We should strengthen existing institutions rather than create a new international body for virus surveillance 

A new organization could face the same problems as existing ones, at vast cost and confusion, argues Clare Wenham

David Cameron, former UK prime minister, is re-entering global politics—but not where you might expect. One of his first forays back into global affairs has been to push the G20 to create a new Global Virus Surveillance Organization. In an Op-Ed in The Times he wrote: “The current system therefore fails in two ways. The WHO relies on countries telling it about emerging viruses. And then the world relies on the WHO telling everyone else”. 

The procedural bottleneck he identified is an accurate descriptionbut he goes on to reveal the real reason that alerting the world to an emerging infection is hard:countries are often reluctant to share for reasons of politics, pride, and capacity”. 

So, it appears here that the problem isn’t the World Health Organization (WHO), but the fault line in global disease control is national politics. While WHO was plagued with some tensions working with Chinese government officials back in January, this can’t be the focus of concern, it’s much more wide reaching than this.

Indeed, when examining the early stages of the covid-19 pandemic, the suggestion that the only problem was that China didn’t share data early enough and/or WHO should have been more assertive in demanding compliance from Xi Jinping completely misses the point. 

Would getting information about this outbreak a day or two earlier have made governments act any faster? The UK and US (and much of the world) didn’t seem to spring into action for many months, not heeding the warnings of WHO. So how will a new global virus surveillance organisation change political decision making to prepare sooner? Knowing about the outbreak is one thing, but inaction once presented with this information has proven to be far more costly for lives and economies than a lack of prescient viral data. 

Moreover, what Cameron is proposing “a new organisation or networkto identify new and re-emerging infectious diseases, investigate their origins, and inform national and international programmes so they can act fast” already exists. Within the WHO, the Global Outbreak Alert and Response Network (GOARN) does this exact job. It works to detect outbreaks in real time and investigate further when necessary. At the same time, the WHO Health Emergencies Programme was established in the wake of Ebola to operationalise response to outbreaks when they emerge, working with governments to detect, respond and recover from emerging infections. Ironically, these organisations are both chronically underfunded, which has restricted their ability to scale up response efforts in a timely fashion, having to fundraise at the start of outbreaks. We saw this earlier in the year with WHO’s Strategic Preparedness and Response plan which needed $675m. The organisation was unable to raise from member states, so it was left to establish a covid-19 Solidarity Fund, asking the global public to help their efforts.

If WHO institutions are too politically charged to undertake global surveillance, there are also other non-WHO organisations which do thisProMED-Mail is a horizon scanning platform collecting real-time information from clinicians, vets, and public health officials across the world and sharing it openly. HealthMap provides a crowd-sourced platform of diseases discussed in media outlets. These are both open access and, indeed, are well used by governments and WHO in their disease surveillance activities. 

Global health actors have a habit of inventing new institutions rather than strengthening the ones that already exist. As a political scientist I understand that politically tarnished institutions are hard to sellas the WHO might be right nowbut it is also going to be considerably cheaper to strengthen WHO, GOARN, HEP, Pro-Med and HealthMap then it is to start afresh with a new institution. 

Moreover, what is to suggest that a new institution won’t encounter  the same problems experienced by WHO in outbreak response? Governments are still going to be reluctant to share data about emerging pathogens, fearing damage to their economyperhaps even more so in the post-covid world. 

In fact, governments may be even less inclined to share virus information with an organisation to which they are not legally required to do so, as they are with WHO through the International Health Regulations (2005). This architecture requires notification to WHO within 24 of identification of a potential virus of concern. Unless Cameron’s proposed organisation comes with significant legal requirements to do so, I don’t think the normative understanding of “global vulnerability” will be enough to get pariah states to comply. 

While I agree with Cameron that the WHO-led system of government reporting is not perfect, the problem is much more fundamental than simply creating a new institutionone which performs the exact same function, with the same actors, at vast cost and confusion. Instead, we should strengthen the mechanisms in place, get governments to commit to working with WHO through whatever overhaul is required of the institution to engender trust and compliance, and ensure that governments take outbreaks seriously and prepare when they have the chance, rather than when it’s too late. 

Clare Wenham is Assistant Professor of Global Health Policy at London School of Economics. Twitter @clarewenham

Competing interests: None declared.