Ómicron forced cooperation
“The Ebola epidemic in West Africa that began in 2013 exposed weaknesses in the national and international institutions responsible for protecting people from the far-reaching human, social, economic and political consequences of infectious disease outbreaks.” That’s what experts in health systems from various countries wrote, in an article published in the Lancet in 2015; Later we transform it into 10 concrete recommendations of what should be done in terms of international cooperation and, especially, what the World Health Organization (WHO) should do; the latter was published by the British Medical Journal in 2016. When Tedros Ghebreyesus was a candidate to lead the WHO in 2017, we presented him with these proposals, not all of them were considered, some were partially implemented, and others were ignored.
What we have been calling for since 2015 was a new way to tackle disease outbreaks that have the potential to become public health problems of international concern. We proposed that the flow of epidemiological information from the national to the international level be transparent, fast, and decision-making on public health be done without involving political interests.
In 2019 at the AHF Global Public Health Institute at the University of Miami, we decided to dwell on this issue. That’s where we were when the new coronavirus appeared and, paraphrasing you know who, “the pandemic suited us like a glove”; We were able to reinforce our arguments, since with Covid-19 the same mistakes were made as with Ebola, slowness, and opacity in sharing epidemiological information and delay in decreeing the emergency.
In 2013, Doctors Without Borders (MSF) was the first organization to raise the alarm about something serious that was happening in Guinea with outbreaks of Ebola, but they were ignored by the WHO. The government of Taiwan assures that in December 2019 it gave the voice of alert to the WHO about what was happening in China with a new coronavirus. Like MSF it was ignored.
Why did the WHO ignore MSF and Taiwan? For a simple reason, they are not WHO Member States, and it was created to interact and respond to governments. The WHO consults and requests the consent of governments to certify an outbreak or declare an epidemiological emergency of international concern.
WHO is accountable not to the population or the health of the people but to governments and, therefore, when dealing with governments invariably involves politics, politicians, and political interests of each country, which, by their very nature, they can use the “sovereignty” argument to interfere and delay the implementation of what science and public health evidence recommend.
Guinea, Sierra Leone and Liberia were isolated by the international community due to Ebola; Initially, China was also isolated due to Covid-19, although later the ban on air flights affected other countries, especially those that did more tests and reported more cases.
South Africa, for reporting on the new Omicron variant, has suffered a lockdown by several countries; If you report outbreaks quickly, quickly other countries isolate you.
Poor countries do not have incentives to be transparent and expeditious in sharing epidemiological information on new outbreaks or new variants that occur within their borders, they fear being isolated, suffering economically and causing a bad international image.
Several experts in international health systems have published new recommendations, Lancet-Public Health, May 5, 2021, for governments to decide once and for all to cooperate, be accountable and establish incentives for those countries that must report data that could be used to declare an international health emergency. It is not only about improving health services, which is of course necessary, but also encouraging transparent epidemiological surveillance and genomic sequencing to identify and monitor variants in real time.
This December 1, the World Health Assembly concluded an extraordinary meeting and approved the initiation of discussions to have a new international accord for the prevention and response to pandemics. We applaud this resolution and consider that it must be legally binding, that is, oblige countries to cooperate and fulfill commitments; The agreement should also include equitable access to public health goods for all countries, especially vaccines.
Until a couple of weeks ago we were sending letters to governments around the world, we convened forums to discuss and support a new international agreement. Initially the United States took it with caution and Latin American countries, except for Costa Rica and Chile, showed little interest; Brazil spoke out against it. It seemed as if our region lived in another galaxy. Now everything has changed, the countries have supported the proposal, including the US and Latin Americans. Why the sudden change? I think it was the fear of Ómicron, they realized that it is better to cooperate than to face a new disaster. Will Ómicron arrive in Mexico? Definitely yes, in California it has just been detected.
*The author is Executive Director of the AHF Institute for Global Public Health at the University of Miami. @jorgesaavedramx
Article originally published at Reforma Newspaper (México)