MARCH 23, 2020
IT WASN'T SUPPOSED TO PLAY OUT THIS WAY. The world had entered into a grand bargain in 2005 with the approval of the revised International Health Regulations (IHR). Countries had essentially ceded some sovereignty to the World Health Organization (WHO) in order to best protect each other from global public health emergencies, and to preserve international travel and trade when these emergencies occurred.
Countries also agreed to implement measures to detect, report and respond to potential international threats that emerge within their borders. The WHO would decide when an event had met the level of a public health emergency of international concern. If it did, the WHO would decide what measures were necessary to prevent the spread of the threat, while at the same time, avoiding unnecessary interference with international travel and trade.
How did this unfold with COVID-19?
On Jan. 20, 2020, using its authority under the International Health Regulations, the WHO declared COVID-19 a public health emergency of international concern. Currently the WHO has stated there is no role for travel bans to prevent the spread of the disease, except at the earliest stages of the disease entering a country to give the country time to develop preparedness measures.
However, from the beginning of this crisis, countries and non-state actors, such as airlines, have exceeded the WHO recommendations. The United States announced a ban of all non-essential travel to mainland Europe. Canada has asked all non-essential travel to be cancelled and has closed its borders to non-Canadian travelers. European nations are rapidly closing borders. The WHO’s statement on travel restrictions remains unchanged.
What went wrong?
The international agreement was always a bit of a long shot. While unanimously approved by World Health Assembly (WHA) member states, there was no enforcement mechanism for the IHR. It was largely based on trust in the WHO, and a trust in global governance.
And that is what has changed. The International Health Regulations were approved in a world which believed in global approaches to combating these and other threats. We don’t live in that world anymore.
We live in a world which is increasingly distrustful of global elites, one characterized by increasing populist sentiment.
In this world, it’s not surprising that countries would disregard WHO guidance. Did President Trump even know (or care) what this guidance was? Is Boris Johnson going to “take orders” from Geneva? Is Modi? Putin? Bolsonaro?
No. In the current world, increasingly, countries are acting solely in their own best interest. But it’s not just the populist nations that are taking this action as the pandemics toll increases. Now we are all looking to protect our own citizens first.
Diseases are harder to control when countries act independently. Travel and trade are unnecessarily impacted. The loss of global wealth attributed to COVID-19 is in the trillions. And when we eventually come out of this crisis, we are all going to have to agree on rules to reopen our borders – it is apparent the WHO is not currently a trusted source to make this decision.
So, what needs to happen?
Countries need to trust the WHO—and the WHO needs to earn this trust.
Trust was dissipating after a series of questions in recent years surrounding WHO leadership in addressing emergencies, most notably its response to the 2014 Ebola outbreak.
It is incumbent upon the WHO to ensure that it acts in a way that is transparent and accountable to rebuild this trust. It is very concerning that there is such a discordance between WHO advice and nation’s actions. Either the WHO advice was incorrect and contributed to the spread of the virus, or countries are over-reacting and causing unnecessary harm to international trade and travel.
The WHO also needs to be financially supported and, in turn, needs to financially support low- and middle-income countries so that they can invest in surveillance and response capacity.
A comparatively small investment in local public health could lead to the early detection and containment of future COVID-19-type outbreaks. A compensation program also needs to be created to offset the economic consequences of early reporting of potential threats—particularly by low- and middle-income countries.
Importantly, the views of local populations affected by outbreaks and travel advisories—which can be devastating to local industries—need to be considered, and these local populations need to be supported. It is the perception that their needs are secondary to global goals that has, perhaps more than any other factor, fueled populist sentiment.
The world needs the International Health Regulations, even in spite of the fact that nations are not following all of their guidance, as we're currently seeing with COVID-19. The good news is if we can learn from this outbreak and make this system work, local populations will be better supported.
Investments in local public health by the global community will have tangible results. And this will increase confidence in global efforts to prevent disease spread as well as other efforts to work as a global community.
Kumanan Wilson, MD, MSc, FRCPC, is a physician at The Ottawa Hospital and a member of the University of Ottawa Centre for Health Law, Policy and Ethics. He has been a consultant to the World Health Organization on the IHR (2005).