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How Global Public Health Could Revive Multilateralism

In the fight against the COVID-19 pandemic, national responses are vital, but in the medium term, international cooperation will be our best weapon. And reforming and reinforcing the institutions and mechanisms that underpin such cooperation will be our best defense against future global threats.

MADRID – As the world struggles to contain COVID-19 and mitigate its impact on our lives and livelihoods, it should be clear to everyone that international cooperation is the only effective way to win the battle. National responses are vital, but in the medium term, multilateralism will be our best weapon in this fight – and our best defense against future global threats.

My country, Spain, is on the front lines of the pandemic. The coronavirus hit us earlier and harder than most other countries. We are mourning thousands of deaths. Our health system has been put to an extreme test. The public is enduring long confinement with exemplary civic duty. And we have had to take unprecedented measures to safeguard our economy.

As governments, our primary responsibility is toward our nationals. But we know that no country will be completely safe until all control the pandemic and, eventually, eradicate it. Our initial international disunion has only strengthened our enemy, moving us further away from our shared goal.

Drawing on some of the lessons we are still learning, we urgently need to devise a more effective approach to global public health that integrates new international, European, and national policies and initiatives.

First, at the international level, we need a more effective framework to prevent, detect, and respond to diseases and pandemics, rooted in reinforced institutions and new mechanisms designed to prevent some of the failures we have witnessed. The new institutional arrangements should be based on a revitalized and reformed World Health Organization, with wider mandates and greater enforcement authority. The WHO ought to have the capacity to design and impose better protocols for preparedness and reaction, compel data sharing, and mobilize whatever resources are needed.

A global health framework with teeth must also be agile enough to cover the whole chain of public-health interventions, from scientific research and early warning to policy formulation, implementation, and evaluation. That’s why, aside from necessary reforms of the WHO’s decision-making process and its Emergency Committee, the potential of other international platforms and organizations to contribute to the global health system we need should not be overlooked.

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For example, the G20 and the G7 can help marshal the necessary political will. The World Bank and other regional development banks are uniquely well positioned to mobilize resources toward health-care reform. And organizations like the OECD have the analytical firepower to distill best health policies and practices. Overall, we need to advance a “one health approach” that brings together the environmental, economic, social, and security dimensions of public health.

Second, the European Union should provide a model of preparedness and crisis management that other regions might emulate, by pooling resources and devising new mechanisms for joint action. Besides leading in the establishment of a new and stronger global health framework, the EU can and should improve its own internal coordination. After all, it was sectoral collaboration on coal and steel that gave birth to the EU, the most innovative global governance mechanism that the world has seen. A similar level of ambition is now needed to combat the health challenges we share.

Deeper European integration in this area would yield several significant benefits. The European Centre for Disease Prevention and Control should gain greater autonomy and resources. A real European Crisis Management Unit could be established, with the means to ensure a rapid response to an emergency. Systematic stress tests on national health systems should also be conducted to assess EU members states’ resilience against shocks. Like the rigorous stress tests conducted on our financial sectors, the process should allow for shortcomings to be addressed, best practices to be shared, and coordination tools to be developed.

Moreover, the EU should invest in joint databases, medical reserves, and stockpiles. Likewise, it should harmonize protocols and foster scientific collaboration on developing treatments and vaccines. In the immediate term, European countries should cooperate on a coordinated transition strategy to restart the economy without triggering a new outbreak.

Finally, at the domestic level, we all have much to do – as a duty not only to ourselves and our countries’ inhabitants, but also to our neighbors and the international community at large. In Spain, we will establish a commission to assess the state of our health-care system and fix its weaknesses and shortcomings. But, because we know that pandemics affect the world’s most vulnerable people the hardest, we will also reinforce our health diplomacy. Strengthening national health systems requires sharing our experience with other countries and learning from theirs, as well as placing a higher priority on health-sector reforms in our development cooperation.

If we take steps like those proposed here, this pandemic will leave us better prepared for the next one. But we should seek a bigger silver lining. International cooperation on health issues should be extended to other global “public bads” that we have failed to address effectively: climate change, armed conflicts, poverty, rising inequality, international migration, nuclear proliferation, terrorism, and more. The urgency of these challenges may seem less pressing now, but the threats they pose to all of us persist.

In our interconnected world, we need to revive multilateralism by making it more coherent and fit for purpose. That means reinforcing the institutions and mechanisms that work, reforming or eliminating those that don’t, and creating those we need. This crisis reminds us of our fragility and the importance of international unity. It leaves no doubt that we are in this together. And it makes clear why we should view closer cooperation on global public health as a catalyst for the multilateralism we need.

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