The Covid-19 pandemic is the latest – though most significant – in a series of disease outbreaks and we can expect others in the future. Rapid changes in the global economy, major population movements, environmental exposure to health risks and climate-related shocks are likely to require major public health responses in the coming years. The inadequate global coordination and leadership in the response to Covid-19, as manifested in the lack of an agreed standard diagnostic test and the competition for necessary supplies, has highlighted the need for new approaches to health governance.
Despite widespread agreement in the early years of this century on the international health regulations and the importance of surveillance and preparedness for possible outbreaks, the delayed and/or weak initial response to Covid-19 by many countries has revealed a wide gap between the language of these legal agreements and the mechanisms in place to put them into practice. There is also a gap between the expectations placed on international agencies and the resources and powers they have been given.
Three alternative directions for the future
This suggests a need for major changes in the management of future threats at national and international levels. I can see three alternative directions for global health governance:
- continuing the current situation with substantial national autonomy and ad hoc arrangements for bilateral and multi-lateral cooperation;
- creating barriers between countries and regions and a reliance on parallel arrangements for global health security between blocs; or
- strengthening global governance arrangements that include China and other countries as equal partners.
The recent action of the United States in suspending its financial support for the WHO suggests a discontent with the first option and a tendency towards the second. It is difficult to envisage how either of the first two options would provide adequate protection. That means that some form of global cooperation will be necessary. The challenge is that there is no blueprint for how to manage a change towards this goal, which must involve the active participation of China.
China’s global role is clear
The Covid-19 pandemic has made the significance of China’s integration into the global economy clear. A virus that emerged in that country has rapidly spread around the world. China’s actions in the pandemic response are having global significance and this will become increasingly apparent in the rush to develop and disseminate new diagnostic technologies, anti-Covid drugs and vaccines, and in the response to the associated economic crisis.
China’s global footprint is growing rapidly. It is now a major source of development finance. Its companies occupy key positions in global value chains. In several sectors, including telecommunications, its companies have become global leaders in the application of cutting-edge technologies. And China’s geopolitical stance has become increasingly assertive. China is increasingly perceived as a global competitor in all these terrains. How can cooperation on health be achieved in this context?
Better collaboration with China is needed
The transition from the global health governance arrangements that were built after the second world war in the period of the cold war and decolonisation is not proving easy. One major challenge has been the need to create new kinds of collaboration with China. It will be important for other countries to acknowledge conflicts of interest and negotiate effectively when this is the case, but, in areas of mutual interest and global public good, mechanisms will be needed for the governments of China and other countries to work together in major initiatives.
These governmental mechanisms should be complemented by long-term collaboration in areas of technical expertise in health and related scientific research and development of innovative technologies. These measures would help build mutual understanding on the technical issues involved and establish mechanisms for more effective cooperation.
At the same time, there is a need to redefine the roles and responsibilities of the WHO and agree a new approach for financing its activities. Over time, it will be necessary to reach new agreements on the responsibilities of governments to the global community and on mechanisms to monitor compliance.
Major global challenges require global cooperation
The emergence of a new global power inevitably disrupts established ways of doing global governance. This is taking place in a period of rapid change that is presenting major challenges that require global cooperation. The challenge for China, other global actors and multilateral organisations is to find ways to incorporate new approaches to global collaboration, while maintaining the stability of existing governance arrangements for global health.
This will require a willingness on all sides to learn from each other and invest the effort needed to build governance arrangements appropriate for the coming decades. This is not only important as a means of ensuring global public health, but also as a demonstration of how governance arrangements can be adapted to the needs of a pluralistic global order in a context of rapid change. This is the challenge the new emerging global community faces as it struggles to build a cooperative approach for addressing the challenge of Covid-19.