O P O C L T I O C B Global P andemics and Y E P R A 2 P 0 E 1 Global P ublic Health R 7 ABOUT THE INDEPENDENT COMMISSION ON MULTILATERALISM The Independent Commission on Multilateralism The research process began with a short “issue (ICM) is a project of the International Peace Institute paper” highlighting core debates and questions on (IPI). It asks: How can the UN-based multilateral each of the fifteen topics. Each issue paper was s ystem be mad e more “fit fo r pu rpose”? discu ssed at a retreat bring ing together thirty to thirty-fiv e member state repre sen tati ves, UN In a nswer ing th at q uest ion, the IC M has analy zed officials, experts, academi cs , and r epresentati ves fifte en topics . Thes e in clud e armed conflict, humani - from civil so cie ty an d the private sector. Based on tarian engagements, sustainable development, and the inputs gathered at the retreats, each issue paper global public health, among others (see complete list was then revised and expanded into a “discussion in Annex 2). The goal of the ICM is to make specific paper.” Each of these was uploaded to the ICM recommendations on how the UN and its member website for comment and feedback, revised accord - states can improve responses to current challenges ingly, and presented at a public consultation. The and opportunities. public consultations were webcast live on the ICM’s website to allow a broader audience to take part in The ICM undertook simultaneous tracks of research the discussions. and consultation for each issue area on its agenda. The Commission initially launched in New York in This paper is one of the fifteen final “policy papers” September 2014, followed by subsequent launches that emerged from this consultative process. A in Vienna, Geneva, and Ottawa. In February 2015, the complete list of events taking place as part of ICM briefed delegates from the five UN Regional consultations on this specific issue area and of those Groups in New York. The Commission also convened involved is included in Annex 1. The recommenda - meetings with Ambassadorial and Ministerial Boards tions from all the policy papers are summarized in in New York, Vienna, and Geneva. Global outreach the ICM’s September 2016 report "Pulling Together: includ ed b riefings to offic ials i n Addis Ab aba, Be rlin, The Multilateral System and Its Future." Bra silia, C openha gen, New De lhi, Lon don, Mad rid, Monte video, an d R ome. Civ il s ociety and priv ate The ICM t ha nks the thre e sponsoring g overnme nts sec tor outre ach and engag emen t also c onstitute d an for their fin anc ial support for its operations: Canada, imp ortant comp onen t of th e IC M’s con sulta tive Norway, and the United Arab Emirates. Without their process, including a briefing specifically for civil support, the ICM would not have been possible. society in June 2015. Contents Executive Sum ma ry . 1 Introduction . 3 Mapping the Lan dscape . 4 Epid em ics and Pandemic s . 4 O ther Health-R elat ed Cha llenges . 5 Th e Impact of Oth er G loba l Trends . 7 Overv iew of Curren t D ebates . 10 Revisiting the WHO’s Role and Structure . 10 Implementing the International Health Regulations and Other Frameworks . 11 C oordina ting am ong Glo bal Health A ctor s . 12 In creasing Prep arednes s in R esponse to Re cent Outbre aks . 13 Conclusions and Recommendations . 16 Reaffirm the Centrality of WHO . 16 Strengthen Normative Frameworks for Accountability . 17 Forge Partnerships and Reinforce Linkages beyond WHO . 18 Recall the Primary Responsibility of States . 19 Annex es . 21 Annex 1: ICM Personnel . 21 Annex 2: ICM Policy Papers . 24 Annex 3: Participation in Consultations . 25 Global Pandemics and Global Public Health Executive Summary The global health architecture is increasingly under accountability within and to it. strain, largely due to recent, ongoing, and potential global health crises. Pandemics and epidemics are The multilateral system can play both a normative occurring at an unprecedented rate in recent years, and a more operative role in helping member states spurred by globalization, environmental changes, build resilient and robust national health systems, and a crowded world population. The Ebola crisis in such as through investment in human capital, particular revealed serious flaws in the capability of political commitment, community engagement, the system to prevent and respond to these crises. technology development, and international As the links between health, development, and solidarity. At the national level, there is a need to security challenges become ever clearer, the implement comprehensive public health policies, as multilateral system anchored in the United Nations many challenges transcend the health sector. The must address these issues with renewed focus. multilateral system should support the development of these inclusive and inter-sectoral national health The World Health Organization (WHO) remains the policies and systems, as well as assist states in right organization to set international policies and implementing the International Health Regulations. coordinate action in the area of global public health. The 2030 Agenda for Sustainable Development in That said, the organization’s structure and particular provides an opportunity for such a operational capacity need to be strengthened and structured and comprehensive approach. More than bolstered by existing and new partnerships, half of the seventeen Sustainable Development including with regional organizations, nongovern - Goals (SDGs) relate to health, either directly or mental organizations (NGOs), and the private sector. indirectly, including Goal 3 to “ensure healthy lives These actors are geared toward finding innovative and promote well-being for all at all ages.” solutions, and establishing stronger relationships with them could enhance the ability of local, The paper makes a series of recommendations national, and global health systems to respond to aimed at the UN system, member states, and other crises. Such partnerships have worked in the past global health actors: and have become increasingly prominent because they are often more flexible and result-oriented and • Reaffirm the centrality of the WHO: WHO attract more resources. remains the right organization to make interna - tional policies and coordinate action on global Institutional silos are an impediment to sound and public health. However, its accountability holistic policymaking, smooth implementation, and mechanisms, operational capacity, and operational capacity. These silos have effectively structure need to be adjusted and strength - created an international system that is insufficiently ened, and it requires more assessed contribu - prepared for an outbreak and reacts too slowly when tions. WHO should also work with the an outbreak escalates to a global health security secretary-general to follow up on the threat. Furthermore, the lack of adequate funding for recommendations of the High-Level Panel on the international health system, including the lack of the Global Response to Health Crises. assessed contributions to WHO, hampers its ability to meet demands. Moreover, as the report of the • Strengthen normative frameworks for High-Level Panel on the Global Response to Health accountability: The international community Crises highlights, there is a need to improve the needs to reaffirm the normative dimensions of operational capacity of WHO and to increase global health mechanisms. A global health 1 Independent Commission on Multilateralism summit and a high-level council on global multilateral system should also strengthen health crises could contribute toward this end. partnerships with private sector actors. • Forge partnerships and reinforce linkages • Recall the primary responsibility of states: beyond WHO: There is a need to establish Governments and health ministries should further synergies and coherence with other ensure their healthcare systems are sustainable, recently adopted agendas and frameworks that reliable, comprehensive, resilient, and based on seek to address challenges that have a direct inclusive approaches. States should also impact on global health, such as the 2030 reaffirm the protection of health professionals Agenda for Sustainable Development, the Paris and facilities and further explore the role of Agreement on climate change, and the Sendai military forces in health emergencies. Framework on Disaster Risk Reduction. The 2 Global Pandemics and Global Public Health Introduction Public health threats have long posed a challenge for in combination with the ongoing industrialization of the international community. International health developing countries, is dramatically changing the cooperation began in 1851 when government Earth’s biosphere. Demand for food and water is representatives gathered in Paris for the Interna - outstripping supply, and the resulting scarcity fuels tional Sanitary Conference to address the spread of conflict and violence. Natural disasters are becoming cholera. Since then, the development of basic public more frequent and more severe. 3 All of this has health practices and advances in medical technology dramatic implications for public health and well- (e.g., vaccines, antibiotics, and diagnostics) have being. countered many public health risks. When combined with other factors, such as declining rates of poverty, Epidemic and pandemic diseases such as influenza, malnutrition, and child mortality, the average global malaria, polio, Ebola, tuberculosis, HIV/AIDS, and life expectancy increased from 67 to 71 years SARS pose additional threats to public health, between 2000 and 2015. 1 particularly in developing countries. Developing countries are disproportionately affected by At the same time, dramatic social, political, outbreaks of these diseases and the resulting crises, economic, environmental, and demographic which are often exacerbated by a lack of investment changes are expected to increase the conditions that in their health infrastructure and uneven burden give rise to pandemics and other public health crises. sharing for this responsibility between developed The world population reached nearly 7.6 billion in and developing countries.