Three years after the WHO declared a ‘public health emergency of international concern’, the Covid-19 pandemic is still taking a dramatic toll on the world, with over 20 million deaths based on excess mortality data. The global community was wildly unprepared, and this translated into improvisation, a lack of global solidarity and flagrant violations of binding international rules.
February 2020 became a ‘lost month’ due to delays in recognising the extent of the emergency; 2021 was a ‘lost year’ in the quest for equitable access to knowledge and technology; and now we face a ‘lost decade’ for many sustainable development indicators.
The pandemic shock led to a massive domino effect, opening cracks in the multilateral order; spurring a ‘syndemic’ made up of disinformation, co-morbidities and mental distress; leading millions back into poverty and dozens of countries to the edge of bankruptcy; pushing health workers into burnout and the whole world into recession; and paving the way for an age of ‘permacrisis’.
Yet there is no sign that the global community has learnt the many hard lessons the pandemic has to offer, and this does not bode well for the future. But the EU can – and should – take a leading role to ensure that global health remains firmly on the global agenda.
Not all doom and gloom… but a mixed bag nonetheless
Faithful to the mainstream view that pandemics spiral into cycles of panic and neglect, political leaders have rapidly moved onto new priorities, notably Russia’s invasion of Ukraine, geo-economic struggles on batteries and semiconductors, and the ghost of stagflation.
Meanwhile, vaccination rates in many countries remain stunningly low. The new wave of (wildly under-reported) infections in China provides new, vivid evidence of dysfunction in coordinating global health emergencies. And while leaders in Davos mentioned between meetings that the world is not ready for the next pandemic, the reality is that we can’t even manage the current one.
To be fair, the global community is trying to react. After several attempts to delegitimise its role (notably by the Trump administration), and despite persistent under-reporting from China, the WHO is now back in the driving seat as the pivotal institution. A new Pandemic Accord will be negotiated during 2023, with agreement found on its legal basis and main scope.
Recently, the WHO put forward ten proposals to strengthen health preparedness and response, including the creation of a Global Health Emergency Council and a committee on emergencies in the World Health Assembly; the strengthening of the health workforce; the standardisation of national preparedness plans; and stronger coordination between finance and health ministers. A strong push from the United States and Europe led to the establishment of a ‘Pandemic Fund’ managed by the World Bank.
Yet without major additional reforms and political commitment, this is unlikely to turn back the tide.
The zero draft of the Pandemic Accord so far pays lip service to the idea of enforceable commitments, more inclusive governance and global solidarity. Likewise, the Pandemic Fund has so far only raised a meagre USD 1.4 billion, a tiny fraction of the (anyway insufficient) USD 10.5 billion a year deemed necessary to strengthen global pandemic preparedness.
The Fund also leaves little space for civil society organisations (two seats out of 21 on the board) and is meant to be complemented by national resources that several countries are unlikely to be able to afford. When it comes to delivering aid, things are even less clear – expectations raised by COVAX have been frustrated by a persistent lack of funding. Consequently, the 70 % vaccination target was spectacularly missed.
Even more importantly, many of the proposed solutions appear to be tailored to Covid, in a manifestation of the oft-evoked streetlight effect. Global leaders are solving the last pandemic, rather than taking a more future-oriented view. This requires a broader, smarter and fairer agenda.
This agenda would be one that approaches health holistically, and animal, environmental and human factors are consistently assessed under a One Health approach. It would be an agenda where health is mainstreamed into all policies as part of the sustainable development goals. And it would use technology in a meaningful and coordinated way.
Some key recommendations for policymakers
In a new study, a group of CEPS researchers have analysed the problems that emerged during the pandemic, as well as their root causes. We find that current proposals are a partial answer to the former, and leave the latter largely unaddressed. We propose ten additional areas of action, which if undertaken would greatly improve global health governance.
These include: (1) introducing health-oriented conditionalities in the international financing of low and middle-income countries; (2) promoting ‘pandemic clauses’ for countries in (or close to) financial distress; (3) strengthening multi-stakeholder partnerships by involving regional authorities and civil society; (4) creating an international task force for pandemic prevention and/or inspections on biosafety compliance; (5) deepening research into social infrastructures to strengthen policy effectiveness; (6) carrying out globally coordinated foresight, modelling and simulations; (7) securing the availability of better and more granular data, leveraging trustworthy Artificial Intelligence for prevention, preparedness and response; (8) strengthening global R&D cooperation; (9) taking the global ‘infodemic’ seriously by containing the spread of disinformation and promoting trust in science; and (10) adopting a ‘maximin’ principle, by choosing policies that are fit for the poly-crisis age we find ourselves living in, and as such prioritise the avoidance of worst-case scenarios.
It’s time for the EU to rise as a global health champion
But will the world find the courage and energy to draw and reckon with the lessons of the pandemic?
Niccolò Machiavelli is credited with having first said that the opportunity offered by a good crisis should never be wasted. For Covid-19, the odds are increasingly high that the crisis will indeed be wasted.
25 years ago, a book by Jared Diamond told the long history of humanity as inextricably linked to germs (infectious diseases), guns (wars) and steel (industrial power).
As global leaders turn their attention from germs to guns and steel, the EU is perhaps the only global actor that can credibly commit to keeping health under the spotlight. As such, the recently proposed EU Global Health Strategy is the world’s best bet against the still very real danger of disease-induced chaos.