ith every news article about the outbreak of a new illness, the world is on the edge of its seat. Global leaders are anticipating the next pandemic—and this time they hope to be better prepared. The World Health Assembly has appointed an Intergovernmental Negotiating Body (INB) to design an international pandemic agreement. The agreement will aim to shore up the world’s preparedness and cooperation for the next global health crisis, but the INB disagrees on the best mechanism to ensure cooperation while still respecting member states’ sovereignty.
The O'Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health (FNIH) stepped in—pooling together experts in health, trade, and diplomacy to address these concerns. Their recently published report highlights the advantages and limitations of existing international treaties at addressing sovereignty and enforcement.
Lessons from the WHO’s Existing Treaties
The report notes two possible routes for the World Health Organization (WHO) to create a pandemic preparedness convention. It may create agreements that member states opt into or out of. The organization’s members are never forced to adopt a treaty, but an opt-out agreement may lead more states to participate purely because opting out takes effort.
Still, this condition does nothing to ensure compliance. The WHO’s International Health Regulations (IHR)—the most significant public health preparedness agreement in effect today—allows states to use their domestic infrastructure to meet convention requirements and recognizes some of the unique challenges states may have in complying, depending on their national government systems. Unfortunately, these sovereignty protection measures have made implementation slow and irregular. A 2005 amendment sought to increase transparency and accountability, but states continue to present information in ways that protect their reputation at the expense of the other WHO member states.
The Framework Convention on Tobacco Control (an opt-in WHO treaty) has been more successful than the IHR. The treaty has both obligations and recommendations, giving countries the freedom to choose which policies to adopt. Member states also receive guidance from the Framework Convention’s Secretariat. The Secretariat is governed independently, allowing it to work with international and non-governmental organizations. The WHO itself is limited in its ability to work with non-state actors, so the Framework’s structure is strategic. Mimicking the Framework could be useful for pandemic prevention, but the Framework Convention is extremely slow-moving, with some negotiations lasting as long as a decade—far too long to address public health crises.
Shopping for the Best Watchdog Mechanism
In light of the strengths and limitations of the IHR and the Framework Convention, the O’Neill Institute and FNIH report underscored the importance of having both an advising body and a surveillance system. The challenge is to determine how to incentivize countries to comply without being too centralized. The report looks to existing treaties for inspiration. These treaties reveal what has worked and what has not in managing the sovereignty-accountability trade-off.
The World Trade Organization (WTO) is successful in both guiding and regulating states. Its dispute resolution mechanism holds states accountable for noncompliance, and specific WTO agreements guide governments on compliance measures, too. But environmental treaties have revealed states’ aversion to ceding regulatory intervention to an external body. We see this with the evolution of climate agreements: the Paris Agreement is a dispersed system as opposed to the former centralized Kyoto Protocol.
Similar to a pandemic, maritime and nuclear treaties address issues that transcend political borders. What’s more, their monitoring mechanisms are less centralized than trade treaties. The Boundary Waters Treaty between the United States and Canada turns to a jury of three Canadian and three U.S. representatives to settle disputes. In the event of a tie, a neutral party makes the ultimate decision. The Convention on Nuclear Safety relies on a peer-review system. In the pandemic setting, states could peer-review outbreak assessments or state’s healthcare capacities.
Human rights treaties have weaker enforcement mechanisms, but nongovernmental organizations can increase public awareness of noncompliance and pressure governments to respect treaties as a result. Nongovernmental organizations’ campaigns may motivate individuals to stage protests or bombard noncompliant governments with letters that demand change. These actions—especially when the media catches on—deliver powerful blows to countries’ reputations. As such countries must work with local media and other communication outlets to build trust. An international pandemic treaty cannot function when citizens are skeptical of its legitimacy or effectiveness.
The Treaty Cannot be One Size Fits All
To effectively prepare for the next pandemic, the treaty must account for regional variation. Diseases manifest differently depending on the weather, climate, immunities of populations, and infrastructure of countries. The world expected COVID-19 to ravage the African continent, yet death rates from the virus remained far lower in Africa than the rest of the world. While this is partly due to weaker data collection, data from obituaries and morgues show that the pandemic was truly less catastrophic—likely because of the continent's relatively young population. Now African governments are wondering if their resources are best spent on COVID-19 vaccination campaigns when malaria, HIV, tuberculosis, and malnutrition remain the continent’s leading causes of death.
To adapt to local differences, countries should cooperate regionally in a pandemic. Luckily, a number of existing regional multilateral cooperation treaties are prepared to do so. For instance, the Association of Southeast Asian Nations adopted an Agreement on Disaster Management and Emergency Response after the 2004 Indian Ocean Tsunami. It now considers pandemic-response as one of its roles.
While the final WHO treaty and INB recommendations may be different, the report from the O'Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health has important items for policy makers to consider. The convention can adopt a strong guidance and dispute resolution mechanism like the WTO, or it may imitate the peer-review system of the Convention on Nuclear Safety. No matter what, the pandemic convention must emphasize regional cooperation and national communication. With these needs met, it will be easier to motivate states to comply with treaty rules.
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How to Ensure International Cooperation for the Next Pandemic
Photo by Martin Sanchez via Unsplash.
July 27, 2022
Millie Brigaud reviews the O’Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health report on recommendations for a new pandemic response treaty. What can be learned from other treaties?
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ith every news article about the outbreak of a new illness, the world is on the edge of its seat. Global leaders are anticipating the next pandemic—and this time they hope to be better prepared. The World Health Assembly has appointed an Intergovernmental Negotiating Body (INB) to design an international pandemic agreement. The agreement will aim to shore up the world’s preparedness and cooperation for the next global health crisis, but the INB disagrees on the best mechanism to ensure cooperation while still respecting member states’ sovereignty.
The O'Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health (FNIH) stepped in—pooling together experts in health, trade, and diplomacy to address these concerns. Their recently published report highlights the advantages and limitations of existing international treaties at addressing sovereignty and enforcement.
Lessons from the WHO’s Existing Treaties
The report notes two possible routes for the World Health Organization (WHO) to create a pandemic preparedness convention. It may create agreements that member states opt into or out of. The organization’s members are never forced to adopt a treaty, but an opt-out agreement may lead more states to participate purely because opting out takes effort.
Still, this condition does nothing to ensure compliance. The WHO’s International Health Regulations (IHR)—the most significant public health preparedness agreement in effect today—allows states to use their domestic infrastructure to meet convention requirements and recognizes some of the unique challenges states may have in complying, depending on their national government systems. Unfortunately, these sovereignty protection measures have made implementation slow and irregular. A 2005 amendment sought to increase transparency and accountability, but states continue to present information in ways that protect their reputation at the expense of the other WHO member states.
The Framework Convention on Tobacco Control (an opt-in WHO treaty) has been more successful than the IHR. The treaty has both obligations and recommendations, giving countries the freedom to choose which policies to adopt. Member states also receive guidance from the Framework Convention’s Secretariat. The Secretariat is governed independently, allowing it to work with international and non-governmental organizations. The WHO itself is limited in its ability to work with non-state actors, so the Framework’s structure is strategic. Mimicking the Framework could be useful for pandemic prevention, but the Framework Convention is extremely slow-moving, with some negotiations lasting as long as a decade—far too long to address public health crises.
Shopping for the Best Watchdog Mechanism
In light of the strengths and limitations of the IHR and the Framework Convention, the O’Neill Institute and FNIH report underscored the importance of having both an advising body and a surveillance system. The challenge is to determine how to incentivize countries to comply without being too centralized. The report looks to existing treaties for inspiration. These treaties reveal what has worked and what has not in managing the sovereignty-accountability trade-off.
The World Trade Organization (WTO) is successful in both guiding and regulating states. Its dispute resolution mechanism holds states accountable for noncompliance, and specific WTO agreements guide governments on compliance measures, too. But environmental treaties have revealed states’ aversion to ceding regulatory intervention to an external body. We see this with the evolution of climate agreements: the Paris Agreement is a dispersed system as opposed to the former centralized Kyoto Protocol.
Similar to a pandemic, maritime and nuclear treaties address issues that transcend political borders. What’s more, their monitoring mechanisms are less centralized than trade treaties. The Boundary Waters Treaty between the United States and Canada turns to a jury of three Canadian and three U.S. representatives to settle disputes. In the event of a tie, a neutral party makes the ultimate decision. The Convention on Nuclear Safety relies on a peer-review system. In the pandemic setting, states could peer-review outbreak assessments or state’s healthcare capacities.
Human rights treaties have weaker enforcement mechanisms, but nongovernmental organizations can increase public awareness of noncompliance and pressure governments to respect treaties as a result. Nongovernmental organizations’ campaigns may motivate individuals to stage protests or bombard noncompliant governments with letters that demand change. These actions—especially when the media catches on—deliver powerful blows to countries’ reputations. As such countries must work with local media and other communication outlets to build trust. An international pandemic treaty cannot function when citizens are skeptical of its legitimacy or effectiveness.
The Treaty Cannot be One Size Fits All
To effectively prepare for the next pandemic, the treaty must account for regional variation. Diseases manifest differently depending on the weather, climate, immunities of populations, and infrastructure of countries. The world expected COVID-19 to ravage the African continent, yet death rates from the virus remained far lower in Africa than the rest of the world. While this is partly due to weaker data collection, data from obituaries and morgues show that the pandemic was truly less catastrophic—likely because of the continent's relatively young population. Now African governments are wondering if their resources are best spent on COVID-19 vaccination campaigns when malaria, HIV, tuberculosis, and malnutrition remain the continent’s leading causes of death.
To adapt to local differences, countries should cooperate regionally in a pandemic. Luckily, a number of existing regional multilateral cooperation treaties are prepared to do so. For instance, the Association of Southeast Asian Nations adopted an Agreement on Disaster Management and Emergency Response after the 2004 Indian Ocean Tsunami. It now considers pandemic-response as one of its roles.
While the final WHO treaty and INB recommendations may be different, the report from the O'Neill Institute for National and Global Health Law and the Foundation for the National Institutes of Health has important items for policy makers to consider. The convention can adopt a strong guidance and dispute resolution mechanism like the WTO, or it may imitate the peer-review system of the Convention on Nuclear Safety. No matter what, the pandemic convention must emphasize regional cooperation and national communication. With these needs met, it will be easier to motivate states to comply with treaty rules.
