NEW REPORT CALLS FOR UPDATED INTERNATIONAL HEALTH REGULATIONS WITH A GLOBAL PUBLIC HEALTH CONVENTION FOR THE 21ST CENTURY

Author:

Arlette Campbell White

Article Type:

Article Number: 7

Ten recommendations to strengthen pandemic preparedness and response

ABSTRACT This Lancet-published Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimize prevention, preparedness, and response to pandemic infectious diseases. It proposes ten recommendations to strengthen global public health governance and promote compliance with global health security regulations.

On 5 May 2021, The Lancet online published a new paper in its Health Policy series, addressing the need for preparedness in the face of global pandemics. The events of the past year have shown that countries are, in general, ill-prepared to address major health threats that appear suddenly and relentlessly. Although the existing World Health Organization (WHO) International Health Regulations provide a framework of binding legal obligations for pandemic prevention, preparedness, and response, many countries do not comply with these regulations. This Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimize prevention, preparedness, and response to pandemic infectious diseases. It proposes ten recommendations to strengthen global public health governance and promote compliance with global health security regulations.

This summary of the key points of the proposed policy for pandemic preparedness and response is based on the publication A global public health convention for the 21st century.

Renewed framework for global collective action

As shown by COVID-19, infectious diseases with a pandemic potential present a grave threat to health and wellbeing. The International Health Regulations (IHR) constitute an international legal framework designed “to prevent, protect against, control and provide a public health response to the international spread of disease”. The IHR set out the minimum core capacities that countries (States/Parties) must implement at the local, regional, and national levels to detect morbidity and mortality, report essential information, and respond effectively to contain health security threats. These regulations are legally binding on all 196 signatory States Parties. Oversight for the IHR is assigned to WHO, as the primary global body for public health-related activities. Responsibility for maintaining these core capacities lies with individual states, with WHO providing technical assistance. Yet, despite clear legal obligations outlined in the IHR, most States Parties do not comply with all requirements.

The authors state that there is a need for a renewed framework for global collective action that ensures conformity with international regulations and promotes effective prevention and response to pandemic infectious diseases. Recommendations for a new global public health security convention include greater authority for a global governing body, an improved ability to respond to pandemics, an objective evaluation system for national core public health capacities, more effective enforcement mechanisms, independent and sustainable funding, representativeness, and investment from multiple sectors, among others. The next steps to achieve these recommendations include assembling an invested alliance, specifying the operational structures of a global public health security system, and overcoming barriers such as insufficient political will, scarcity of resources, and individual national interests.

Improving the current system of global public health security

Authority
The governance structure for a global public health system should grant the necessary authority to one or more agencies, such as WHO, to coordinate pandemic prevention, preparedness, and response globally, including across regions, countries, and subnational jurisdictions. This authority could include an agreed-on power to lead countries and other relevant agents to act and collaborate.

Responsiveness
The global public health system (and its governing agency or agencies) should possess the capability to flexibly and rapidly respond to, instill protections for, formulate interventions against, and mobilize and deploy resources for, a range of possible public health security threats and scenarios such as infectious disease outbreaks and pandemics.

Expertise
In a global public health system, one body should exist as the singular authoritative source for information, data, and technical assistance. This agency should possess appropriate technical expertise and must be able to communicate a clear and compelling message to the world.

Evaluation
The capacity of objectively evaluating countries on their progress in achieving requirements and of providing or coordinating remediation for identified deficiencies should be built into a governing framework for a global public health system.

Enforcement
Reform must equip a governing body (or bodies) with appropriate enforcement mechanisms, which can include substantial incentives for countries to cooperate, sanctions for non-compliance, or both.

Autonomy
The governing body (or bodies) should be autonomous, having freedom of self-governance and decision-making processes resistant to undue political pressures

Financing
An effective global public health security framework requires a sustainable financing system that protects the governing body (or bodies) from political influence, possible retribution, or the threat of inconsistent funding.

Representation
A governance structure for a global security system must be representative of all countries and other relevant non-state stakeholders. The governing framework must possess a high degree of transparency and accountability.

Multisectorality
A formal pandemic prevention, preparedness, and response system (including governing bodies) must involve multiple sectors at all levels of governance and action. In addition to national governments, participating agents can include the private sector, local governments, and civil society.

Commitment
or a global health security convention to be effective, all relevant parties participating in the system must understand the threat posed by pandemic infectious diseases; accept the gravity of this threat; acknowledge their own responsibility in contributing to effective prevention, preparedness, and response; show a commitment to these efforts; agree to comply with a global convention; fulfill their individual responsibilities to the global contract among nations; collaborate with other parties; and cede some degree of authority to a global governing body, thus permitting that body to effectively coordinate and intervene to prevent, prepare, and respond to infectious disease outbreaks and pandemics.

Conclusion

The COVID-19 pandemic clearly exposed how the existing global health infrastructure failed the world when it was needed most, with devastating human and economic consequences. However, as the authors note, with crisis comes opportunity. The lessons learned from the COVID-19 pandemic response efforts present a unique chance to reevaluate, refocus, and revise the current global public health security system. Identifying the target principles of a convention is only the first step. Ensuing steps must establish the specific policy systems and operational structures needed to actualize these principles. Subsequent actions must then determine the mechanisms to effect these changes, and then work to implement them. The pandemic has captured the world’s attention and awakened political leaders to the threat of pandemic infectious disease. The current crisis could be a catalyst for transformation in the way the world manages health security prevention, preparedness, and response efforts.

It should also be noted that the Third Edition of the IHR dates from 2005 and has not been updated since. It is to be hoped that WHO is currently engaged in revising the Regulations to take account of lessons learned during the pandemic.

Further reading:

• Duff et al (2021). A global public health convention for the 21st century. Health Policy. 5 May 2021. The Lancet online. https://doi.org/10.1016/ A global public health convention for the 21st century (thelancet.com)
• International Health Regulations (2005). Third Edition.  International Health Regulations (2005) Third Edition (who.int)