emergencies like COVID-19 to improve the global response.

The RSI provides guidelines to states. These include bans on unnecessary interference with international travel and trade, notification of risk events, and review of health measures to manage a pandemic. But there is a lack of data analysis platforms and coordination mechanism among states, and between WHO and states.

On January 30, 2020, WHO chief Tedros saidExternal link Public Health Emergency of International Concern (USPPI) based on IHR but WHO has not recommended any border restrictions.

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He said, “The formal notification and emergency declaration procedures under the International Health Regulations were, however, far too slow to elicit a rapid and precautionary response.” The IPPPR finds that the current system at national and international levels is “not adequate” for disease outbreaks and calls for a new global system for the future.

The new treaty proposed by the WHO targets precisely that. But given the current situation and states that still follow individual policies, Professor Suerie Moon and Professor IIona Kickbusch of the Global Health Center at the University Institute of Geneva both sayExternal link such a treaty on the global pandemic is “ambitious”.

“A treaty must interweave self-interest and material factors within a flexible framework of shared principles and goals if the world is to live up to this exceptional political opportunity to prevent future pandemics,” they wrote in the Lancet Public Health journal.

Discord over travel and masks

Nothing illustrates the lack of global cooperation better than the lockdown policies and travel restrictions implemented by states without any global consultation. Going against WHO recommendations under the IHR, China was the first to impose a strict lockdown in the city of Wuhan in January 2020 for more than two months. Severe restrictions on the mobility of nine million residents have been put in place. Following in Wuhan’s footsteps, all major Chinese cities have also closed their doors.

However, the WHO has arguedExternal link that travel restrictions generally have significant economic and social implications and, ultimately, “did not prevent the importation of disease”.

“Travel restrictions can slow the spread of infection in the early stages of a pandemic, but it is not optimal to use travel restrictions to stop the possible global spread of pandemic infections,” says Keiji Fukuda, influenza pandemic expert and former WHO Assistant Director-General. A travel restriction is “a temporary and tactical step allowing a country to gain time to prepare its systems and adopt basic infection prevention and control measures such as social distancing, masks and tests”, did he declare.

Research has proven that with hindsight, travel restrictions aren’t such a bad decision. Many have kept them in place to this day.

“The travel quarantine introduced in Wuhan on January 23, 2020 only delayed the spread of the epidemic by three to five days in China, but international travel restrictions have helped slow the spread elsewhere in the world until mid-February. concluded a research of the American academic journal ScienceExternal link.

Masks are another topic that no one can agree on. Debate rages again after US Centers for Disease Control and Preventions (CDC) announcementExternal link that people fully vaccinated against Covid-19 no longer need to wear masks or implement social distancing.

Meanwhile, the WHO has recommended caution when lifting the requirement to wear masks. The organization advises people to wear masks in areas where the infection is spreading, even after being vaccinated.

Still, just over a year ago, the WHO said healthy people don’t need to wear a face mask if they don’t have symptoms. This view changed in June 2020, when Tedros advised the general public “to wear masks where transmission is widespread and physical distancing is difficult.”

Subjective data analysis

One of the problems that the WHO faces is that preventive measures during a pandemic are usually based on available scientific evidence and anecdotal experiences. These change over time.

Another is the interpretation of data and what constitutes a risk to health by Member States. Countries impose measures based primarily on health, social and economic concerns. They take into account epidemiological thresholds such as new cases of Covid-19 per 10,000 inhabitants and the capacity of local hospitals. These differ considerably from country to country.

This subjective interpretation of the data continues as countries now exit lockdowns. For example, the European Commission proposesExternal link to ease travel restrictions for people vaccinated around the summer. Meanwhile, many Asian countries are now introducing stricter travel and social distancing measures due to the spread of the Indian variant. In some countries, simply arriving from India or not wearing a face mask properly can result in fines or jail time.

As Covid-19 enters its second year, experts warn the world will simply have to learn to live with the virus, implying that better global cooperation is still very much relevant. Vaccinations alone will not be enough to keep the virus from circulating.

“There is a good chance that Covid-19 will persist indefinitely as a significant human infection like the flu,” Fukuda warns.

Jagan Chapagain, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC), sees an international treaty as “an opportunity to reassess how we can ensure a more effective and equitable approach to future crises”.

“We need bold new solutions – both in international and national law – to avoid the same mistakes,” he argues.

Since immune protection against Covid-19 is likely to wane over time and new variants of the virus will continue to appear, there is a very high chance that individuals will need repeat vaccinations against Covid-19. Mutant strains of the virus are more infectious, making it difficult to fight the virus with vaccines alone. Some countries have reported cases of infection even after being vaccinated against Covid-19. According to Soumya Swaminathan, WHO chief scientist, “the vaccine is not 100% effective against infection prevention.”

WHO member states will discuss these issues at the annual World Health Assembly, the organization’s highest governing body, starting May 24.


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