Where is the public debate in Africa on the draft WHO Pandemic Treaty and amendments to the International Health Regulations?
In my 24th April 2024 article, I pointed out that if the WHO’s Pandemic Agreement were signed into international law in its current form in May 2024 as scheduled, several of its provisions would greatly harm the peoples of Africa.
Among the harms would be the fact that the sovereignty of the continent’s states would be greatly eroded by the centralised management of public health emergencies. Besides, an unprecedented censorship infrastructure would be put in place, thus inhibiting the building of open societies. Furthermore, African states would be under the obligation to divert a significant proportion of their meagre health budgets from their immediate health concerns such as malaria, TB, and malnutrition in order to contribute to the global kitty on “pandemic preparedness.”
Yet as I also pointed out in my previous article, along with the Pandemic Agreement, the WHO has scheduled the signing of amendments to the International Health Regulations (IHR) at the end of May 2024 which should greatly concern African countries. According to the prevailing rules contained in the IHR (2005), the amendments require a simple majority vote from member states for their adoption.
Commenting on the potential impact of the Pandemic Treaty and amendments to the IHR, Dr David Bell and Dr Thi Thuy Van Dinh, global public health specialist and international law expert respectively, write: “Together, they reflect a sea-change in international public health over the past two decades. They aim to further centralise control of public health policy within WHO and base response to disease outbreaks on a heavily commoditised approach, rather than WHO’s prior emphasis of building resilience to disease through nutrition, sanitation and strengthened community-based health care.”
In his Inaugural Lecture titled “Taming the Tyranny of the Barons: Administrative Law and the Regulation of Power,” University of Nairobi’s Law Prof. Migai Akech pointed out that most tyranny is perpetrated by bureaucrats at the level of subsidiary legislation (“statutes”) rather than at the level of the constitution. He went on to point out that our interactions with bureaucrats “are often fraught with tyranny that takes forms such as delays, broken promises, and extortion.”
It seems to me that in the field of global public health, the Pandemic Agreement is intended to play a role similar to that played by a country’s constitution, while the International Health Regulations (IHR) a role equivalent to that of the subsidiary legislation. Of great relevance to my reflections in the present article is Prof. Akech’s further observation:
… the proliferation of international regulatory mechanisms over the last two or so decades has…created a democracy deficit in the international arena. Our interactions across borders…have led to a realization that our interests/grievances cannot be addressed by separate national governance systems. As a result, the making of these governance decisions has shifted to global institutions, often without our participation or accountability to us…Yet these institutions exercise immense powers and regulate vast sectors of our social and economic lives. Their decisions directly affect us, in many cases without any intervening role for national government action. Here as well, a need arises to democratize the exercise of power.
Below I mainly focus on three salient issues touching on the amendments to the International Health Regulations (IHR); namely, the opaque nature of the negotiations on draconian provisions, dire threat to human rights, and attempts to violate the statutory four-month window for states to interrogate the draft amendments before a vote. Thereafter, I address the urgent need for African states to guard their sovereignty from erosion by conflicted global public health legislation and policy, before making some remarks on the wider question of public health imperialism.
Opaque Negotiations on Draconian Provisions
Contrary to the democratic principle of public participation, negotiations for the amendments to the IHR have been extremely opaque. In early 2023, the public was provided with a set of draft amendments dated November 2022, after which it heard nothing from the negotiating teams despite their many meetings until a revised draft was released in mid-April 2024. UK Solicitors Ben Kingsley and Molly Kingsley have provided a helpful comparison of the November 2022 and April 2024 draft amendments, as have Dr David Bell and Dr Thi Thuy Van Dinh.
Below is an outline of Ben Kingsley and Molly Kingsley’s comparison and contrast of the 2022 and 2024 draft amendments to the IHR:
The WHO’s recommendations remain non-binding.An egregious proposal that would have erased reference to the primacy of “dignity, human rights, and fundamental freedoms” has been dropped.Proposals to construct a global censorship and ‘information control’ operation led by the WHO have been dropped.Provisions that would have allowed the WHO to intervene on the basis of a mere ‘potential’ health emergency have been dropped: a pandemic must now either be happening or likely to happen, but with the safeguard that to activate its IHR powers the WHO must be able to demonstrate that a series of qualitative tests have been met and that rapid coordinated international action is necessary.A material dampening of the expansionist ambitions of the WHO: provisions that had proposed to expand the scope of the IHRs to include “all risks with a potential to impact public health” (e.g. climate change, food supply) have been deleted.A climbdown on mandatory funding for pandemic-related infrastructure and subsidies, and implicit recognition that public spending is a matter for national governments to determine.Explicit recognition that Member States, not the WHO, are responsible for implementing the IHRs, and bold plans for the WHO to police compliance with all aspects of the regulations have been materially watered down.Many other provisions have been diluted, including surveillance mechanisms that would have installed the WHO at the pinnacle of a global system of surveillance identifying thousands of potential new pandemic threats on which it could act; provisions that could have expedited regulatory approvals for new medicines including vaccines; provisions which would have encouraged and favoured digital health passports; provisions requiring forced technology transfers and diversion of national resources.
Thus as Dr David Bell and Dr Thi Thuy Van Dinh have also observed, the draft amendments to the IHR dated 16th April 2024 have watered down many of the draconian measures that health freedom advocates have flagged for over a year now:
The latest version of the IHR amendments released on April 16th…removes wording that would involve member states “undertaking” to follow any future recommendation from the Director General (DG) when he or she declares a pandemic or other Public Health Emergency of International Concern (PHEIC) (former New Article 13A). They now remain as “non-binding” recommendations. This change is sane, conforms with the WHO Constitution and reflects concerns within country delegations regarding overreach. The shortened review time that passed in rather ad hoc fashion by the 2022 World Health Assembly will apply to all but four countries that rejected them. Otherwise, the intent of the draft, and how it is likely to play out, is essentially unchanged.
Furthermore, the April 2024 draft amendments to the IHR are still being negotiated, so the possibility of the original 2022 amendments carrying the day cannot be ruled out; and as I show below, they still constitute a threat to human rights.
Dire Threat to Human Rights
In 1948, the United Nations (UN) General Assembly adopted the Universal Declaration of Human Rights (UDHR), with its oft-quoted first article: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” Then in 1966, the UN General Assembly adopted the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights. Together, these three instruments constitute what is commonly known as the international bill of human rights.
The UN has adopted numerous other declarations and conventions to promote and protect the rights of vulnerable groups such as children, women, persons with disabilities, and refugees. As such, the authoritarian nature of the amendments to the IHR and the Pandemic Agreement has been contrary to a body of human rights conventions spanning more than seventy years, violating a raft of entitlements such as freedom of thought and expression, freedom of movement, and the right to bodily autonomy with the attendant right to informed consent to vaccines and courses of treatment. For example, as I pointed out in COVID-19 Vaccine Mandates in the Light of Public Health Ethics, “Vaccine mandates are instances of state overreach, as they violate human dignity, human agency, and human rights, thereby eroding the very foundation of democratic society.”
Furthermore, as I pointed out in my previous article, if the 2022 draft amendments to the IHR are voted in at the May 2024 World Health Assembly (WHA), 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 prescribe certain kinds of “treatment” and proscribe others, just as we saw during Covid-19, only now with the force of international law. Yet in its own 2019 guidelines titled “Non-pharmaceutical Public Health Measures for Mitigating the Risk and Impact of Epidemic and Pandemic Influenza,” the WHO had indicated that lockdowns were not an effective measure for dealing with pandemics and epidemics.
Indeed, while at the height of Covid-19 the WHO encouraged “social distancing,” in its 2019 pandemic influenza guidelines it stated: “…social distancing measures (e.g. contact tracing, isolation, quarantine, school and workplace measures and closures, and avoiding crowding) can be highly disruptive, and the cost of these measures must be weighed against their potential impact” (p.4). Furthermore, it did not use the term “lockdowns” because the term was previously used exclusively for prisons. Besides, it indicated that under no circumstances should border closures, quarantine of exposed people, contact tracing (once transmission is established), or entry/exit screening be deployed (p.3). It also indicated that workplace closures should only be deployed under extraordinary circumstances, noting that after 7-10 days the harm is likely to outweigh the risk, especially for low-income groups (p.41).
Thus just as the WHO itself had cautioned in 2019, the Covid-19 measures that it turned around to encourage governments in Africa to impose on their citizens from 2020 have had a catastrophic impact on the economic, social, and psychological well-being of millions of people on the continent. Regarding lockdowns, for example, King’s College London’s Lusophone African History Prof. Toby Green, in the introduction to his ground-breaking book, The Covid Consensus: The New Politics of Global Inequality, writes:
… while the impact [of lockdowns] on the young, poor, and disadvantaged in the Global North was devastating, it cannot be compared to that in the Global South (…). Here, in many countries from South Asia and Africa to Latin America, the lives of hundreds of millions were upended. As early as July, the UN stated that each month 10,000 children were dying from virus-linked hunger as their communities were cut off from markets and food and medical aid owing to the new restrictions, and that 550,000 new children were also being struck monthly by wasting diseases as a direct consequence of these measures taken to halt the spread of the virus. Meanwhile, as countries locked down to protect against Covid-19, day-to-day medical interventions and vaccination programmes ground to a halt. It soon became clear that the death toll arising from the lockdown could far outweigh that from the novel coronavirus.
Moreover, as Ben Kingsley and Molly Kingsley observe regarding the April 2024 draft of amendments to the IHR, “a swathe of legacy IHR provisions relating to, inter alia, border control measures of questionable efficacy deployed during the Covid pandemic remain untouched in the interim draft (Articles 18 and 23), including quarantines, isolations, testing and requirements for vaccination, but a proposal originally to have been inserted as a new Article 23(6), which controversially would have created a presumption in favour of mandating digital health passports, has been dropped.”
The fact that such draconian measures witnessed during Covid-19 are retained in the April 2024 draft of amendments should be of deep concern to all of us from a human rights perspective, and particularly to the peoples of Africa because they ruined many lives and livelihoods. It is noteworthy that the measures in both the 2022 and 2024 draft amendments to the IHR are contrary to the WHO’s own definition of “health” in its Constitution as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Thus Dr David Bell and Dr Thi Thuy Van Dinh caution against celebrating the changes in the April 2024 draft amendments to the IHR:
The proposed amendments should be reviewed in the light of the lack of urgency, low burden and currently-reducing frequency of recorded infectious disease outbreaks and the huge financial requirements on countries – already heavily impoverished and indebted post-lockdowns – for setting up additional international and national bureaucracies and institutions. It must also be assessed in light of the accompanying draft Pandemic Agreement, the apparent conflicts of interest, the concentration of wealth among sponsors of WHO during the COVID-19 response and the persistent absence of a transparent and credible cost-benefit analysis of the COVID-19 response and proposed new pandemic measures from WHO.
Procedural Injustice
According to the WHO’s own rules in Article 55 of the current International Health Regulations (2005), state parties are entitled to a minimum of four months to consider any proposed amendments to the Regulations. This means that with the scheduled commencement of the 77th World Health Assembly on 27th May 2024, the deadline for the Director General to submit such proposals to the WHO’s member states was 27th January, 2024. However, as I earlier indicated, by mid-April 2024, amendments to the document were still being negotiated. According to an Open Letter to the WHO written by David Bell, Silvia Behrendt, Amrei Muller, Thi Thuy Van Dinh, and others, although the draft WHO Pandemic Agreement and amendments to the International Health Regulations contain significant health, economic, and human rights implications, they are being negotiated unprocedurally by various committees.
The authors of the Open Letter to the WHO further observe that the draft amendments to the International Health Regulations have been developed with unusual haste on the premise that there is a rapidly increasing urgency to mitigate pandemic risk. This, they point out, is despite the fact that the alleged high risk of a pandemic in the short-to-medium term has now been shown to be contradicted by the data and citations on which the WHO and other agencies have relied. The authors of the letter are alluding to the WHO’s contention that shortening the four-month statutory window for countries to review proposed amendments to the IHR is justifiable on the grounds that due to “climate change,” the risk of the outbreak of another pandemic as a result of transmission of pathogens from animals to humans (“zoonotic diseases”) is very high.
According to a report prepared by researchers from the University of Leeds, “This agenda is supported by unprecedented annual financial requests for over $10 billion in new Overseas Development Assistance and over $26 billion in LMICs investment, with over $10 billion additional for ‘One Health’ interventions.” However, as I indicated in my previous article, the University of Leeds report illustrates that the risk of such zoonotic diseases is not high, and may even be lower than before, but the impression is easily created of heightened risk due to great improvements in technology for detecting infections (“diagnostic capability”).
In sum, while states are entitled to four months to interrogate the draft amendments to the International Health Regulations (IHR) to be voted on at the end of May 2024, the WHO Director-General did not submit those amendments to WHO member states by the 27th January 2024 statutory deadline. As such, a vote on the amendments to the IHR at the end of May 2024 would be tantamount to procedural injustice, as it would place at a gross disadvantage countries with limited resources requisite for an adequate interrogation of the amendments before the scheduled vote.
It is worth noting here that the opaque nature of negotiations is not limited to the text of the IHR, but is also manifest in the negotiations of the Pandemic Agreement. For example, the WHO recently released a revised draft of the Pandemic Agreement dated 13th March 2024, but the WHO has not adequately publicised it to enable the public to interrogate it. This is in stark contrast to the media blitz to promote lockdowns and vaccine mandates at the height of Covid-19.
Africa Arise!
African states have the ability to effectively demand processes and outcomes that serve their interests in the context of global public health legislation and policy. They demonstrated this at the WHO’s 75th World Health Assembly (WHA) in Geneva in May 2022. According to Reuters, during that year’s WHA, the US had proposed 13 amendments to the IHR that sought to authorise the deployment of expert teams to contamination sites, and the creation of a new compliance committee to monitor implementation of the rules. Reuters went on to report that the draft amendments were seen as the first step in a broader IHR reform process, with the aim being to amend Article 59 of the IHR to enable the speeding up of the implementation of future reforms from 24 to 12 months.
However, Reuters reported that the African group at the WHA in 2022 expressed strong reservations to the US-led amendments to the IHR, insisting that all reforms be tackled together at a later stage. Reuters quoted Moses Keetile, Botswana’s deputy Health permanent secretary, as having told the Assembly on behalf of the group: “The African region shares the view that the process should not be fast-tracked…” Besides, According to the Reuters report, an African delegate in Geneva who was not authorised to speak to the media stated: “We find that they are going too quickly and these sorts of reforms can’t be rushed through.” (see Shabnam Palesa Mohamed’s excellent article for more on WHA 75).
Not surprisingly, unnamed diplomats, probably Western ones, were reported to have made the demeaning comment that there was a likelihood that African objections were a strategy to seek concessions on vaccine and drug-sharing from wealthier countries who were seen to be hoarding supplies during Covid-19. Will the countries of Africa again make their voices heard against the current intense pressure to rush the signing of the WHO’s Pandemic Agreement and amendments to the WHO’s International Health Regulations (IHR)?
Pandemic Politics in the Light of Western Colonialism and Neo-Colonialism
In The Invention of Africa, the renowned Congolese philosopher V.Y. Mudimbe writes: “colonialism and colonization basically mean organization, arrangement. The two words derive from the latin word colére, meaning to cultivate or to design.” According to Mudimbe, this is manifested in “the domination of physical space, the reformation of natives’ minds, and the integration of local economic histories into the Western perspective.” This “colonizing structure,” Mudimbe informs us, “completely embraces the physical, human, and spiritual aspects of the colonizing experience” (pp.1-2).
…many scholars in Africa have pointed out that colonialism was a three-legged stool. First, the colonisers executed military incursions to effect the initial subjugation of their victims and the occupation of their lands. Second, they used religion to calm down the vanquished peoples with hopes of a blissful life after death. Third, they deployed formal education to destroy indigenous systems of knowledge and to provide a rationale for the colonial project.
Nevertheless, the “three-legged” conceptualisation of colonialism does not account for one of its crucial aspects, namely, the imposition of the colonisers’ economic system on their victims. The colonisers achieved this by requiring colonial subjects to pay taxes using money which they could only acquire by working for the European overlords. In Kenya, for example, the British colonisers issued the Hut Tax Regulations in 1901 imposing the Native Hut Tax of 1 Rupee annually on huts used as dwellings by men. By 1903, they had raised the Hut Tax to 3 Rupees. Then in 1910 they issued the Hut and Poll Tax Ordinance to ensure that all males over twenty-five years old who were not eligible to pay Hut tax were nevertheless taxed. In that year, they also included African women who owned huts in the obligation to pay Hut Tax. Those unable to pay these taxes were subjected to forced labour. In short, the British, who had led the campaign to end slavery and slave trade around the world in the nineteenth century, also enslaved the peoples of Kenya and other colonial territories through taxation and forced labour in the nineteenth and twentieth centuries.
In Neo-colonialism: The Last Stage of Imperialism, Kwame Nkrumah, the first President of Ghana, wrote: “The essence of neo-colonialism is that the State which is subject to it is, in theory, independent and has all the outward trappings of international sovereignty. In reality its economic system and thus its political policy is directed from outside.” Nkrumah was emphatic that Western multinational corporations take centre stage in the domination of former colonial territories as they exploit the continent’s natural resources. It was not coincidental or accidental that Nkrumah was overthrown less than a year after this book was published. Thus in February 2023, Esther de Haan indicated that “Big Pharma raked in USD 90 billion in profits with COVID-19 vaccines.”
Indeed, many of my readers will recall how the same pharmaceutical corporations that sold the Covid-19 vaccines under emergency use authorisation were also at the forefront of promoting their use on the back of the “safe and effective slogan” on legacy and social media – a blatant case of conflict of interests.
In the third chapter of The Wretched of the Earth, written a few years before Nkrumah’s treatise on neo-colonialism, Frantz Fanon cautioned that at the time the colonial territories get their independence, the struggle for liberation is far from over because the structures of colonial domination remain intact under the custody of the emerging local middle class to whom the colonisers bequeath political power:
The national economy of the period of independence is not set on a new footing. It is still concerned with the ground-nut harvest, with the cocoa crop and the olive yield. In the same way there is no change in the marketing of basic products, and not a single industry is set up in the country. We go on sending out raw materials; we go on being Europe’s small farmers who specialize in unfinished products.
Fanon went on to write:
The economic channels of the young state sink back inevitably into neo-colonialist lines. The national economy, formerly protected, is today literally controlled. The budget is balanced through loans and gifts, while every three or four months the chief ministers themselves or else their governmental delegations come to the erstwhile mother countries or elsewhere, fishing for capital.
Yet Western imperialism maintains its firm grip on the economies of its erstwhile colonies through its domination of the production of knowledge. In “The Politics and Economics of Knowledge Production,” I cited the late Nigerian social scientist Claude Ake’s observation, in Social Science as Imperialism, that science in any society is apt to be geared to the interests and impregnated with the values of the ruling class which ultimately controls the conditions under which it is produced and consumed.
He pointed out that the ruling class achieves this by financing research, setting national priorities, controlling the education system and the mass media, and in other ways. This explains why, for example, British colonial education in Africa taught the children of its victims that various Europeans “discovered” various places on our continent, as though our forefathers and foremothers were not living there before the foreign invaders showed up. It also accounts for the way in which many scholars in Africa take great pride in studying in the West, and/or having their books and journal articles published there.
In the field of health and healing, the peoples of Africa are now largely subjected to Western neo-colonial medicine, as though they did not have their own systems of healing that responded to their climatic, demographic, social, and economic circumstances. This has been graphically illustrated during the Covid-19 crisis, when people are laughed out of town for suggesting that they have come up with therapeutics to manage the disease. Tragically, due to Western hegemony over knowledge production, many sons and daughters of Africa are now convinced that if a therapeutic or preventive innovation has not been approved by the WHO, it is useless for managing the infection.
Even more regrettable is the fact that many scholars in Africa embrace Western narratives and interventions about Covid-19 without due reflection on our continent’s unique circumstances. Similarly, as George Ogola lamented at the height of Covid-19, the media in Africa was merely copying and pasting Covid-19 Western discourses instead of promoting context-specific African interventions. For example, Ogola asked: “…how can the African news media fail to point out the fallacy of state directives for people to work from home, with no prospects of any financial support when 85% of the population work in the informal sector?”
The WHO’s Pandemic Agreement and amendments to the WHO’s IHR proceed from the false premise that disease burdens and thus public health priorities are uniform around the world. Yet it is a well-known fact in medical circles that even a single disease affects people in different parts of the world very differently due to factors such as the climate of a locale and the general age of the population in it, the availability of social services such as clean water and sanitation that promote overall well-being, and the economic status of the population. Consequently, the public health priorities of the wealthy countries of the so-called Global North cannot possibly be the same as those of countries of the so-called Global South decimated by centuries of slave trade, colonialism, and neo-colonialism.
Indeed, in a 2021 article in The American Journal of Tropical Medicine and Hygiene, Global public health specialist and former medical officer at the World Health Organization Dr. David Bell and his colleagues illustrate that the impact of Covid-19 in sub-Saharan Africa is significantly lower than in other parts of the world, while tuberculosis, HIV/AIDS and malaria continue to be major health challenges in the region. More specifically, they observe that deaths from each of these three diseases were much more than those from Covid-19 in all age groups younger than 65 years, and conclude: “…resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.”
Similarly, in January 2024, King’s College London’s African history Professor Toby Green took issue with the UNDP’s November 2023 claim that 50 million more people fell into extreme poverty due to Covid-19:
This claim is not…borne out by Covid data. The African continent has registered fewer than 260,000 Covid deaths in three-and-a-half years, and over 100,000 have been in South Africa alone. On a continent where around 12 million people die every year, this is a 0.75% increase over 3 years; removing South Africa from the equation, this becomes a 0.25% increase. Even accounting for missed diagnoses, mortality impacts have been very low – which, given Africa’s population pyramid, was predicted by many in March 2020.
So how can this negligible impact have ‘caused’ 50 million people to fall into extreme poverty, as stated by the UNDP? Policymakers need to assess other explanations for this catastrophe: principal among them is the impact of Covid lockdowns on the Global South, the harms of which were warned of by many as the pandemic began.
Yet due to Western hegemony, the countries of Africa are now under intense pressure to sign up to the WHO’s Pandemic Agreement and amendments to the WHO’s IHR that jointly obligate them to divert a significant percentage of their meagre resources from diseases that decimate their populations to a global fund for “pandemic prevention, preparedness and response” – a manifest case of public health imperialism with its penchant for false universality. As Ben Kingsley and Molly Kingsley point out, “It must…be recognised that the purpose of the IHR amendment exercise has only ever been to expand the scope of the IHR’s and strengthen existing positions and powers; it has never been on the table to narrow the scope or powers that have been in force in various forms for decades, and most recently updated in 2005.”
Conclusion
In the 19th and 20th centuries, Western imperialism dispossessed the peoples of Africa of huge tracts of land through treaties that it made them sign under duress or deception. For example, the Anglo-Maasai treaties of 1904 and 1911 obligated the Maasai to relocate to reserves in Laikipia and Loita plains. In this way, the British colonisers moved the Maasai away from their own ancestral lands for exclusive occupation by European settlers. We the peoples of Africa must now guard our health sovereignty with all that we have against recolonisation by demanding that no international legal instrument violates our right to sovereignty in its multiple dimensions, public health included.
In conclusion, I ask:
Where is the public debate in Africa on the draft WHO Pandemic Treaty and amendments to the International Health Regulations?How come there is deafening silence on the WHO’s draft Pandemic Agreement and amendments to the International Health Regulations in sharp contrast to the media blitz in support of measures such as masks, lockdowns, and Covid-19 vaccine mandates?Are our journalists truly committed to promoting informed, balanced public discourses on public health, or are they beholden to the enslaving agenda of Big Pharma and Big Tech?Where are the scholars of Africa in diverse fields to interrogate the implications of the WHO’s draft Pandemic Agreement and amendments to the WHO’s International Health Regulations?
