After 29 million deaths, the world seems to have learned nothing

The director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has earned the reputation of a disciplined representative of the United Nations, restrained in form and language.

That is why he attracted so much attention when, a few days ago, he described the negotiations of the new multilateral pandemic agreement as “a torrent of fake news, lies and conspiracy theories.”

A potential failure for which future generations “may not forgive us.”

After 29 million deaths, a generational trauma and a billion-dollar bill that we will deal with for decades, the main health authority on the planet said, the international community seems to have learned nothing.

Any serious analysis of this process justifies Ghebreyesus's alarm.

With less than 16 weeks left for the World Health Assembly, which should approve an agreement that until recently seemed indisputable, the differences between rich and poor countries, the distortion of the geopolitical context and the greedy interference of private interests threaten to pulverize two years of negotiations and leave the multilateral system defenseless against the next pandemic.

A simple glance at the ProMED alert chart should be enough to remind us what is at stake.

This program of the International Society for Infectious Diseases has been working since 1994 to gauge and address the risk of emerging pathogens and infectious vectors that could lead to much larger problems.

If you consult the cover of its website you will see a world map full of red and orange indicators that suggest that health risks derived from viruses and bacteria are as real a threat as in February 2020, although we hardly talk about it.

One of the best indicators of the transience of political priorities is that ProMED itself is struggling to stay financially afloat.

If, in the throes of a pandemic, the international community is unable to understand why we need a good epidemiological surveillance system, how can we expect it to prepare for other health risks?

If, in the throes of a pandemic, the international community is unable to understand why we need a good epidemiological surveillance system, how can we expect it to prepare for other health risks?

After all, infectious diseases are not our only concern.

Extreme natural phenomena - such as uncontrolled fires, droughts or floods resulting from climate change -, conflicts or biochemical and radioactive accidents can put the most sophisticated health systems on the ropes.

The nuclear episodes, without going any further, were typical of a cinematographic dystopia before the wars in Ukraine and the Middle East, but today they constitute a real scenario for which we are forced to prepare in a very similar way to what we would do for other emergencies. sanitary.

In this context, the multilateral agreement on pandemics contains a symbolic and political burden that multiplies the value of its contents.

The text that is being negotiated covers a broad spectrum of the preparedness and response system: from epidemiological surveillance and models for sharing information to the resilience of health systems, including access to biotechnological innovation, coordination between public actors -private and public communication.

All of them are complex territories in which the international community has demonstrated a very large margin for improvement.

The main difficulties for the agreement are concentrated in two minefields of global health: the control of knowledge and the distribution of available resources.

For the global South, correcting the deep inequities and inefficiencies of the Covid-19 response will only be possible if the North facilitates the distributed production of diagnostics, treatments and vaccines.

Also if the financing of any response is based on the principle of differentiated common responsibilities that is already applied in other negotiations, such as climate negotiations.

For the North – and its influential pharmaceutical sector – reconsideration of intellectual property rules is almost anathema, as much as the introduction of mandatory financial commitments.

In 17 OECD countries, the health budget effort had fallen in 2022 to levels similar to or lower than those of 2019

The disinterest of the richest in the multilateral agreement reflects deeper problems.

While experts churn out reports warning about the possibility of new health cataclysms, governments' commitment to preparedness and response systems appears to be fading.

In 17 OECD countries, health budgetary effort had fallen in 2022 to levels similar to or below those of 2019. The new Pandemic Fund of the WHO and the World Bank – one of the few tangible consequences of this catastrophe – has received from donors only 1,600 of the 10,000 million dollars (about 9,300 million euros) requested for a first relevant preparedness and response effort in low- and middle-income countries.

We risk setting a dangerous precedent.

The most worrying thing about the evaluations of the response to covid-19 in many countries is not the circus of lies, abuses and incompetence that they have been uncovering, but a surprising lack of interest in learning from mistakes.

And in this Spain is no exception.

Although the State Public Health Agency will see the light of day very soon - which must organize preparation and response actions, among other functions -, the Government has not yet approved a Global Health Strategy that determines our priorities in this essential debate, as Yes, the EU and several surrounding countries have done so.

In Parliament, this issue seems to have lost all electoral

sex appeal

: of the 459 initiatives related to health issues in 2023, less than a dozen made direct reference to preparation for future health risks.

Meanwhile, the evaluation of the National Health System's response to the pandemic, which was commissioned in 2021 by independent experts, took a year and a half to arrive and ended up in a drawer for eight months, to be quietly published in December 2021. last year without any apparent consequences in the public debate.

Ignoring the recommendations of this report would be as serious a mistake as trying to impose particular interests in the negotiations for a multilateral agreement on pandemics.

In both spaces, the fundamental role of health systems is emphasized, starting with primary care and public health services, and the need to correct serious deficiencies in administrative coordination, the flow of information or the institutional and legal framework.

Multinational mechanisms are called upon, such as the Pandemic Fund or, in the European case, the new Health Emergency Preparedness and Response Authority (HERA).

The need for fairer and smarter mechanisms to develop, produce and distribute vaccines and other essential products is emphasized.

And we warn against a fragmented approach that ignores the deep interconnections between the health of people, the planet and other beings that inhabit it.

This is not another leaden debate about an obscure international agreement.

Nor can it be a bargaining chip in the geopolitical game.

Negotiations to regulate the global response to a pandemic should be fueled by the memory of those we saw suffer and die.

That is the standard that citizens must establish for their representatives.

As the authors of a letter signed by fifty scientific, political and social leaders alarmed by the state of the negotiations point out, “a new pandemic threat is inevitable, but a new pandemic is not… if we act now.”

Gonzalo Fanjul

is director of policy analysis at the Barcelona Institute for Global Health. 

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