In Boris Johnson’s speech to the United Nations General Assembly last week, the world welcomed the commitment for the UK to increase its spending to the World Health Organization (WHO) and in doing so become the largest donor to WHO if indeed the USA continues to withdraw from the organisation. The UK also increased commitments to COVAX for equitable covid-19 vaccine distribution.
Yet, what has been less discussed is the commitment made for the UK government’s leadership of G7, which will focus on global health security. The UK committed to forge a network of research hubs on zoonotic disease to stop new viruses emerging; develop manufacturing capacity for vaccines and treatment; design a new pandemic early warning system, devise protocols for what governments must do in the event of an outbreak with global reach in future, and ensure tariff free supply chains for clinical resources such as personal protective equipment (PPE).
Sounds good? Well yes, but a lot of what he suggests exists already—it exists in international law. The International Health Regulations (2005) lay out clear protocols as to how governments must develop or strengthen core capacity to “prevent, detect, and respond” to epidemics through building surveillance and laboratory facilities. Governments must report emerging outbreaks to WHO in a timely manner. The regulations set out what governments should do at borders and within the transport industry to minimise spread, and what provision there is for WHO to make recommendations for trade or travel restrictions to minimise global disease transmission, doing so within efforts to reduce any potential impact on trade (that finely account for the balance between public health and the economy that is continuing to dominate policy decisions during covid-19).
If this law exists, then you might ask why has covid-19 caused so much chaos, and why would any new protocols be any different? The problem is that this international law is hard to enforce, based on normative commitments to global collective action under the banner of “diseases know no borders,” and considering a highly pathogenic risk in any country could pose a concern to all. For some governments this is enough, and they are willing to forego some sovereign power to WHO and other states to ensure this global public good of health security, and implement the IHR (2005) as much as possible within their state capacities.
Yet, the opposite it also true, and we have consistently seen governments flouting this international law, prioritising domestic politics over the collective responsibility enshrined in the IHR (2005). Even during the early stages of covid-19 outbreak, many governments imposed travel bans, despite the WHO advising against them, which falls within WHO’s mandate under the IHR (2005). We have also seen governments failing to report outbreaks to WHO in a timely manner, whether actively shirking such a responsibility, or simply not having the surveillance infrastructure to detect an outbreak in a timely manner. The only punishment governments face for non-compliance is being “named and shamed,” rather than deterrent sanctions, such as those implementable by the World Trade Organization (WTO).
Given this, it is hard to imagine what the new protocols that the UK government is suggesting may cover, that isn’t already included within the IHR? While the IHR (2005) are in need of some significant reforms in the wake of limitations during the Ebola outbreak and covid-19, the fundamental problem with these is not the legal content, inasmuch as their implementation and the failure of governments to comply. Why would this be any different for any new proposal that Johnson puts forward?
The IHR (2005) were developed in consultation with multiple governments over many years towards the late nineties and early 2000s. Catalysed by the SARS outbreak, they were finally agreed upon, after significant deliberation, at the World Health Assembly in 2005 (the governing body of the WHO) and entered force in 2007. Points of contention in the negotiations centred on the proposed authority given to the WHO and the challenge to sovereign decision making and power during an outbreak. These issues still remain fundamental to designing new governance arrangements for global disease control—and the question remains why would global governments collectively agree to have stricter protocols for pandemic preparedness and response, when they don’t abide by the ones that they have in place already?
This is particularly tense for the UK government to suggest changes to international law to improve global health efforts, at the very time when the UK government itself has decided to contravene international law in “specific and limited ways” within the Internal Markets Bill. Given this, why would any government commit to proposed changes, when there is precedent for law to be breached by the very government who proposed it.
The success of the IHR (2005) is rooted in voluntary commitment to the normative goal of reducing the global risk of epidemics, and indeed many governments do just this. While I welcome the UK government’s revitalised commitment to global health security, we must hold the government to task for the ramifications for global virus control by seemingly unrelated domestic politics within the UK. If the UK wants to be a leader in global health, then it must demonstrate a commitment to the norms and values of international law which underpin global governance.
Clare Wenham is Assistant Professor of Global Health Policy at London School of Economics. Twitter @clarewenham
Competing interests: None declared