Pandemics could become\u00a0more frequent<\/a>\u00a0in the years to come as the world grows even more interconnected, increased agricultural production leads to more contact between humans and animals with the potential for further spread of zoonotic diseases, and humans encroach further into wildlife areas. While an international pandemic organization sounds important in theory, organizations like the UN Security Council can\u2019t necessarily solve the problems they were intended to solve. Creating a new pandemic response system will likely require years of difficult negotiations and could still result in a structure unable to forcefully respond to an outbreak, or an agreement supported by only some countries and perhaps not all of the key global leaders. By looking at the reform ideas that people and organizations have put forward, one can begin to see the contours of what a new global response system might look like.<\/p>\n Reform at the WHO.\u00a0<\/strong>Each major public health emergency during the last 20 years has led to the pervasive conclusion that the WHO has serious shortfalls that have prevented it from effectively communicating with and supporting member nations and the broader global community in response to health crises.<\/p>\n The WHO was established in 1948 as the health policy body within the UN system and was given the\u00a0responsibility<\/a>\u00a0to \u201cdirect and coordinate the world\u2019s response to health emergencies.\u201d The centerpiece for WHO pandemic preparedness and response are the\u00a0International Health Regulations<\/a>, which trace their roots back to the cholera epidemics of the mid-1800s. The regulations have been updated in response to subsequent public health emergencies, and the most recent major update happened after the 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus outbreak, a virus related to the one that causes COVID-19. The 2005 rules require all countries to detect, assess, report, and respond to public health events.<\/p>\n Despite efforts at reform over the last 20 years, fundamental flaws remain. The WHO\u2019s International Health Regulations\u00a0don\u2019t<\/a>\u00a0allow the organization to conduct independent investigations of international public health emergencies or to compel countries to act during such crises. The organization can\u2019t even enforce its regulations. Furthermore, it can employ only the limited authorities, capacities, and funding that the 194 member nations have given it. This lack of agency is not an oversight, but rather a deliberate limitation of the WHO\u2019s power\u2014many countries do not want to have an international organization interfering in the internal affairs of sovereign nations. Given the WHO\u2019s lack of authority, countries that violate the International Health Regulations are unlikely to face any repercussions. It also means that the WHO must take a collaborative approach in dealing with nations to gain their cooperation.<\/p>\n COVID-19 shortfalls.\u00a0<\/strong>SARS-CoV-2 has exposed key shortfalls in pandemic preparedness and response. The WHO remains underfunded and has limited power. It\u2019s had trouble effectively offering\u00a0guidance and coordination<\/a>\u00a0to its member states.<\/p>\n Several high visibility missteps provide poignant examples of underperformance at the organization.<\/p>\n Early on, the WHO was slow to declare COVID-19 an international emergency, and at times, provided inconsistent and inaccurate information. For example, the organization revised a\u00a0global risk assessment<\/a>\u00a0from \u201cmoderate\u201d to \u201chigh\u201d in late January 2020 after admitting it made a mistake in previous reports. The WHO was also\u00a0slow<\/a>\u00a0to call for a comprehensive investigation of the origins of the virus, which contributed to a loss of confidence in the organization by some member countries. As a result, some have accused the WHO of failing to be independent or even of being too \u201cChina centric.\u201d<\/p>\n Recognizing the need to examine its early COVID-19 actions, the WHO commissioned an\u00a0independent panel<\/a>\u00a0in May 2020. The group\u2019s year-long deliberations \u201cfound weak links at every point in the chain of preparedness and response.\u201d The panel found, for example, threat warnings were not acted on, funding allocated by nations to their responses was not adequate, and coordinated global leadership was absent. These shortfalls were well documented and highlighted actions necessary to end the current pandemic\u2014as well as longer-term recommendations for ensuring that future outbreaks do not become pandemics.<\/p>\n The panel recommended developing a \u201cglobal health threats council\u201d which would be led by heads of state. Separate from the WHO, the council would be able to hold countries accountable for controlling epidemics. Specific long-term recommendations of the independent panel included elevating pandemic preparedness and response to the highest level of political leadership; strengthening the independence, authority, and financing of the WHO; investing in new preparedness measures; building a new surveillance and alert system; and giving national pandemic coordinators a direct line to heads of state or government.<\/p>\n World leaders, infectious disease experts, and worried citizens alike have also\u00a0voiced concerns<\/a>\u00a0about the WHO\u2019s COVID-19 response and what it portends for ending the current crisis and preparing for the future. The calls for reform have been resounding, and reform advocates have identified at least six discrete reform initiatives. These initiatives are certainly not the only calls for change, but they reflect an interesting range of transformational activities that might change the way world governments prepare for and respond to pandemics. Each seeks to address the shortfalls of the COVID era.<\/p>\n A WHO-adjacent organization.\u00a0<\/strong>WHO members agreed to start the reform process when they met at the World Health Assembly in May 2021. Informed by the independent panel, members called for a special meeting on reform to be held in the fall, signaling that a new organization would likely be related to, but not under WHO leadership. The proposed global health threats council led by heads of state could serve as a model for this agreement.<\/p>\n At the November 2021 special meeting, countries formally\u00a0agreed<\/a>\u00a0to initiate a process \u201cfor negotiating a pandemic treaty or other international pact.\u201d The move was seen as an important step that could lead to \u201csweeping reforms of global health if it succeeds.\u201d WHO Director General Tedros Adhanom Ghebreyesus called the decision a \u201ccause for hope\u201d\u2014the goal would be to begin negotiations in March 2022 and to\u00a0develop<\/a>\u00a0a \u201cglobal agreement to strengthen pandemic prevention and response\u201d by as early as May 2024.<\/p>\n The European approach.<\/strong>\u00a0The European Union also offered\u00a0a proposal<\/a>\u00a0for a standalone international treaty on pandemics. The proposal identifies areas that would be covered under an agreement: improved early detection and prevention of outbreaks; increased pandemic resilience; more rapid pandemic response; a stronger international health framework; and more complete integration of so-called \u201cOne Health\u201d policies that recognize the interconnections among people, animals, plants, and their environment. At this stage, it is the most encompassing of the six proposals, but would undoubtedly require negotiators to make sure that it does not conflict with current (and likely overlapping) WHO authorities. Given the comprehensive approach, negotiating a treaty that might give countries new responsibilities for reporting\u2014and even require they submit to inspections\u2014will likely be a challenge. At the special November World Health Assembly, supporters believed they had gained critical international receptivity for the EU proposal to serve as the basis for a \u201ctreaty or pact.\u201d<\/p>\n An outside-of-government proposal.\u00a0<\/strong>A group of non-governmental, concerned citizens have offered\u00a0a third proposal<\/a>, the Pandemic Mitigation Project. It calls for the adoption of a more modest agreement that would require countries to provide immediate notification of potential epidemic\/pandemic events, grant immediate access to pre-vetted specialists \u201cto assist in identification, isolation and mitigation of the pandemic threat,\u201d and accept enforcement provisions that would encourage compliance. As with the EU proposal, the Pandemic Mitigation Project proposal would be a legally binding, standalone agreement that would need to be negotiated.<\/p>\n The G20 way.<\/strong>\u00a0Another proposal comes from\u00a0a statement<\/a>\u00a0of G20 nations\u2019 science academies. The statement urges their governments to \u201cpromote the creation of a global surveillance network that could detect the harbingers of a potential new pandemic.\u201d It calls for not only a global biosurveillance network but also the capacity for manufacturing and delivering medical countermeasures and other supplies as well as working toward a formal international treaty.\u00a0 However, at the\u00a0G20 meeting in Rome<\/a>\u00a0in October 2021, the discussion on pandemics focused on the more immediate issue of gaining additional vaccine commitments for developing countries rather than longer-term and broader pandemic preparedness and response issues. It is noteworthy that on the eve of the G20 leaders\u2019 summit, health and finance ministers established a Finance-Health Task Force\u00a0to strengthen<\/a>\u00a0both \u201cpublic health measures and the funding to support them.\u201d<\/p>\n The UN or Biological Weapons Convention routes?<\/strong>\u00a0Other ideas worth considering include actions within existing international organizations other than the WHO. For example, governments could develop a UN Security Council\u00a0resolution<\/a>\u00a0for pandemics. Under the UN charter, resolutions adopted by the Security Council are considered binding, carry the force of law, and can be used to compel nations to act. Security Council resolutions have been\u00a0successful<\/a>\u00a0in other areas such as nonproliferation of weapons of mass destruction. One Security Council resolution, 1540, for example, calls for countries to adopt policies to keep the financing, technologies, and materials needed to create weapons of mass destruction out of the hands of terrorists.<\/p>\n The final initiative considers the possibility of\u00a0using<\/a>\u00a0the Biological Weapons Convention, the treaty that bans bioweapons, as an avenue for international reform. This could have the most relevance in outbreaks and pandemics where the origin is suspected to have come from deliberate use of biological pathogens or release from an illicit bioweapon\u2019s lab. The first step could be a discussion along these lines at the upcoming 2022 Biological Weapons Convention review conference, where representatives meet every five years to discuss the treaty. The convention includes\u00a0provisions<\/a>\u00a0for bilateral or multilateral consultations in the event of questionable activity and a route for bringing intractable issues to the UN Secretary General.<\/p>\n Using the Biological Weapons Convention would take advantage of an existing arms control convention. The legally binding instrument, however, lacks verification and compliance mechanisms to ensure countries are adhering to the treaty, a frequent source of complaints from member nations.<\/p>\n Which path to reform?\u00a0<\/strong>No single path seems superior at this point; more detail would be required before making a decision on which to choose. However, each of the six initiatives provides interesting elements that could be useful in a future international mechanism to ensure global preparedness and response capabilities are in place and functional.<\/p>\n The decision on a path forward should also account for the realities of international cooperation and collaboration. Developing new agreements and treaties is normally a time-consuming process that does not ensure that the final product will achieve the desired outcomes. Intensive negotiations can also expose fissures within the international community. For example, the discussion of a legally binding treaty has put the European Union, Britain, and some 70 other countries on opposing sides with the United States, Brazil, and India, which have been\u00a0reluctant<\/a>\u00a0to commit to such an approach.\u00a0Politico Europe<\/em>\u00a0cited<\/a>\u00a0one European Union official as characterizing the United States as \u201cone of the most difficult partners\u201d in talks to develop a legally binding agreement. Given these differences, a May 2024 agreement might be overly optimistic for a comprehensive pandemic agreement.<\/p>\n Several proposals would likely have significant costs associated with them. Sweeping reforms, such as those proposed by the European Union, or foreshadowed by the WHO independent panel, could include expansive new public health measures; the plans might be costly both to establish and maintain. More narrowly focused proposals such as the Pandemic Mitigation Project and UN Security Council proposals would undoubtedly have less upfront and sustaining costs.<\/p>\n Adapting existing organizations such as the WHO and the Biological Weapons Convention could also be challenging as their long histories often get in the way of comprehensive reform efforts. Even\u00a0updating<\/a>\u00a0the International Health Regulations\u2014which were developed for pandemic detection, assessment, reporting, and response\u2014would likely require negotiators to extensively rewrite WHO policies to grant the organization greater authority and to develop the new enforcement mechanisms necessary for reform to have a meaningful effect.<\/p>\n The acceptability and terms of a pandemic agreement would also be key. Any agreement that includes only a \u201cslice of the world\u2019s countries<\/a>\u201d but not major powers like the United States would be problematic; economically powerful countries would likely be the source of the funding and technical capability necessary for successful implementation of a treaty. Likewise, agreements that rely on consensus might result in \u201cleast common denominator\u201d solutions, hardly what the world needs from reform.<\/p>\n Still, the six proposals provide grist for thought and even potential starting points from which deliberations could begin; however, unless WHO member nations are willing to expand a future pandemic organization\u2019s authorities, capacities, and funding beyond what the WHO currently has, the prospects for success will be limited. Whatever pathway reform efforts proceed down, one thing is clear: The death; sickness; and political and economic destabilization of the last two pandemic years make it clear that the world needs to do something different next time.<\/p>\n![\"\"](\"https:\/\/www.fie.undef.edu.ar\/ceptm\/wp-content\/uploads\/2022\/04\/ebola-response.png.webp\")