Damian Sendler: Events affecting public health, as a matter of global concern, necessitate a global response. The outbreak of the COVID-19 has highlighted the challenges facing the global governance of international public health, including limited functions of international organizations and difficulties in achieving objectives, poor collaboration between governance subjects and their limited performance, overlapping legal basis of governance and blurred core function, and lack of solutions to specific problems. There are several ways to increase the effectiveness of global public health governance, including supporting the role of international organizations, enhancing coordination among international governance subjects to create synergy, promoting compliance with IHR2005 to avoid conflict of law applications, and upholding the vision of a community with a shared future for mankind to respond jointly to global public health challenges.
Damian Jacob Sendler: More than a million people have been infected and thousands of people have died as a result of COVID-19, which emerged in December 2019. COVID-19 has a long incubation period and is extremely contagious, posing a serious threat to human health and even life (1). It was determined that the outbreak met the criteria for a PHEIC on the evening of January 30th, 2020, after an increasing number of patients and reports from countries around the world, in accordance with the International Health Regulations (2005) (IHR2005). Because of the increasing global interdependence in the face of disasters, PHEIC has become a global issue.
Dr. Sendler: The impact of international public health events became a global concern as early as the second half of the nineteenth century (2). An international health conference was held in New York in July 1946 by the UN Economic and Social Council, where the World Health Organization’s constitution and a plan to establish the WHO were adopted. A major role has been played by WHO since its establishment by promoting international health cooperation, infectious disease control, biomedical research and practice, the development of health programs in member countries as well as improving people’s health…. The value of health to an individual and to society cannot be overstated (3). This aspiration is enshrined in the preamble of the WHO Constitution. Public health has also become more globalized as a result of the development of society and frequent international economic, trade, and personnel exchanges. The importance of public health has risen to a new level in our global age. Pathogens are being propelled by globalization, putting us all at risk (4). Disease and its transmission have been the subject of a variety of beliefs and political ideologies for centuries (5). The first recorded outbreak of smallpox occurred in Egypt around 1350 BCE. By the year 49 CE, it had reached China; by 700 CE, Europe; by 1,520 CE, the Americas; by 1789, Australia. Pestilence spread from Asia to Europe, where it killed a third to a fourth of the continent’s population during the fourteenth century. In the fifteenth and sixteenth centuries, Europeans brought diseases to the Americas that decimated up to 95 percent of the indigenous population (6). More than 12,000 major outbreaks of novel diseases, 215 infectious diseases, and 44 million cases in 219 countries occurred between the 1980s and the mid-twentieth century (4). The political, economic, and social dynamics of domestic and international affairs have never before been so dominated by public health issues (7).
Almost universally, as the twenty-first century begins, people recognize the interdependence of national and international health (8). In less than a month, the COVID-19 virus spread to a number of countries. This unprecedented and enormous impact on global economy, governance structures, and the lives of people is not yet fully understood (5). Human efforts to control these global public health crises are now mired in even more ambiguity and difficulty. scholars of law and politics have long been fascinated by the governance challenges of global health (9). International health cooperation is currently based on a variety of legal norms, processes, and institutions, which should be examined in light of the recent COVID-19 outbreak (10). The IHR and the WHO’s legitimacy as a global health agency will once again be put to the test by the outbreak of COVID-19 (10). Once again, it has brought the issue of international public health governance back into the international community’s attention.
When it comes to 2020, COVID-19 has been likened to “black swan events” that can cause catastrophic damage to businesses and disrupt entire economic systems at a level never seen before (11). However, the WHO has been lauded for its quick response to the more technical aspects of a global pandemic, countries are implementing their own strategies. China appears to have been successful in implementing early lockdown and quarantine measures, but these measures can’t be easily implemented elsewhere (12). Free, massive testing has been used in South Korea to track and treat those who have been infected by the virus. School closures, telework, and bans on large gatherings have been used to encourage social isolation, but quarantine has not been implemented (13). Despite the worsening conditions in both countries, Italy and Spain chose less restrictive lockdown methods, delaying their containment strategies (14). Local and regional governments in Germany are primarily responsible for addressing health issues. Most of the time, the federal government’s role is limited to coordinating regional efforts and formulating national policy recommendations (15). The United States and the United Kingdom were ill-prepared and inept in responding to the coronavirus, which was a major threat to global health (16). There have been mixed results in the United Kingdom with a strategy of containment, delay, research, and mitigation. Early restrictions targeted the most vulnerable, such as the elderly and those with comorbid conditions, in the United Kingdom, where schools remained open for longer than in other countries on the continent. Delaying action may have helped the UK avoid some of the social and economic costs of the virus, but it does not appear to have significantly reduced the spread of COVID-19. (17). Several African countries have taken a more robust approach to border security, including flight restrictions, visa denials, and two-week quarantines for foreign visitors. Uncertainty persists as to whether Africa’s more restrictive borders are to blame for the decline in infection rates (18).
COVID-19 remains the primary focus of the World Health Organization and the governments of the affected countries. There is a need to think and act locally, but we must also think and act globally. In addition, concepts of global caring, global compassion, and strong international institutions are crucial (4). Many of the most significant global efforts have been challenged by COVID-19, and the subsequent enormous impacts have posed new challenges to the global governance of international public health.
The International Health Regulations 2005 (IHR2005) and the World Health Organization (WHO) are the foundations of global public health governance. International normative documents lay out the groundwork and provide the assurances necessary for international organizations to carry out their responsibilities, as well as the means by which they can do so. As a result of a world order dominated by independent nations, WHO’s ability to influence national health decisions that have a significant impact on economic and social life is limited (20). According to the International Covenant on Civil and Political Rights (IHR2005), international and national interests must be balanced. The WHO, the world’s primary health organization, does not have the legal authority to ensure that medical supplies and equipment, vaccines and treatments are distributed equally and based on need during a pandemic, increasing the vulnerability of people in less developed countries (21). Governments like the World Trade Organization, on the other hand, prioritize the protection of intellectual property over the development of low-cost biotechnologies (22). User fees and structural adjustment mandated by the World Bank and the International Monetary Fund have resulted in shrinking national health budgets (22). Moreover, laissez-faire capitalism gives transnational corporations the green light to relocate to low-tax and low-regulation states, thus depleting domestic resources for health and failing to regulate corporate marketing, products and workplace safety and environmental impacts that harm the public health and safety (22).
There has been significant influence on public health response by the UN General Assembly, its Human Rights Council, and the UN Environment Program (UNEP). The OIE and the International Plant Protection Convention (IPPC) also have the right and authority to regulate plant, animal, and organism protections related to public health emergencies. The causal mechanism for selection seems even weaker at the global level than with respect to competition among states and thus does not warrant a functionalist account of how governance arrangements for globalization would emerge (23). Lack of a strong restraint mechanism will lead to poor communication and coordination between PHEIC-infected countries. International organizations will also be hindered in their joint response to PHEIC.
Globalization has increased economic interdependence, global communication, and international migration, resulting in a new urgency for addressing health issues globally and a new era of global health governance to replace the previous international health governance model (24). From its twentieth-century origins in the WHO Constitution, global health law has moved on to include other United Nations (UN) agencies, the World Trade Organization (WTO), arbitral tribunals and the UN Security Council as well as large corporations in health-related sectors such as food, medicine and tobacco (19). The twenty-first century’s more globalized world has led to multi-layered and trans-scalar governance (25). International public health governance encompasses a wide range of issues.
When an epidemic like COVID-19 breaks out, it reveals our collective vulnerability to an enemy that can easily cross national borders (10). In the face of PHEIC, the efforts of international organizations, countries, non-governmental organizations, businesses, and individuals are required. International public health governance bodies’ inability to coordinate their efforts in the fight against COVID-19 was an ongoing issue.
First and foremost, the issue of uneven global development and limited medical supplies is clear. As a result of their health care systems and social and economic infrastructure, people in low- and middle-income countries are particularly vulnerable to the effects of climate change (26). (27). People in low- and middle-income countries are the most likely to be affected by corruption, violence, and other forms of political instability. Wealthier countries have more affordable access to high-tech medical treatments like gene therapy and precision medicine (21). Worrying current trends show that the United States and Europe, which can afford to pay more for critical medical supplies and equipment, are the primary recipients of these goods (28). There are vast numbers of people in the world who have not reaped the benefits of global health advancements (21). Inequities within countries are mirrored by these enormous global health disparities – sometimes narrowing, but often widening (21). However, global forces make it extremely difficult to achieve health and justice at the same time. Governments around the world have vastly different amounts of resources at their disposal. Health care in low and middle-income countries is frequently underfunded, especially in areas with high rates of disease and a large or rapidly growing population. COVID-19 has the potential to unleash a global pandemic in countries with weak healthcare and social support systems.
Damian Jacob Markiewicz Sendler: It’s also important to keep in mind that no single country can guarantee a healthy environment for all its citizens. Think about global forces such as greenhouse gas emissions, or global rules and norms in areas such as trade and investment (22), or transnational corporations that actively seek low-tax, low-regulation destinations like COVID-19. In terms of location, the disparity in development can be seen both between and within states. In the event of an outbreak of an epidemic, the country or region most directly affected is the first to respond and is dependent on the active involvement of other countries. Even though they bear the greatest burden of disease, the countries that do have the wherewithal to make a real difference in global health care are loath to spend the political capital and economic resources necessary to do so (29). Despite IHR2005’s demands that its members improve their domestic health conditions, developing countries, which are economically and technologically backward, are still unable to improve their domestic public health systems. Responding to a pandemic poses different difficulties in urban and rural areas of the same country due to differences in population density and infrastructure (15). When dealing with PHEIC, it’s difficult for them to quickly provide adequate medical supplies. However, global health with justice, in which everyone, regardless of location or race, can reap the benefits of health advancements, is still a long way off (21).
Even in states where economic and medical development is uneven, the ability to respond to PHEIC can vary greatly from one region to the next. When a state lacks a strong central government, it is easy for the various regions to respond to a crisis in an uncoordinated fashion. The willingness of a country to regulate public health and safety standards is also influenced by trade (30). There is a conflict between these incentives and mechanisms of cooperation and equitable access to health resources such as international law and scientific decision-making (16). As a result, the effectiveness of governance was severely hampered due to the aforementioned lack of cooperation or poor collaboration among the various governance subjects.
International law may be applied to a PHEIC event for various reasons, and this may cause a misunderstanding of the main legal basis for international public health management provided by IHR2005 and other treaties. Failure to comply with these obligations has no legal consequences or responsibility under these agreements (31). When it comes to public health issues in trade, there are many roadblocks to overcome, including institutional resistance and a lack of coordination and resources, as well as issues of “institutional overload” and inconsistent standard setting (32). (30). IHR2005 empowers its members to enact laws to implement health policies in accordance with their own circumstances, provided that they adhere to IHR2005’s purposes in accordance with article 3.4 of IHR2005. This is to balance health, trade, and human movement.
Damian Sendler
As a result of the COVID-19 outbreak, globalization was affected. For many governments, free trade is no longer a top priority when the pace of globalization slows (33). IHR aligns with international trade law under WTO, which recognizes the right of the state to restrict trade for health purposes, but limits this right to ensure that restrictions are necessary (34). Tweak the TRIPS Agreement’s broad protections for intellectual property holders by referring to articles 7 and 8 as “context” and “purpose,” respectively, in accordance with Vienna Convention on Treaty Law article 31.1. As a result of their ambiguous wording and the “ordinary meaning” of treaty terms, such as compulsory licensing for patented pharmaceuticals, these provisions are unlikely to address issues. This is especially true when it comes to ambiguous drafting and “ordinary meaning” (35). Unified coordination is still lacking, even though it has become a consensus among international organizations and regions to strengthen international cooperation to address global health issues. International lawmaking has the potential to become fragmented, uncoordinated, and inefficient due to the involvement of numerous international organizations and other health actors in the international legislative process (9). Lack of enforceable sanctions is IHR’s most significant structural flaw. In other words, there are no legal consequences if a country fails to explain why it has implemented trade and traffic restrictions that are stricter than those recommended by WHO. The IHR2005 has many operational issues based on the experiences of handling COVID-19 up to the time of writing this paper. As far as guiding States Parties in combating the outbreak, the IHR2005 does not appear to have much of a role (36). Pandemics like Ebola and SARS have shown that global health governance does not have an effective system of law (16).
Because of its sudden and comprehensive nature, many of the problems with the COVID-19 were previously unknown. In the context of broader concerns about democratic backsliding around the world in recent years, the government response to the COVID-19 pandemic raises concerns over potential erosions of democracy and human rights (37). Some experts have warned of a “parallel epidemic” of government repression as governments around the world respond to the COVID-19 with lockdowns, travel restrictions, and other measures (38). When health-related limitations can be defended, the way they are implemented can raise human rights issues in some cases. Meanwhile (37). Abuse and arbitrary state power could be facilitated by the “securitization” of health law (39). Surveillance cell phone technologies have been used in several states to track people who may have been exposed to COVID-19 and their contacts (40). Take a look at the Infodemic as a case study. It is a term that describes the rapid spread of information of all kinds, including rumors, gossip and unreliable information. At present, we live in a time when networks are ubiquitous and data is swarming everywhere at breakneck speed As soon as a public health emergency occurs anywhere, it becomes the focus of the entire world’s attention, resulting in a flurry of rational analysis and irrational outrage. The use of infodemics in outbreak response is critical. Three main areas are covered: (1) monitoring and identifying health threats, (2) investigation of outbreaks, and (3) actions for mitigation and control (41). There are two reasons for this. As a first step, affected cities and countries may implement a lockdown policy, which raises the likelihood of information and security concerns.. It won’t help to make people afraid of reality, either. Many different opinions have been expressed since the outbreak of COVID-19 in public media and on the Internet. This has seriously harmed the morale and zeal of those who have been affected by the epidemic to fight it. Because of this, some countries have imposed limits on certain human rights, which has sparked controversy. Experts are concerned that some restrictions do not meet the necessary standards for human rights protection (42). Others argue that during the pandemic, civil liberties were increasingly threatened, including threats to freedom of speech, debate, and the press for reporters covering the news and scientists who had different opinions on the results of their research or studies (43). There is a bifurcated approach to balancing societal goals with individual rights in states of emergency because of the artificial dichotomy between “the norm” and “the exception” (43). Consequently, states may differ in the extent to which COVID-19-related restrictions deviate from previous modes of governance (37).
Damien Sendler: As far as the abilities of local governments around the world are concerned, the situation varies from state to state. Investing in international cooperation during a health crisis will be more difficult for local governments in a highly centralized state than in more decentralized and federal structures (15). When it comes to health care, a lot will be determined by how each state allocates its resources (15). As a result of these patterns, it is possible to gain a better understanding of the role of law in relation to the globalization of public health (44). As a result, health justice is a fundamentally global concept that requires equal access to health care for all people, regardless of where they live (45). The challenges faced by the international community in dealing with the epidemic can be addressed from a global governance perspective in the following ways:
States parties and WHO share the responsibility for implementing IHR2005. Considering that it is one of the United Nations’ largest special agencies and that it is the world’s largest international health organization, the WHO has enormous responsibilities to address global public health issues (9). Of the 22 functions listed in Article 2 of the Organization’s Constitution, almost all appear to be relevant to the COVID-19 pandemic’s size and scope (5). The WHO is the only international organization with lawmaking authority that wields unmatched power (10). Because of its amiable power and authority, the WHO can unambiguously influence international health policies; however, commentators have observed that the WHO is more content with acting as a technical agency than accepting leadership in global health (46). (46).
Damian Jacob Sendler
Even though achieving a global health framework convention or a similar mechanism would not be simple, and it would not provide an ideal solution, at least a framework convention would address the root of the problem: the obligations of states to act outside their borders, and thus establish the levels of commitment and the types of interventions required to make a significant difference for the world’s population (29). States parties should actively work with WHO, mobilize financial resources, and facilitate the implementation of their IHR2005 obligations in day-to-day public health governance; they must improve their national surveillance and response infrastructure so that timely warning of public health risks and emergencies is possible. If there is a threat to public health or an emergency, the states parties must immediately notify WHO of the relevant risks and circumstances; WHO should assess conditions and create a special information website for the country where the risk or emergency occurs. A daily report from each state party is required for WHO to publish the data on the information website during the duration of any risk or event. WHO will make relevant data available to all focal points of states parties and the general public, including progress, guidance, and warnings. In the event of an outbreak, WHO should send investigators to the outbreak site to better understand the situation. WHO and the states parties will strictly observe and carry out all of the aforementioned responsibilities. The states parties specifically agree to provide WHO with all necessary facilities and assistance so that the organization can better carry out its responsibilities. To help member states better prepare for a public health emergency, the WHO is currently developing specific indicators for core competency readiness (47).
The local governments in each jurisdiction are supposed to be in charge of dealing with COVID-19 and preventing its spread. WHO is supposed to work closely with governments around the world and lead the fight against the outbreak based on IHR2005 at the international level. (36). What matters is that we already have a place where people can come together and share their knowledge and resources, regardless of whether or not some of the criticism leveled at the WHO’s initial response to the crisis is justified (15). As the rate of economic globalization continues to rise, health global governance has become an increasingly contentious issue, with many sides fighting over differing ideologies (10). At the COVID-9 special summit, the parties pledged to take all necessary steps within their mandates with relevant international organizations, including WHO, and expressed their full support and commitment to further enhance WHO’s role in coordinating international anti-epidemic actions, all in the knowledge that (48).
Governments cannot manage the world’s affairs on their own, so international organizations, non-governmental organizations, and multinational corporations play an increasingly important role in what is known as “global governance” (49). The growing role of public and transnational corporations in the governance of international affairs necessitates the inclusion of transnational corporations and industry elites as well. Countries are the driving force behind the promotion of global governance of public health, and the role of WHO in the global governance of public health is to be a leader, coordinator, and platform provider. The principle of subordination underpins the wide range of governance subjects, theoretically. It is impossible to deny the significant influence that non-state actors have on international affairs (49). In order to effectively contain and combat a pandemic that threatens the entire world, international cooperation is clearly required (15). In order to effectively combat pathogenic threats (16), effective collaboration between various governance subjects is required at the international level. This is due to differences in economic development, medical supply, and scientific and technological personnel reserves between different countries and within a country.
Set up a virtual medical platform in order to fix problems caused by development gaps. As a result of PHEIC, some countries may be reluctant to export their limited supplies of raw materials and medical supplies. This means that no matter where they are produced or stored, a reliable global supply of medical resources and necessities is essential. Global health with justice requires an international order and transnational action that systematically advances the conditions for good health and accountable governance, particularly for people in countries on the short end of global health disparities (21). In the framework of WHO, a virtual warehouse is recommended. Because this is a virtual warehouse, there is no need for each member country to deposit its claimed materials. Rare raw materials and medical supplies are primarily stored in the virtual warehouse. The global health governance system’s health financing is a critical, but often overlooked, component (10). The warehouse’s funding sources can be categorized into the following. Reserved by the states parties amount. Member states are entitled to a proportionate share of medical products based on their annual contributions; b. social donation. Since the virtual warehouse is open to the entire public, charitable donations can come from any and all groups, companies, or individuals. In addition to their assessed amounts, countries with a national supply or domestic manufacturing capacity contribute more medical supplies to the virtual warehouse. WHO is in charge of the warehouse’s virtual operations. It is possible for the affected country or region to request WHO resource allocation in the event of a major outbreak. It is possible for the WHO to direct countries that are not affected by the outbreak to supply affected areas with appropriate medical materials, based on a principle of proportion and cost, to alleviate the problem of insufficient medical facilities due to regional development gaps.
Encourage international cooperation. With the advent of globalization, nations are increasingly turning to international cooperation to meet national public health goals and exert some control over the cross-border influences on their populations (32). This has resulted in an interdependent relationship between countries in today’s world. The mutual benefits of interdependence lead to a greater desire for cooperation. Because it touches on the most fundamental and pervasive aspects of people’s daily lives, public health is easier to understand and apply than other types of health care. As a result, cooperation is beneficial to the general public’s well-being and will produce the cooperative effect. Because of the novel coronavirus’s rapid spread across the globe, effective outbreak containment necessitates global cooperation (10). In order to get these ideas into the public eye, the heads of state and government could play an important role (21). Following an agonizingly high toll, the international community has gradually come to realize the importance of working together against the virus (50). March 26 was marked by an international consensus at the G20 Extraordinary Leader’s Summit, where leaders affirmed their commitment to “task our top relevant officials” in support of the global fight against the COVID-19 pandemic’s effects. Responding to an emergency involving public health necessitates international cooperation. As a first step, countries and regions infected with the disease should take action right away to stop it from spreading to other countries and regions. A secondary point is that other countries should do everything they can to assist the affected countries. The health departments at the state and local levels play a critical role in epidemic preparedness for the entire country (51). One of the most important things one can do for one’s own well-being is to help others. Using China as an example, foreign governments, businesses, non-governmental organizations, and friendly people around the world have assisted China in its fight against COVID-19’s sudden outbreak. It has been widely praised by the international community that as China’s domestic situation improved, it began to assist the WHO and other UN agencies, as well as neighboring countries, developing nations and even the United States and Europe (52).
Build a system that allows everyone in the community to participate. While the WHO acknowledges its constitutional responsibility for disease nomenclature, it has also been cognizant of its functions to coordinate with other UN Specialized Agencies and scientific and technical groups (5). Several commentators have suggested that the role of intergovernmental organizations in global health governance is dwindling due to the large number of international health actors actively involved in global health cooperation and the widespread criticism of the UN and its specialized agencies. Genuine cooperation is needed to achieve global health justice since all parties involved in the production of health equity are interdependent. Individuals and groups must accept and successfully carry out their respective roles and responsibilities in accordance with their functions, needs, and voluntary commitments in order to complete this task successfully (53). “Power shift” from international organizations to private sector actors and the above-mentioned innovative health coalitions has been emphasized by some analysts (54). Public-private partnerships have proliferated since 2,000 and will serve as a major source of global health law (19). It is not only in the public sector, but also in the private sector, that the dispersion of governance has taken place in contemporary history, with various regulatory mechanisms emerging in both sectors (25). People are calling for access to quality health care. They’re looking for people who are kind, compassionate, and well-versed in their fields. There is a demand for affordable access to essential medicines, vaccines, and medical equipment (21). Large pharmaceutical companies and research and development centers, in addition to the government and scientific research institutions, play an active role in responding to major disease outbreaks with their advanced research resources and strong capability of R&D on immune and anti-epidemic drug. Donations from all walks of life have also helped alleviate the problem of medical resource and material shortages in the most affected areas of the epidemic. Modern high-tech development necessitates the involvement of companies that dominate artificial intelligence and medical drug development. For countries dealing with the outbreak, the large number of volunteers is also a powerful force. Consequently, the World Health Organization (WHO) and other countries should actively support and promote the efforts of both private and public sector organizations and individuals.
Health disparities between people around the world have long been a global issue that requires a global response. The enormous impact of COVID-19 on global public health governance is a new challenge. In the face of the global public health crisis, the IHR2005 prevention mechanism has fallen short of expectations. Because member states have not all adopted the WHO’s recommendations, the international system for managing public health is exposed as having some serious flaws. COVID-19 and other PHEIC are the common “enemy” of all humankind, so states must be united in their response to the epidemic and maintain the vision of a community with a shared future for all humanity.