"Mixed messages." "Acted too slowly." "Partial and incomplete."
These words, put forth by the Economic Times, leading international health journalist Elizabeth Mahase, and the United States government respectively, are just some of the criticisms lobbied against the World Health Organization (WHO) in the wake of the COVID-19 pandemic. Leaders from across the globe have criticized the WHO for its ineffectiveness in responding to and containing the virus. Many nations—including major players like Russia, China, the US, France, and others—have begun to feel that the WHO's existing disease surveillance and prevention apparatus is too vulnerable to political corruption, inefficient bureaucracy, and national non-compliance to be effective. This crisis of confidence has led to the birth of an international movement to reform the World Health Organization to more effectively contain future pandemics.
Yet this movement faltered nearly out of the gate. In 2020, an initial push to reform the WHO during the pandemic fell apart, largely due to two separate plans by the United States and European Union (EU) to reform the institution. Much of the chaos was centered around the simultaneous and brief US exit from the organization during the Trump administration. The reform initiative attempted to work within the framework of the WHO, namely through its legislative body, the World Health Assembly. However, seeing the failure of these efforts, the WHO called a summit to begin negotiating a new pandemic treaty designed to modify the WHO charter and provide meaningful reform to global health institutions.
However with this new treaty, there are substantial doubts about whether nations will actually agree to it. Some nations, like China, would most likely want a weak treaty, as domestic political pressures and authoritarian leadership make them unlikely to comply with stronger terms. EU countries are seeking to create new international bureaucracies to deal with pandemics, overhaul international data-sharing practices, and more. Meanwhile, the United States hopes to strike a careful balance between these approaches. To accommodate these perspectives while also effectively improving global public health, a new pandemic treaty should remain within the existing confines of the WHO without creating new multilateral organizations. Negotiators of the new treaty should also focus most of their attention on creating health financing and development frameworks.
A Divided Planet
Reforms to international health organizations and views on a new pandemic treaty are largely split into three camps. The EU and developing countries favor a very broad treaty, which might include establishing new research institutions and new international bureaucracies for pandemic surveillance. Their perspective is driven by the belief that the damage of the COVID-19 pandemic was largely due to weakness in international institutions, which prevented a more robust response.
The United States favors a more limited reform approach focused on working within health institutions. Some speculate Washington may fear that new organizations would be unduly influenced by China and Russia, or that there are concerns of getting a new treaty through the US Senate. China has offered its own slate of WHO reforms, but it is more likely that they, along with Russia, will resist any international treaties altogether. Previously, both governments have slow-walked agreements or failed to comply with global health treaties altogether. They also have strong nationalist factions at home which often oppose Western-backed international institutions. The chances of getting all these actors to cooperate are therefore already low. There is also the issue of ongoing tensions in the South China Sea, East Asia, and other regional flashpoints in the US-China and US-Russia relationships which could derail any talks.
Yet the need for reform is pressing with increasing criticism of the WHO’s response to the pandemic along multiple lines. First, many have attacked WHO pandemic surveillance and warning systems, which have been perceived to be inefficient and subject to politicization. Second, many WHO member states refuse to comply with WHO sharing and surveillance guidelines, due to a host of domestic political concerns ranging from national security to national sovereignty. Third, the WHO has not seen much success in building healthcare infrastructure and response capacity in developing states, which precipitated the crisis and weakened developing countries' response to the virus.
To combat this myriad of challenges, a new treaty needs to be broad and transformational. A limited treaty will likely prove insufficient to counter novel diseases and prevent future pandemics. Nations that prefer a limited treaty, like China and Russia and to some degree the United States, may actually find a broader pandemic prevention treaty more in line with their national interests. The pandemic has caused serious disruption to nearly every national economy and triggered unrest worldwide, something all three states would like to quell. Even for states with concerns about national sovereignty, the net benefit of containing a new virus far outweighs the costs of adhering to international regulations.
A United Solution
Given the necessity of a new treaty, the international community must find ways to accommodate these different factions to create a newfound approach. First, however, to ensure that a new treaty can pass successfully, the EU and its allies in the World Health Assembly should move away from attempting to build new global public health institutions from the ground-up. Rather, a new treaty should focus on amending the existing World Health Organization charter. Only by working within the confines of existing health agreements will ambivalent nations like the United States and China agree to a new framework, given that they both have tremendous influence within the WHO they don’t want to lose to a new organization.
Nevertheless, working within the WHO charter does not necessarily mean that a treaty must be symbolic instead of functional. Rather, a new agreement can and should aim to be broad and transformational, with a particular focus on development and financing, and the United States and China should be more supportive of this position. A broader treaty could, for example, include non-traditional approaches, like providing funding for the development of surveillance and disease response systems in developing states, which would allow national governments to contain viruses and prevent the spread of new diseases.
To incentivize actors like China or Russia, the treaty could leverage financial rewards.
For example, inducements could include providing support to develop healthcare clinics in rural China or financing Russian hospital modernization programs in exchange for compliance with international data-sharing requirements about new pathogens. At present, such programs do exist, but they are often experimental in nature. Hence, greater international aid could encourage governments to engage in a multitude of experimental approaches, diversifying their portfolio for managing global health.
Some would say that the kinds of compromises proposed here are fundamentally problematic. They might argue that limited approaches are simply ways to shortchange reform of international institutions. However, these arguments ignore the critical question of feasibility. Russia, China, and the United States are not likely to agree to a new international organization, given upswings of nationalism present in all of these countries and their desire to maintain the influence they wield within existing international organizations.
The pragmatic compromises proposed here do not represent restrictive thinking. They are the most feasible way in which the international community can make a material impact in improving pandemic prevention and detection without nations refusing to comply. This approach presents a tangible way for the international community to control the spread of infectious diseases, help prevent new pandemics, protect national economies, and ultimately, save lives worldwide.