Re-arming the global health order

The Covid -19 pandemic has mercilessly pummelled the health system globally. The human toll exceeds many times the number of those killed in the atomic bombings of Hiroshima and Nagasaki. Even terrorism has taken a far lesser toll averaging 21,000 lives globally each year over the past decade. The economic cost of the pandemic is incalculable. Estimates vary in trillions of dollars. One of them by The Economist indicates $10 trillion of foregone GDP over 2020-21.

Diseases have spread due to congestion, close proximity to animals and absence of proper sanitation and nutrition.

India is struggling to cope with the tsunami of the second pandemic wave. Heart wrenching reports of severe shortages of oxygen, hospital beds, vaccine supplies and a related rising death toll have contributed to a horrific situation. Epidemiologists observe that with the rigorous implementation of containment measures announced by various States, the peak is reached and a decline is expected in the next four to six weeks. In the meantime, millions of lives and a trillion dollars of economic output are in the balance.

This is a rare but by no means a one-off event. Over time, infectious diseases, like civilisation, have flourished. Diseases have spread due to congestion, close proximity to animals and absence of proper sanitation and nutrition. While every pandemic has provided a lesson, there has not been enough debate on establishing a global order to deal with the inevitability of suffering from periodic pandemics.

Such a global order already exists. The UN has an elaborate system of imposing sanctions on member countries for not complying with UN resolutions. The UN Security Council is authorised to take action under Chapter VII of the UN Charter. Under Article 41, the sanctions cover a broad range from economic and trade sanctions to targeted measures like arms embargoes, travel bans, and financial or commodity restrictions.

The risks to public health from pandemics like Covid-19 are more widespread and graver in nature than the acts of money laundering, financing of terrorism or the like. However, there are no WHO specified uniform international public health standards. 

According to the UN website, “The Security Council has applied sanctions to support peaceful transitions, deter non-constitutional changes, constrain terrorism, protect human rights and promote non-proliferation”. The time has come now to add public health to this list.

Further, standards developed by the Financial Action Task Force (FATF), popularly known as FATF Recommendations, have to be implemented by all countries and jurisdictions, which are members of either the FATF or of FATF styled regional bodies. This FATF regime has become increasingly effective in sending the message that the risks to the international financial system and human life from money laundering, terrorist financing and proliferation financing are grave, and that non-compliance with the FATF standards can be costly. This has encouraged countries to take effective measures to address these risks.

A similar global order needs to be brought to issues of health. When the global diplomatic community met to shape the UN in 1945, one of the areas discussed was a global health body. The World Health Organisation (WHO) came into being in 1948. It inherited specific tasks relating to epidemic control, quarantine measures and drug standardisation from the health organisation of the League of Nations (1923) and the International Office of Public Health at Paris (1907). There is an urgent need to extend the application of Chapter VII of the UN Charter, which charts out a course for “action” with respect to threats to the peace and aggression, without which the WHO is a toothless body.

This regime should specifically include obligations of the member countries to provide information and data and subject themselves to an independent audit or evaluation much in the same manner as the obligations of the member countries under the IMF/UN/FATF systems.

The WHO constitution Article 1 defines its objective as the attainment by all peoples of the highest possible level of health. Article 2 lays down the functions of the Organisation that include: to act as the directing and co-ordinating authority on international health work; to stimulate and advance work to eradicate epidemic, endemic and other diseases; to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products; and to take all necessary action to attain the objective of the Organisation. There is no mention of international standards on public health and ensuring measures against the spread of epidemics.

The risks to public health from pandemics like Covid-19 are more widespread and graver in nature than the acts of money laundering, financing of terrorism or the like. However, there are no WHO specified uniform international public health standards that universally apply to all countries, especially in the area of containing the spread of a pandemic, much less holding countries accountable for negligence and not sharing the related information for an independent review.

Covid’s controversial origin

In the aftermath of the Covid-19 pandemic, there have been serious questions on the origin of the virus, its timely notice to the world at large and the adequacy of efforts to contain its spread after it was first detected. In May 2020, the World Health Assembly asked the WHO to identify the source of the virus and the route of its introduction to the human population.

The WHO report, released on March 30, 2021, after a visit of the WHO experts from January 14 to February 10, 2021 to Wuhan (China), has been inconclusive and criticised by a group of 14 countries including the United States and Japan that the WHO team was “significantly delayed and lacked access to complete, original data and samples”.

WHO’s Director-General Tedros is reported to have said that he did not believe that this assessment was extensive enough; and that although the team has concluded that a laboratory leak is the least likely hypothesis, this requires further investigation.

There is much for the UN system and the WHO to learn from the FATF experience. A comprehensive set of regulations setting down standards of public health and expectations from the member countries in managing and arresting the spread of potential pandemics and providing a framework for evaluation of the countries for their compliance with these standards, as well as a sanctions regime for non-compliance, will go long way in raising awareness of the gravity of the matter and mitigating the risks posed by potential pandemics in future.

This regime should specifically include obligations of the member countries to provide information and data and subject themselves to an independent audit or evaluation much in the same manner as the obligations of the member countries under the IMF/UN/FATF systems. Such a system should explicitly state the consequences of non-compliance which, to borrow a phrase from the FATF regime, should be “effective, proportionate and dissuasive”.

Such a sanctions regime should include the imposition of punitive tariffs, travel bans, and other economic sanctions. If implemented, this will pave the way for enforcing an internationally coordinated and supervised approach with a view to ensuring the safety of public health.

(The writer is a former Chairman of SEBI and LIC)