In a world where microscopic pathogens — which know no borders — can topple national economies and threaten human security, multilateral approaches are paramount. No matter how effective any single country’s pandemic prevention efforts are, they are only as good as those in the countries with the worst of such plans. Think of Ebola. Guinea, Liberia and Sierra Leone — all exceptionally poor countries — had inadequate resources and planning to contain the virus, turning an epidemic into a pandemic.
Given that covid-19 has vividly illustrated how a pandemic can do as much destruction as a war, building global institutions that enable us to combat public health threats just as we address geopolitical ones — picture a public health U.N. Security Council — is key to preventing such damage in the future.
This goes against Americans’ traditional instinct to “go it alone,” or work bilaterally with selected countries. But when it comes to public health and infectious disease, a new model that prioritizes international collaboration is necessary. In short, global public health demands a grand strategy, something that has long been at the heart of American diplomatic and military efforts.
This is not a new idea, but American leadership in it would be. After World War I, the Health Organization of the League of Nations convened to coordinate international collaboration on infectious diseases such as leprosy and malaria and do big-picture thinking about drug development, standardization and exchange across borders. Nationalists and isolationists in the U.S. Congress, however, refused to support American participation.
A quarter-century later, the WHO was established to foster international collaboration on public health. Again, the United States remained ambivalent, despite playing a role in spearheading the United Nations.
In fact, in 1948, when the WHO convened, the American delegates literally did not have a seat at the table. Instead, they were seated in the public gallery because Congress had emphasized placing reservations on ratifying the WHO constitution, privileging national autonomy over international cooperation. Ironically, it was N.A. Vinogradov, the deputy minister of public health from the Soviet Union, who spoke in favor of accepting the United States for membership — perhaps understanding that viruses and other public health menaces didn’t care about superpower rivalries.
In the past 75 years, U.S. support for multilateral collaboration with other WHO members has ebbed and flowed. U.S. backing has been particularly strong in efforts to tackle infectious diseases such as smallpox, polio and malaria. It has been less engaged in multilateral WHO efforts to mitigate broader social and economic threats to health.
Yet, even one of the United States’ most consequential global public health interventions, President George W. Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR), which is credited with saving more than 18 million lives, showed the limits to a nationalist approach to pandemics.
PEPFAR, overseen by a dedicated Office of the U.S. Global AIDS Coordinator and Health Diplomacy in the State Department, worked with seven U.S. agencies and departments to make a sustained commitment of money, know-how and leadership.
Nonetheless, PEPFAR was imperfect, thanks to the continued U.S. reluctance to promote international or multilateral institutions and planning. The Bush administration implemented PEPFAR largely through bilateral collaborations in which Congress held the reins — setting targets and dictating strategies (such as abstinence) that could garner support on both sides of the aisle.
Crucially, PEPFAR failed to forge a blueprint for fighting future pandemics. While it partnered with organizations and programs, such as the Joint U.N. Program on HIV/AIDS, it was a one-off, largely done “the U.S. way,” without any agreement or obligation for future collaboration in battling pandemics.
This failure to create stable infrastructure reflected the inability to see the need to treat public health like geopolitical matters — in need of a grand strategy that supports institutions, organizations and planning on a global scale. The consequences of this approach have become clear during the covid-19 pandemic. Mitigating the damage of pandemics requires lightning-fast action and intense collaboration, which were absent in January and February 2020, during the crucial, early days of the pandemic.
Even the historic and successful race to develop effective coronavirus vaccines revealed just how necessary it is for international collaborations to more effectively deploy science, research, development and public health expertise in the collective interest. For the vaccine to be maximally effective in stopping the spread of the coronavirus, it requires global coordination to guarantee the manufacturing and uptake of vaccines across all countries (not just those that are wealthy or more closely allied).
Such an effort would be easier and quicker if the proper international institutions and plans already existed. Even so, the United States has a chance to correct the mistakes of the past. Notably, an empowered WHO — with the robust backing of the United States but also China, Russia, the European Union and other major powers — could monitor, unearth and share information more rapidly, foster preventive capacities and enable non-pharmaceutical and pharmaceutical interventions to be produced and distributed more equitably.
A set of common principles and best practices applied by a consortium of countries would minimize the risk of viruses jumping from animals to humans through wet markets, the melting permafrost or deforestation that places wildlife in closer proximity to humans. Such collaboration would also allow for coordinated travel limits to minimize spread when new viral threats arise and combining forces to develop vaccines quickly and distribute them broadly.
We have seen the world community come together to eradicate smallpox and to halve malaria deaths in the 25 most-at-risk counties since 2000. But we also have seen how the failure to think big and exercise foresight produced a disaster in the ongoing pandemic that has caused historic levels of death and destruction and necessitated economic interventions that no nation can sustain regularly.
The stakes are high, but so are the consequences of inaction.
The effectiveness of the WHO, as the public health arm of the United Nations, is only as strong as its member countries’ commitment in the fight to prevent future pandemics. As covid-19 demonstrated, racing the clock to play catch-up in combating a pandemic carries a massive cost. Embracing the lessons of the past can prevent this race and leave the world better positioned to minimize the damage done by the next covid-19.