Building a Better Global Health Framework

By Tedros Adhanom Ghebreyesus

GENEVA – It is incredible to think that when the last Paris Peace Forum was held, in November 2020, no COVID-19 vaccine had yet been approved. A year later, more than seven billion doses have been administered, preventing countless deaths and helping to turn the tide of the pandemic in many countries. But this scientific triumph is being overshadowed by the failure to ensure that all people benefit from it.

At the time of writing, more than one-third of the world’s population is fully vaccinated. But in Africa, that share is just 6.7%. This is unacceptable, and we must urgently change it. Any threat to global solidarity is a threat to global security and stability.

All governments have a responsibility to protect their own people. But the failure of some governments to share crucial resources – including information, biological samples, and tools including vaccines, tests, and other supplies – has deprived their counterparts in many low- and lower-middle-income countries of the ability to fulfill that mandate.

The COVID-19 pandemic will not be our last. That is why, as we recover and rebuild from this crisis, we must also take steps to ensure that we can meet future disease outbreaks with effective cooperation and collaboration, instead of the kind of chaos and confusion that have exacerbated the current one.

The global response to the COVID-19 pandemic has been the subject of much analysis. And there have been many recommendations for measures that would enable us to detect the next disease outbreak early, and either prevent it from becoming an epidemic – let alone a pandemic – or ensure a rapid and effective response. In all of these reviews and reports, four themes stand out.

First, global governance must be made more inclusive, equitable, and accountable. The existing global health-security architecture is complex and fragmented, and voluntary mechanisms have not produced the necessary level of collective action.

That is why I advocate the creation of a new international instrument, such as a treaty, to guide pandemic preparedness and response. By providing an overarching framework for global cooperation, including clear rules of the game, such a mechanism could boost solidarity among countries significantly. The World Health Organization’s member states will discuss this initiative this month, at a Special Session of the World Health Assembly.

Second, we need more and better financing for pandemic preparedness and response. That includes a substantial increase in domestic investment, as well as far more international financing to support low- and lower-middle-income countries. Crucially, any financing facilities must be built via existing financial institutions; creating new ones would fragment the global health architecture further. Moreover, such mechanisms should not be funded solely by voluntary development assistance, which would intensify competition for already scarce resources. Rather, we propose a Health Threats Fund to pool additional resources, which could be established at the World Bank as a Financial Intermediary Fund, and financed by countries and regional organizations on a burden-sharing basis.

Third, we need to devise and implement better systems and tools for multisectoral health surveillance. Already, the WHO has begun building such tools. On September 1, we inaugurated the new WHO Hub for Pandemic and Epidemic Intelligence in Berlin, which will provide the world with better data and analytics to support the detection of, and response to, public-health emergencies. I then had the honor of joining French President Emmanuel Macron in Lyon to celebrate the groundbreaking ceremony for the WHO Academy, which will use cutting-edge technologies to expand access to high-quality, lifelong learning for the world’s health workers.

Other initiatives are in development, such as the WHO BioHub, a facility for storing and sharing pathogens in Switzerland, and the Universal Health and Preparedness Review. Modeled after the Universal Periodic Review used by the United Nations Human Rights Council, the UHPR will make use of peer review to increase accountability and transparency among WHO member states as they identify gaps and build capacity for pandemic preparedness and response.

Finally, we need a strengthened, empowered, and sustainably financed WHO at the center of the global health framework. With 194 member states and 152 country offices, the WHO stands out for its global mandate, reach, and legitimacy. But over the last several decades, it has been progressively weakened by a debilitating imbalance between assessed (compulsory) contributions and voluntary, earmarked contributions. This distorts our budget, thereby constraining our ability to attract and retain top talent and to fulfill our member states’ expectations.

The COVID-19 pandemic has highlighted the critical importance of global health security. The further weakening of the WHO, and the further fragmentation of the institutional framework of global health, are among the greatest risks to such security. The world must now invest in an organization that truly represents and works for the health of all countries.

In the coming months and years, other crises will inevitably demand our attention. But we must not lose sight of the importance of bolstering global health security. If the world continues down its current path, our health will only deteriorate – with devastating economic and political consequences. But if we embrace new ideas and work together in solidarity, we can build a future that is healthier, safer, fairer, and more peaceful.

Tedros Adhanom Ghebreyesus is Director-General of the World Health Organization.