Much has been written on the current proposals putting the World Health Organization (WHO) front and center of future pandemic 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.
Unfounded Messaging on Urgency
The pandemic agreement (treaty) and International Health Regulations (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 the 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.The WHO does not refute this but simply ignores it. Nipah viruses, for 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 and with North Korea on its executive board (insert your favorite geopolitical rivals) to manage a future bioweapons emergency?
Low Relative Burden
The burden (e.g., death rate or life years lost) of acute outbreaks is a fraction of the overall disease burden, far lower than many endemic infectious diseases such as malaria, HIV, and tuberculosis, as well as a rising burden of noncommunicable disease. Few natural outbreaks over the past 20 years have resulted in more than 1,000 deaths—or eight hours of tuberculosis mortality. Higher-burden diseases should dominate public health priorities, however dull or unprofitable they may seem.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.Centralization for a Highly Heterogeneous 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 that 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 the WHO, “Most people are safe, even when some are not.”
Absence of Prevention Strategies Through Host Resilience
The WHO IHR amendments and the 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 it became controversial. It’s really basic immunology.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 percent of its use of funds specified directly by the funder, its approach is different. If that Malawian village could stump up tens of millions of dollars for a program, they would get what they ask for. But they don’t have that money; Western countries, pharma, and software moguls do.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.