The COVID-19 pandemic exposed nations’ social and political discordance, highlighting the stark realities of fragilities and inequalities. In the process, the World Health Organization (WHO) was captured in the poly-crisis whirlwind of political, conflict, financial turmoil, and climate crises. The lack of compliance with International Health Regulations (IHR) and cooperation among nations for pandemic preparedness and response have been considered to have led to policy and action paralysis. Dr Tedros Adhanom Ghebreyesus, WHO Director-General responding to the crisis opined that the health sector alone should be responsible for the preparedness, prevention, and response activities. To prepare countries for future pandemics, the WHO launched the Preparedness and Resilience for Emerging Threats Initiative, or PRET which aimed to employ shared learning by incorporating tools and approaches established during the COVID-19 pandemic. However, a concerted and collaborative approach from governments and societies to overcome the inherent weakness of global health governance in the context of pandemic preparedness and response is required. In this regard, reaching a consensus on the long-due Pandemic Prevention, Preparedness and Response Accord, which intends to address the issues of finance, access, and technology transfer, for prevention and preparedness of future pandemics is imperative. With World Health Day, observed on 7th April, going with the theme of “My Health, My Right”, the discussions on the Pandemic accord are critical to advance health as a priority and intrinsic of human rights for all citizens without any discrimination.
While the pandemic highlighted the gap in public health preparedness and response strategies globally, the Fragile and Conflict-Affected States (FCAS) where the population while being in an active conflict or its recovery faced the disproportionate impact of the pandemic. In regions already burdened with conflict, inequalities, grievances, and political instability, they have a high burden of diseases with 70 percent of the epidemic diseases, 53 percent of deaths in children under the age of 5, and 45 percent of infant deaths. The dearth of essential services and goods, disruption of medical supply chains, and attack on health infrastructure, medical professionals, and patients, make it difficult to address health challenges in FCAS. The chronic and protracted conflicts hampering the FCAS have resulted in the exhaustion of their domestic as well as international resources required for an effective response during public health emergencies. Thus, there is a need for both immediate and long-term recovery strategies in the form of humanitarian assistance and foreign aid provided by international organizations, development partners, and multilateral forums to support the multitude of needs in such settings.
The ever-increasing gap between disposable funds and humanitarian requirements in the region due to volatility and uncertainty is one of the major barriers to building a resilient health system. A lack of appropriate accountability mechanisms also hinders the ability to shift from planning to implementation and successful delivery of critical services such as healthcare. For instance, the fragmented and fragile health systems across the Eastern Mediterranean Region (EMR), experienced disproportionate inequities during the COVID-19 pandemic. Healthcare being a critical sector, has faced threats during conflicts, leading to further deterioration of key infrastructure such as the availability of hospital beds and trained professionals for healthcare. One of the essential components needed by individuals to sustain themselves is a functional healthcare system that has adequate infrastructure, health professionals, and services, which face a threat due to prolonged violence. In this circumstance, a pandemic accord can enable the FCAS to navigate health crises by facilitating the support system it requires amidst adversity.
Ensuring equal availability of medical tools and supplies such as vaccines, therapeutics, and diagnostics in FCAS could be one of the major avenues that the new accord could intervene. Building and maintaining medical stocks is another strategy that if guided through the pandemic accord could help prepare and respond to health emergencies. Managing these medical products by international organizations could help cater to unanticipated shortages of supply while ensuring equitable access during multiple outbreaks. Additionally, there is a need to promote health as a right to all individuals, which is also the 2024 World Health Day theme. Involvement of various stakeholders at the local, national, and regional levels to work towards building resilient health systems that can enable access to quality health services that are equitable and efficient. The political will at the country level along with international collaboration could help build the sustainable capacities required to attain Universal Health Coverage (UHC), health security, and tackle the environmental, social, and economic factors that have a detrimental influence on health.
Health emergencies like a pandemic require a tailored preparedness plan based on the socio-political, socio-economic, and health infrastructure status. COVID-19 was a critical juncture that exposed global politics by highlighting that most of the existing governance mechanisms could not implement balanced, uniform, and proportionate public health measures. However, the negotiations surrounding the pandemic treaty and IHR reforms, face the challenge of overcoming geopolitical competition and systemic rivalry, which threatens to jeopardize the effective formulation and implementation of policy priorities. The amplified geopolitical tensions across the world have the potential for furthering nationalist policies on supply-chain dependencies, production of vaccines, and medical equipment which can be detrimental to global health governance. This situation of power imbalances and intense competition necessitates dialogue, deliberation, and push for the application of international diplomacy for health which can play a critical role in the implementation of complex health programs through multisectoral partnerships and facilitate better response strategies. Integrating health in foreign policies and dialogue can also aid states in supporting sustainable development as it promotes viewing challenges in health as a both social and economic issue that requires collective actions.
The threats to public health witnessed during the COVID-19 pandemic established clear reasons for global action. A pandemic accord is a critical tool for safeguarding the collective future and preventing the recurrence of a polycrisis. However, with states either engulfed in conflicts, armed warfare, or trade wars, it has hampered the progress of the pandemic talks and delayed its conclusion. These fractious discussions have started to raise questions about the possibility of adopting the accord during the World Health Assembly (WHA) at a time when stronger international cooperation is required. In his book, ‘Why Bharat Matters’, External Affairs Minister of India, Dr S Jaishankar, reiterated the need for cooperation to overcome the challenges related to supply chains and global governance triggered due to the pandemic. Hence, reaching a consensus on a pandemic accord amidst geopolitical and systemic rivalries is critical for the protection from future pandemics and to validate that international cooperation can deliver collective, effective, equitable, and pragmatic solutions to mitigate global threats.
[Photo by IAEA Imagebank, CC BY 2.0, via Wikimedia Commons]
Aniruddha Inamdar is a Research Fellow at the Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education.
Kiran Bhatt is a Research Fellow at the Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE) Manipal Karnataka India.
Prof Dr Sanjay Pattanshetty is Head of the Department of Global Health Governance and Coordinator of the Centre for Health Diplomacy at Prasanna School of Public Health Manipal Academy of Higher Education (MAHE) Manipal Karnataka India. The views and opinions expressed in this article are those of the authors.
