The World Health Assembly just closed its doors with disappointing results: an effective prevention plan to address future pandemics requires full recognition of linkages between human health, animal and plant health, and environmental factors, i.e., the One Health approach
by Richard Seifman – Former World Bank Senior Health Advisor and U.S. Senior Foreign Service Officer
June 7, 2024
The just completed 77th World Health Assembly (WHA) took action or made progress on some international health matter agenda items:
- International Health Regulations amendments
- Antimicrobial resistance (AMR) resolution approval which the United Nations General Assembly will take up in September; and
- Global Action Plan and Monitoring Framework for infection prevention and control (IPC)for 2024–2030.
While this is to be welcomed and marks definite progress in the right direction, it is important to note, as Mariana Mazzucato, a world-known economic expert recently put it, that preventing or responding to future pandemics will require aligning health, economic, social, and environmental policy objectives.
She reminds us that at the WHA, the Health ministers vote. But their perspective is not enough; what is needed is a more comprehensive international and whole-of-government approach.
From a One Health perspective, there are another three existing major global elements that have critical roles to play:
1) The Pandemic Treaty is a “work in progress or process,” with its future core question being whether any more time will allow greater consensus and ultimately a comprehensive and implementable treaty;
2) The Global Pandemic Monitoring Board (GPMB) is a high-level policy body whose latest report contains a strong aspirational statement by experts, but it is without power:
3) The Pandemic Fund is a new financing mechanism established by international entities, funded by multiple external donors, and housed at the World Bank to focus on pandemic prevention preparedness and response.
Even with approvals at the World Health Assembly and the three described above, and despite efforts and intentions by many governments, institutions and civil society organizations, it is not enough.
Any full agreement on ways to deal with the massive risks and costs of pandemics seems distant. Any future effort will need to significantly increase focus on the interface between human health and that of animals, plants, and the environment, i.e., One Health. Many governments, institutions and civil society organizations demonstrate good intentions and even announce policies to address future pandemics, but all this won’t be enough if the One Health approach is not fully adopted and systematically applied.
A closer look at the Pandemic Treaty, GPMB, and the Pandemic Fund
1) The Pandemic Treaty
After more than two years of multiple meetings with hundreds of international experts and officials, long discussions, and many drafts, these intensive negotiations did not end in an Agreement.
Below is the draft that was put before the Assembly but was not approved. It does mention One Health and yet — this is to be noted — One Health was not considered among the major obstacles to adoption.
Article 5. One Health
- “The Parties commit to promote a One Health approach for pandemic prevention, preparedness and response, recognizing the interconnection between people, animals and the environment, that is coherent, integrated, coordinated and collaborative among all relevant organizations, sectors and actors, taking into account national circumstances.
- The Parties commit to identify and address the drivers of pandemics and the emergence and re-emergence of disease at the human-animal-environment interface through the introduction and integration of interventions into relevant pandemic prevention, preparedness and response plans.
- Each Party shall, in accordance with its national context, protect human, animal and plant health, with support from WHO and other relevant international organizations, by:
- implementing and regularly reviewing relevant national policies and strategies that reflect a One Health approach as it relates to pandemic prevention, preparedness and response;
- promoting the effective and meaningful engagement of communities in the development and implementation of policies, strategies and measures to prevent, detect and respond to outbreaks; and
- promoting or establishing One Health joint training and continuing education programmes for human, animal and environmental health workforces to build relevant and complementary skills, capacities and capabilities.
- The modalities, terms and conditions and operational dimensions of a One Health approach shall be further defined in an instrument that takes into consideration the provisions of the International Health Regulations (2005) and will be operational by 31 May 2026.”
This draft language is positive, but until a Treaty is adopted or approved in some other form, it has no formal effect. It is unclear whether efforts will continue to produce a version for approval and in what time frame.
2) The Global Pandemic Monitoring Board (GPMB)
The 2023 Monitoring Framework for Preparedness was designed as a single, authoritative framework to guide the Board’s assessments of progress. It included as its first systems pillar component “One health Interface and Health Systems, which states in part …” The One Health perspective addresses the wider context in which pathogens arise, focusing on the measures required from the environmental, animal, and human health sectors.
Effective monitoring of preparedness for “upstream factors such as deforestation, biodiversity loss and animal trade is needed to mitigate spillover threats. At the level of preparation and detection, global surveillance and risk assessment functions are crucial, and data must be effectively managed and shared in practice.” (page 31 in the GPMB document).
Then, in May 2024, the “Equity in pandemic preparedness” vision statement was released. It calls for six areas of action to advance equity in pandemic prevention, preparedness, and response (PPPR) and spells out how policymakers can advance it.
One of which is to “mitigate the social and economic impacts resulting from pandemic prevention and response efforts”, and explicitly states “… the One Health approach, which seeks to sustainably balance and optimize the health of people, animals, and ecosystems, must incorporate an equity component.”
The GPMB framework and vision statement are very well formulated and stated. The problem is that while the GPMB is valuable in suggesting what might be pursued, it lacks the authority to see it followed or executed.
3) The Pandemic Fund
The Pandemic Fund was established in 2022 with the objective “to prioritize high-impact investments in i) early warning and disease surveillance systems, ii) laboratory systems (human and animal), and iii) strengthening human resources/public health and community workforce capacity, including workforce capacity related to human and animal health.”
Operations began in 2023 with several of the first 16 country proposals (e.g., Bhutan, Cabo Verde, Mongolia) and a Central Asia regional project specifying One Health. A second round of proposals has been launched and those awarded will be announced later this year.
While positive, realistically given the Fund’s challenges and resources, the amounts pale in comparison to the need. The amounts now or likely to be contributed in the future fall far short of meaningful impact for One Health concerns.
It is also worth considering whether there is sufficient need for a new financing organization, given there are many other entities and funders — whether international financial institutions, regions and countries, technical entities, research entities, and non-profits — which could directly or indirectly contribute to a more robust One Health effort.
Are there other options?
In a separate presentation, I proposed with Ok Pannenborg three possibilities other than continuing to try and come up with another Pandemic Treaty text, at least in the near future.
The ideas range from reliance on surveillance systems which are already/could provide an early warning; to allowing regions to formulate their agreements; to establishing a new technical (not financial) body with representation by the civil society organizations, the private sector, and governments, modeled along the lines of the International Labor Organization.
How should we feel now: are we really in a better position to address the next pandemic?
Considering the subject of pandemics from a global perspective, it is fair to say that we have come some way forward over the past decades in terms of greater prominence and resources. But threats of pandemics are increasing in our globalized, climate-battered world, and they are not being addressed in any systematic or unified way. Collective voices need to be heard loud and regularly, to garner attention and concrete actions.
It is hard to decide if there is room for moderate optimism — or not. How you view where we are depends on whether you are mostly more of an optimist than a skeptic for the future.
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This article was originally published on IMPAKTER. Read the original article.