Global accountability to prevent pandemics
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The impetus for the creation of the Panel for a Global Public Health Convention came from the publication of a research study titled “A Global Public Health Convention for the 21st Century” in the Lancet Public Health journal in 2021. The Panel continues to evolve and iterate upon these recommendations in response to real-time developments in the global public health security landscape.
This study was conducted by the University of Miami under the leadership of Prof. José Szapocznik Ph.D., with the support of the AIDS Healthcare Foundation. After the research team gathered and analyzed input from 29 leading public health experts, it distilled this information into a list of 10 recommendations on what a new global public health security convention would need to best prevent, prepare and respond to infectious disease outbreaks and pandemics.
Methods
Data were collected using semi-structured individual interviews with 29 experts in the fields of global health, public health, economics, infectious diseases, epidemiology, politics and government, law, or medicine. Data were analyzed using qualitative content analysis of themes and categories, which were further organized into the recommendations.
Recruitment involved identifying experts who were published in the field of global public health security or had held relevant positions of responsibility in their countries or in international agencies. The investigators sought diversity among participants across fields of study, occupation, regional representation, and professional roles in global health security. Individuals were sent a recruitment letter inviting them to share their views and opinions on how best to achieve global health security.
From the interviews, the authors distilled ten recommendations:
Authorize one or more agencies to coordinate pandemic prevention, preparedness, and response globally—across regions, countries, and subnational jurisdictions.
Grant this public health agency (or agencies) the authority to lead countries to act and collaborate around a global vision for collective health. This agency or agencies would:
Give the global public health system—and its governing agency or agencies—the capability to flexibly and rapidly respond to a range of possible public health security threats and scenarios.
Plan for, mobilize and deploy resources for infectious disease outbreaks, pandemics, and other possible public health security threats. Be flexible in approach to meet the diverse needs of countries at different stages of infectious disease response.
One agency must be designated to be the singular authoritative source for information, data, and technical assistance and to communicate a clear and compelling message to the world.
Continue to support WHO as the agency that creates and communicates preparedness and response standards for the world without undue political interference. Communicate compelling, evidence-based, authoritative, consistent information when needed. Particularly in a public health emergency, when situations and data are emerging and uncertain, countries need clear expectations for public health security policies, benchmarks, and activities.
Build the capacity to objectively evaluate countries on their progress in achieving requirements and the capability to remediate identified deficiencies.
Objectively monitor each country’s progress and compliance in meeting outbreak/pandemic preparedness and response requirements. Monitor progress independently rather than relying on countries to report progress themselves. Make the evaluations publicly available to ensure transparency and promote compliance. Require remediation when there are gaps in countries’ readiness or response and assist countries in achieving compliance.
The evaluation of progress in preparedness and response should be conducted objectively and externally. Evaluation should not rely extensively on countries self-evaluation as is the case now. Guide and support countries toward desired outcomes rather than using evaluation as a mechanism for punitive measures.
Equip a pandemic prevention, preparedness and response governing body (or bodies) with appropriate enforcement mechanisms. These may include substantial incentives for countries to cooperate and/or sanctions for noncompliance.
No global public health agreement today includes adequate mechanisms to enforce compliance.
To promote global accountability, reward compliance with tangible, robust benefits, such as financial aid or technical assistance in pandemic prevention and preparedness; support and guidance through pandemic response; and access to data, information, and public praise. Specifically, low- and many middle-income countries require financial support to properly prepare and respond to outbreaks and pandemics, and to avoid economic repercussions when reporting an outbreak.
Non-compliance might be addressed with public reprimands, economic sanctions, or denial of travel, trade and tourism benefits, for example. Rely heavily on incentives but employ sanctions when and if necessary, considering varying levels of access to resources and capabilities. There is a need to involve countries and civil society in exploring and identifying just incentives and disincentives that are commensurate with countries’ needs and global risk, respectively.
Empower the governing body to work collaboratively across global borders, while maintaining the ability to make independent decisions. When a governing body is funded primarily by voluntary financial contributions from select member states, like the WHO is, it becomes vulnerable to political influence and limited in its ability to make difficult decisions that might affect donors.
Autonomy of a governing body would allow independent, evidence-based decision-making, in the best interest of global public health – free from conflicts of interest or pressure from participating entities.
Global public health efforts have never been adequately funded. Global pandemic prevention agencies must have sovereign control of sustainable financial resources and enduring, annual funding to:
Sustainable and independent financing could be achieved through a combination of compulsory and voluntary member state contributions; taxes on global private industry or international trade; and/or a permanent endowment from philanthropies, private companies and countries.
Empower the governing body to work collaboratively across global borders, while maintaining the ability to make independent decisions. When a governing body is funded primarily by voluntary financial contributions from select member states, like the WHO is, it becomes vulnerable to political influence and limited in its ability to make difficult decisions that might affect donors.
Autonomy of a governing body would allow independent, evidence-based decision-making, in the best interest of global public health – free from conflicts of interest or pressure from participating entities.
Governance could be achieved through regional or rotating representative members. For a global public health security system to succeed, the major global economic powers, such as the USA and China, should be involved. A body with of nearly 200 governing members is too unwieldy to rapidly and flexibly respond to emerging threats. A nimbler governing body that may not include all countries at all times, will be required.
The governance system must be transparent and accountable across every level of decision-making and action, including open data sharing, thorough public independent evaluations of countries’ levels of preparedness and compliance, and accurate reporting of infectious disease incidence and outcomes.
Public health activities must be reflected in the core functions of an entire national government, not solely the agencies responsible for health.
Participating stakeholders must include the private sector, philanthropic organizations, non-governmental organizations, local governments, and academia. Local public health sectors typically responsible for prevention, preparedness and response-related activities must be engaged alongside national governments responsible for determining participation in international agreements.
For a global public health system to work, individual countries must cede some degree of authority to a global governing body. Every member must commit to shared sovereignty over regulatory and enforcement processes and accept interventions necessary to protect worldwide public health, as well as the penalties of noncompliance. National laws must institutionalize public health security practices and core public health capacities to make them sustainable through legislation, allocation of resources, training of personnel, and employment of preparedness and response strategies.