The World Health Organisation (WHO) is currently developing two international legal instruments intended to increase its authority in managing health emergencies, including pandemics:
- Amendments to the 2005 International Health Regulations (IHR), and
- A pandemic treaty, termed ‘CA+’ by WHO.
The draft IHR amendments (analysed in detail here) would lay out new powers for WHO during health emergencies and broaden the context within which they can be used. The draft CA+ (‘treaty’; analysed here) is intended to support the bureaucracy, financing and governance to underpin the expanded IHR.
These proposed instruments, as currently drafted, would fundamentally change the relationship between the WHO, its Member States and their populations, promoting what can fairly be described as a fascist and neo-colonialist approach to healthcare and governance. The documents need to be viewed together, and in the wider context of the global/globalist pandemic preparedness agenda.
The exaggerated threat of pandemics
The current rapidly increasing funding for pandemics and health emergencies is based on several fallacies, frequently repeated in white papers and other documents as well as the mainstream media as if they were facts, in particular:
- Pandemics are increasing in frequency;
- Pandemics are causing an increasing health burden;
- Increased contact between humans and wildlife will promote more pandemics (as most are caused by zoonotic viruses).
The last pandemic to cause major mortality was the 1918-19 ’Spanish Flu’, estimated to have killed between 20 and 50 million people. As noted by the National Institutes of Health, most of these people died of secondary bacterial pneumonia, as the outbreak occurred in the pre-antibiotic era. Prior to this time, major pandemics were due to bubonic plague, cholera and typhus, all addressable with modern antibiotics and hygiene, and smallpox, which is now eliminated.
WHO lists just three pandemics in the past century, prior to COVID-19: the influenza outbreaks of 1957-58 and 1968-69 and the 2009 Swine Flu outbreak. The former two killed 1.1 million and 1 million people respectively, while the latter killed 150,000 or fewer. For context, 290,000 to 650,000 people die of influenza every year, and 1.6 million people die of tuberculosis (at a much younger average age).
In Western countries, COVID-19 was associated with deaths at an average age of about 80 years, and global estimates suggest an overall infection mortality rate of about 0.15%, which is similar to that for influenza – though with considerable local variation.
Thus, pandemics in the past century have killed far fewer people and at an older age than most other major infectious diseases.
The COVID-19 event stands out from previous pandemics due to the aggressive and disproportionate responses employed, instituted contrary to existing WHO guidelines. The harms of this response have been discussed extensively elsewhere, with little doubt that the resultant disruptions to health systems and increased poverty will do considerably more harm than any benefit the responses might have achieved. Despite the historical rarity of pandemics, WHO and partners are pushing forward with a rapid process that will ensure repetition of such responses, rather than first analysing the costs and benefits of the recent example. This is clearly reckless and a bad way to develop policy.
The growing role of WHO in public health
The WHO, whilst having a role in coordinating cross-border health emergencies included in its Constitution, was founded on human rights principles and originally emphasised community and individual rights. These culminated in the Declaration of Alma Ata, emphasising the importance of community participation and ‘horizontal’ approaches to care.
Apart from its basis in human rights, this approach has a strong public health basis. Improved life expectancy and major reductions in infectious disease in wealthier populations predominantly occurred through improved living conditions, nutrition and sanitation, with a secondary impact of improving basic health care and availability of and access to antibiotics. Most vaccines came later, though playing an important role in certain diseases such as smallpox. Basic nutrition and living conditions are still the predominant determinant of life expectancy, with GDP recognised as directly impacting infant mortality in particular in lower income countries.
The emphasis of WHO has changed over the past few decades, associated with two major shifts in funding. Firstly, a large proportion of funding now comes from private and corporate sources, rather than being almost solely country-based at its inception. Secondly, most funding is now ‘specified’, meaning it is given to WHO for specific projects in designated geographies, rather than being used at WHO’s discretion to address the greatest disease burdens. This is reflected in an apparent move from priorities based on disease burden to priorities based on commodities, particularly vaccines, that generate profit for their private and corporate sponsors.
In parallel, other ‘public-private partnerships’ have arisen, including Gavi, the vaccine alliance, and CEPI (dedicated solely to pandemics). These organisations include private interests on their governing boards and address a narrow health focus that reflects the priorities of private sponsors. They influence WHO through direct funding and through funding within WHO Member States.
Other UN agencies have evolved in similar ways, with UNICEF now heavily focused on implementing mass Covid vaccination among populations already immune, whilst children, its former focus, have had rapidly deteriorating health metrics. The World Bank has developed a Financial Intermediary Fund (FIF) to support related pandemic preparedness with WHO as technical partner, in order to fund development of a surveillance, identification and response network as envisioned in the two WHO pandemic instruments and backed by the recent G20 meeting in Indonesia.
The WHO pandemic instruments
WHO is pushing two instruments to enhance its role and authority in health emergencies including pandemics; (1) Amendments to the International Health Regulations (2005) (IHR) and (2) a new treaty-like instrument currently designated CA+.
The IHR (2005) currently has force under international law but is written as non-binding recommendations. The World Health Assembly (WHA), the governing body of WHO, will only need a simple majority of States (97 of 194) to pass the amendments. Countries will then have six months in which to opt out, otherwise being considered to have accepted the amendments as existing signatories to the IHR. This opt-out period was reduced from 18 months by the WHA in 2022.
The IHR amendments and the CA+ (treaty) instrument are due to be presented to the WHA in May 2024. Adoption of the CA+ will require a two thirds majority of Member States, and the IHR amendments will require a simple majority.
Both draft instruments are currently passing through a usual WHO process of open and closed committee meetings and internal and external reviews after submission of proposals by various States. The IHR amendments process is under the Working Group on Amendments to the International Health Regulations (2005) (WGIHR) while the CA+ instrument is under the International Governmental Negotiating Body (INB).
What the two WHO pandemic instruments will do
As currently drafted, the CA+ and IHR amendments complement each other. The IHR amendments concentrate on the specific powers and processes sought by WHO and its sponsors. The CA+ concentrates more on the governance and funding to support these. Specificities in both instruments
will change between now and when the WHA votes on them in May 2024. However, in broad terms, they are currently written to achieve the following:
IHR draft Amendments:
- Expand the definitions of pandemics and health emergencies, including the introduction of ‘potential’ for harm rather than actual harm. It also expands the definition of health products that fall under this to include any commodity or process that may impact on the response or “improve quality of life”.
- Change the recommendations of the IHR from ‘non-binding’ to mandatory instructions that the States undertake to follow and implement.
- Solidify the Director General’s ability to independently declare emergencies.
- Set up an extensive surveillance process in all States, which WHO will verify regularly through a country review mechanism.
- Enable WHO to share country data without consent.
- Give WHO control over certain country resources, including requirements for financial contributions and provision of intellectual property and knowhow (within the broad definition of health products above).
- Ensure national support for promotion of censorship activities by WHO to prevent contrary approaches and concerns from being freely disseminated.
- Change existing IHR provisions affecting individuals from non-binding to binding, including border closures, travel restrictions, confinement (quarantine), medical examinations and medication of individuals. The latter would encompass requirements for injection with vaccines or other pharmaceuticals.
- Set up an international supply network overseen by WHO.
- Fund the structures and processes by requiring at least 5% of national health budgets to be devoted to health emergencies.
- Set up a ‘Governing Body’, under WHO auspices, to oversee the whole process.
- Expand scope by emphasising a ‘One Health’ agenda, being defined as a recognition that a very broad range of aspects of life and the biosphere can impact health, and therefore fall under the ‘potential’ to spread harm across borders as an international health emergency.
Both draft instruments remain under discussion and further changes are likely. A recent external review committee report pushed back on some aspects of the IHR amendments in a report to the Director General, but left much of the basis intact.
It is important to consider these texts together and in the context of the wider pandemic preparedness agenda that includes agencies such as Gavi and CEPI, their private and corporate sponsors, and private industry lobby groups including the World Economic Forum (WEF). The WEF has been influential in promoting the agenda; CEPI was inaugurated at the 2017 WEF Davos meeting. The pandemic agenda must also be seen in the context of the unprecedented profits and wealth transfers, and the suspension of basic human rights that the COVID-19 public health response promoted.
The momentum behind the agenda
An international bureaucracy is currently being built with funding envisioned at up to $31 billion per year, including $10 billion in new funding. (For context, the entire current WHO annual budget is about $3.6 billion.) This same bureaucracy will surveil for new and variant viruses, identify them, determine their ‘threat’ and then implement a response. This is essentially creating a self-perpetuating pandemic industry, with major internal conflicts of interest, funded by the world’s taxpayers but, being under a UN agency, having no national legal oversight and little accountability. Its justification for continued funding will rely on declaring and responding to perceived threats, restricting the lives of others whilst accruing profit to its sponsors through pharmaceutical recommendations and mandates.
While both texts are intended to have force under international law, countries can theoretically opt out in order to preserve their sovereignty and protect their citizens’ rights. However, low-income countries could potentially face financial pressures, restrictions and sanctions from entities such as the World Bank that are also invested in this agenda. Of relevance, the 2022 United States National Defense Authorization Act (HR 7776-960) includes wording concerning adherence to the IHR, and action concerning countries that are uncooperative with its provisions.
What can be done
These initiatives, if continued, will reverse the direction of international public health and the WHO itself, driving back towards a colonialist and fascist approach to health governance reflecting values the world sought to put aside in the aftermath of World War Two. As the COVID-19 response demonstrated, they will have wide and profound impact across society, removing basic human rights, increasing poverty and wealth concentration. They deserve global attention and a robust society-wide response.
Both draft instruments could be stopped by the IHR amendments failing to achieve 50% of Member States’ support, and the CA+ failing to achieve two thirds majority, or, after adoption, failing to have a minimum 30 ratifications. While it is inevitable that some provisions will change prior to being put to a vote, and some amendments may fail to pass, the bureaucracy and mechanisms being built in parallel means that the passage of any of the proposed provisions will further promote this anti-democratic approach to society. Blocking them seems vital, but the voting structure of the WHA (one country-one vote) makes international diplomacy by vested interests influential. Votes commonly depend on the views of a small group of health bureaucrats.
Blocking in national legislatures seems a very important approach, including the introduction of legislation to embed health policy including emergency responses within national jurisdictions, and specifically preventing national agencies from following external dictates.
While international coordination is important in public health, particularly in cross-border risks and disease spread, this must be at the behest of States parties. Such measures must respect the fundamental human rights principles established through the post-World War Two tribunals and treaties intended to stop colonialist and totalitarian approaches to individuals and international relations. This may require a different set of international agencies that have sufficiently strong constitutions to withstand private conflict of interest, and that cannot violate basic individual and national sovereignty. This may require defunding current agencies and replacing them with structures more fit for purpose. If the world is not to be locked into a situation from which it becomes difficult to extract itself, this question must be addressed very urgently.
A detailed review of the IHR amendments is available here, and of the pandemic treaty provisions here.
Dr. David Bell is a clinical and public health physician with a PhD in population health and background in internal medicine, modelling and epidemiology of infectious disease. Previously, he was Director of the Global Health Technologies at Intellectual Ventures Global Good Fund in the USA, Programme Head for Malaria and Acute Febrile Disease at FIND in Geneva, and coordinating malaria diagnostics strategy with the World Health Organisation. He is a member of the Executive Committee of PANDA.
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