In the second part of her interview with WILL BROWN, global health expert SOPHIE HARMAN looks at why the international response to Covid-19 has been so flawed and calls on Labour to rethink development.
Will Brown: There have been some criticisms of the World Health Organisation (WHO) and claims we need to rethink the approach to pandemics at the international level. Is that right?
Sophie Harman: We don’t need to rethink the international approach at all. We have the structures there. If you wanted to design what you would do in response to a pandemic, it’s all there. The international health regulations (IHR) are clear about reporting mechanisms, there are frameworks for investing in countries to prepare their systems, and lots of money has gone into low- and middle-income countries to map and report outbreaks.
There are two main criticisms of the international health regulations. The first is that, of course, they are subject to politics. They always have been.
They were reformed in 2005 after SARS when everyone was worried about under-reporting by China. Now anyone can report an outbreak to avoid relying on states. But the wider politics are still there because the WHO still has to be allowed into a state to see what’s happening.
With Covid-19, they not only did the quiet diplomacy, they then praised China and criticised Taiwan. You can’t say you’re apolitical then get involved in politics. So there were a couple of missteps and that created a wider proxy war with Trump and the US.
The second issue you’ve got with the IHR is that one of the regulations says there’s no point shutting borders, that by the time a virus is out there it’s too late. Yet some people claim those states that were most effective were the ones that did shut borders.
So do we need to revisit the IHR? I understand that question but it was such a lot of pain setting up these regulations in the first place, any replacements would be watered-down, they wouldn’t be an enhanced version.
What’s happened with global health is the WHO has been hollowed out since the 1990s. First, it was seen as ineffective on HIV and AIDs, so they created UNAIDs [United Nations Programme on HIV/AIDS]. Then it was seen as ineffective on funding malaria and tuberculosis, so they created The Global Fund to fight AIDs, tuberculosis and malaria. Then, after Ebola, the international community went to the World Bank to create a pandemic preparedness fund.
No-one really invests in the WHO or trusts that it can do this, so it’ll be interesting to see if Covid-19 hollows it out further. It gets more money now from the Bill & Melinda Gates Foundation, its number one donor, than the US which is pulling out. Further change or reform is not needed right now.
WB: Was the international response always going to be limited in effectiveness given there is such a tense relationship between USA and China?
SH: That was always going to be a struggle. The whole global health response rests on a certain level of internationalism, of sharing information, of at least cooperating, if not actually trusting each other.
If you want to defeat the virus you are only as strong as your weakest element. You can’t pull up the drawbridge, you have to work together. We have to shift from thinking these outbreaks are rare to knowing they’re quite common, thinking about how we mitigate them and prevent them becoming pandemics.
WB: Is it surprising the European Union’s response was not speedier and more cooperative?
SH: The EU is a funny one on global health. Even though it’s a major donor, it’s not really a major player in global health security. The fact that it wasn’t super quick doesn’t really surprise me. But it wouldn’t surprise me now if the EU learns lessons and is more proactive in the future.
It will also be interesting to see what it does within the European region of the WHO. Is there going to be a particular interpretation of the international health regulations – about borders, in particular, and access to vaccines and vaccine sharing?
WB: Labour’s new international development team has started thinking about what the UK’s international development response should be. For several years it has promoted the goal of universal health care. What should Labour focus on now?
SH: There needs to be a new conversation about what development means. Labour needs to rethink the principles – not just saying, ‘We’re going to give you a school or a health clinic or anti-retroviral drugs.’ On what principles is that assistance provided? Preparing for pandemics can be based on a principle of solidarity: ‘We are as vulnerable as you are.’
Information sharing is also vital. It’s depressing there was so much the UK could have learned from Sierra Leone and Liberia on how to respond to health emergencies, but there was none. Sharing knowledge and learning is important not just for strategic interests – it’s not just a gimmick, it’s really important for us.
This goes back to the arrogance of the UK, the belief that this doesn’t happen here and if it does, we’ll be fine. If what has happened in the UK with Covid-19 was happening in Nigeria, we’d have sent in the international community by now and said we’re going to deal with it.
Sophie Harman is Professor of International Politics at Queen Mary University London.
She is an expert in global health governance specialising in African politics and gender and was nominated for a BAFTA in 2019 for her work on the film Pili.