[BMJ Opinion] We need new forms of governance to better manage our response to pandemics

BMJ Opinion, 3 February 2020

Ilona Kickbusch, Gabriel Leung

Highlights

• Preparedness systems are always designed to deal with the immediate past pandemic, and never the next.
• The role of the WHO needs to be strengthened, financially and politically. Not only has declaring a Public Health Emergency of International Concern (PHEIC) lost its meaning and power, the fact that there are no independent observers during an outbreak, assessing what is going on in countries, opens the door for speculation, political gamesmanship and misinformation.
• The mechanism of declaring a PHEIC needs urgent revisiting. It does not capture the complexity that we are experiencing now during the COVID-19 outbreak because an outbreak is never just a danger to health.
• Transparency is paramount but there clearly needs to be a set of rules to which both traditional and social media need to adhere to in such critical situations. We need effective media watchdogs to monitor how disease outbreaks are reported.
• The mechanisms that exist to provide rapid financial help are insufficient and do not have activation criteria that fit complex situations such as the present one.
• WHO recommendations mean nothing if there are no sanctions to follow — either political or economic. There must be a political mechanism to call out non-compliance and a more regular analysis of the politics of epidemics. 
• There needs to be sanctions for countries that do not cooperate. William Nordhaus proposes a club model that could be explored for outbreak preparedness and control.

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