LENIAS HWENDA: Quo vadis international co-operation to mitigate pandemics post Covid-19

The World Health Organization’s (WHO) executive board convening on January 30 was an opportunity for African countries and others to reflect on where the world should go after the failures of the Covid-19 pandemic.

The Covid-19 pandemic gave us a good look at the state of international co-operation as a means to limit the spread of pandemics and their impact on the global economy. It was not a pretty sight.

The world had two existing international accords the purpose of which was to guide a collective global response to disease outbreaks of international concern. The International Health Regulations (IHR) and the Pandemic Influenza Preparedness (PIP) Framework. Both accords failed to fulfil this purpose during the Covid-19 pandemic and other pandemics before that.

Over the coming decades disease outbreaks in Africa are expected to increase in frequency and severity. In an era of multiple crises where rising government debt, geopolitical risks, a climate crisis and concurrent health crises with global ramifications converge, where does international co-operation on outbreak control go from here?

More international accords to save humanity

The WHO legislative body, the World Health Assembly, thinks it has a clear solution: craft a new pandemic treaty to protect the world from infectious disease crises such as the Covid-19 pandemic. The new accord, aptly named the Pandemic Treaty, is currently under negotiation. It will be an add-on to the two existing international accords that have already failed multiple times. It is expected to augment the IHR by strengthening pandemic prevention, preparedness and response.

Why would a new pandemic treaty work where the existing treaty failed? The existing international accords have repeatedly failed to drive a unified global response to disease outbreaks of international concern for three principal reasons. Existing accords were too technical, their expectations were unrealistic, and they lacked adequate safeguards against noncompliance for political expediency.

According to a former World Bank development expert Olusoji Adeyi, “If you have an accord that is based on expectations of normative behaviour, it is unlikely to pass a real-life stress test because in real life, individuals and governments do not behave according to norms. They respond to incentives – economic and political incentives.” The Covid-19 pandemic lacked such incentives. So did other past pandemics.

The IHR-2005 provides no incentives to compel countries to perform even the most basic function of accurately and promptly reporting disease outbreaks. This is made worse by the fact that countries that report outbreaks are sometimes penalised for alerting the world to a new threat. For example, when SA reported the Omicron variant European and North American countries immediately shut out travellers from Southern Africa and many other parts of the world.

Adeyi explains: “What incentive is there for a country to accurately and promptly report a disease outbreak if the government knows it’s going to become an international pariah and people are going to shut the door to its nationals?” In early 2023 we may be seeing the ramifications of this. The WHO is lamenting that too few countries are reporting genomic data to track viral evolution and the emergence of new variants globally. It is likely that other countries took SA’s experience as a warning to them.

Misalignment of incentives and expectations

The Covid-19 pandemic graphically illustrates that when incentives are not aligned with the normative expectations of treaties and other international accords, they are likely to fail. For example, existing international accords require that countries keep their borders open. They also proscribe hoarding of diagnostics, treatments and vaccines during a pandemic. However, under political stress leaders often choose to ignore those requirements.

Inevitably, such requirements fail because the WHO does not have the power to compel sovereign nations to keep their borders open. Nor can it stop them buying more vaccines than they need. In this respect international accords are setting themselves up to fail by setting impractical goals that are not enforceable. This raises the question whether it is realistic to expect that a new treaty could become the solution to the catastrophic failures of a global Covid-19 pandemic.

The geopolitical reality is this. Ultimately, no revision of any treaty is going to change the fundamental reality of geopolitics. Geopolitical power dynamics are a potent force. When they come into play they render treaties useless and irrelevant. Powerful countries do as they please, leaving weaker countries at the mercy of lethal diseases. This is exactly what the Covid-19 pandemic showed us, and not for the first time. Powerful governments ignored the IHR Treaty and the PIP Framework.

Why? Because they could. Following the accords was not politically expedient. National interest came first and global solidarity second. Only when national interests were secured did countries take a solidarity stance. It is an infallible logic, one that is hard to question. The bottom line is that treaties alone aren't going to cut it. Not when the underlying power structures and power imbalances persist. Under such circumstances the odds of success of any subsequent treaties remain low.

National interest versus global solidarity

What does this tell us? It tells us that the visceral geopolitical reality is that national interest always comes first and global solidarity is an abstract concept. There are few exceptions to this. One is when solidarity yields significant economic rewards. None of this is new. World leaders have always known this. The Covid-19 pandemic merely amplified the flaws we already knew existed. Leaders parroted the rhetoric of global solidarity to protect everyone everywhere while doing the opposite. Covid-19 was a manifestation of the exact same behavioural pattern seen in every pandemic in recent memory.

Countries hoarded vaccines, diagnostics and therapeutics. They banned exports of medical products. They bought medical products including vaccines far in excess of quantities they needed to effectively protect their populations. Nothing was left for weaker countries to buy. Countries refused to share their excess stocks until they were about to expire. Then they offered near-expiring products as donations to weaker countries, often with such little warning that the recipient countries could not use them within the tight timelines.

When this happened the donors took this as proof of the incompetence of weaker countries. One may marvel at such a display of stoic heroism by donors. This is not solidarity. The unspoken truth in all this is as brutal as it is unpalatable. Lives of people in weaker countries hold less value than those in powerful countries.

In this case, what good can new accords do? Given the benefit of the doubt, could they enable the old ones to work better in the current geopolitical environment? Countries are increasingly abandoning the principles of globalisation in preference for nationalistic sentiments. For example, at the time of writing EU capitals are anxious about a large and aggressive US green subsidy package worth $370bn that threatens to harm Europe’s industry and economy.

At the World Economic Forum in Davos, when Financial Times chief foreign affairs commentator Gideon Rachman asked President Ferdinand Marcos of the Philippines what the most pressing question on his mind was, his answer was this: “Would geopolitics derail globalisation?” He is not the only global leader worried about this.

Globalisation and the world’s shared vulnerability to disease

Some analysts believe globalisation is dying. If globalisation dies, solidarity dies with it. After all, the shared vulnerability to disease arising from global connectedness was always the most persuasive argument for health co-operation. As inequality gaps widen while power dynamics persist, how will emerging economies like those in Africa survive the existential threat of more frequent and more severe pandemics and greater demand for medical products when current needs are not being met in the decades ahead? After all, the efficiency of any health system depends on the availability of quality safe medical products and the international system is as strong as its weakest link. Quo vadis international health co-operation against pandemics?

As countries confront the compounding effect of geopolitical risks, the climate crisis and the concomitant health crises, international accords will not save them. African economies are staring at a debt crisis and debt default abyss that will affect their ability to invest in strengthening health systems. They are on their own and must find creative ways of mitigating their significant vulnerability. Accepting the unvarnished truth, that national interests take precedence over solidarity and that no-one is coming to save them is a good place to start.

The second step is to carefully choose what should be their priority. Devoting energy and resources towards crafting ineffective solidarity tools like international treaties have as much chance of working in the current geopolitical reality as those that already exist. A more prudent use of the resources of emerging economies would be to work together to fix things that are within their power.

For example, to invest their own money to make health systems more resilient and collaborating with the private sector to create an environment in which private investors are willing to invest, for instance in the production of medical products on the African continent, would improve supply security in the face of a climate-driven growing burden of disease.

Finally, countries should minimise relationships that lock them into dependency, because what is easily given is easily taken. Beyond the rhetoric of co-operation and solidarity, the reality is every nation for itself and so African nations should be asking themselves what they can collectively do for themselves instead of what international health accords can do for them.

Hwenda is founder and CEO of Medicines for Africa.