With the declared outbreak of COVID-19 in December 2019, the world changed in ways most of us could not have possibly anticipated – “contact tracing”, “social distancing”, meticulous handwashing, quarantines at the victims’ expense, curfews, lockdowns, mask mandates, vaccine mandates and the attendant vaccine passports jointly constituted the so-called new normal.

Furthermore, the daily evening briefings in which health authorities read out figures of COVID-19 infections, deaths and recoveries enhanced the sense of utter powerlessness in populations. Yet the sense of powerlessness is ultimately a loss of sovereignty. According to the Merriam-Webster Dictionary, sovereignty refers to supreme power especially over a body politic, or freedom from external control. At the level of the individual, it denotes autonomy over one’s thought, speech and actions.

At the annual meeting of the leading economic powers commonly known as “the G20” in November 2020, it was proposed that a “pandemic treaty” be prepared to ensure countries handle future pandemics “effectively”. Then in March 2021, the World Economic Forum (WEF) echoed this call. Now the Draft WHO Pandemic Treaty, sometimes referred to as The WHO Pandemic Agreement and the WHO’s Amended International Health Regulations are scheduled for signing by member states of the WHO in May-June 2024. However, there is very little public awareness and public debate about these documents.

Brief history of the World Health Organisation

Over the past two centuries or so, interstate public health organisations have arisen from wars and their aftermaths. Thus after the 1914–1918 European interethnic war, a Health Section of the League of Nations was established in 1923 and functioned until the 1939–1945 European interethnic war. After 1945, the United Nations Relief and Rehabilitation Administration (UNRRA) was established to process displaced persons in such a way as to prevent the spread of disease, and was responsible for the planning that led to the establishment of the WHO.

The WHO was conceived at the 1945 San Francisco Conference in which the United Nations (UN) was founded. It was established on 7 April 1948 as one of the specialised agencies of the UN, and has a broad mandate for health. Its Constitution famously defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition enables the WHO to make interventions on a wide range of matters such as political and economic sanctions or environmental conservation that would traditionally not be regarded as health issues. In 1951, the WHO adopted the International Sanitary Regulations from the Paris-based International Office of Public Health and renamed them the International Health Regulations (IHR) in 1971.

The WHO initially devoted much of its resources to the fight against the major communicable diseases such as malaria, trachoma, yaws and typhoid. However, at the International Conference on Primary Health Care (PHC) held in Alma-Ata, Kazakhstan, in 1978 and co-sponsored by the WHO and UNICEF, PHC was adopted as the key to attaining the goal of Health for All by the year 2000. The conference called for a radical re-definition of healthcare. Encyclopedia.comsummarises the strategy adopted at the conference thus:

“Instead of the traditional ‘from-the-top-down’ approach to medical service, it embraced the principles of social justice, equity, self-reliance, appropriate technology, decentralisation, community involvement, intersectoral collaboration, and affordable cost.”

In 1979, the WHO declared that it had eradicated smallpox from the globe. However, hardly had the celebrations of that success died down than news of the emergence of the Human Immunodeficiency Virus (HIV) started to spread, with the WHO initially at the forefront of efforts to contain it. From 1997, the WHO also got involved with the management of avian influenza, commonly known as bird flu. Then in 2003, it was involved in managing the Severe Acute Respiratory Syndrome (SARS). It is also credited with managing the outbreak of the H1N1 virus commonly known as swine flu in 2009.

According to the Encyclopedia.com, “WHO has three different modes of action under its constitution: It can adopt conventions, make regulations, or issue nonbinding recommendations. Whereas the first two actions bind its members to act, the third does not.” According to the Encyclopedia.com, WHO has over the decades been slow to exercise its normative role partly due to the initial reluctance of the US to ratify the WHO Charter for fear that it could enable the organisation to dictate the passage of domestic laws.

Nevertheless, in 2003, WHO spearheaded the adoption of the Framework Convention on Tobacco Control to reduce smoking through taxation, and through rules on labelling and advertising. Now with the proposed Treaty and Amended International Health Regulations, the WHO’s hesitancy to exercise its normative mandate seems to be a thing of the past.

Implications of the proposed WHO Pandemic Treaty and Amended International Health Regulations on African countries

While some presume that the draft Treaty and Amended International Health Regulations are certain to enhance the management of pandemics in the coming years, others point out that several of their provisions may actually result in dire consequences for humanity.

Imposition of the ‘One Health’ approach

The notion of “One Health” goes back at least to a symposium titled “One World, One Health: Building Interdisciplinary Bridges to Health in a Globalized World” organised by the Wildlife Conservation Society and hosted by The Rockefeller University on 29 September 2004.

The symposium adopted The Manhattan Principles on ‘One World, One Health’. The symposium declared: “Only by breaking down the barriers among agencies, individuals, specialties and sectors can we unleash the innovation and expertise needed to meet the many serious challenges to the health of people, domestic animals, and wildlife and to the integrity of ecosystems.” It also emphasised the alleged positive role of private sector players in this endeavour. Nevertheless, the twelve principles say nothing explicitly about the need to protect and promote human rights.

In 2016, the One Health Commission, the One Health Platform Foundation, and the One Health Initiative declared 3^rd November One Health Day to be observed annually. Regarding the One Health approach, the proposed Treaty states:

“The parties commit to promote and implement a One Health approach for pandemic prevention, preparedness and response that is coherent, integrated, coordinated collaborative among all relevant actors, with the application of, and in accordance with, national law.”

The European Union (EU) is a key leader in the push for the Treaty with the One Health approach at its core. Among the actions the EU commits itself to work towards in its Global Health Strategy are “robust, binding international rules on pandemics” and “an overall approach that tackles all the links between the environment, animal/plant health and human health (‘One Health approach’).”

Countering “misinformation” and “disinformation”

At the height of COVID-19, those who questioned the various measures put in place in the name of containing the spread of the virus were dismissed as “conspiracy theorists”, “killers of grandmother”, “anti-science”, “antivaxxers”, and people having “vaccine hesitancy”.

On 4 October 2020, three highly qualified scholars in the medical field, Profs. Martin Kulldorff of Harvard Medical School, Sunetra Gupta of Oxford University, and Jay Bhattacharya of Stanford University Medical School authored The Great Barrington Declaration calling for those with the lowest risk of death from COVID-19 to be allowed to carry on with their lives without observing any public health protocols, and appealing that special care be taken to keep the immunologically vulnerable protected from infection. Their proposed strategy came to be referred to as “focused protection”. It would have been helpful to allow highly qualified medics and public health specialists to debate the Declaration in a free atmosphere, with more articles such as Queen’s University’s Medicine Prof. Stephen L Archer’s “5 Failings of the Great Barrington Declaration’s Dangerous Plan for COVID-19 Natural Herd Immunity”. Instead, the Declaration was dismissed offhand on the simple premise that it contradicted the WHO’s prescribed protocols.

Besides, major social media platforms deactivated thousands of accounts and deleted millions of posts that contained statements about COVID-19 flagged as false or misleading. Several highly qualified scholars of medicine and public health were banished from such platforms or subtly warned to engage in self-censorship. For example, when in March 2021, Prof. Martin Kulldorff tweeted that those who have been once infected and children did not need the COVID-19 vaccine, the social media platform labelled the tweet as misleading and inserted a link offering users an opportunity “to learn why health officials recommend a vaccine for most people”. Twitter also limited the post’s ability to be retweeted and liked, Kulldorff said in an interview. This was despite the fact that Prof. Kulldorf, a biostatistician and epidemiologist, had spent 20 years researching infectious diseases and contributing to the development of the US vaccine safety surveillance system. Similarly, Stanford University’s Prof. Jay Bhattacharya was blacklisted by Twitter for posting a link to an article he had written, whose message was: “Mass testing is an insidious form of lockdown by stealth.” Soon after acquiring Twitter, Elon Musk released what have come to be called the Twitter Files, that, according to him, reveal the massive government-driven censorship under the former Twitter management.

Moreover, universities and professional associations joined in the censorship fray, intimidating highly qualified scholars for holding views contrary to the dominant COVID-19 narrative. Thus Dr Scott Atlas was condemned by Stanford University’s Faculty Senate for questioning the COVID-19 protocols. There is also the legal suit filed by a group of doctors, most of whom prefer to remain anonymous, against the UK’s General Medical Council for allegedly neglecting to investigate the world-renowned UK-based cardiologist Dr Aseem Malhotra for allegedly spreading vaccine misinformation. Dr Malhotra was a committed advocate for the COVID-19 vaccines until his father died after receiving a shot. Acutely aware of his family history and highly experienced and published in cardiology, Dr Malhotra investigated the case and concluded that the death was caused by the vaccine. Since then, he has turned his efforts to sensitising the public about the dangers of the vaccines.

Now the Draft Treaty proposes to entrench censorship of opinion touching on public health measures in international law:

“The WHO shall collaborate with and promptly assist State Parties, in particular developing countries upon request, in (…) countering the dissemination of false and unreliable information about public health events, preventative and anti-epidemic measures and activities in the media, social networks and other ways of disseminating such information.

To this end, the [signing] parties shall promote (…) knowledge translation and evidence-based communication tools, strategies and partnerships relating to pandemic prevention, preparedness and response, including infodemic management, at local, national, regional, and international levels.”

According to the WHO, “’Infodemic’ means too much information, false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risk-taking behaviors that can harm health. It also leads to mistrust in health authorities and undermines public health and social measures.” In short, if the WHO has its way, under its supervision during a pandemic, countries would allow only information that it deems safe. That would be censorship grounded in paternalism – the treating of adults as though they were children.

Had the Treaty been in place and ratified by all countries by the time COVID-19 broke out, Sweden would not have had the opportunity to demonstrate that refraining from lockdowns was more pragmatic than enforcing them, as she would have been obligated to impose lockdowns along with the rest. Even if she had stayed out of the treaty and implemented her strategy, the sharing of the information about her sterling success would have been forbidden as “misinformation” if not “disinformation”.

Emergency Use Authorisation of pharmaceutical products

The drafters of the Treaty seem to affirm the sovereignty of states over the process of formulating and implementing their own medical and public health policies, including the approval of new drugs:

“States have, in accordance with the Charter of the United Nations and the general principles of international law, the sovereign right to legislate and to implement legislation in pursuance of their health policies (Draft Pandemic Treaty Article 3, paragraph 2).”

However, with the advent of COVID-19, vaccines and other products were allowed into the market under Emergency Use Authorisation (EUA). This saved manufacturers substantial sums of money that they would typically have spent on thoroughly testing new products before they could be allowed into the market, while shielding them from liability for any injuries that might result from such products. Now Article 14 paragraph 5 of the proposed Treaty requires state parties to put in place laws and regulations to quickly allow pandemic drugs and vaccines into the market, while Article 15 paragraph 1 obligates state parties to “manage” liability for such products. This is clearly an eroding of the sovereignty of state parties over the supervision of the process of authorising new drugs and devices, Article 3, paragraph 2 of the draft Treatynotwithstanding.

Interference with the sanctity of the doctor-patient relationship

From the time of the Hippocratic Oath about 2500 years ago, it has been acknowledged that the doctor and the patient have the right to agree on a course of treatment without interference from third parties. However, as I pointed out elsewhere, the COVID-19 era is characterised by intense centralisation. Thus we have witnessed health authorities forbidding the use of affordable repurposed drugs such as ivermectin, hydroxychloroquine and azithromycin. For example, COVID-19 patients were frequently denied the use of azithromycin for COVID-induced pneumonia on the basis that using it would be contrary to laid down policy on the use of antibiotics. In Article 43, the draft Treaty stipulates that the usage of medications during a pandemic can be restricted if the use “is disproportionate or excessive”. This would render the doctor a mere agent of the WHO which would henceforth have the authority to choose everyone’s course of treatment. In effect, the time-honoured principles of informed consent and confidentiality would be rendered null and void.

The Amended International Health Regulations

Besides the terms of the draft Treaty, if a requisite number of countries approve the Amended International Health Regulations, the WHO Director General would have powers to impose contact tracing or require people to be “swabbed” or examined, order quarantines, lockdowns, border closures, vaccine mandates and the attendant vaccine passports, as well as to prescribe certain kinds of “treatment” and proscribe others. In short, once the WHO Director General declares a Public Health Emergency of International Concern (PHEIC), the ministries of health around the globe would be reduced to servants of the WHO. This would further erode state sovereignty. Besides, the Amended International Health Regulationsdocument is 197 pages long, making it very difficult for the public to engage with it.

Imposing a false universality

The efforts to further globalise public health through the draft Treaty and Amended International Health Regulations proceed from the premise that medical and public health interventions are, or ought to be, the same around the world. This is the thinking behind the ridicule that often meets any claims of remedies for COVID-19 not approved by the WHO or the FDA. Yet such an outlook privileges Western medicine over other systems of healing, thereby perpetuating the colonial policy of dismissing the medical knowledge systems of non-Western cultures. That was how the colonisers pejoratively referred to our healers as “witch doctors”. This killed vast bodies of traditional medical knowledge in a venture which Miranda Fricker correctly refers to as epistemic injustice, and Boaventura de Sousa Santos as epistemicide. This is despite the fact that Western medicine is as open to limited knowledge, human error and ethical misconduct as any other system of healing. For example, it is impossible to develop a vaccine that is totally free from adverse effects. Similarly, in February 2024, a research group based at the University of Leeds, UK, published a report that questions the widely held belief that the world faces a greater risk of pandemics due to viruses transmitted from animals to humans than ever before:

“[T]he data suggests that an increase in recorded natural outbreaks could be largely explained by technological advancements in diagnostic testing over the past 60 years, while current surveillance, response mechanisms and other public health interventions have successfully reduced the burden in the past 10 to 20 years.”

Key issues for African states

If the Treaty were to come into force, state parties, that include African countries, would be obligated to contribute financially to “pandemic preparedness” (Draft Treaty Article 20). The Pan-Africa Epidemic and Pandemic Working Group (PEPWK) is deeply concerned that this would divert resources from the major health needs of African states such as malaria, TB and malnutrition. The group goes on to observe:

“[The COVID-19 response] expanded an increasingly colonialist agenda in Africa with substantial economic, human rights, socio-cultural and political consequences. The lockdown regulations were a class-based and unscientific instrument, harmful to lower-income people and useless for crowded informal settings as in urban parts of Africa. At the same time, and as predictable, the indigenous national response was stifled and rendered inoperable.”

The group goes on to highlight the following concerns and consequences should the Treatyand Amended International Health Regulationssee the light of day: that the WHO is significantly privately funded by corporations and individuals based in wealthy countries who directly benefit from the pharmaceutical and digital health aspects of these proposals; that most WHO funding is now determined by its largest funders – wealthy countries with strong pharmaceutical sectors (the US and Germany), and the Bill and Melinda Gates Foundation.

The group observes, furthermore, that the WHO’s track record in the COVID-19 response is poor. The organisation promoted policies that it has previously recognised as causing significant collateral harm and disproportionately impacting low-income populations and countries in Africa. The WHO also had recourse to mass vaccination against COVID-19 of African populations known to be at very low risk due to their young age and already having immunity thereby diverting resources from malaria, TB, HIV and other urgent health challenges. These policies disrupted economies and education, thus entrenching future poverty and multi-generational inequality, and expanding the national debt that directly correlates to the debt crisis in Africa today.

Where is the public debate on the draft WHO Pandemic Treaty and Amended International Health Regulations?