Avenue Apia, on the outskirts of Geneva.
On February 6th, 2018, a group of 30 world-renowned experts gathered at the headquarters of the
WHO.
Their goal?
To review the list of priority diseases, that is to say the most dangerous viruses at present,
for which no effective diagnostic tests exist, nor vaccines or other treatments, those which
have the highest potential to cause an epidemic.
To assemble this list, the group compared facts, research data, number of outbreaks,
possible responses and more.
At the end of their meeting, they had identified diseases like the Ebola virus disease, Middle
East respiratory syndrome coronavirus, or MERS-CoV, and severe acute respiratory syndrome,
also known as SARS.
New to the list was disease X, representing, quote, a serious international epidemic caused
by a pathogen currently unknown, end quote.
The disease X variable was a breakthrough in the way the WHO produces knowledge.
Disease X was expected to work as a heuristic tool, accelerating research and developing
medical responses to a potential pandemic.
Yet the 2020 global outbreak of COVID-19 could not be prevented, and the WHO has been scrutinized
harshly for its handling of the pandemic.
On July 7, 2020, the US administration notified the United Nations that the country was going
to withdraw from the WHO.
If nothing else, the pandemic has proved that the issue of health is central in national
foreign policies.
Health can be used as a diplomatic tool in international relations.
As the WHO argued in 2014, quote, the role of diplomacy in health is vital.
Global health needs global health diplomacy, end quote.
But what does this mean for battling lethal diseases on a global scale?
And how did the WHO become the key player in health diplomacy?
Let's look back to the origins of this idea for a transnational organization for global
health, which emerged in the shadow of a pandemic.
Whether smallpox or the plague, HIV or even the flu, humans have experienced a series
of pandemics with devastating health results.
The cholera pandemic from 1817 is just one example.
It was the first of six cholera outbreaks between 1817 and 1917, just 100 years.
It exploded in British India and spread through Russia, China and the Middle East across to
West Africa.
In India alone, it is estimated that one to two million people died.
By 1832, during the second pandemic, the disease had traveled across Russia to Western Europe
and England and had reached the Americas.
The disease created and aggravated social issues.
In Russia, the poor protested quarantine restrictions that hindered their ability to work and survive.
Paris, like many other capital cities in Europe, was growing fast at that time, so fast actually,
that it outpaced its administrative capacities and could literally not bury its dead.
Cholera spread especially easily in the crowded and deprived parts of the city, where the
poorer residents lived.
They suffered the most.
Here, history shows us why pandemics need to be taken seriously.
They do not respect national borders, and they affect more than just human health.
They can also immobilize trade, amplify social inequality and intensify political strains.
In short, they have a significant impact on political systems and economies.
Gradually, scientific advancements offered a better understanding of cholera.
In 1849, researcher and physician John Snow hypothesized that the cholera outbreaks had
microbial origins.
He also inferred that microbes spread via the sewage system by leaking into the aqueduct's
clean drinking water.
In 1854, Italian microscopist Filippo Puccini identified the microscopic Vibrio responsible
for what was then called Asiatic cholera.
He realized that the contagion needed an organic living substance in order to be able to cause,
reproduce and spread the disease.
Scientists and diplomats joined forces during the pandemic in order to coordinate responses
to cholera across country borders.
Between 1851 and 1938, a series of conferences, known as the International Sanitary Conferences,
took place across Europe and the United States.
Each country was represented by a diplomat and a physician.
The goal was to standardize international quarantine regulations and negotiate preventive
measures.
These measures not only affected health policies, but also political systems and economies.
While scientists continued their efforts to fully describe the disease, diplomats strengthened
identification and documentation measures with visas, sanitary passports and bills of
health.
These measures allowed border crossings by travelers and vehicles to be tracked.
While the US and countries in Europe made major health and sanitation reforms in their
respective countries and struggled to deal with the resulting social agitation, cholera
proved that nations had to collaborate on an international level if they were going
to effectively address infectious disease.
Thus, several international health organizations were formed before the First World War.
In 1922, after the end of World War I, the League of Nations became the world's first
intergovernmental organization.
It established its own health committee and health section.
Diplomacy in the time of cholera indeed proved to have an astonishing power.
This spirit of cooperation in health proved beneficial in the second half of the 20th
century as well.
In 1948, the World Health Organization, or WHO, was established as one of the earliest
specialized agencies of the United Nations.
The UN started with 55 member states and today represents 194 states and two associate members.
All member states belong to the WHO's General Assembly, which approves and supervises the
organization's budget and also elects its Director General.
According to the WHO's assembly, quote, the World Health Organization is by its nature
a technical organization whose objective is the attainment by all peoples of the highest
possible level of health, end quote.
In short, the WHO's goal is to ensure health for everybody, globally.
The WHO presents itself as technical and apolitical, an organization that welcomes membership universally.
Accordingly, staff members are considered, quote, international civil servants, end quote,
with no national responsibilities and no national attachments.
A special focus of the organization is on epidemic diseases.
Working on both regional and global levels, it helps to track disease outbreaks, recommends
preventive policies, and offers guidelines on medicines, diagnostic tests, and regimens.
During the Cold War, the organization attained a global leadership status in matters of health
and disease, but it also suffered from Cold War tensions between the United States and
the Soviet Union.
Throughout the post-war years, the WHO decisively shaped the dissemination of medical knowledge,
practices, technologies, and materials across the globe.
It standardized therapies for common diseases, procedures of drug approval, and health data
collection processes.
For example, the WHO has facilitated the international use of antibiotics and vaccines, and has tried
to eradicate epidemics such as syphilis, smallpox, and polio.
Yet, it lacks an explicit authority to enforce its recommendations.
What's more, because the WHO is the result of strong diplomatic negotiations, it is far
from being just an apolitical and technical organization.
Instead, the WHO has been a product of the global political, social, and economic context
throughout its history.
The most influential member states push for their own interests and mobilize their diplomatic
channels within the organization to achieve their goals.
As was clearly stated in a 2011 WHO report,
"...WHO's scientific and technical aspirations for global health are constantly conditioned
by the multiplicity of views, needs, and preferences of its member states."
In the same year, the WHO warned that the world was ill-prepared to respond to a pandemic.
Politics and diplomacy strongly conditioned health policies and international actions.
This is how Peter Dajac, one of the experts who created the new priority list for dangerous
diseases in 2018, explained this issue.
Quote,
"...The problem is not that prevention was impossible.
It is very possible, but we didn't do it.
Governments thought that it was too expensive.
Pharmaceutical companies operate for profit.
The WHO, for the most part, had neither the funding nor the power to enforce the large-scale
global collaboration necessary to combat it."
End quote.
In 2020, COVID-19 spread across the whole globe.
As of December 17, 2020, it has infected more than 74 million people and led to more than
1.6 million casualties.
The pandemic's impact on social and economic structures worldwide is ongoing and devastating.
The international race for a vaccine reveals the blatant economic and political interests
of individual countries.
After all, health is not a technical issue to be managed by allegedly apolitical institutions.
It is a matter of political priority that demands publicly informed health diplomacy.
In the midst of yet another global pandemic, it is time to critically reflect upon the
role of international organizations and their health diplomacy efforts in the fight against
the coronavirus crisis and its aftermath.