What is the missing ingredient in global pandemic preparedness and response?

There is an emerging global consensus for a political compact to prevent future crises on the scale of the covid-19 pandemic, writes Tedros Adhanom Ghebreyesus

The covid-19 pandemic is a lesson in humility for the world. It has shown us what devastation a novel pathogen can wreak, especially if we fail to come together in global solidarity. 

The health impacts of the pandemic have been traumatic and unprecedented with more than 220 million reported cases worldwide, and more than 4.5 million deaths. Health systems have been overwhelmed and essential health services disrupted. This will have implications for morbidity and mortality for years to come. 

Equally painful has been the social and economic impact of the pandemic and the great inequities that we have seenespecially in access to vaccines.

One of the biggest lessons is that we must revamp the world’s collective response. This means improving how we collaborate, across all sectors, to protect the global population from a global threat.

In 2003, the SARS outbreak propelled the world to adopting what it thought would be the answer to preventing and responding to disease outbreaks of international concern: the International Health Regulations (IHR 2005).

This global playbook is still in place today. The IHR are designed to prevent, detect, and respond to infectious disease events. They advise on the introduction of safeguards to protect travelers’ rights and trade, and treat personal data carefully. They contain many of the ingredients needed to keep outbreaks and pandemics in check. 

Even today, there is broad consensus on the critical role of the IHR, and their centrality to the global architecture for pandemic preparedness and response, even if some adjustments are needed to ensure they remain fit for purpose. 

But certain elements have held the IHR back, in particular, the short supply of broad, high level, political commitment and global collaboration needed to fully implement their provisions for the common public good.

Earlier this year, dozens of world leaders reacted to this gap with a landmark call for change, proposing a global, legally binding compact agreed at the highest levels of government to prevent a crisis like covid-19 occurring again.

I, too, believe the time has come for such an accord between WHO’s Member States. 

The call for such an instrument, rooted in the WHO Constitution, helped initiate a process now playing out within the framework of the World Health Assembly, which will meet from 29 November 2021 to 1 December 2021 for a special session to consider the way forward for such a bold proposal.

The WHO Constitution was built for this purpose. It was designed in 1948 with the knowledge that the attainment by all people of the highest possible level of health was not a job for one ministry, or one sector, or one institution. 

It also empowers WHO to engage with all relevant actors, including Heads of State and non-health authorities. It enables countries to send Heads of State as their representatives to the World Health Assembly and special sessions of this body, such as the upcoming one considering an agreement on pandemic preparedness and response.

The consideration of a global agreement, framework, or treatycall it what you wanton pandemic preparedness and response does not represent an “either or” decision between a new accord and a stronger IHR.

In fact, a global agreement that secures the highest level of commitment to ready the world for future pandemics will, in turn, provide the political muscle and motivation needed to ensure tools, like the IHR, are properly implemented.

A strong, durable agreement will increase compliance with the letter and spirit of the IHR, renew commitment to the principles, objectives, and purpose of the WHO Constitution, and support the need for sustained investment in global health and keep people safe. 

Covid-19 has laid bare global shortcomings, including the grossly uneven distribution of vaccines, oxygen, diagnostics and other tools, on the background of fragile health systems, exacerbating already existing global inequalities. 

What would this instrument look like? That would be up to Member States to decide. But at its heart is a commitment to sharing data, information, resources, knowledge, and tools; and strengthening global, regional, and national health systems to make them ready to respond.

It will embrace a One Health approach that addresses the interface between environmental, animal, and human health. 

And it will foster improved trust and accountabilityso sorely lacking in this pandemicand provide the solid foundation on which to build other mechanisms to protect global health.

The pandemic has shown how some countries that invested too little in outbreak prevention and response were badly caught short, but it has equally highlighted how many nations responded rapidly due to their past experience in fighting outbreaks.

This practiced preparedness must become the norm.

The pandemic has also shown that the mechanisms we have in place to detect, prevent, and respond to an outbreak of potential pandemic threat are inadequate, particularly in our digital world. 

We expect the new WHO Hub for Pandemic and Epidemic Intelligence, supported by Germany and inaugurated in Berlin recently, to play a key role in this regard.

But we need more. The world cannot afford to pay lip service to the need to respond. We must seize the once-in-a-generation opportunity presented by the pandemic to breathe life into a true global commitment to act. 

I believe this can be achieved through a legally binding instrument covering all facets of pandemic prevention, preparation, and response, and addresses itself to today’s leaders and future generations and to adapt to a rapidly changing world. 

I look forward to supporting WHO’s Member States do all in our collective power to prevent the next pandemic before it starts, to commit to take the steps needed before the first cases are reported, and to invest in the measures needed to stop an outbreak in its tracks.

The world needs thisand now is the chance to make the need a reality.

Tedros Adhanom Ghebreyesus, Director-General, World Health Organization.

Competing interests: none declared. 

This is the first in a special collection of articles on a global pandemic treaty. The collection is published in cooperation with, and with funding support from, a research project at the Global Health Centre, Graduate Institute, Geneva.