In December 2021, at the World Health Assembly (WHA), the World Health Organization (WHO) announced their intention to initiate a draft of a new pandemic treaty “to strengthen pandemic prevention, preparedness, and response.” The goal of this draft was to lessen the likelihood of the world suffering through another years-long pandemic with devastating global health, social, and financial impact.
Then, in May 2022, the 75th WHA meeting was met with deep reservations about the rumored scope of the pandemic treaty, including concerns that nations would be forced to surrender their sovereign rights to govern to the WHO. Some speculated whether the WHA could establish global vaccine passports and have the power to unilaterally impose national lockdowns and/or restrictions on international travel. And when Director-General Tedros Adhanom Ghebreyesus said the WHO should be “at the center of global health security architecture,” he further fueled critics of the proposal.
The meeting concluded without any such treaty being drafted, let alone imposed on member nations. This is just the start of the process, which is now in the hands of the Intergovernmental Negotiating Body (INB). The proposed pandemic treaty is not set to be ratified until 2024, at which point it would need to be ratified by the United States Senate for it to take effect in the U.S.
Since the start of the COVID-19 pandemic, the U.S. has proposed amendments to the WHO’s International Health Regulations (IHR). Crossing international borders, these amendments would place mandates on member nations requiring reporting and accountability for emerging infections. One key feature was a requirement of robust surveillance for new pathogens and including notifying WHO of all details (including genetic sequence data) within 48 hours of a possible public health emergency. (A response to the alleged Chinese cover up of the existence of the SARS-CoV-II virus.) The amendments would also require WHO members to immediately investigate any possible emergency and report the findings to all member nations.
The proposed amendments also clarified that these rules apply to “potential or actual public health emergencies of international concern,” and would delegate power to the Director-General to make that preliminary determination upon consultation with the State Parties involved in the “public health emergency,” before bringing it before the newly established “Emergency Committee” to approve temporary recommendations.
The amendments also proposed that the WHO Director-General should consult with international agencies in order to “avoid unnecessary interference with international travel and trade,” particularly when it comes to healthcare workers and supplies. This would assign to six WHO Regional Directors the power to handle regional health emergencies and establish a Global Compliance Committee to ensure compliance with IHR directives and reduce adoption time for amendments to six months.
As proposed, the U.S. amendments to the IHR would significantly expand the WHO Director-General’s power to declare a global health emergency by removing the requirement of approval of the member nation of origin. However, as some have pointed out, the proposed amendments do not address the fact that current WHO policies permit the automatic declaration of a Public Health Emergency of International Concern in the event of a new SARS outbreak, automatically inspiring additional lockdowns and other potentially harmful countermeasures before assessing the threat of the new respiratory virus. Moreover, the U.S. Senate would not have to ratify these amendments as it would in the case of a new treaty, as it would merely be the decision of the U.S. representative on the INB on whether or not to vote for the amendments. This has generated concerns about legislative oversight into impactful policy changes.
On May 24, 2022, at the WHA meeting, the WHO formally renamed the working group in charge of these amendments as the Working Group on IHR Amendments (WGIHR). The WGIHR is tasked with proposing “a package of targeted amendments” to be presented for consideration at the 77th World Health Assembly meeting in 2024.
On May 27, 2022, largely in response to reservations expressed by the African group around equity and technological gaps, the WHA nearly scrapped the proposed amendments altogether. The WHA did, however, adopt a U.S. proposal for reduction in the implementation time for new amendments from 24 months to 12 months, and allowed countries ten, rather than nine, months to reject an amendment.
Because of this, for the time being, there have been no substantive changes to WHO policies, nor has the WHO’s power been broadened. So should we still be concerned? Yes.
During the COVID-19 pandemic, there was an erosion of trust in the WHO over ineffective (and often harmful) management, in addition to their unwillingness to thoroughly investigate the origins of COVID-19, seemingly giving in to Chinese resistance.
For the WHO to have the authority to enact any new policies with broad global implications that reach far beyond just health, the agency must rebuild that trust.
It can start by establishing full transparency, admitting its many mistakes, and basing policies only on the mountains of clinical and epidemiological evidence created during the COVID-19 pandemic. It can also restrain itself from broadening its powers beyond public health. As Sarosh Nagar said in Harvard International Review in Fall 2021, “a new pandemic treaty should remain within the confines of the WHO without creating new multilateral organizations.”
How should any changes to WHO’s powers be decided upon? For now, we have more questions than answers.
In medicine, every decision between a physician and patient is made following a thoughtful analysis of all the risks, benefits, and alternatives, through a process known as informed consent. Without being informed, how could we offer consent to a new pandemic treaty or any IHR amendments? While in theory, having an all-powerful pandemic prevention and detection organization sounds like a wonderful benefit, but is it too good to be true? Is it even feasible? And what are the risks and costs of doing this?
We must also take into account any freedoms that could be surrendered to an unelected body with limited accountability to achieve this. Moreover we must also consider, if it is truly possible to “prevent” the next pandemic if we couldn’t effectively manage the pandemic that we faced for over two years. Is there a strong body of evidence-based pandemic prevention literature that would support the roll-out of an effective prevention system that doesn’t cause more harm than good? Would this involve restrictions on gathering, on travel, or mask mandates? Would it formalize the WHO’s moral authority to impose lockdowns or endorse the decisions by member nations to impose their own lockdowns, like we have been seeing in China, at the first sight of any new pathogen that might ignite the next pandemic? We have seen how those lockdowns turned out. These questions all must be answered before we can even begin to craft new global policies which could lead to the effective imprisonment of millions of people at home for indefinite periods of time.
With respect to the IHR amendments proposed by the U.S. and supported by many other nations, WHO apologists like Dr. Lawrence Gostin argue that they would result in unenforceable mandates that serve more like recommendations. Even if that is true, do we want to put ourselves in a position to have to face strong recommendations that may not be necessary? And what if the costs outweigh any potential benefits?
We have seen how seriously organizations, from local school boards to the CDC, take WHO’s recommendations and hide behind them while imposing their own unpopular and sometimes even harmful mandates to justify their decisions. We should not agree on any recommendations, binding or otherwise, that are not fully based in clinical evidence, are not applicable globally, or which fail the cost/benefit analysis.
We must, therefore, consider the alternatives to creating yet another global layer of bureaucracy that could require nations to give up some degree of “sovereignty” for the greater good. Rather than remain solely focused on preventing or detecting another pandemic, wouldn’t the WHO’s resources be better spent on good global surveillance of emerging pathogens? These efforts could be coupled with programs that reduce the risk factors for morbidity and mortality which we learned about from the current pandemic, such as respiratory disease and diabetes. Wouldn’t keeping the world’s population healthier produce benefits far beyond the elusive goal of preventing the next pandemic?
According to the WHO, in a recent round of public comments on the pandemic treaty, “several speakers stressed that the potential international instrument should include a focus on strengthening universal health coverage to ensure resilient health systems during a pandemic. Having the ability to maintain essential health services during a pandemic, including mental and social health care, was seen as a key substantive element of any pandemic instrument.”
The world can absolutely not afford to rush into this. For something so significant, so impactful, and so potentially costly, we must not make any final decisions or enact any new treaties until we thoroughly understand the issues. That should start with a thoughtful, independent review of all the lessons we have learned from the COVID-19 pandemic, followed by an honest admission of mistakes that were made during the COVID-19 response, and a fact-based analysis of all the aforementioned questions – one that doesn’t immediately assume that pandemic prevention takes priority over all other aspects of human society.
And if we must err, we must err on the side of freedom of choice and independence for nations and individuals. While we face pandemics together, a “one size fits all” approach will never work across the diverse range of medical, social, economic, and cultural values and needs, across nations or even within individual nations and municipalities. The ball is in the WHO’s court to demonstrate a sincere commitment to the liberal values of free speech and basic human rights.
Houman David Hemmati, M.D., Ph.D. is a board-certified ophthalmologist and biomedical research scientist in Santa Monica, California. You can follow him on Twitter: @houmanhemmati