An international treaty enshrining the right to health should be part of post-covid reforms

Eric A Friedman, Kelly E Perry, and Luiz Galvão
Originally published in The BMJ Opinion | June 24, 2021

As covid-19 claimed ever more lives, destroyed livelihoods, and overwhelmed health systems, world leaders and global health experts rightly recognized the shortcomings of the International Health Regulations (2005) (IHR), and many are now calling for a new treaty to strengthen pandemic preparedness and response. Following this call, the World Health Assembly will convene a special session in November 2021 to consider a new kind of agreement. The proposed pandemic treaty could address key failings in the response to covid-19, such as the World Health Organization’s (WHO) inability to independently verify information from China, insufficient international assistance and cooperation to implement the IHR’s core public health capacities, and the deep inequities in vaccine distribution. Yet such a treaty is insufficient on its own.

Not only does any attempt to redress the global failings in our response to the covid-19 pandemic need to adopt a broader view of health security, it must also respond to deeper, persisting problems of global health architecture. Now is the time for a Framework Convention on Global Health (FCGH), a proposed global treaty based on everyone’s right to health and aimed at achieving national and global health equity. Such a treaty would both enhance global health security—the current priority of political leaders—and address the day-to-day indignities and inequities that are part of national and global health systems, costing many millions of lives every year.

Much of how disease proliferation unfolds in a particular country is not conducive to being solved by targeted fixes. The response further requires transforming the nature of health systems and how people experience them. As we’ve seen throughout history and during this pandemic, people, especially those who are part of marginalized communities, will often mistrust the sociobehavioral recommendations and mandates instituted by the health system and may experience vaccine hesitancy when health systems are not accountable to their people. Health systems lacking universality and inclusivity will always fall short on disease surveillance, detection, and response during health emergencies, failing to reach all populations—especially those who are disenfranchised—with diagnostics, therapies, vaccines, and messages about behavioral interventions. 

If governments do not proactively involve their entire populations in planning processes for health emergencies, communities may lack access to information and resources that are crucial to keep themselves safe and not spread diseases to others, such as information for migrants in their own languages and food and medicine during isolation and quarantine. By overlooking the needs and voices of marginalized communities, governments cement the inequities that create conditions for disease transmission, promoting local, national, and ultimately global spread—conditions that are also ripe for the emergence of new, more dangerous variants of the pathogen causing the health emergency.

The FCGH would respond to systemic factors like these that undermine preparation for and responses to novel and emerging diseases, as well as public health and health equity more broadly. Its remit would encompass advancing key right to health principles, such as equity, participation, and accountability, in both the public and private spheres. It would operate across sectors and at all levels from national to global, and help resource the right to health. The treaty would create specific standards, catalyze key mechanisms, and establish an overarching regime of accountability. In so doing, it would both facilitate governments to achieve and put greater pressure on governments to meet their longstanding right to health obligations, accelerating their implementation.

To ensure state actions respect right to health principles, governments could be required to assess how policies may affect the right to health of populations and adjust them accordingly to ensure compliance with human rights obligations. These assessments would encompass not only their own populations, but those beyond national borders too. For example, how will a vaccine contract or export controls of medical supplies impact the wider global community? 

States could also address the root causes of the inequities that covid-19 inescapably exposed by pursuing health equity programs, with action-oriented roadmaps that factor in the social determinants of health and address the needs of all populations experiencing health inequities. A new treaty like the FCGH, with specific standards on participation, including facilitating engagement with marginalized populations, would help to ensure that communities most harmed by health emergencies (and most subjected to structural and institutional barriers within the health system and beyond) are proactively involved in developing the plans to address such health inequities. Furthermore, a national and global health financing framework would establish both domestic and international health assistance funding targets. Countries would then have inclusive national processes to turn these targets into appropriate timelines and budgets that are contextually appropriate but still aligned with the responsibility of using maximum available resources to meet human rights obligations.

The covid-19 pandemic has heightened calls for treating vaccines as a global public good. The right to health, too, is a collective public good. Just as each of us will be safer if vaccines are treated as such, individuals, their local communities, and our global community will be healthier and more secure if countries individually and collectively foster the right to health in all of their actions. The FCGH can establish the legal foundation for this approach, from informed individuals and communities who know their rights to global cooperation aimed at securing them. 

Amid the continued devastation of the covid-19 pandemic, the central promise of the 2030 Agenda for Sustainable Development to leave no one behind feels ever more distant. As the health inequities and failings of the global health system have made undeniably apparent during this pandemic, only systemic change can confront health inequities and shortcomings in health emergency preparedness.

Read the article on The BMJ Opinion.

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