Analysis of COVID-19 Chronology Points to Need for Urgent IHR reforms and a New Treaty to Reduce Pandemic Risk

Geneva/Washington  8 November 2021 As work is underway to reform global governance of pandemic preparedness and response,  a new paper published in the Lancet offers comprehensive and specific ideas for legal reform. This is based on a careful mapping and analysis of the Independent Panel’s authoritative COVID-19 chronology.   

Through analysis of the meticulous timeline, the authors, including many members of the Independent Panel Secretariat, sought to understand how and when the existing legal regime – the International Health Regulations (IHR) – helped or hindered rapid alert and response.  The Independent Panel for Pandemic Preparedness and Response released the authoritative chronology at the time of its main report in May 2021. 

“The Independent Panel’s authoritative chronology helps to pinpoint where the IHR obligations are not precise enough, or fail to encourage countries and decision makers to more proactively respond to outbreaks with pandemic potential,” said Dr. Sudhvir Singh, lead author on the paper and an advisor to the Independent Panel. “COVID-19 demonstrated that losing even a few hours or days of time can have deadly consequences.” 

The IHR are currently the only legally binding international instrument governing countries’ obligations to report and respond to pathogens that could result in cross-border disease outbreaks and potential public health emergencies of international concern.  

Revised following the Severe Acute Respiratory Syndrome outbreak almost two decades ago, the IHR focus on balancing disease notification and health risks with international trade and travel considerations. They  specify when and how States should notify WHO of a local disease outbreak, and broadly what actions WHO and States take following that notification. 

“Despite significant focus on origin countries’ obligations to rapidly report outbreaks, COVID-19 has shown that the existing obligations under the IHR are insufficient for our interdependent and digital world,” said Dr. Alexandra Phelan, an Assistant Professor at Georgetown University and senior author.

“Our analysis demonstrates that collectively, countries urgently need to update our international system to respond to the potential rapid spread of a high impact respiratory pathogen. We have concrete suggestions for ways in which the IHR may be revised or amended, as well as the approach and issues that must be covered in any new legal framework, like a pandemic treaty.”  

The Independent Panel developed a peer-reviewed, authoritative chronology that shows the day-by-day, and at times hour-by-hour and even minute-by-minute actions taken by local, national and international actors when a novel respiratory virus was identified in December to the end of March when COVID-19 had spread worldwide. 

The Lancet paper authors have established and analysed the chronology, and mapped the actions taken against IHR obligations.   The authors provide analysis of five sequential phases of the emergence of the pandemic, and suggest objectives to detect and mitigate high-impact respiratory pathogens in future. These suggestions can inform those working on reforms to the IHR and a potential pandemic treaty.

The analysis also adds even more weight to the argument that a pandemic treaty, building on and complementing the IHR, would fill deadly gaps in the current system, and instil norms of equity, justice and global public goods. This includes faster and ongoing sharing of data, variant tracking and the equitable development and distribution of diagnostics, therapeutics and vaccines.   

“It’s clear: if a new, fast-spreading pathogen were to emerge next month, the current IHR regime would not protect people and trade as intended,” said Dr. Singh. “We suggest change to the IHR and a new treaty or other instrument that would result in more information shared faster, WHO able to investigate rapidly, all countries moving immediately to assess risk, and tools – like tests and vaccines – available to all who need them.” 

“The upcoming Special Session of the World Health Assembly is a critical opportunity for Member States to move ahead with strengthening the IHR and to agree on a process for negotiating a pandemic treaty. We must not lose this opportunity to protect global public health and future generations,”  said Dr. Phelan. 

The World Health Assembly Special Session is scheduled from 29 November- 1 December 2021. A new pandemic legal instrument is the sole major item on the agenda. 

For more information:  

The Lancet paper How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic.

All Independent Panel for pandemic preparedness and response publications, including the authoritative chronology: 

Christine McNab, communication lead,  Toronto, Canada,  

Dr. Sudhvir Singh, lead author, Oslo, Norway,

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