By: Vikram Bhardawaj
The International Health Regulations (IHR) is the quintessential binding international public health framework. The IHR emphasizes surveillance, notification, and response systems, establishing clear obligations for countries and the World Health Organization (WHO) during public health emergencies. In a perfect world, the IHR, established in 2005, would have ushered in an age of global health cooperation. Yet, this is not the case. Five years removed from the 2020 shutdown, COVID-19 has highlighted the sheer failure that the global medical industry faced as a result of lackluster international policy and diplomacy efforts. While the IHR seeks to establish a clear baseline, it falls victim to delayed and inconsistent reporting, weak intrastate capacity for surveillance and response, and finally, significant political pressure and the weakness of the WHO’s authority.
The case of COVID-19 seems like a distant past, but nearly half a decade later we are still reeling in its effects. Most notable is the lack of transparency states have regarding their reports. Take, for example, China’s delay in reporting initial cases to the WHO. China was criticized for delaying the disclosure of crucial information about human-to-human transmission, violating the IHR’s requirement to notify the WHO within 24 hours of identifying a potential threat. However, China faced little-to-no backlash from the WHO due to both the status the world superpower holds along with the IHR framework lacking an enforcement mechanism. Without enforcement, reporting is based on speculation and individual states’ willingness to come forward. Such expectation fails on the world stage, where states are heavily incentivized to protect their domestic information and assets. However, it is not just superpowers that have not been forthright in relaying information to the WHO, as during the 2014 Ebola crisis. Guinea, Liberia, and Sierra Leone failed to report early signs of the outbreak, contributing to its rapid spread. The IHR’s fundamental goals of surveillance and notification fail at all levels, as states have no real reprimand.
The 2014 Ebola crisis displays a rarely discussed aspect of how meaningless the IHR’s requirements are, as it concerns states that have significant intrastate difficulties. Many low-and middle-income countries (LMICs) lack the resources to meet the IHR’s core capacity requirements (the ability to detect, assess, notify and report events). This is for a multitude of reasons, from the neo-colonialist policies of states, such as China with its Belt and Road initiative, the U.S.’ strong military presence, or even just the after-effects of centuries of colonial rule. However, these effects culminate in the significant underfunding of critical national healthcare infrastructure, which was highlighted by West Africa’s Ebola outbreak. Yet, the IHR has limited resources to address this issue. The WHO itself provides no financial aid, let alone structure, for these states to begin creating robust healthcare infrastructure, choosing only to temporarily patch the leaks through initiatives such as COVAX and the African Vaccine Acquisition Trust (AVAT). COVAX failed to have an impact due to richer states hoarding vaccines in the interest of domestic national security, further exacerbating the global pandemic. Fundamentally, LMICs prioritize domestic stability, causing international cooperation and information sharing to become low priorities.
Nothing highlights the weakness of the IHR and the WHO as a whole as the disregard states have for its authority. With the U.S. exit from the WHO earlier this year, despite being a founding member, the purpose of the WHO has been called into question. When the WHO attempted to declare a Public Health Emergency of International Concern (PHEIC) for COVID-19, there was significant political pressure from China for it to not be released. There is no real punishment for states failing to abide by the core tenets of the IHR, leading to gross negligence on the part of states. No “stick” to compel states to act means that states will simply act in their best interest, avoiding disclosing any data they deem detrimental to their image abroad or at home. On top of this, when the WHO released a PHEIC for the H1N1 pandemic (2009), it faced significant backlash from the international community for supposedly “over-exaggerating the significance of the outbreak,” which killed over half a million people globally. Even when the WHO does its job properly, states will continue to complain, leading to de-prioritization. This can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and two billion people face financial hardship due to health costs.The best way to address the failing WHO is to take conditional aid and trade measures (soft penalties), emergency intervention protocols, and strengthen partnerships with regional bodies. Similar to the World Bank, IMF, or WTO, tying the requirements of the IHR to economic measures would ensure that states prioritize their domestic reporting infrastructure and decrease the likelihood of states failing to report to the WHO when concerns do come up. In extreme cases where a country conceals or suppresses critical public health information, the WHO could invoke emergency powers to deploy rapid response teams and work directly with states to be able to mobilize neighboring countries or regional coalitions to address the outbreak.
This framework has largely been ignored by states due to their national security concerns, but at the end of the day, human security is what should matter. Allowing for the IHR and the WHO to have a realistic, non-military enforcement mechanism is the best possible solution to its current failings. Finally, working with regional bodies such as the Africa CDC, European Centre for Disease Prevention and Control (ECDC), or ASEAN BioDiaspora Initiative would allow for a more global approach as well as a general increase in the legitimacy of the WHO’s mission and existence. On top of this, regional bodies often have better diplomatic leverage and cultural understanding. Partnering and working with them would decrease issues related to sovereignty, as well as expedite information communication between individual states and the WHO. The best way forward is to create a path in which the WHO can truly operate on the world stage. Without these changes, we risk the collapse of the only significant international framework that seeks to benefit the health of people worldwide.
