In mid-November 2021, a medical researcher in South Africa spotted an unusually large set of mutations in a handful of coronavirus samples. Worryingly, the identification of the mutations coincided with an uptick in Covid-19 cases in a local region, which had already experienced high levels of infection. Concerned about the upsurge, the head of a South African genomic surveillance network launched a wider investigation. Within 36 hours, his team had confirmed the widespread distribution of the variant, worked with the South African government to make a public announcement, and notified the World Health Organization (WHO), which the next day classified Omicron as a variant of concern.
In one way, the discovery of Omicron showed the system of global public health working effectively in the fight against Covid-19, given that it quickly identified and publicized a new and threatening mutation. But the story of Omicron also underlined the persistent international divisions that have marked the world’s response to the pandemic. When many countries put in place travel bans targeting southern African countries, it amplified the perception in Africa that the rich world was only looking out for itself. “We are honestly tired of this” – Tulio de Oliveira, leader of the team that detected Omicron, told an interviewer – “after not having access to vaccines, having to pay more expensive prices, having to get in the back of the queue, and still doing some of the best science on Covid in the world.” While it seems that Omicron may have originated in the period before vaccines were developed, the variant focused attention on the threat of further mutations among unvaccinated populations around the world.
Two years into the pandemic, many medical experts believe that at least some parts of the world may soon escape the acute phase of the outbreak. The WHO’s Europe Director, Hans Kluge, said in January 2021 that it was plausible to think that Europe was “moving towards a kind of pandemic endgame”. A combination of testing, vaccines, and over-the-counter antiviral treatments could allow countries that have access to these countermeasures to resume something like normal life. But many nations continue to be held back by shortages of vaccines and by their limited capacity to distribute and administer the supplies they have. Some countries fear, too, that the distribution of promising new antiviral medication will follow the same unequal pattern as vaccines, with wealthy states monopolizing initial supplies.
At the global level, the greatest remaining challenge of the pandemic is in ensuring that all countries have the resources they need to contain Covid-19. But states should not see the campaign against the SARS-CoV-2 virus as a one-off effort. Instead, given that the virus is likely to become endemic and that it is only a matter of time before there are further outbreaks of highly transmissible diseases, the world needs to improve the way in which it prepares for and responds to health emergencies more broadly. The catastrophic impact of Covid-19 and the weaknesses in global cooperation on public health it revealed have led to a series of high-level reviews and a slew of recommendations for change. Intensive international negotiations under the auspices of the WHO are under way to decide how these suggestions should be put into practice. And the subject is also on the agendas of the G7 and the G20 meetings this year.
What is the best way to improve global cooperation against Covid-19 and prepare for future pandemics? To answer this question, one needs not only to assess the failures exposed by Covid-19 but also to understand the political concerns and agendas that shape states’ policies on global health. Of course, global institutions, agreements, and processes have an impact on how states behave – but, at the same time, national political considerations impose limits on the reforms to the global health system that they are willing to sign up to and affect the way they interpret those commitments in practice. The world’s response to the pandemic has been defined both by national interests and geopolitical rivalries. Yet the effort to promote a more cooperative global approach to health emergencies should not be defeatist in the face of these interests. Rather, it should try to supersede and harmonize states’ interests as far as possible.
In this context, the European Union and its member states need to follow a twin-track strategy to promote multilateral cooperation on global health and pandemic preparedness in a world of growing geopolitical competition. The union should try to preserve and work through universal membership organizations as far as possible, while engaging in deeper cooperation with like-minded states. The EU should work both to strengthen the WHO and to support moves by like-minded powers to increase funding for national healthcare systems and health surveillance capacity around the world. The EU has an interest in strengthening the WHO as a technical and norm-setting body, but it should also recognize the limits imposed by the WHO’s universal membership and consensus-based approach. It is especially important to move quickly to take advantage of governments’ heightened attention to global health issues and an administration in the United States that shares at least some of the EU’s goals.
It will be difficult, if not impossible, to persuade all states to accept stronger commitments to transparency and inspections given the intense political considerations that public health involves. Similarly, the EU’s cherished project of a new pandemic treaty will be difficult to negotiate; the most important provisions of such a document are likely to bind only a sub-set of states. Above all, the EU needs to do more to support global equity in access to medical technology and expertise to fight epidemic diseases, particularly by increasing vaccine manufacturing capacity and the availability of vaccines in Africa and other parts of the global south. The best way to improve international cooperation on public health is through a new and open global compact. In this arrangement, countries around the world would commit to step up health surveillance and share information about potential outbreaks, while wealthy states would increase their investment in health systems and take steps to ensure a more equitable distribution of medical goods.
There is an urgent need to improve the system for international cooperation on the threat of Covid-19 and in preparation for future pandemics. The EU should move ahead on priority areas of global health with its most relevant partners rather than wait for a universal agreement on a comprehensive package. The union’s central goal should be to create a compact between the most scientifically advanced countries and the developing world, in which a commitment to share information on emerging threats and accept robust inspections of healthcare systems is matched by offers of funding for improved preparedness and much greater transfers of knowledge and technology.
The EU and the African Union could work together to develop such an approach. But this would require the EU to go much further in promoting effective partnerships between European and African pharmaceuticals companies. At the same time, the EU could cooperate with its partners in the G7 and the G20, particularly the US and the UK, to agree to a broader framework for sharing technology, knowledge, and access to epidemic countermeasures. The union should also work with the US to balance support for a new pandemic fund and increase assessed contributions to the WHO, with a globally representative body overseeing the new fund’s decisions. This approach provides the best chance to improve the world’s capacity to manage Covid-19 and respond to the next pandemic.
‘Health of Nations: How Europe Can Fight Future Pandemics’ — Policy Brief by Anthony Dworkin — European Council on Foreign Relations / ECFR.
