NATIONAL, REGIONAL AND GLOBAL PREPAREDNESS
WHAT IS THE ISSUE?
There is wide consensus that the world was not prepared for the Covid-19 pandemic. National health systems were overwhelmed as surveillance systems failed to detect human to human transmission for weeks, faced severe shortages of medical supplies, and hospitals and healthcare facilities were overwhelmed. Globally, a fragmented and inadequately funded system was unprepared to provide an adequate response to the outbreak. The World Health Organization (WHO) struggled to exercise its coordinating role and was both praised and criticized for its technical recommendations, and how it handled the initial declaration of a Public Health Emergency of International Concern (PHEIC). Covid-19 has further demonstrated how existing international arrangements are patchy, weak, and inadequate in scope and strength to deal with health crises.
WHAT WAS DONE BEFORE COVID-19 TO ADDRESS THIS ISSUE?
Through the International Health Regulations (2005) (IHR), inter alia, countries commit to ensuring their national surveillance and health system’s capacity to detect and respond to outbreaks; reporting rapidly to the WHO events that may constitute a PHEIC; responding to WHO requests for event verification; and refraining from imposing unnecessary restrictions to international traffic and trade. The WHO’s Joint External Evaluation (JEE) process established in 2016 is a voluntary external assessment of countries’ progress on IHR targets; it has consistently found low levels of preparedness across countries of all income levels. Only sixty countries completed a National Action Plan for Health Security (NAPHS) (the next step after the JEE), and it is not clear how far they had implemented their plans before Covid-19. Another measurement, the Global Health Security Index (GHSI), found in 2019 that no country was fully prepared for epidemics or pandemics.
WHAT HAVE COVID-19 INTERNATIONAL REVIEW PANELS RECOMMENDED TO ADDRESS THIS PROBLEM? *
Review panels agreed on the importance of increased predictable national investments in preparedness and response ¹ ² ³ and of employing a whole-of-government and/or whole-of-society approach ¹ ² ³ ⁴. Other suggested reforms have included the creation of specific mechanisms or government positions meant to ensure pandemic preparedness and IHR implementation ² ⁴, or the enactment of legal frameworks for public health events and emergencies ³ ⁴. In terms of regional arrangements, reports emphasized the need to strengthen mechanisms for pathogen tracking and alerts, information sharing and allocation of countermeasures ¹.
Globally, equitable access to countermeasures is essential to adequately address health crises ¹ ² ³ ⁴. Furthermore, many reviews called for the creation of an international normative framework, such as a treaty, addressing health emergency preparedness and response ¹ ² ⁴. Other recommendations included strengthening regional production capacity of medicines and other health-related technologies, adopting a multisectoral One Health approach, and strengthening the multilateral system of pathogen tracking, information sharing and R&D.
WHICH REFORMS ARE UNDER DISCUSSION?
The 74th World Health Assembly (WHA) in May 2021 placed great emphasis on strengthening WHO and created a Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR). The Working Group was requested to consider the findings and recommendations of a number of international reviews on the international response to COVID-19 as well as other relevant information and to report to the 75th WHA in May 2022. Subsequently, the Working Group submitted a report on “the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response” to the special session of the WHA at the end of November 2021. This report led to the establishment by the WHA of an International Negotiating Body (INB) which will continue to meet periodically in order to draft the text of such an instrument to be presented at the 77th WHA in 2024.
Also during the 74th (2021) WHA, resolution 74.7 urged governments to strengthen their surveillance and early-warning systems, adopt a multisectoral One Health approach, ensure universal health coverage for their populations, avoid unnecessary interference to travel and trade, and prevent stockpiling of products that may hinder access to countermeasures. It also called for non-state actors (NGOs, private sector) to strengthen their partnerships with governments. Additionally, it requested the Director-General to support Member States in the implementation of the IHR and broaden mechanisms such as the WHO Solidarity Fund and the WHO Foundation. With respect to national preparedness, a Universal Health and Preparedness Review process modeled off the Universal Periodic Review by the UN Human Rights Council has been developed and tested by the WHO Secretariat, and is under review through ongoing consultations.
* 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.