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The United Nations and global health

Seventy-six years ago, the United Nations (UN) was  established  as a global institution of hope for a world emerging from the shadow of a catastrophic war. Today , peoples of the UN carry this hope forward around the whole planet. COVID-19, conflicts, hunger, poverty and the climate emergency remind us  in a dramatic way that our world is far from perfect. “But they also make clear that solidarity is the only way forward”.(1)

Since 2008 the item “Global health and foreign policy” is on the agenda of the UN General Assembly (UNGA) and is considered in plenary meetings. (2)

 As a result of fruitful negotiations, this item is not only  permanently present  on the UNGA agenda, but it led to the circulation of professional reports prepared by the World Health Organization (WHO). The reports , discussions and resolutions resulting from the consideration of this item revealed the existence of different areas of collaboration between health and foreign policy, helped to formulate specific recommendations, and thus contributed to a better understanding of the importance of global health in international policy and developmental discussions.

 On 11 December 2019 in a comprehensive resolution (11 pages,41 operative paragraphs) adopted by consensus and circulated worldwide  under the title Global health and foreign policy: an inclusive approach to strengthening health systems  the UN offered persuasive warnings and recommendations which deserved universal attention. Moreover,  in the same year 2019, the UNGA decided to convene a high-level meeting on universal health coverage in 2023 in New York in order to identify gaps and solutions to accelerate progress towards the achievement of universal health coverage by 2030.It was also decided that the scope and modalities of this objective should be decided no later than the 75th session of the UNGA in 2020, taking into consideration the outcomes of other existing health-related processes. At the same time, in 2019, the UNGA requested the UN Secretary-General, in close collaboration with the Director-General of the WHO, to address, inter alia, the challenges and opportunities of inclusive approaches to strengthening health systems.(3)

It should be reminded that on 11 December 2019 France, on behalf of the seven members of the Foreign Policy and Global Health Initiative – Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand introduced the draft resolution entitled “Global health and foreign policy: an inclusive approach to strengthening health systems”. Several paragraphs of the draft were approved by vote, while the resolution as a whole was adopted by consensus. There was no reference to COVID-19 in all diplomatic deliberations about the above 2019 resolution, in spite of the fact that, as announced by BBC, on 1 December 2019 the first onset of symptoms of this virus were observed, according to the Lancet medical journal.(4)

Unfortunately, this resolution was not taken into account by the decision-makers at the national level  and today, as estimated at the highest political and scientific levels , the world faces its gravest health crisis  since the founding of the UN in 1945.

From 2020 the following documents deserve to be mentioned.  First of all the UN Secretary -General report  entitled  Shared responsibility, global solidarity: Responding to the socioeconomic impacts of COVID-19. The report was published as a brochure and is available in extenso at https://unsdg.un.org/resources/shared-responsibility-global-solidarity-responding-socioeconomic-impactscovid-19;

Two UNGA’s resolutions have been adopted :

 The first one  is entiltled Global solidarity to fight the coronavirus disease 2019 (COVID-19.The second  resolution is entitled International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19.(5)

The implementation of these resolutions is far from being satisfactory , as we are going  to illustrate below based on the  assessments made by the UN Secretary-General.

In strictly legal terms, the non-implementation of an UNGA  resolution should not generate disputes, not even between its initial sponsors. As demonstrated  by professor Michel Virally “La recommandation donne un contenu concret aux engagements statutaires des Etats et déterminer les conditions dans lesquelles ils devraient s’en acquitter. Ces derniers ont le droit de lui opposer leur propre conception, mais ne peuvent utiliser ce droit pour se soustraire à leurs obligations. Ils ne sauraient éviter de se conformer à la recommandation qui leur est adressée que si leur refus se justifie en droit et en fait. Ils peuvent d’ailleurs renoncer à ce droit d’appréciation individuelle ou encore s’engager à faire étudier la recommandation par leurs autorités contrôlées en droit interne et à faire rapport sur les mesures qu’ils ont prises pour la mettre en œuvre”.(6)

The majority of UNGA’s resolutions, including those adopted unanimously or by consensus, in practical terms, without a vote , contain just recommendations. The  real difference between recommendations and legally binding resolutions consists in the fact that a recommendation is just a specific  suggestion  addressed to Member  States, whereas the bindings ones impose legal obligations on all of them . In the case of a recommendation, the States  themselves determine their  attitude thereto, whereas a binding resolution leaves no choice to the State but to implement it.

 Indeed,  the resolutions  dealing with the novel coronavirus (officially named COVID-19) are  devoted to what is  now an obvious global danger, and must be treated with utmost attention. Realities are undisputable. It is a tragic fact of life that by 15 December 2021 this virus has resulted in 271,963,258confirmed cases   and 5,331,019deaths. Globally, as of 5 January 2022, there have been 293,750,692 confirmed cases of COVID-19, including 5,454,131 deaths, reported to WHO. As of 4 January 2022, a total of 9,118,223,397 vaccine doses have been administered.(7)

The unprecedented magnitude of health crisis generated by COVID-19 was expected to  stimulate legitimate questions about the role of health diplomacy in promoting an effective international cooperation for the defense of the fundamental rights to life and health.

An academic answer for the pre-COVID-19 period can be  found in the chapter entitled Health Diplomacyby David P. Fidler, who is James Louis Calamaras Professor of Law at the Maurer School of Law, Indiana University-Bloomington.This chapter published in

The Oxford Handbook of Modern Diplomacy (2013),edited by Andrew F. Cooper, Jorge Heine and Ramesh Thakur,contains the following assessment: “ Diplomatic endeavours involving specific health threats has a long, diverse history, but, without question, these endeavours today involve more problems, players, processes, and principles than witnessed in any other period.The proliferation of threats, actors, venues, and norms challenges attempts to bring order to this expansion of diplomatic activities on health. For health advocates, this expansion is a bitter pill—higher  profile tends to equate with worsening health problems, meaning that prevention of disease and creation of conditions that produce better health outcomes is failing globally”.(8)

Consequently, we should not be surprised by discovering how unprepared was the world community of nations in 2019 at the birthday of COVID-19.

So being the case with the unexpected proliferation of COVID-19 worldwide, in his well-received report entitled Our Common Agenda, published in September 2021,the UN Secretary-General Antonio Guterres had all reasons  to pay primordial attention to global health. In this programmatic document there are 47  direct references to health.(9)

Around 400 reports are issued  annually in the Secretary-General’s name. But Our Common Agenda is an exceptional document, as it  sets out a comprehensive vision for a better, more sustainable and peaceful future, as well as for more effective, inclusive and networked multilateral diplomacy, including health diplomacy.

According to this report , COVID-19 pandemic has been a challenge like no other since the Second World War, revealing our shared vulnerability and interconnectedness. It has exposed human rights concerns and exacerbated deep fragilities and inequalities in our societies. It has amplified disenchantment with institutions and political leadership as the virus has lingered.  Many examples of vaccine nationalism have been reported . Moreover, with less than a decade to go, the Sustainable Development Goals in 2030 Agenda have been thrown even further off track. 

Under these circumstances,  the report  concludes that “ The world needs to unite to produce and distribute sufficient vaccines for everyone. We have been reminded of the vital role of the State in solving problems, but also the need for networks of actors stretching well beyond States to cities, corporations, scientists, health professionals, researchers, civil society, the media, faith-based groups and individuals. When we all face the same threat, cooperation and solidarity are the only solutions, within societies and between nations”.

Fighting COVID-19 is not an easy task . The document explains the causes : public distrust of governments and government distrust of publics made it harder to maintain consensus behind public health restrictions on COVID-19. Conversely, countries with higher levels of trust in public institutions (along with higher levels of interpersonal trust) did better at managing the pandemic.

  In order to change the current situation, the report asserts  that one of  the key lessons from  the experience with  COVID-19 is  to recognize the importance of the State as a provider of trustworthy information, goods and services, especially in times of crisis. Institutions can analyze and reduce administrative burdens that make it hard for people to gain access to their services. A total of $78 billion would be needed for low-income countries to establish social protection floors, including health care, covering their combined population of 711 million people.

The report offers lucid practical warnings. While dealing with global public health, countries must be persuaded that the costs of their failure to heed the warnings of a possible pandemic and work together more effectively once the virus took hold will reverberate for generations to come. Therefore, States  must ensure this never happens again. Mechanisms to manage health as a global public good effectively and proactively are essential for the very sustainability and safety of human life. 

 In this context, it is cogently  reminded that the greatest near-term test of multilateralism is the effort to end the COVID-19 pandemic, notably by winning the race between vaccines and variants.  Over 11 billion doses are needed for the global population to cross the 70 per cent vaccination threshold that might end the acute phase of COVID-19 pandemic. This will involve the largest public health effort in history. As for the future, longer-term governance of global health must focus more on prevention, preparedness and equity.

In the last section of the report  dealing with global health under the title Moving forward Antonio Guterres finds it necessary to emphasize the  obvious fact that it is imperative to ensure sustainable financing; to boost partnerships; to listen to and work with youth; and to be prepared for future crises, including but not limited to public health crises. The UN should be at the center of the efforts to deliver on these commitments, as there is no other organization with its legitimacy, convening power and normative impact.(10)

The report Our Common Agenda has been endorsed by  the UNGA through a resolution adopted by consensus,  after being introduced by a large group of States, including Romania. The UNGA  welcomed  the Secretary‑General’s vision on the future of global cooperation and reinvigorating inclusive, networked, and effective multilateralism over the next 25 years, as requested by Member States. 

The resolution  asked the Secretary‑General to inform and engage in consultations with Member States on his proposals in the report for follow‑up action to expedite full implementation of agreed frameworks, including the 2030 Agenda for Sustainable Development and the Paris Agreement on climate change.(11)

On December 16 2021, in a press -conference the UN Secretary-General Antonio Guterres had the occasion  to formulate his conclusions on global health  at the end of a very  difficult year. We summarize below some of these conclusions, while respecting the original terminology of the press- conference. The picture is dramatic.(12)

The COVID‑19 pandemic raged on.  Inequalities kept rising…  we face even harder times ahead.  COVID‑19 is not going away.  It is becoming clear that vaccines alone will not eradicate the pandemic.  Vaccines are averting hospitalization and death for the majority who get them and slowing the spread.  But transmissions show no sign of letting up.  This is driven by vaccine inequity, hesitancy and complacency.

Statistics are disturbing. Two months ago, the WHO unveiled a strategy to vaccinate 40 per cent of people in all countries by the end of 2021, and 70 per cent by the middle of 2022.  That strategy requires the total commitment of Member States — especially those with vaccine production capabilities or large supplies. But just days from the deadline, 98 countries have not been able to meet that end-of-year target.  Forty of them have not yet even been able to vaccinate 10 per cent of their population.  In lower income countries, less than 4 per cent of the population are fully vaccinated.  And the vaccination rates in high-income countries are eight times higher than in the countries of Africa.  At current rates, Africa will not meet the 70 per cent threshold until August 2024.  Vaccine inequity is giving variants a free pass to run wild — ravaging the health of people and economies in every corner of the globe.

A serious and well-balanced warning has been launched. ”We cannot defeat the pandemic in an uncoordinated way.  All countries, especially those that have potential of responsibilities, must take concrete action in the coming days to make greater progress to achieve WHO’s global 40 per cent target, and be far more ambitious in their efforts to reach 70 per cent of people in all countries by the middle of 2022”.But are 193 UN member States ready to act in that direction ?Facts do not encourage an optimistic answer.

Moreover, it is recognized that  at the same time, in a multitude of contexts, countries and national economies are getting squeezed from all sides — especially in the developing world.  Lopsided COVID‑19 recovery efforts are accelerating inequalities and increasing stresses on economies and people.  Advanced economies were able to mobilize nearly 28 per cent of their Gross Domestic Product into economic recovery.  For middle-income countries, that number fell to 6.5 per cent.  And even worse, it plummeted to 1.8 per cent for the least developed countries — a tiny percentage of a very small amount.

The situation described by the UN Secretary-General is even worse in sub-Saharan Africa,  where the International Monetary Fund  projects that cumulative economic growth per capita over the next five years will be 75 per cent less than the rest of the world.  “This is unacceptable”, says Antonio Guterres. 

 Finally, the UN Secretary-General refers to  two governance failures that represent  also two moral failures : a serious governance problem with respect to the prevention, detection and response to pandemics and a second   serious governance problem in relation to the international financial system. His final conclusion is future-oriented : “2022 must be the year in which we finally address the deficits in both governance systems.  And this is a central aspect of the common agenda.  In making those much-needed reforms, we will move to a much more fair, peaceful and sustainable world”.

A significant regional event

Bangkok hosted from 26 to 29 April 2021 the most important UN event of the year in the field of multilateral diplomacy as practiced at the regional level.

As reported, but without the benefit of large publicity, the biggest UN regional commission – the Economic and Social Commission for Asia and the Pacific (ESCAP) – composed of 62 members and associate members had its annual virtual session under the very difficult conditions generated by the pandemic COVID-19.(13)

The session took place under the theme “Building back better from crises through regional cooperation in Asia and the Pacific”.

The tone of deliberations was given by the president of the ESCAP session (Kazakhstan) who inter alia asserted:” Recovering from this crisis will need truly innovative solutions and urgent collective efforts that no country can do alone. It will require a whole-of-society, whole-of-government and whole-of-the-world approach, strong political will, and bold leadership, driven by compassion and solidarity.”

It   should be reminded that the value of solidarity is universal, as clearly expressed in the UN Millennium Declaration of 8 September 2000.

Because of COVID-19, only 52 Asian and Pacific countries attended the 77th session of ESCAP. In the final resolution of the session ESCAP called for a “whole-of-society” response to COVID-19 and encouraged coordinated action across the region to mitigate the economic and social devastation brought on by the pandemic.

In more specific terms, in this comprehensive resolution (16 operative paragraphs), in one of the very first operative paragraphs the ESCAP “Emphasizes the key leadership role of the World Health Organization and the fundamental role of the United Nations system in catalysing and coordinating the comprehensive response to the COVID-19 pandemic for the international community, ensuring universal and equitable distribution of vaccines and their accessibility and affordability, particularly in developing countries and least developed countries, and the role of extensive immunization as a global public good.”

This UN regional body, the only one in which all five permanent members of the Security Council are full members, also reaffirmed its commitment to multilateralism in response to global crises such as the COVID-19 pandemic.

In their statements, in a spirit of solidarity, many delegates, from a total of over 500, underlined the importance of ensuring universal and equitable access to vaccines, investing in social protection systems that promote access to essential services and decent jobs, particularly to meet the health and social care needs of the most vulnerable populations, and promoting the continued flow of essential goods and services.

The US delegation stated inter alia that “Faced with a global health crisis of unprecedented proportions, the people of the United States are proud to support the international COVAX vaccine facility. We have already contributed an initial two billion dollars and committed to provide an additional two-billion-dollar contribution through 2022. We urge current donors to fulfill their pledges and call on others to contribute to address the COVID-19 vaccine funding shortfall”.

Guided by solidarity, China announced that “We are working on providing vaccines to 80 developing countries with urgent needs, exporting vaccines to more than 40 countries, and donating vaccines to UN peacekeepers. We have announced our decision to supply 10 million doses of vaccines to WHO’s COVAX facility”.

From a similar perspective , Russia reminded that “The events associated with the coronavirus crisis have become another reminder, if not a warning, to all of us, the peoples of the United Nations, that the only way to defeat global threats is not by erection of dividing barriers, but by solidarity, by combining the efforts of all states. The age-old wisdom says: “If you want to go fast, go alone. If you want to go far, go together. “

Speaking on behalf of the 10 ASEAN members, as current Chair of this regional organization, Brunei Darussalam said :” , We agree that the promotion and strengthening of multilateralism is pertinent in accelerating global economic recovery and in mitigating the COVID-19 pandemic. Therefore, we welcome the ESCAP resolution which will be adopted during this session that calls for closer cooperation in multiple sectors to enable the realization of the building back better agenda”.

As a general conclusion formulated in the official account of the ESCAP session, “The Commission agreed that multilateral and regional cooperation were essential to build back better and should be aligned with the 2030 Agenda to ensure more sustainable and resilient economies. It was stated that regional and global cooperation should be promoted under the principles of multilateralism, unity, equality, mutual benefit, solidarity and respect for sovereignty, while preventing politically motivated factors and sanctions rhetoric from destructively affecting the overall efforts to recover from COVID-19 and achievement of the Sustainable Development Goals”.

“We are committed to supporting governments to building back better from the COVID-19 pandemic through inclusive, resilient and sustainable recovery strategies,” Armida Salsiah Alisjahbana, United Nations Under-Secretary-General and Executive Secretary of ESCAP, said in her closing remarks to the Commission’s 77th session. “It is my utmost hope that the resolution on regional cooperation to build back better from crises in Asia and the Pacific will further mainstream our response to COVID-19.” In her view, the spirit of goodwill prevailed, and “solidarity remained at the core of our responses”.

The Executive Secretary of ESCAP also  remarked that “regional cooperation is as needed today as it was 75 years ago.” She noted that as the Commission approaches this landmark milestone it is poised to take concrete actions on shaping the future of regional cooperation to advance the 2030 Agenda for Sustainable Development and deliver on the common agenda set out by member States.(14)

In this complex process, the guiding light should be the truth cogently formulated by the UN Secretary General António Guterres according to whom “Solidarity is humanity. Solidarity is survival.”(15)

As António Guterres secures from 2022 a second term as UN Secretary-General, his  calls for new era of “solidarity and equality” should be taken most seriously by the world community of nations during the current era of global vulnerabilities , perplexities and discontinuities.

A global debate

Interesting examples about national positions of UN Member States on fighting COVID-19 pandemic and its consequences can be quoted from the verbatim records of the general debate in the UNGA. The space of this article permits only a few quotes.

A critical assessment of the situation  was made by Chile , according to which “Despite repeated scientific warnings that pandemics were potential threats, the international community and States chose to ignore them. The coronavirus disease (COVID-19) pandemic therefore took us by surprise, with no early warning mechanisms, no information-sharing systems and fragile health systems, even in the most developed nations, which could not always respond to all those who were ill, and, most seriously, without vaccines or drugs to combat COVID-19”.(16)

According to Argentina, ” we face a triple pandemic with common roots: the pandemic of global inequality, the pandemic of climate change and the coronavirus disease (COVID-19) pandemic. “….The pandemic has revealed the globalization of inequality and, at the same time, a vulnerability that transcends borders. The pandemic has also exposed the risk of greed, waste and slowness in providing supportive responses to global problems”.(17)

 Moldova saluted “the report of the Secretary-General, entitled Our Common Agenda, as a forward-looking blueprint for enhanced global cooperation to effectively address our common challenges. Only through solidarity and closer international cooperation will we — the States Members of the United Nations — be able to overcome current and emerging challenges and attain the vision of a world where people live in peace and prosperity in harmony with nature”.(18)

Indonesia reminded that “We know that “no one is safe until everyone is”. The capacity and pace among countries in tackling COVID-19, including in vaccinations, differs widely. Politicization and discrimination towards vaccine continues to take place. We must solve these issues with concrete steps. In the future, we must reorganize global health security architecture, global health security system. New mechanisms are required to mobilize global health resources, which includes financing, vaccines, medicines, medical equipment, as well as healthcare workers worldwide, quickly and fairly.”(19)

Romania informed the UNGA that ”The pandemic has also prompted us to act together to consolidate our national health systems and make them more resilient. An urgent priority is to ensure equitable and affordable global access to vaccines and treatments for COVID-19. Romania reaffirms its support for the COVID-19 Vaccine Global Access Facility, and we have contributed to the Team Europe approach to help various countries tackle the impact of the pandemic. Romania fully supports the adoption of an international legal instrument for pandemic preparedness and response”.(20)

Vietnam declared that “No statistical figures can truly measure the grief and loss caused by the COVID-19 pandemic. It is a question, above all, of the loss of lives, and subsequently of severe economic damage and far-reaching impacts on societies and people’s well-being. The pandemic has sounded a warning bell of the shocking destruction that results from such non-traditional security challenges as disease or climate change if they are not addressed in a timely and decisive manner. The pandemic has also exposed the shortcomings of the global governance system and the increasing inequalities among nations.”(21)

In the opinion of Spain,” The truth is that despite appearances, the virus also reinforced inequalities. The poorest regions had neither the health infrastructure to stop the spread of the disease nor the resources to create a social safety net to protect citizens from the economic crisis. The pandemic taught us that we are all vulnerable, but it also reminded us that intolerable inequalities persist in the world and are exacerbated by global crises such as that caused by COVID-19”.(22)

Realistic considerations have been expressed on 22 September 2021 by Norway who asserted that “We need to reform and strengthen the global health architecture to prevent, detect, and respond to future threats. And we need a fully financed WHO playing a central, coordinating role. We must invest in health. We must build robust national health systems and ensure universal health coverage. There is a glaring inequity in vaccine distribution. Some countries have vaccinated their populations, and are on the path to recovery. For others, the lack of vaccines and weak health systems pose a serious problem. In Africa, fewer than 1 in 20 people are fully vaccinated. In Europe, one in two are fully vaccinated. This inequity is clearly unfair”.(23)

The representatives who took the floor the same day in the next UNGA’s session made 42 references to health. Some of them are remarkable by their focus on the necessity of  immediate global action. Panama, for instance , declared :” Panama once again offers itself as a bridge to bring nations closer together, seek shared, concrete solutions to problems and face regional and global challenges. We can do it, with a road map marked by solidarity and respect for human rights. We can do it through broad and honest dialogue, focusing international efforts on maintaining social peace and providing the necessary vaccines to all countries in order to save lives, preserve health and get all of us on the road to economic recovery as soon as possible. For all of those immense challenges, the future is now. Let us make no mistake. For all of those immense challenges, the future is now. The time for stories and philosophy is over. The time for fairy tales and words is over. The time for promises is over. The moment of truth has arrived. The time for action has come”. (24)

In the opinion of South Africa ,” In dealing with the COVID-19 pandemic it is generally agreed that vaccines are the greatest defense that humanity has against the ravages of this pandemic. It is therefore a great concern that the global community has not sustained the principles of solidarity and cooperation in securing equitable access to COVID-19 vaccines. It is an indictment on humanity that more than 82 per cent of the world’s vaccine doses have been acquired by wealthy countries, while less than one per cent has gone to low-income countries. Unless we address this as a matter of urgency, the pandemic will last much longer and new mutations of the virus will emerge”.(25)

On a similar note, Cuba reminded that “Hundreds of millions of persons in low-income countries are still waiting to receive their first dose and cannot even estimate when or if they will ever receive it. At the same time, it is hard to believe that the world’s military budget in the year 2020 amounted to almost $2 trillion. How many lives would have been saved should those resources had been invested in health or the manufacturing and distribution of vaccines? The possible answers to this question involve changing the paradigm and transforming the unequal and antidemocratic international order that subordinates the legitimate aspirations of millions of persons to the selfish attitudes and narrow interests of a minority becomes an imperative”.(26)

Finally, we will refer to the statement of Italy, a country most dramatically affected by COVID-19 from the very beginning of the pandemic. In Italy’s lucid opinion “ the pandemic is not over and even when it will be, we will have to deal with its consequences for a long time. Globally, we face dramatic differences in the distribution of vaccines. In high-income countries, more than 65 per cent of the population has received at least one dose. In the poorest ones, only 2 per cent. These disparities are morally unacceptable: fewer vaccinations mean more deaths. And as long as the virus continues to circulate freely, it can mutate in dangerous ways and put even the most effective vaccination campaigns at risk. We need to increase the availability of vaccines for poor countries and overcome logistical hurdles to distribute them where they are most needed. Furthermore, we must preserve at the global level the free circulation of vaccines and of the raw materials needed to produce them.”(27)

Further debates in more specific terms  are expected in 2022.

During the current 76th session of the UNGA, a  separate report of the UN Secretary-General has been circulated  under the title Global health and foreign policy: strengthening health system resilience through affordable health care for all as well as improving international coordination and cooperation to address the health needs of all States during health emergencies . (28)

In this report, the Secretary-General highlights the unprecedented and devastating health and development losses resulting from the coronavirus disease (COVID-19) pandemic – losses that have reversed gains made over the past decades and threaten attainment of the Sustainable Development  Goals. He also sets out priority actions that countries can take to strengthen their health systems and enhance resilience against shocks and explores priority actions within the domain of global health policy and cooperation, for consideration by the Foreign Policy and Global Health Initiative.

We will reproduce below for their obvious relevance, but without comments,  the  list of priorities for global health action and foreign policy, as seen by the Secretary-General.

*Accelerating equitable access to COVID-19 technologies between and within countries;

*Strengthening the global health architecture, including through a new pandemic preparedness treaty;

*Pursuing foreign policy that promotes rights, gender, equity and multisectoral action;

*Taking stock with clear action plans and necessary implementation support at the 2023 high-level meeting on universal health coverage;

*Towards a renewed global health and foreign policy vision for health and sustainable development;

The report informs that the priorities set out above are tabled for consideration and further development. They require the leadership of foreign policy and global health communities in order to advance.

The  final  conclusion of this report reads : “The world’s worst global health crisis in generations presents an opportunity: this is not the time for small changes and temporary solutions, but for bold ideas, bold commitment and bold leadership. There is an urgent imperative and opportunity to strengthen each country’s health system and reinvigorate international cooperation so that current and future generations are protected from health emergencies and have universal health coverage to ensure health and well-being at all ages and in all situations”.(29)

Towards an international legal instrument and WHO action

It should be reminded that  in 2021  the  WHO agreed to hold a special session of its Assembly in November 2021 to consider a proposal for a pandemic treaty already mentioned above. This is a highly significant initiative. Such an international  legal instrument  would foster improved sharing, trust and accountability and help to strengthen national, regional and global capacities for global health security in the form of a framework convention on pandemic preparedness and response. The proposal, now under development by a working group on the pandemic treaty, involves reviewing recommendations of various panels and committees to strengthen pandemic preparedness and response and prioritizing the assessment of the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response. As the  objective is to strengthen pandemic preparedness and response for the future, the  practical focus is supposed  to be on bringing various actors and components together in a coordinated manner, using   existing structures, rather than establishing new ones,  in order to avoid further fragmentation and duplication. The  general aim  of the whole exercise would be the elaboration of an international agreement  that represents all countries and people, deals with shared risks and is inspired by  shared humanity and solidarity. It is also necessary to add that , according to the relevant  report on the matter, “There is also a requirement for the global architecture to lead on global solidarity”. (30)

In an  article entitled Global health system in dire need of restructuring by Tang Bei,executive director of BRICS Research Center, Shanghai International Studies University,published in Global Times on  January 6, 2022 we find some interesting ideas about the content of the future international legal instrument  mentioned above. We will summarize the most relevant suggestions.(31)

   The article  reminds  that Member States of the WHO, on the special session held on December 2021, considered developing a convention on pandemic preparedness and response, which should reconstruct the response system of the international community. The following ways are suggested:

First, countries should work together to combat the pandemic after an outbreak, rather than simply relying on issuing negative travel or trade bans. It is considered that  connecting the WHO’s various alarm systems to international assistance and collective action will it be possible to change the fragmented situation. This requires a strengthened capability of WHO in order to establish linkage with the entire UN system, the G20, and other institutions such as the World Bank. 

Second, the international public production capacity for critical protective materials, vaccines and drugs should be established. The COVID-19 Vaccines Global Access (COVAX) is a worldwide initiative aimed at equitable access to vaccines, especially for poor countries which cannot afford them.

It is appreciated that  the international community should no longer rely on a few multinational pharmaceutical giants to produce vaccines and drugs, benefiting their corporate profit and stock price with public funds. Instead, the international community should invest capital and technology in developing countries to establish international public production capacity that meets WHO production standards.


Third, the responsibilities and obligations of individuals during a pandemic response should be emphasized. The new international convention should not only protect individual freedoms, but also promote their responsibility for others, societies and the human community as a whole. 

 While the process of preparation of an international legal instrument  is a complex one and needs time, in 2021 the COVID-19 pandemic highlighted other significant aspects , like  the importance of resilient societies worldwide. According to the final communique of the 10th Global Conference on Health Promotion on 13-15 December 2021 it is necessary  the start of a global movement on the concept of well-being in societies. Over 4500 participants of the Global Conference, who met virtually in Geneva, Switzerland, agreed on a Geneva Charter for Well-being. The Charter focused on the need for global commitments to achieve equitable health and social outcomes now and for future generations, without destroying the health of our planet. This Charter will drive policy-makers and world leaders to adopt this approach and commit to concrete action.(32)

We  do not have at our disposal the proceedings of the Conference. From press reports, we have learned that “Health does not begin in a hospital or clinic. It begins in our homes and communities, with the food we eat and the water we drink, the air we breathe, in our schools and our workplaces,” as emphasized by Dr Tedros Adhanom Ghebreyesus, WHO Director General. “We have to fundamentally change the way that leaders in politics, the private sector, and international institutions think about and value health, and to promote growth that is based on health and well-being for people and the planet, for countries in all income levels.”

The Geneva Charter outlines the necessary elements of a ‘well-being society’ and what needs to be done in order to better prevent and respond to the multiple health and ecological crises we face globally. It identifies key action areas and offers instruments for implementation.

The document encourages five key actions:  

  • Design an equitable economy that serves human development within planetary boundaries;
  • Create public policy for the common good;
  • Achieve universal health coverage;
  • Address the digital transformation to counteract harm and disempowerment and to strengthen the benefits; and
  • Value and preserve the planet.

The comments about the Geneva Charter are quite instructive. “It is time to look at how the economy can support the societal goal of well-being, as an investment that is the foundation of productive, resilient and inclusive economies,” said Dr Rüdiger Krech, WHO Director for Health Promotion.  “We cannot – we must not – go back to the same exploitative patterns of production and consumption, the same disregard for the planet that sustains all life, the same cycle of panic and neglect, and the same divisive politics that fueled this pandemic.”

According to the Geneva Charter ,to change the global development landscape, both the well-being of people and the planet must become central to defining humanity’s progress. The Charter calls upon nongovernmental and civic organizations, academia, business, governments, international organizations and all concerned to work in society-wide partnerships for decisive implementation of strategies for health and well-being. These will drive the transformation towards well-being societies in all countries, centering around the most marginalized populations.

In conformity with the same document,moving forward countries must prioritize health as part of a larger ecosystem that encompasses environmental, social, economic, and political factors. Universal health coverage, based on strong primary health care, must be at the core of all our efforts, as the cornerstone of social, economic and political stability. And the narrative around health should be reframed, not as a cost, but as an investment in our common future.(33)

Conclusion

The UN system in general  and the WHO in particular  are still due  to offer persuasive examples about their capacity  to effectively deal with a multi-vectorial crisis tragically affecting now the whole human society on our planet. A major condition for positive results in this field would  be the genuine recognition  of solidarity  among nations as the indispensable foundation in coping with pandemics, and thus,  proving the readiness to promote an  international cooperation based on this universal value must be at the core of all diplomatic efforts.

We may express the hope that UN  Member States will  support the recommendations contained in the reports of the UN Secretary-General  and will take action to move forward on an active intergovernmental process  culminating in 2023 with a successful diplomatic event during which positive results would have to be reported about  the implementation of Our Common Agenda, – a programmatic document which  is considered to be highly  cogent during the current era of global vulnerabilities, perplexities and discontinuities.

 Meanwhile, multilateral diplomacy  needs to deploy more robust efforts to contribute to the success of the  difficult test confronting  the world community of nations in practicing global solidarity. The promotion of this fundamental value  remains a widely open topic for future debates, consultations and diplomatic negotiations at the bilateral and  multilateral level, as well as for a fruitful and continuous exchange of doctrinal views on the matter.

However, no tangible progress can be reached in the final battle against COVID-19 without  radical changes in national policies  on the right to health. In this regard, all countries  should be inspired by the lucid analysis made in December 2021 by the UN Secretary- General Antonio Guterres according to whom “ things are getting so bad; things are getting so nasty in relation to the pandemic, in relation to the dramatic injustice from the economic and financial side, and in relation to the climate situation that my hope is that people will finally understand that the only way to be an egoist intelligence is to be in solidarity; not to be in solidarity is a stupid form of egoism.”(34)

On the doctrinal side, we my join professor Richard A. Falk  who  summarized the situation by writing that “COVID-19 suddenly emerged as the most impactful governance threat to human wellbeing in more than a century, especially if measured by its planetary scope and real time worldwide awareness”. He advocates appropriate action to fight COVID-19, but cogently warns that “This presupposes increased respect for international law, a stronger UN, and regional actors with more governance authority”. (35) 

2022 is a crucial year  not only in the global battle against COVID-19 pandemic, but also for giving tangibility to an effective multilateralism in the noble cause of defending the fundamental rights to life and health  at the global level. The UN system , including WHO  are expected to continue to promote in a more robust manner a well-coordinated  framework that builds on available  approaches in the field of  human rights to generate more accurate and realistic solutions to health inequities. The integrated nature of this framework should facilitate an opportunity to build on foundational strengths and complementarities between all competent institutions at the national, regional and global levels in order to create a cohesive and efficient mechanism  to defend and advance health and well-being on the whole planet.

Dr.Ioan Voicu

Doctor in political sciences (international law) of Geneva University (1968); Doctor honoris causa in international law of Assumption University of Thailand (1998); alternate representative of Romania to the United Nations Security Council (1990-1991); Ambassador of Romania to the Kingdom of Thailand and permanent observer to international organizations based in Bangkok (1994-1999); Visiting Professor in Assumption University in Bangkok (2000-2019.)

End Notes:

1.See https://www.un.org/sites/un2.un.org/files/un-comprehensive-response-covid-19-2021.pdf. See also UN General Assembly, Global Health and Foreign Policy: Strategic Opportunities and Challenges—Note by the Secretary-General, A/64/365, 23 September 2009.

2.See an analysis of  this topic in Ioan Voicu, Idealul sănătății globale în viziunea Națiunilor Unite at https://tribuna-magazine.com/idealulsanatatii-globale-in-viziunea-natiunilor-unite/

See also the collective volume entitled In the fight with us, the virus and the crises of the world. Academic journal in pandemic (in Romanian), coordinators Cristina Vohn, Dan Dungaciu, ISPRI Publishing House, Bucharest, 2020. For health diplomacy in Europe see Peter Van Kemseke, Europe Reinvented: How COVID-19 Is Changing the European Union, Boeklyn, 2020, 228 pages. According to this book, the lack of solidarity between European countries seemed to bring the union – once again – to its knees. For the situation in ASEAN countries, see http://www.oecd.org/coronavirus/policy-responses/covid-19-crisisresponse-in-asean-member-states-02f828a2/. A fundamental book on the matter remains Kickbusch Ilona (Editor), Global health diplomacy, Springer, New York, 2013.For the situation in Poland see Bogdan J. Góralczyk, Coronavirus in Poland: domestic solutions, international impact, Preliminary Report, available at Working_paper-202010-by-Bogdan-J.-G%C3%B3ralczyk%20(11).pdf.

3.All UNGA  resolutions quoted in this article are available at https://research.un.org/en/docs/ga/.

4.See for details https://www.thelancet.com/coronavirus.

5.See note 3 supra.

6. See M. Virally, La valeur juridique des recommendations des organisations internationales, Annuaire français de droit international, II (1956), pp.87-88.

7.All relevant  data about COVID-19, including updates , are permanently available at https://covid19.who.int/.

8.The quotation is taken from the e-version of The Oxford Handbook of Modern Diplomacy (2013),edited by Andrew F. Cooper, Jorge Heine and Ramesh Thakur,Oxford University Press.

9.The report Our Common Agenda is available in e-version at https://www.un.org/en/content/common-agenda-report/

10.All quotations from Our Common Agenda are taken from the e-version of the report mentioned in note 9 supra.

11.The UNGA resolution on Our Common Agenda is available at https://undocs.org/en/A/RES/76/6.

12.The  transcript of the press-conference of the UN Secretary-General is available in full version at

https://www.un.org/press/en/2021/sgsm21083.doc.htm

13.All documents of the ESCAP session quoted in this article  are available at https://www.unescap.org/events/commission77.

14.The quoted statements are available in full version at https://www.unescap.org/sites/default/d8files/event-documents/Statement%20Kaz.pdf

15.Source of quotation : https://twitter.com/antonioguterres/status/1340469970019393536?lang=bg

16.For the full text of the statement  by Chile see https://www.undocs.org/en/A/76/PV.3.

17. For the full text of the statement  by Argentina see https://www.undocs.org/en/A/76/PV.4.

18. For the full text of the statement  by Moldova see https://www.undocs.org/en/A/76/PV.6.

19.  For the full text of the statement  by Indonesia see https://www.undocs.org/en/A/76/PV.7.

20. For the full text of the statement  by Romania  see https://www.undocs.org/en/A/76/PV.4.

21. For the full text of the statement  by Vietnam see https://www.undocs.org/en/A/76/PV.7.

22 For the full text of the statement  by Spain see https://www.unmultimedia.org/avlibrary/asset/2657/2657159/.

23. For the full text of the statement  by Norway  see https://www.undocs.org/en/A/76/PV.9.

24. The full text of the statement  by Panama is available at  https://www.undocs.org/en/A/76/PV.10.

25.  The full text of the statement  by South Africa  is available at  https://www.undocs.org/en/A/76/PV.10.

26. The full text of the statement  by Cuba can be consulted at    https://www.youtube.com/watch?v=UGOe2wK1Qfo.

27. The full text of the statement  by Italy   is available at  https://www.undocs.org/en/A/76/PV.11.

28.The full text of the report is available at https://digitallibrary.un.org/record/3947363?ln=en

29.See note 28 supra.

30.Details  about COVID-19 from the perspective of the WHO are available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

31. See the e-version of Global Times at https://www.globaltimes.cn/page/202201/1245306.shtml

32.All information about this conference can be found athttps://www.paho.org/en/events/10th-global-conference-health-promotion#:~:text=The%20Tenth%20Global%20Conference%20on,United%20Nations%20agencies%20and%20partners.

33.All quotations about the Conference and about Geneva Charter are taken from the source indicated in note 32 supra.

34.The quotation is from the transcript of the press conference mentioned in note 12 supra.

35.See Richard A.Falk, Global Governance After the COVID Pandemic,available at https://richardfalk.org/2020/08/. For a Romanian doctrinal  perspective on after-pandemic world see Lumea de maine. Ce urmeaza dupa pandemie?Authors : Olivia Toderean; Sergiu Celac; George Scutaru, Editura  Curtea Veche, Bucuresti, 2020, 552 pages.

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