Nina Schwalbe, the founder of the public health think tank Spark Street Advisors, has held senior leadership positions at the vaccine alliance Gavi, Unicef and USAID, where she was inaugural director of the Biden administration’s COVID-19 Vaccine Access and Delivery Initiative. Elliot Hannon is senior researcher at Spark Street Advisors.
Within weeks, as cases spread into the capital, the outbreak grew into a crisis.
This cycle of state denial and downplaying, followed by disaster, is commonplace in public health, and the consequences, as the covid-19 pandemic showed, spread far beyond individual states. A new global pandemic treaty can strengthen the system of how we prepare for and respond to health emergencies. But the only way to interrupt this pattern is to create an independent check that is honest about the system’s performance and is not afraid to call out power politics.
The early language of the WHO’s new pandemic accord is already repeating the mistakes of the past. The working draft of the agreement released last month explicitly treats the idea of compliance as an afterthought. That approach is a mistake and won’t generate the oversight the world needs.
This week, countries are meeting to continue negotiations on the accord. There is a simultaneous effort to shore up the existing set of rules for pandemic preparedness and response, known as the International Health Regulations. Those rules, which are legally binding in 196 states, require states to build the capability to detect, report and respond to public health events within their territories and notify WHO when an outbreak could cross borders.
But assessing compliance with these rules relies largely on states’ self-reporting. If states lag or misrepresent their data, there is no mechanism to call them out, much less compel compliance. A new pandemic accord faces this same challenge. If states do not do what they signed up for, the world will be just as unprepared for a pandemic as it was for covid-19.
To make the accord more than aspirational, it must confront these questions of accountability and compliance head-on. The most straightforward mechanism to see whether states are “walking the walk” is an independent monitoring body that would check whether states adhere to treaty conditions.
There are many examples of strong independent monitoring mechanisms in the international system: The Human Rights Council tracks compliance with human rights obligations; the International Atomic Energy Agency monitors peaceful use of nuclear energy; and the International Monetary Fund keeps an eye on states’ economic policies to ensure monetary stability. Each mechanism ensures its success by monitoring the timeliness, completeness and robustness of states’ reporting.
To replicate this success with the pandemic accord, we recommend — based on an extensive literature review and interviews with more than 40 experts around the world — establishing an independent monitoring committee fire-walled from the WHO. The committee’s primary function should be to identify cases of inadequate state reporting and noncompliance with the accord. The body should consist of independent experts serving in personal capacities, each for a limited period to help maintain the authority and independence needed to hold powerful actors accountable.
While the WHO has a vital role to play in supporting states on pandemic preparedness and response, it has often struggled to call out bad behavior publicly as it seeks to maintain good relations with member states. The committee, therefore, needs to report to a higher authority than the WHO, such as the U.N. General Assembly, a “Global Health Threats Board” or the U.N. secretary general.
The monitoring committee’s power to publish its findings would promote public accountability. The accord should also specify a formal follow-up mechanism to create social pressure and reputational risk, both of which are proven tools for compliance for other treaties.
Because reporting requirements can be onerous, particularly for states with limited resources, the committee would rely primarily on existing data and reports to avoid creating an additional burden for states. But when states’ self-reporting is questionable or insufficient, the committee should be empowered to verify and triangulate the data through alternative sources and confidential reports, including from civil society and social media. Like existing human rights treaties, it should also have a formal process of soliciting independent input from experts.
Such a system would have a better chance of securing compliance than the threat of imposing sanctions, which are typically a protracted, politically fraught and, in a pandemic context, counterproductive to the needs of at-risk populations.
That is why the establishment of an independent monitor must be central to the accord talks. Without accountability for inaction, the accord — no matter how well-conceived or well-intentioned — will repeat the avoidable mistakes of denial and neglect that enabled the covid-19 pandemic. The world deserves better.