The Stocking Report, the evaluation of the WHO’s response to Ebola, was released yesterday. The report is very critical of the WHO, and calls for a number of reforms. It also requests that the “High-Level Panel on the Global Response to Health Crises should…identify procedures to take specific health matters to the United Nations Security Council and consider incentives and disincentives needed to improve global health security.”
When I joined the Centre for Policy Research, my colleague Sebastian von Einsiedel, drawing on his work for the 2004 High Level Panel on Threats, Challenges and Change, said that he worried about pandemics. I was not persuaded. But over the last year, I have realized how wrong I was.
I have been persuaded, in part, by this piece by Bill Gates. But in the margins of the World Humanitarian Summit and the reviews of Peacekeeping and Peacebuilding, as I have looked at responses to sudden-onset crises and tried to match that to the scale of any potential pandemic… it is clear that the panel is right and that we are simply not equipped.
Here is the worry. Ebola was not a serious pandemic. It had a low R0 – the number of infections expected based on one initial infection – and it was in countries that have weaker international links than many others. The response was not great (see here for the failure of the international aid system, and here for the failure of the US military). In total, over 11,000 people died – which is horrible, but also 140 times fewer than the number that die of tuberculosis every year. Bill Gates’ pandemic model for a Spanish Flu-like epidemic suggests 33 million people dead in less than a year.
So what could be done? I have no idea, whatsoever, about the medical side of response. But over a decade working on conflict-response has taught me that (a) everything costs money; and (b) nothing happens until the money starts flowing. So I want to make a few proposals here that could provide the international system with a financial and legal infrastructure to rapidly respond to a pandemic.
This draws on a two pre-existing instruments:
The response of a global pandemic could follow two basic pathways:
There is a prior step that is required, which is for the General Assembly to pass an enabling resolution that sets up the architecture, today, prior to an actual pandemic. Such a resolution would need to:
An alternative pathway that relies on the Security Council exists. But the Council has had difficult prior discussions on the issue of pandemics, and the politics around the issue do not appear to be conducive for the Council to set up the mechanisms outlined above. But, in theory, one could also foresee a process that unfolds as follows:
The necessary precursor would be for the Security Council to adopt a resolution, now, that declares pandemics (or PHIECs) a threat to peace and security, and requests the SG to conducts steps (B) to (D) above. It would also need to specify the language in a series of operative clauses that would mandate the SG to take these measures as required. But although the instinct might be that the Council is a better option, given the threat of pandemics, the General Assembly has the right level of universality for a pre-planned response such as this.
Perhaps the right format to prod the GA into action would be a meeting where Bill Gates could present the Gates Foundation’s pandemic models, and MSF could draw its stark lessons from the Ebola response. Rumour has it that Chancellor Angela Merkel is particularly exercised about the systemic risk that Ebola exposed, the support of a few key Member States to see this process through would need to accompany the leadership of the Secretary-General.
The next phase, which is more technical and more difficult, is the negotiation of a response plan. My worry is that what we currently see are negotiations around what should happen without adequate attention to both the resource mobilization and the need for political will/legitimacy. This proposal – flawed as it may be – seeks to address that gap prima facie, so that we can all concentrate on figuring out how to respond.