Building a new health framework

COVID-19 will not be our last pandemic. 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 COVID-19 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.

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-middleincome 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.

Third, we need to devise and implement better systems and tools for multisectoral health surveillance. Already, the World Health Organization has begun building such tools.

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.

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.