Do we need stricter international health rules to end the pandemic? 

World Health Organization's Executive Board meeting in Geneva in February 2020. Keystone / Salvatore Di Nolfi

Most countries were unprepared for the Covid-19 pandemic and only sporadically implemented World Health Organization (WHO) recommendations. As the virus risks becoming endemic, what are the next steps? Some world leaders and the WHO have suggested an international pandemic treaty. Experts and the WHO disagree on whether the approach is realistic.

Last March, WHO Director-General Tedros Adhanom Ghebreyesus, along with several world leaders and international agencies, called for an international pandemic treatyExternal link  to encourage collaborative action.

Among those that supported the call were French President Emmanuel Macron and German Chancellor Angela Merkel.

The new agreement, named “Treaty for pandemic preparedness and response”, would ask states to cooperate in the fight against pandemics nationally, regionally, and globally. The objectives include prompt data sharing on new infectious diseases and better response mechanisms to develop new vaccines and treatments.

The Swiss Federal Office of Public Health (FOPH) told SWI swissinfo.ch that “Switzerland is participating in the first reflection”. Some countries like the US, Russia and China were absent from the initiative.

The call comes after an apparent lack of leadership arose from the Covid-19 pandemic, with the WHO’s recommendation consistently overlooked by national states.

The Independent Panel for Pandemic Preparedness and Response (IPPPR), established by WHO in 2020, reported the pandemic was “preventable”. To date, the pandemic has spread to 200 countries, contaminated over 159 million people and caused more than 3.3 million deaths.

In its final reportExternal link, the IPPPR points its finger at countries which were late in introducing containment measures and failed to get ahead of the pandemic. But they are only part of the problem. The report also says WHO holds its part of responsibility. The WHO’s International Health Regulations (IHR) also caused a delay in early response, the IPPPR said. The panel added that the IHR are “a conservative instrument as currently constructed and serve to constrain rather than facilitate rapid action and that the precautionary principle was not applied to the early alert evidence when it should have been”.

The International Health Regulations (IHR)

IHRExternal link are the existing legally binding framework last revised in 2005 by the WHO’s Member States. It addresses public health emergencies like COVID-19 to improve the global response.

IHR provides guidelines for states. These include prohibitions on unnecessary interference with international travel and trade, notification of risk events and review sanitary measures to manage a pandemic. But there is an absence of data analytical platforms and coordination mechanism among states, and between WHO and states.

On 30 January in 2020, WHO chief Tedros has declaredExternal link Public Health Emergency of International Concern (PHEIC) based on IHR but WHO did not recommend any border restrictions.

It said, “The formal notification and emergency declaration procedures under the International Health Regulations, however, were much too slow to generate the rapid and precautionary response”. The IPPPR finds that the current system at both national and international levels is “not adequate” for disease outbreaks and calls for a new global system for the future.

The new treaty proposed by WHO aims at just that. But given the current situation, and with states still following individual policies, professor Suerie Moon and professor IIona Kickbusch of the Global Health Center at the Graduate Institute Geneva both sayExternal link such a global pandemic treaty is “ambitious”.

“A treaty must intertwine self-interest and material factors within a flexible framework of shared principles and goals if the world is to live up to this exceptional window of political opportunity to prevent future pandemics,” they wrote in the Lancet Public Health journal.

Discord on travel and masks

Nothing illustrates the lack of global cooperation better than the lockdown policies and travel restrictions implemented by states without any global concertation. Going against WHO recommendations under IHR , China was the first to impose a strict lockdown in the city of Wuhan in January 2020 for more than two months. Severe restrictions on the mobility of nine million residents were put in place. Following in the footsteps of Wuhan, all major Chinese cities also shut themselves down.

However, WHO has arguedExternal link that travel restrictions usually have significant economic and social implications and, in the end, that they “did not prevent the importation of the disease”.

“Travel restrictions might slow the spread of infection in the early stages of a pandemic, but it is not optimal to use travel restrictions to stop the eventual overall spread of pandemic infections,” says Keiji Fukuda, an expert in Influenza Pandemics and former WHO Assistant Director-General. A travel restriction is “a temporary and tactical step for a country to buy time to prepare its systems and to enact basic infection prevention and control measures like social distancing, masks and testing”, he said.

Research has proved that in hindsight, the travel restrictions were not such a bad move. Many have kept them in place to this day.

“The travel quarantine introduced in Wuhan on January 23, 2020 only delayed epidemic progression by three to five days within China, but international travel restrictions did help to slow the spread elsewhere in the world until mid-February.” concluded research by the US academic journal ScienceExternal link.

Masks are another topic that no one can agree on. The debate is raging once again after the US Centers for Disease Control and Preventions (CDC) announcedExternal link that fully vaccinated people against Covid-19 no longer need to wear masks or implement social distancing.

Meanwhile, WHO has recommended caution when lifting the obligation to wear masks. The organisation advises people to wear masks in areas where the infection is spreading, even after being vaccinated.  

Yet just over a year ago, WHO said that healthy people needn’t wear face masks if they don’t have symptoms. That view changed in June 2020, when Tedros advised the general public “to wear masks where there is widespread transmission and physical distancing is difficult”.

Subjective analysis of data

One of the issues WHO is facing is that preventive measures during a pandemic are usually based on available scientific evidence and anecdotal experiences. These change over time.

Another is interpretation of data and what constitutes a health risk by member states. Countries impose measures depending mainly on health, social and economic concerns. They take into account epidemiological thresholds such as newly reported Covid-19 cases per 10,000 people and local hospital capacity. These differ greatly between countries.

This subjective interpretation of data continues as countries are now leaving lockdowns. For instance, the European Commission proposesExternal link to ease travel restrictions for vaccinated people towards summer. Meanwhile, many Asian countries are now introducing stricter travel and social distancing measures due to the spread of the Indian variant. In some countries, simply arriving from India or not wearing a face mask properly can lead to fines or jail.  

As Covid-19 enters its second year, experts warn the world will just have to learn to live with the virus, implying better global cooperation is still very much relevant. Vaccinations alone won’t be enough to stop the virus circulating.

“There is a high chance that Covid-19 will persist indefinitely as an important human infection like influenza,” Fukuda warns.

Jagan Chapagain, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC), sees an international treaty as “an opportunity to reassess how we can guarantee a more effective and equitable approach to future crises”.

“We need bold new solutions – both in international and domestic laws – to avoid the same mistakes,” he argues.  

Since immune protection against Covid-19 is likely to go down over time and new variants of the virus will continue to appear, there is a very high chance that individuals will need repeated vaccinations against  Covid-19. The mutant strains of the virus are more infectious, making it difficult to fight the virus with vaccines alone. Some countries have reported infection cases even after being vaccinated against Covid-19. WHO chief scientist Soumya Swaminathan says “vaccine is not 100% effective against preventing infection”.

WHO member states will discuss these issues at the annual World Health Assembly, the organisation’s highest governing body, starting on May 24.