LEADERSHIP, MONITORING AND ACCOUNTABILITY
WHAT IS THE ISSUE?
Effective pandemic preparedness and response requires leadership, as well as adequate arrangements for monitoring and accountability. Covid-19 exposed weaknesses in these critical aspects of governance. For example, some political leaders neglected to implement national control measures seen as politically or economically disadvantageous, at times undermining the decisions of their public health authorities. Nations of all income levels struggled with public trust in authorities, and many saw low adherence to preventive measures and the spread of false information, in many cases fueled by political leaders. Particularly in the early months of the pandemic, international cooperation broke down with many governments focused on addressing outbreaks internally, but without adequate attention to the international measures that were also necessary to control the pandemic. Covid-19 also demonstrated that arrangements for monitoring outbreak preparedness were insufficient to ensure the world was ready. And, beyond the plethora of reviews of WHO, arrangements for accountability of national governments, non-state actors, and global health initiatives at the international level remain poorly-defined at best. For example, there are virtually no enforcement mechanisms if countries do not comply with their IHR commitments.
WHAT WAS DONE BEFORE COVID-19 TO ADDRESS THIS ISSUE?
Accountability for leadership failures at national level are largely left to the governance arrangements of each country. At the international level, the Independent Oversight and Advisory Committee was established as a targeted accountability mechanism for the WHO Health Emergencies Programme. The WHO-World Bank co-convened Global Preparedness Monitoring Board was also created in 2018 as an independent monitoring and accountability body to ensure global preparedness for health crises. A number of academic efforts to monitor and analyze various aspects of global preparedness were also launched, including the Global Health Security Index and Global Health Security Conference.
WHAT HAVE COVID-19 INTERNATIONAL REVIEW PANELS RECOMMENDED TO ADDRESS THIS PROBLEM? *
Covid-19 review panels have largely called for political commitments in international forums. Some call for a UN Summit on Global Health Security and/or a political declaration on pandemic preparedness by heads of state through a global body, such as the UN General Assembly ¹ ². Greater transparency to combat misinformation and accessibility of governance structures to communities is also recommended to promote trust ¹.
The creation of an international Global Health Threats Council was also recommended to improve monitoring and accountability ², as well as a peer review system to monitor member states’ actions during health emergencies ⁴. Panels also recommended that the WHO coordinate periodic peer reviews of national pandemic preparedness plans, and that the IMF and World Bank include pandemic preparedness in their country assessments ².
WHICH REFORMS ARE UNDER DISCUSSION?
The WHA74 resolution on strengthening preparedness and response to health emergencies stresses the importance of Member State engagement in all levels of governance across WHO, and urges them to share reliable information with their population and the global community to strengthen health literacy and counter misinformation. It also requested the Director-General to develop a concept note on the Universal Health and Preparedness Review, a peer-to-peer review mechanism that aims to increase Member State accountability. The tool is currently being developed and is in the first phase of pilot testing with a group of volunteer countries.
Finally, debates on a possible legally-binding instrument for pandemic preparedness and response include consideration of stronger accountability mechanisms such as international inspections in the event of outbreaks. However, negotiations on such a framework have not yet begun, and the extent to which countries will commit to such obligations remains to be seen.
* This section is derived from a systematic comparison (available here) of recommendations from four international reviews: ¹ the Global Preparedness Monitoring Board (GPMB), ² the Independent Panel for Pandemic Preparedness and Response (IPPPR), ³ the Independent Oversight and Advisory Committee (IOAC) for the WHO Health Emergencies Programme, and ⁴ the International Health Regulations (2005) Review Committee.