A new global health order
To effect change in the global health system and make the world safe, we need a stronger, streamlined – and, crucially, coordinated – approach to preventing, preparing for and responding to pandemic threats
Recent intensifying calls for a new global health order reflect the fear that we are entering the last phase of the usual cycle of panic and neglect. But if no decisions are taken now, the world will be unprepared for the next pandemic. The signs are everywhere: this year’s World Economic Forum did not have health threats high on its agenda, nor did the Munich Security Conference.
Russia’s invasion of Ukraine, the food crisis, continuous environmental damage from floods and earthquakes, and other crises are redirecting attention and money. The same might be the case with this year’s G20 and G7 – especially as the war, the North–South divide and broader geopolitics make agreements ever more difficult to achieve. And we are also witnessing weakening trust in the multilateral system, including in the World Health Organization.
We are at a crossroads in making the world safer and better protected from health threats. We can succumb to neglect and nationalism or heed the great human and economic losses caused by the pandemic as the most compelling reasons to change things for the better. This is the challenge the G7 faces, as some members actively aim to create new structures, such as a Global Health Threats Council at the United Nations, a proposal that would significantly weaken the WHO.
To effect change, a new global health order must mean a stronger, streamlined approach to preventing, preparing for and responding to the inevitable pandemic threats. But new structures and centres of influence can lead to duplication, fragmentation and inefficiency – that was the message from WHO member states at the Executive Board meeting in early 2023.
THE WHO at the front line
From the first case of Covid-19 reported on New Year’s Eve of 2019 to the WHO’s immediate sharing of available information and advice with all countries and the declaration in late January 2020 of the highest level of alert over the pandemic, the WHO led the response – and consequently is at the front line of criticism. Countries created the WHO 75 years ago to be the guiding international voice on global health threats. It is the only mandated body that brings the political and technical dimensions of health together in one place, through the World Health Assembly and its Executive Board. And it functions, despite immense geopolitical turbulence and the many unknowns associated with Covid-19.
Rightly, many recommendations have been made to strengthen the world’s ability to deal with pandemics, and important government-led processes – centred at the WHO – are under way. Negotiations for a legally binding international agreement or instrument rooted in the WHO constitution, known as the pandemic accord, is one. Considering more than 300 targeted amendments to the 2005 International Health Regulations is another. And the historic decision by WHO members to gradually increase membership dues to represent 50% of the organisation’s core budget by 2030–31 will help it fulfil its vast, expanding mandate across all areas of health, including emergencies. Moreover, there will be a high-level Pandemic Summit at the United Nations General Assembly in September this year.
Clearly, all these negotiations and proposals are about both a potential pandemic and, equally, the power balance in global health and the North–South divide, as most global challenges disproportionally affect the Global South. Countries’ lack of trust in one another – one outcome of Covid-19, based particularly on unequal vaccine distribution – stands in the way of collective action and unified solutions.
Collective action
The WHO was the glue that held the global health infrastructure together during the pandemic, while many countries embarked on their own, often selfish and invariably disconnected courses, to the detriment of the global response. Of course, the WHO faced unforeseen challenges and was not successful in all of its pandemic endeavours.
The G7 must avoid the tendency to seem impactful by creating yet another structure that fragments the world’s health emergency response. We are already witnessing the limited success of the Pandemic Fund created by the G20. We must also ensure that the three major diplomatic processes now under way do not get in each other’s way and are not exploited to achieve short-term diplomatic trade-offs.
The WHO’s constitution, adopted by all countries, explicitly gives it the task to “act as the directing and co-ordinating authority on international health work”. This must be the North Star of all the processes under way: the pandemic accord negotiations, the IHR revisions, the Pandemic Summit, and the deliberations at the G7 and the G20. The best way to move towards a new global health order is to strengthen and empower the WHO to fulfil its essential roles.
