Straight to the point

by Dr David Bell

The WHO and Pandemic Preparedness: What is going on?

The World Health Organization (WHO) and its Member States, in concert with other international institutions, is proposing and currently negotiating two instruments to address pandemics and widely manage aspects of global public health.

Both will significantly expand the international bureaucracy that has grown over the past decade to prepare for, or respond to, pandemics, with particular emphasis on the development and use of vaccines. This bureaucracy is to be funded mainly by taxpayers and would be answerable to the WHO. In turn, the WHO has become increasingly vulnerable to influence from private individuals, corporations and large authoritarian states, through its funding and the process of electing its Director General.

If adopted, these proposed rules and structures would fundamentally change international public health. Control over significant areas, which have traditionally been the purview of elected governments answerable to the population in most constitutional democracies, could be fundamentally affected. These structures will change the balance between individual and national rights and favour the preferences of supra-national organisations not directly answerable to the people affected by their decisions.

The terms ‘pandemic’ and ‘public health emergency’ are not clearly defined by the WHO, but are based on opinions of the Director General and (in the case of public health emergencies) the Regional Directors. A ‘pandemic’ in WHO parlance does not take severity into account,  but merely requires broad spread – a property common to respiratory viruses.  Furthermore, the amendments and new ‘treaty’ are being proposed for discussion and implementation before a full impact assessment (costs and benefits) of the unprecedented Covid-19 public health measures has been undertaken. This, despite the WHO, Unicef and other United Nations (UN) agencies recording extensive collateral damage resulting from the Covid-19 response.   

Proposed International Health Regulations (IHR) amendments

The IHR amendments, proposed by the United States, build on the existing IHR that were introduced in 2005 and are binding under international law. While many are unaware of this mechanism, it already enables a WHO DG to declare public health emergencies of international concern and recommend measures be taken such as border closures to isolate countries and restrict the movement of people. The draft document includes proposals to:

• Establish an ‘emergency committee’ to assess health threats and outbreaks and recommend responses.
• Establish a ‘country review mechanism’ to assess compliance of countries with the various WHO recommendations / requirements regarding pandemic preparedness, which include surveillance and reporting measures. This appears to be modelled on the UN’s human rights country review mechanism. Where their internal programs are considered inadequate, countries would then be issued with requirements to bring them into compliance, on the request of another State party (country).
• Expand the scope for the WHO DG and Regional Directors to declare public health emergencies and instruct border closures, interruption and removal of rights to travel and potentially internal ‘lockdown’ requirements. This will remove the necessity of local country consultation, and expand the power to send teams of WHO personnel to countries to investigate outbreaks, irrespective of the findings of the emergency committee.
• Reduce the usual review period for countries to internally discuss and opt out of such mechanisms to just 6 months (rather than 18 months for the original IHR), and then implement them after a 6-month notice period.

Regional Directors, of which there are 6, will be empowered to declare regional ‘public health emergencies’, irrespective of a decision by the DG.

These amendments will be discussed and voted on at the World Health Assembly on 22-28 May 2022 and may require only a simple majority of countries present to come into law, consistent with Article 60 of the WHO constitution. For clarity, this means countries such as Nuie, with 1300 people, have an equal weight on the voting floor to India, with 1.3 billion people. Countries must then signal their intent to opt out of the new amendments within 6 months.

These measures will become legally binding as articles of the IHR. Therefore heavy pressure will be applied to governments to comply with the dictates of the WHO DG and the unelected bureaucrats that comprise the organisation, and thus also the external actors who are influential in WHO decision-making processes.

Proposed WHO Pandemic ‘Treaty’

The WHO proposes a new ‘instrument’ to allow it to manage pandemics, with the force of a convention under international law. This has been formally discussed within the WHO since early 2021, and a special session of the World Health Assembly (WHA) in November 2021 recommended it go to a review process with a draft to be presented to the WHA meeting in Q2 2023.

This proposed ‘binding’ instrument or ‘treaty’ would give WHO powers to:

• Investigate epidemics within countries;
• Recommend or even require border closures;
• Potentially recommend travel restrictions on individuals;
• Impose measures recommended by the WHO which, based on the Covid-19 experience, may include ‘lockdowns’, prevention of work, disruption of family life and internal travel, and mandated masks and vaccination;
• Involve non-state actors (e.g. private corporations) in data gathering and predictive modelling to influence and guide pandemic responses, and in implementing, including providing commodities for, the response;
• Promote censorship through control of, or restrictions on, information the WHO considers to be ‘mis-information’ or ‘dis-information’, which may include criticism of the measures the WHO imposes.

It envisions the setting up of a large entity within the WHO to support permanent staff whose purpose is to undertake and enforce the above measures. This sounds very similar to the ‘GERM’ entity proposed recently by Mr Bill Gates, a wealthy US software developer with major pharmaceutical investments, who is the second largest funder of the WHO.

This proposed treaty would prioritise vertical structures and pharmaceutical approaches to pandemics, reflecting approaches by Gavi and CEPI, two organisations set up in the past decade in parallel to the WHO and concentrated on vaccine delivery and pandemic response (mainly through vaccination) respectively. The proposal would add a further bureaucracy, not directly answerable directly to any taxpayer base but imposing further requirements for support, reporting and compliance.

Process, acceptance and implementation

These two mechanisms for increasing direct WHO control of pandemics have strong backing from private sector funders of the WHO and from many national governments, starting with Western governments who adopted the draconian Covid measures. To come into practice they must be adopted by the WHA and then be agreed, or ratified, by national governments.

The proposed IHR amendments modify an existing mechanism. To prevent their adoption, sufficient individual countries will need to signal non-acceptance or reservations after the coming WHA and WHO DG’s notice of adoption –  most likely  before the end of November 2022. A simple majority of States present at the WHA voting against them at the May 2022 meeting could also reject them, but this appears unlikely.

The proposed treaty will require a 2/3 majority at the 2023 WHA in order to pass, and then be subject to national ratification by processes which vary according to national norms and constitutions.

Funding for the large increase in bureaucracy proposed to support both mechanisms will be necessary – this may be partially diverted from other disease areas but will almost certainly require new, regular funding. A refusal of countries to fund may not be sufficient, as there is considerable private and corporate interest in the treaty by entities who benefited heavily financially from the Covid-19 response and stand to benefit from an increased frequency of similar responses. Whilst pandemics are historically rare, the existence of a large bureaucracy dependent on their declaration and response, coupled with the clear gains to be made by influential funders of the WHO, raise a strong risk that the bar to declaring emergencies, and imposing human rights restrictions on States, will be far lower than before.

If accepted by the WHA, because of the mechanisms in place it will potentially be difficult for individual States not to comply unless they are particularly influential on the WHO itself. The possibility therefore arises that important States that are highly influential on the DG election may be subject to different levels of implementation compliance requirements than smaller ones. International financial agencies, such as the International Monetary Fund and World Bank, can also exert considerable pressure on non-complying states, potentially tying loans to implementation and commodity purchase, as the World Bank has done for the Covid-19 response.

The most likely scenario for preventing the adoption of the two new mechanisms is for populations in democratic States – who have the most to lose in terms of autonomy, sovereignty and human rights –  to stimulate open debate, leading to national governments rejecting the treaty at the WHA, and/or otherwise refusing to ratify it in sufficient numbers to make the treaty and IHR amendments unworkable.

Useful reference documents

WHO constitution: https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
IHR 2005: https://www.who.int/publications/i/item/9789241580410
WHO IHR proposed amendments: https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_18-en.pdf
EU and proposed WHO treaty: https://www.consilium.europa.eu/en/policies/coronavirus/pandemic-treaty/
WHO WHA Nov 21 Special Session draft report: https://apps.who.int/gb/wgpr/pdf_files/wgpr5/A_WGPR5_2-en.pdf
WHO (EURO) influenza pandemic definition: https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/pandemic-influenza
WHO ‘zero draft’ of proposed pandemic treaty: https://apps.who.int/gb/wgpr/pdf_files/wgpr9/A_WGPR9_3-en.pdf
Review of WHO pandemic definitions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127275/
Unicef on harms from public health response:
https://www.unicef.org/rosa/media/13066/file/Main%20Report.pdf
https://data.unicef.org/covid-19-and-children/
IFF harms from public health response: https://www.globalfinancingfacility.org/emerging-data-estimates-each-covid-19-death-more-two-women-and-children-have-lost-their-lives-result
BIS on health impact of economic harms: https://www.bis.org/publ/work910.htm