The Problems of Post COVID-19 International Solidarity and Collaboration Revealed at the 74th World Health Assembly (WHA)

The first unknown pneumonia cases were identified in Wuhan, China, in December 2019.1 Since then, the virus has rapidly spread to many regions, and about 3 months after, coronavirus disease 2019 (COVID-19) was declared a pandemic by the Director-General of World Health Organization (WHO) on March 11, 2021.2 WHO's delayed response to COVID-19 created confusion and distrust worldwide,3 and the WHO's role and governance in the global community is losing strength due to political confrontations between superpowers, such as the US and China.4 Through experiencing several new infectious diseases over the past decade, WHO urged countries to implement health-related recommendations and obligations such as the International Health Regulations (IHR) (2005). However, there are a growing number of countries not complying with the regulations due to lack of financial and human resources5 and insufficient national core capacity.6 Therefore, the need to strengthen the implementation of IHR (2005) is being raised.

The 74th World Health Assembly (WHA), held from May 24 to May 31, 2021, highlights two main factors to prepare for and respond to new infectious diseases such as COVID-19 in the future; 1) strengthening the WHO's role and governance, and 2) strengthening the implementation of the IHR (2005). The purpose of this article is to introduce strategies for strengthening the WHO's role and governance discussed at the 74th WHA and suggest directions to improve the limitations in implementing of IHR (2005).

Although the outbreak of zoonotic diseases has become more frequent worldwide, WHO has become underpowered due to its limited capacity to validate national reports of a public health crisis and lack of resources that need to be deployed in local areas by WHO.7 In the long run, these problems have limited WHO and made predicting a potential pandemic, such as COVID-19, more difficult. The key strategies and directions to strengthen the WHO's role and governance to prepare for and respond to the outbreak of new infectious diseases can be summarized as follows.

The 74th WHA decided to establish the Member States Group on Strengthening WHO Preparedness and Response to Health Emergencies. This Working Group will submit a report that prioritizes the benefits of establishing a WHO convention, agreement, and other international instruments for future pandemic preparedness and response. The findings will be reviewed at the special session of the Assembly, which will be held from November 29th to December 1st in 2021.8

The resource mobilizing is one of the WHO's core functions.9 The country-offices can be financed by subsidies supported through cooperation with bilateral partners such as the Global Vaccine Alliance (GAVI). These grants are gradually increasing the WHO's budget.

WHO needs more active collaboration with various national and international partners, including bi- and multilateral agencies at government, academia, community, civil society, and national levels.9 A close cooperation between country offices and bi- and multilateral partners can serve as an opportunity to develop further partnerships at national levels.

The main problems and limitations of the IHR (2005) were specifically discussed in the provisional item 17.3 of the 74th WHA10: lack of core capacity by countries to detect, monitor, and analyze a public health crisis; lack of digital notification and alert systems in countries, which delays a reporting of disease outbreaks; absence or lack of national focal points (NFPs) at country offices; and lack of appropriate risk assessment tools to accurately measure a public health crisis. Moreover, WHO does not have the authority to impose legal sanctions for countries that do not comply with the IHR (2005).

The major amendments of IHR (2005) were guided at the 74th WHA11; 1) needs to provide a clear guidance and tools for countries through regional and country-offices to work collaboratively with partners and States Parties, 2) needs to develop a stronger and scientific evidence-based IHR (2005) monitoring and evaluation framework to increase the accuracy of assessment and reporting on national capacity.

First, in order to effectively prepare for and respond to the next pandemic, WHO needs to secure sustainable budget through various financial channels and to use this budget more flexibly. While considering political and diplomatic confrontation between the US and China, WHO's financial problems will not be solved in a short-term period. WHO may request the Member States to increase the annual voluntary contributions, but simultaneously, WHO needs to expand multilateral ODA (official development assistance) projects to secure financial resources through country or regional offices. Of the WHO programmes that include various health topics, these projects can provide financial benefits coupled with bilateral ODA projects supported by major developed countries, multilateral banks, non-governmental organizations, or private companies. For example, the Asian Development Bank (ADB) and WHO made a grant agreement for prevention and control of Avian Flu in Asia and Pacific region in 2018,12 and recently has developed the online platform with Ban Ki-Moon Foundation to prepare for and respond to COVID-19 and future pandemics.13 Although the expansion of multilateral projects through WHO may not be a fundamental solution to WHO's financial problems, it could support developing countries to solve or alleviate an urgent public health crisis, such as COVID-19, more effectively. Such a project can be derived as a project outcome led by the WHO with sustainable financial support. Also, the Independent Panel suggests to establish a new international pandemic financing facility which could deliver a long-term contribution for 10 to 15 years to ensure a comprehensive pandemic preparedness and response.3

Second, despite the fact that the COVID-19 pandemic has formed the international implications for the need of strengthening the IHR (2005), a decision on developing a new international treaty has remained debatable. While the Director-General of WHO, the European Council, and some Member States proposed a new treaty rather than amendment to the IHR (2005), other Member States proposed to strengthen the existing regulations. The Independent Panel proposed the establishment of Global Health Threats Council consisting of high political leadership which has legitimate authority for ensuring a pandemic preparedness and response at national, regional, and global levels.3 Also, the Panel suggests a Framework Convention to reinforce legal obligations and norms for the Member States and international organizations.

In conclusion, COVID-19 is still widely spreading all around the world and WHO needs to urgently make a decision on either developing a new treaty, WHO convention, or strengthening the implementation of the IHR (2005), including the issues on vaccine governance. A mechanism to increase the distribution of vaccines for developing countries could include an increase of financial support for the COVAX facility and GAVI through a WHO programme supported by Member States and multilateral agencies. WHO cannot solve an international public health crisis alone; it certainly requires international solidarity and cooperation. The world needs to make an effort for better preparedness and response to the next pandemic along with strengthening the role and governance of WHO.