Global Health Security Needs New Thinking | Opinion

President Trump's decision to withdraw the United States from the World Health Organization has few silver linings. It distracts attention from fighting COVID, makes global health security a matter of partisan politics, and has the pervserse outcome of giving greater sway to other countries in the World Health Organization (all the more ironic given that Trump's decision was in protest at existing Chinese influence.)

The U.S. decision does however require the rest of us to think boldly. It is welcome that the WHO has announced its own review of the crisis, led by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Johnson Sirleaf. In 1944 the Bretton Woods conference reconceived the post-second world war economic architecture. The war was not over, but post-war planning had begun. We need similar ambition today.

Defending the WHO is necessary but not sufficient to address the weaknesses that the COVID crisis has revealed. Fundamentally, those weaknesses revolve around the interplay between, first, underfunded national and local health systems which are strikingly unequal, and second, international coordination which relies on goodwill and is too weak in a world of great power rivalry.

In 2019, 64 countries were paying more in debt payments (multilateral, bilateral and private) than they were spending on health. That is how you end up with one doctor for 5000 people in Africa, compared to one for 300 in America. Only a third of countries could meet the basic requirements of a functional health care system.

Meanwhile, COVID has shown the dangers of weak links in the global health chain. As such, health presents itself as a prime test of whether the idea of a global community exists in reality or only in rhetoric.

In the years that followed 2000, global health policy was a domain of innovation. Initiatives like the Global Alliance for Vaccination and Immunization (GAVI) and the Global Fund to Fight TB, AIDS and Malaria, represent a new generation of public-private partnerships. The governments we were part of gave these new institutions ambitious mandates and freedom to move forward at rapid pace, cutting bureaucratic corners and red tape. The result has been to rally global opinion, mobilize local efforts for change and save tens of millions of lives.

The starting point today is the unfulfilled promise of the 2005 International Health Regulations. 196 states made commitments in response to the dangers of international disease. These Regulations are a binding instrument of international law. Their stated purpose is to "prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks". Yet COVID shows these promises are unfulfilled.

The delays in communication flow between Chinese health officials and the WHO were serious. A March study suggests that if Chinese authorities had acted just three weeks earlier, the number of global COVID cases could have been reduced by 95%. In addition the WHO is wary of criticizing member states (not just China). Like other UN agencies, it depends on its members for political and economic support. Furthermore, the procedures for declaring a public health emergency do not aid public understanding, and when the WHO does come to conclusions, it lacks the power to enforce them.

Our experience from the foreign and security side of international relations has reminded us of mechanisms of cooperation that could be relevant. For example, the IMF and World Bank monitor the economic performance of member states. One reason to do so is to provide early warning if destructive macro economic imbalances emerge. Such monitoring has relevance in the health field, because public health failings in one corner of the world can become a threat to the global system in the same way, or even far more seriously, as macroeconomic problems.

An additional lesson of the crisis is that there need to be more direct, more powerful ways for non state actors to get information directly, if necessary anonymously, to the highest levels, and for it to be taken seriously.

When it comes to inspection of health systems, the WHO lacks legal authority for independent visits. Yet we know from other fields that such authority, including for no notice inspections, is key for global agreements to work. For example, in arms control treaties and in the rules of engagement of organizations such as the IAEA (commitments to peaceful use of nuclear technology) or the OPCW (control of chemical weapons), certified experts inspect and verify the compliance of treaty obligations by member states.

A more empowered WHO secretariat would likely also be more willing to sound the global alarm. The European Commission, and especially the European Central Bank, are examples of independent executives. Recent examples from competition policy to macroeconomic policy show that they are not beyond challenges, by governments or by national courts. But they also show the strength that comes from independent mandates.

There is also a technical fix that could be helpful. At the moment, the WHO operates a binary system of declaring, or not, a Public Health Emergency of International Concern (PHEIC). The delay in declaring Covid a PHEIC has been criticized by the WHO's own emergency experts panel in part because of its binary nature. Yet we know from the UN's surveillance system of food insecurity, up to and including famine, that a graduated scale of concern can be helpful.

The biggest lesson of the COVID crises is political not technical. Denial thrives in darkness. But transparency challenges sovereignty. If the leading states are willing to resolve this conundrum, then reform in global health security could set a template for other fields, like climate and education, where global action lags far behind needs.

The decision of the next US Administration on whether to complete the withdrawal started by President Trump will be consequential. Even more consequential would be a decision to reform the system to meet the needs of the modern world. There is no time to lose.

Jonas Gahr Store is Leader of the Norwegian Labour Party and former Health and Foreign Minister. David Miliband is CEO of the International Rescue Committee and former UK Foreign Secretary.

The views expressed in this article are the authors' own.

Global Health Security Needs New Thinking | Opinion | Opinion