When crises happen the standard response of politicians is to argue that the crisis is so big that it was impossible to foresee. But in the case of Covid-19, this argument does not apply. While we do not know what form viruses may take or where they may originate, there is a vast apparatus of global health security designed to prepare, identify, and respond to the threat of destructive pandemics. Global health security rests on the notion that health crises can be a threat to individuals, states, and international peace and security. Those working in the field of global health security have been warning for decades about the potential threat of a mass pandemic. These warnings were ignored.
At the centre of pandemic preparedness is the World Health Organisation (WHO) and its main mechanism of global health security – the International Health Regulations (IHR). These rules commit member states to “detect, assess, and report” on new and emerging outbreaks and rest on a simple logic: identify an outbreak quickly; share information; follow clear public health protocols to contain it; stop an outbreak becoming a pandemic.
The system has been modified and developed in response to previous outbreaks. States don’t always detect or report cases for fear of a negative impact on their economies, diplomatic relations and social wellbeing (often in that order). The 2002-04 Sars outbreak, which led to 774 deaths, was a tipping point in confronting compliance issues, resulting in the strengthening of the IHR in 2005. Under the new system, non-state actors were able to report virus outbreaks (circumventing the problem of state interests), and provide guidelines as to when an outbreak constituted a Public Health Emergency of International Concern. Such a declaration, made by the director general of the WHO, would in turn be a signal for the world’s population and leaders to take the emergency seriously, and release funding to support containment.
Preparedness systems were again strengthened following the 2013-16 Ebola outbreak, which led to 11,323 deaths, in Guinea, Liberia, and Sierra Leone. Ebola was a stark reminder that global health security rests on the strength of the weakest disease surveillance system. This precipitated significant investment in disease surveillance – increased technological capacity, new laboratories, trained staff – in low-income countries, particularly in sub-Saharan Africa.
The UK is no bystander to all this. Public Health England, the Department for International Development, the Foreign and Commonwealth Office, and UK research institutions have played active roles in developing disease surveillance and global health security frameworks in both the WHO and low-income countries.
How is it, then, that despite having the mechanisms to detect and respond to global health security threats, we find ourselves in this crisis? The easy answer is the lack of state investment in pandemic preparedness. States only invest during or after a major outbreak; it is hard to motivate national leaders and the public to prepare for something they have not witnessed before. In the case of the UK, it was difficult to convince politicians to invest in pandemic preparedness during an era of austerity and large NHS funding gaps.
People can be complacent about global health security, seeing outbreaks as something that happens to other countries. Complacency not only leads to a lack of investment in pandemic preparedness but disinvestment. In the US, contrary to all expert warnings, one of Donald Trump’s first acts as president was to strip funding from the National Institutes of Health (NIH) and the Centers of Disease Control and Prevention (CDC) – two fundamental pillars of global health security in the US and around the world. Complacency points to a fundamental lack of understanding that pandemics are as big, if not greater, threats to our well-being than armed conflict, terrorism, and financial crises.
Trump’s denial of risk and blame-shifting over Covid-19 points to a familiar problem of security and international relations: effective control and containment of pandemics depends on state collaboration and pooled sovereignty in international institutions. Countries often only follow advice or begin to work together when it’s too late. At this point they look for other actors to blame – other states, the WHO, bats. The dismissal of expertise by governments, growing isolationism, and a lack of co-operation by prominent world leaders all exacerbate the problem.
Finally, pandemic preparedness and response rests on what Christian Enemark, professor of international relations at the University of Southampton, terms “biosecurity dilemmas”. The major biosecurity dilemma is the question of when to notify the WHO and take immediate action, potentially risking basic human freedoms and economic stability.
The public health answer is: not soon enough; speed is everything. The political answer is more complex. Act too early and the public think you’re curtailing their freedom and risking their economic security for a flu. Act too late and you risk people’s lives, livelihoods, and wellbeing, and wider economic, political, and social crises. While surveillance and preparedness mechanisms inform these decisions, they ultimately depend on the ability of politicians to understand global health security. As we are seeing around the world, dangerously few do.
Sophie Harman is professor of international politics at Queen Mary University of London
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