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WHO takes a giant step forward by Suzanne Harris, J.D. Copyright © 2005 The Law Loft For decades, the World Health Organization (WHO), a United Nations specialized agency, has acted as the ‘coordinator,’ ‘assistant’, and ‘collaborator’ to member nations’ public health services and food and drug regulatory authorities. Now with a single, dramatic step, WHO is turning itself into the international health global governance/regulatory body with new powers so vast and so sweeping that WHO is literally taking control over the life, the liberty, the very bodies of human beings across the planet. What follows is our first hand eyewitness account of how this dramatic event took shape at the World Health Assembly in Geneva, Switzerland. As the bell sounded, delegates from ----- countries took their seats in the large white assembly chamber in the Palais des Nations in Geneva for the opening of the 8th plenary session of the 58th session of the World Health Assembly (WHA), the legislative body of the World Health Organization. There was a palpable sense of excitement in the room as the President of the Assembly called for the report of Committee A, one of two main committees tasked with preparing draft resolutions for final vote in the WHA, to made its final report on agenda item A58/55, Revision of International Health Regulations.[i] Would it be approved? Would some country throw a wrench into the proceedings at the very last moment? Many delegates no doubt wondered as the President proposed the item for adoption - International Health Regulations 2005 (IHR 2005). “Are there objections?” asked the President of the Assembly. Hearing none, she declared, the International Health Regulations (2005) officially adopted at 9:13 a.m. on Monday, May 23rd, 2005. Seconds later, spontaneous applause was heard throughout the chamber. Within minutes, the acting delegate from South Africa, Patricia Lambert, asked for the floor and spoke officially on behalf of South Africa on the momentous nature of the occasion and in so doing voiced the feelings of a majority of the health ministers and high level health delegates present in the room when she said: “Once again we are making history…This will be another public health milestone….[This is] a great deal more than just a revision of the 1969 regulations. The new International Health Regulations are much more like an international convention or treaty. [The new international health regulations are] deliberately intended to be comprehensive,…wide reaching…but still within the mandate of WHO.” What’s in them? Did South Africa overstate their importance? The new International Health Regulations (2005) are so sweeping in scope, that they take the reader’s breath away. Here for the first time is a global disease surveillance scheme with mandatory reporting duties to WHO within 24 hours not of the outbreak of a public health crisis but rather within 24 hours of any ‘unusual or unexpected public health event that may constitute a public health emergency of international concern.’ Each nations that signs on to this international convention agrees to develop the surveillance capabilities necessary to accomplish global health surveillance within its territories within 5 years of ratifying the convention. But just reporting to WHO on what may be the early signs of a public health emergency is just the beginning of an internationally agreed to process with WHO not nations at the helm. Once WHO has gotten notice from a nation or from other sources, WHO conducts a series of rapid verification steps and then decides whether to share the data with other nations and international organizations or not. WHO decides what public health measures should be implemented by the affected state and others. WHO decides when a public health emergency of international concern exists. WHO makes the principal decisions as to what public health measures should be implemented. Signatory states that ratify IHR 2005 agree to implement WHO screening measures at airports, sea ports and on land carriers both public and private. WHO screening measures can include compulsory medical examinations for travelers including invasive ones, compulsory vaccinations or other compulsory prophylaxis in some cases including measures which carry the risk of creating disease in the recipient. WHO public health measures can include quarantine, isolation and treatment as well as entry refusal. WHO approved travel health documents are required for all travelers. IHR 2005, a treaty-like international agreement, shall be ratified by all member countries within 18 months of May 23rd and disputes as to its terms and conditions between members will be subject to compulsory arbitration. In the case of a dispute between WHO and a member state as to its terms, the WHA decides resolves the dispute by majority vote. Who if anyone sounded the alarm bell objecting to this massive transfer of power to WHO? No nation raised a serious objection by the time this resolution, two years in the making, reached the floor of WHA for final decision. But it became apparent that a number of nations had voiced serious objections before the 58th World Health Assembly. What objections did they raise? The same ones you are raising - about sovereignty and transfer of power, a member of an African delegation told TLL in an off-the-cuff conversation. Others clearly had concerns as well about the vagueness of the definitions and the lack of specificity in setting the outer parameters of measures that can be taken. For example, instead of providing a medical/scientific definition, the term affected area a term used throughout IHR 2005 is defined as ‘a geographical location specifically for which health measures have been recommended by WHO under these regulations.’ The definition of the term public health risk, another key term, is even more troubling: “ a likelihood of an event that may affect adversely the health of human populations, with an emphasis on one which may spread internationally or may present a serious and direct danger.” [emphasis added] The United States is apparently one of those nations that liked the vagueness of the text from the very start. “We attach particular importance to universal application,” said David E. Hohman, health attaché to the United States Mission in Geneva. He added that the United States will submit a formal understanding that the new IHR applies not just to traditional public health emergencies but to other types of public health emergencies like the accidental or deliberate release of chemical or biological agents or radiological events. When I asked him later just exactly what he mean here, Mr. Hohman said that events like the Chernobyl accident were within the parameters of the kinds of applications of IHR 2005 that the USA intends to make when it applies the agreement in the future. When does the public find out about a IHR public health risk? Maybe never. Another curious feature here is the utter absence of a duty to inform members of the traveling public, you know the folks like you and me who may be jabbed, probed, vaccinated, detained and isolated without warning or recourse if we accidentally venture into an area of the globe that may become a public health risk area. Instead the public rather curiously is not to be notified unless the information is already public and there is a need to disseminate authoritative information about the outbreak or health risk. That’s bureaucrat legalese for if the cat gets out of the bag, make sure you are the one who directs the search party. So what’s this all about - these vague definitions, broad powers, massive transfers of power to WHO, all wrapped up in an enforceable international convention? The age of globalization brings new fears that no disease will be local, that new pandemics are just over the horizon and that trade, economic growth and commerce will suffer as death, disease, and illness spread. One really big clue here appears in the text of IHR 2005 near the very beginning in Article 2 on Purpose and Scope which says the purpose of these regulations is “to prevent, protect against, control and provide a public health response to public health risks… which avoid unnecessary interference with international traffic and trade.” [emphasis added.] It became even clearer in the technical briefing on pandemic threats that occurred as a side bar to WHA that nations and the public health authorities within them have discovered - that public health emergencies don’t just kill people they can kill whole economic sectors too, including the newly globalized and now important sectors of food export and tourism on which a number of countries now depend for a substantial portion of their livelihood. Evidently what John Smith and David Ricardo never told us is that specialization to take comparative advantage in a global trading system makes globalized economic enterprises more vulnerable to public health emergencies than ever before. Still another factor at work here is the discovery that while all politics may be local, diseases aren’t. Diseases that in the past would have remained the problem of a few affected areas now travel rapidly and unpredictably from place to place and continent to continent as refugees, illegal aliens and ordinary travelers move across the globe. Still another problem is the growing body of evidence that new diseases, that are drug and treatment resistant are developing in pockets around the globe. Modelers say that these new diseases will inevitably spread from country to country unless nipped in the bud in the early ‘clustering’ stage. Unfortunately describing an illness cluster is apparently easier in the abstract than it is to identify in time in reality. In fact global public health models now speak in terms of when the next pandemic will strike not if it will strike. Global models project death tolls in the millions anywhere from 6 million to 100 million deaths in the near future unless new treatments are found soon and surveillance measures are deployed rapidly. Economic loss projections are equally grim projecting losses in the multi-billions unless epidemics are stopped in their tracks before they become pandemics. Think I’m exaggerating? Health official after health officer at the WHA spoke of comparisons to the Spanish Influenza which followed World War I and circled the globe killing 40 million in a matter of months. Do we have to give up all of our liberties to protect our health? What can, what should be do now? Another really curious thing about IHR 2005 is that whereas in the past when dangerous disease without cures broke out, whole areas were quarantined - no one in, no one out, IHR 2005 speaks in terms of taking measured steps against travelers and cargo not restricting the flow of persons and goods from an affected area. While the IHR 2005 is now a done deal, the ratification of this international convention is not. Nor is the language of the legislation that will implement it in each country that ratifies IHR 2005 a done deal. While the overwhelming majority of countries favor IHR 2005, that does not mean that every legislative body in the world need buy into its vague language and overly broad powers. Enabling language that makes national laws must be written in every country that ratifies this convention. And that means there is a chance to write into the texts, specific protections for civil liberties, a right to refuse treatment and alternatives to compulsory vaccination as well as limitations on the dissemination of personal medical information, specific procedures to rectify erroneous medical entries as well as compensation schemes to protect victims of the new powers conferred by IHR 2005. Alert your members of Congress now to the emergence of this problem. Talk to state and local officials who are going to get stuck paying the bill for increased health surveillance. Get them all thinking about how to protect us from a WHO that’s becoming a global power broker like the WTO and a federal government that is gathering too much power while talking about protecting America‘s fundamental freedoms and values. # This text of this document is written in the ‘thou shall’ or ‘thou shall not’ style, but the text lists so many exceptions that the exceptions literally eat the Rule.
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