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Much has been written on the current proposals putting the World Health Organization (WHO) front and center of future pandemics responses. With billions of dollars in careers, salaries and research funding on the table, it is difficult for many to be objective. However, there are fundamentals here that everyone with public health training should agree upon. Most others, if they take time to consider, would also agree. Including, when divorced from party politicking and soundbites, most politicians.
So here, from an orthodox public health standpoint, are some problems with the proposals on pandemics to be voted on at the World Health Assembly at the end of this month.
Unfounded messaging on urgency
The Pandemic Agreement (treaty) and IHR amendments have been promoted based on claims of a rapidly increasing risk of pandemics. In fact, they pose an ‘existential threat’ (i.e. one that may end our existence) according to the G20’s High Level Independent Panel in 2022. However, the increase in reported natural outbreaks on which WHO, the World Bank, G20 and others based these claims is shown to be unfounded in a recent analysis from the UK’s University of Leeds. The main database on which most outbreak analyses rely, the GIDEON database, shows a reduction in natural outbreaks and resultant mortality over the past 10 to 15 years, with the prior increase between 1960 and 2000 fully consistent with the development of the technologies necessary to detect and record such outbreaks; PCR, antigen and serology tests, and genetic sequencing.
WHO does not refute this, but simply ignores it. Nipah viruses, as example, only ‘emerged’ in the late 1990s when we found ways to actually detect them. Now we can readily distinguish new variants of coronavirus to promote uptake of pharmaceuticals. The risk does not change by detecting them, we just change the ability to notice them. We also have the ability to modify viruses to make them worse – this is a relatively new problem. But do we really want an organization influenced by China, with North Korea on its executive board (insert your favorite geopolitical rivals), to manage a future bioweapons emergency?
Irrespective of growing evidence that COVID-19 was not a natural phenomenon, modelling that the World Bank quotes as suggesting a 3x increase in outbreaks over the next decade actually predicts that a COVID-like event will recur less than once per century. Diseases that WHO uses to suggest an increase in outbreaks over the past 20 years, including cholera, plague, yellow fever and influenza variants were orders of magnitude worse in past centuries.
This all makes it doubly confusing that WHO is breaking its own legal requirements in order to push through a vote without Member States having time to properly review implications of the proposals. The urgency must be for reasons other than public health need. Others can speculate why, but we are all human and all have egos to protect, even when preparing legally-binding international agreements.
Low relative burden
The burden (e.g. death rate or life years lost) of acute outbreaks is a fraction of overall disease burden, far lower than many endemic infectious diseases such as malaria, HIV and tuberculosis, and a rising burden of non-communicable disease. Few natural outbreaks over the past 20 years have resulted in more than 1000 deaths – or 8 hours of tuberculosis mortality. Higher burden diseases should dominate public health priorities, however dull or unprofitable they may seem.
With the development of modern antibiotics, major outbreaks from the big scourges of the past like Plague and typhus ceased to occur. Though influenza is caused by a virus, most deaths are also due to secondary bacterial infections. Hence, we have not seen a repeat of the Spanish Flu in over a century. We are better at healthcare than we used to be and have improved nutrition (generally) and sanitation. Widespread travel has eliminated the risks of large immunologically-naive populations, making our species more immunologically resilient. Cancer and heart disease may be increasing, but infectious diseases overall are declining. So where should we focus?
Lack of evidence base
Investment in public health requires both evidence (or high likelihood) that the investment will improve outcomes, and an absence of significant harm. The WHO has demonstrated neither with their proposed interventions. Neither has anyone else. The lockdown and mass vaccination strategy promoted for COVID-19 resulted in a disease that predominantly affects elderly sick people leading to 15 million excess deaths, even increasing mortality in young adults. In past acute respiratory outbreaks things got better after one or perhaps two seasons, but with COVID-19 excess mortality persisted.
Within public health, this would normally mean we check whether the response caused the problem. Especially if it’s a new type of response, and if past understanding of disease management predicted that it would. This is more reliable than pretending that past knowledge did not exist. So again, WHO (and other public-private partnerships) are not following orthodox public health, but something quite different.
Centralization for a highly heterogenous problem
Twenty-five years ago, before private investors became so interested in public health, it was accepted that decentralization was sensible. Providing local control to communities who could then prioritize and tailor health interventions themselves can provide better outcomes. COVID-19 underlined the importance of this, showing how uneven the impact of an outbreak is, determined by population age, density, health status, and many other factors. To paraphrase WHO, ‘most people are safe, even when some are not’.
However, for reasons that remain unclear to many, WHO decided that the response for a Toronto aged care resident and a young mother in a Malawian village should be essentially the same – stop them meeting family and working, then inject them with the same patented chemicals. WHO’s private sponsors, and even the two largest donor countries with their strong pharmaceutical sectors, agreed with this approach. So too did the people paid to implement it. It was really only history, commonsense and public health ethics that stood in the way, and they proved much more malleable.
Absence of prevention strategies through host resilience
The WHO IHR amendments and Pandemic Agreement are all about detection, lockdowns and mass vaccination. This would be good if we had nothing else. Fortunately, we do. Sanitation, better nutrition, antibiotics and better housing halted the great scourges of the past. An article in the journal Nature in 2023 suggested that just getting vitamin D at the right level may have cut COVID-19 mortality by a third. We already knew this, and can speculate on why if became controversial. It’s really basic immunology.
None-the-less, nowhere within the proposed US$30+ billion annual budget is any genuine community and individual resilience supported. Imagine putting a few $billion more into nutrition and sanitation. Not only would you dramatically reduce mortality from occasional outbreaks, but more common infectious diseases, and metabolic diseases such as diabetes and obesity, would also go down. This would actually reduce the need for pharmaceuticals. Imagine a pharmaceutical company, or investor, promoting that? It would be great for public health, but a suicidal business approach.
Conflicts of Interest
All of which brings us, obviously, to conflicts of interest. The WHO, when formed, was essentially funded by countries through a core budget, to address high-burden diseases on country request. Now, with 80% of its use of funds specified directly by the funder, its approach is different. If that Malawian village could stump up the tens of millions for a program, they would get what they ask for. But they don’t have that money; Western countries, Pharma and software moguls do.
Most people on earth would grasp that concept far better than a public health workforce heavily incentivized to think otherwise. This is why the World Health Assembly exists and has the ability to steer WHO in directions that don’t harm their populations. In its former incarnation, WHO considered conflict of interest to be a bad thing. Now, it works with its private and corporate sponsors, within the limits set by its Member States, to mold the world to their liking.
The question before Member States
To summarize, while it’s sensible to prepare for outbreaks and pandemics, it’s even more sensible to improve health. This involves directing resources to where the problems are, and using them in a way that does more good than harm. When people’s salaries and careers become dependent on changing reality, reality gets warped. The new pandemic proposals are very warped. They are a business strategy, not a public health strategy. It is the business of wealth concentration and colonialism – as old as humanity itself.
The only real question is whether the majority of the Member States of the World Health Assembly, in their voting later this month, wish to promote a lucrative but rather amoral business strategy, or the interests of their people.
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