1 Introduction1
During the special session of the World Health Assembly (WHA), held between 29 November and 1 December 2021, member States of the World Health Organization (WHO) agreed to establish an Intergovernmental Negotiating Body (INB) to draft and negotiate a WHO convention, agreement or another international instrument on pandemic prevention, preparedness and response.2 During the second session of the INB, which took place between 18 and 21 July 2022, member States agreed to negotiate a legally binding instrument by grounding its legal basis in art. 19 of the WHO Constitution (dealing with conventions and agreements), while also continuing to consider the suitability of art. 21 (regulations) as the work progresses.3 The Bureau of the INB has also presented a working draft which, although not yet negotiated, constitutes a starting point for the discussion of the new treaty.4 The decision to negotiate a new international pandemic treaty creates an opportunity to consider the improvement of Early Warning Systems (EWS) with regard to zoonotic risks.
EWS remain an underdeveloped and under-addressed area in the institutional and legal architecture governing global health. According to the United Nations Office for Disaster Risk Reduction’s (UNDRR) definition, EWS may include:
(1) disaster risk knowledge based on the systematic collection of data and disaster risk assessments;
(2) detection, monitoring, analysis and forecasting of the hazards and possible consequences;
(3) dissemination and communication, by an official source, of authoritative, timely, accurate and actionable warnings and associated information on likelihood and impact; and
(4) preparedness at all levels to respond to the warnings received. These four interrelated components need to be coordinated within and across sectors and multiple levels for the system to work effectively and to include a feedback mechanism for continuous improvement.5
EWS can refer to a multitude of hazards and actions. For the purpose of this paper, we focus on the EWS comprising of surveillance, detection and reporting of animal pathogens that have a known potential of infecting humans, the risk of spillover from animal to human hosts, as well as early indications of an outbreak in the human population. We believe that the current international EWS architecture could be improved and that the ongoing pandemic treaty negotiations constitute an important opportunity for reform.
Throughout the COVID-19 pandemic, still ongoing as of the time of writing, emergency response has dominated the agenda, while proactive pandemic prevention and preparedness measures have received less attention. The existing EWS capacities tend to be siloed from each other; they also suffer from the vagueness of obligations in existing normative instruments and from the weakness of self-reporting tools.6 Meanwhile, robust and integrated EWS are necessary for the timely detection of zoonotic risk and the prevention of future outbreaks and pandemics. The systematic collection of human and animal health data, coupled with reporting and modelling of climate-related data and other environmental indicators is of great importance for successful pandemic prevention and preparedness.7
For these reasons, we consider it useful to provide a review of proposals which have been made by academic commentators in relation to the integrated approaches toward EWS. In particular, we review the proposals which have been made under the umbrella of two conceptual approaches: 1) disaster risk reduction and 2) “One Health”. For the purpose of this paper, we see disaster risk reduction and “One Health” as complementary approaches aiming at cross-sectoral integration of EWS. We deem it relevant to the ongoing reform processes of global health security and the current work on a pandemic treaty to take into account the toolsets and lessons learned from disaster risk reduction and “One Health” approaches, in order to consider principles and transplants that might be of help in reforming EWS for pandemic prevention and preparedness (see Sections 3 and 4 of this article). We also deem it necessary for the EWS reform to further integrate considerations of zoonotic risk by addressing the drivers of harmful events (see Section 4).
In this paper, we focus on EWS as an important part of zoonotic risk prevention and preparedness, and we review the integrated approaches to EWS which rely on multi-hazard and multi-stakeholder engagement toward surveillance and safeguarding of human, animal and environmental health. We begin by discussing the weaknesses of existing EWS obligations and core capacities under the 2005 International Health Regulations (IHR). We then consider the added value of disaster risk reduction and “One Health” approaches against the background of the existing legal and institutional architecture governing EWS for health. Finally, we review the proposals for a new pandemic instrument which have been made by academic commentators through the conceptual frameworks of disaster risk reduction and the “One Health” approach.
2 The Shortcomings of Existing EWS Obligations
The obligations with regard to health EWS are enshrined in the IHR. Under that instrument, States Parties have an obligation to detect and notify WHO disease outbreaks which have the potential to spread and to develop the capacity to fulfil this duty as well as to contain disease outbreaks to prevent the risk of international spread. Art. 5 IHR requires States Parties to establish the ‘capacity to detect, assess, notify and report events in accordance with these Regulations, as specified in Annex 1’. Article 13 IHR further requests States to develop ‘the capacity to respond promptly and effectively to public health risks and public health emergencies of international concern as set out in Annex 1’. Section A of Annex 1 elaborates upon the ‘[c]ore capacity requirements for surveillance and response’.8 It sets out minimum requirements concerning surveillance, infrastructure, decision making, and institutional information capacities deemed necessary for compliance with arts. 5 and 13 IHR (‘core capacities’).
The IHR have been criticized for their lack of specificity with regard to the content of measures which are to be taken in the fulfilment of core capacities.9 The interpretative challenge results in ambiguity and a lack of precision with regard to the implementation of obligations provided by IHR. The monitoring of compliance with IHR also suffers from the lack of independent mechanisms and the simplification of the process at the expense of granularity. The compliance monitoring system developed in the course of implementation of the IHR is largely based on self-assessment: no statutory on-site visits are envisaged and the submission of reports to the Health Assembly is used to produce statistical figures and is not followed up by a meaningful debate.10 The compliance monitoring process has largely moved away from the more detailed model of ‘IHR Monitoring Questionnaire’,11 consisting of more than 250 questions concerning core capacities, towards the current ‘State Party Self-Assessment Annual Reporting’ (SPAR)12 model which consists only of 24 indicators of compliance with 13 core capacities relevant to Annex 1.13 These legal shortcomings are translated into a situation where, in the absence of international political will and solidarity, IHR have suffered from poor implementation and contributed to the COVID-19 pandemic becoming a protracted global health emergency.14 The IHR Review Committee noted that ‘that scores of IHR core capacities alone were not a good predictor of pandemic response’.15
A number of policy proposals have been put on the table with a view to remedying these shortcomings. While combined with dynamic assessments through external evaluations, simulation exercises and after-action reviews, static measurements of capacities were found to provide a more detailed picture of the level and functionality of core capacities.16 The IHR Review Committee on the COVID-19 pandemic has recommended the adoption of a peer-review mechanism, modelled after the Universal Periodic Review (UPR) of the Human Rights Council, in order to improve emergency preparedness and response as well as compliance with States Parties’ legal obligations under the Regulations.17 It has also been argued that voluntary mechanisms such as the Joint External Evaluations (JEE)18 and the WHO Benchmarks for International Health Regulations capacities (WHO Benchmarks)19 could be used more effectively, to provide requirements under Annex 1 with granularity and more precise criteria.20
Numerous academic commentators have also argued for an integrated approach toward preparedness measures, which could take into account measures and principles pertaining to disaster risk reduction.21 In particular, the importance of synergies between different sectors, multi-stakeholder coordination and the sharing and management of information has been noted by academic commentators and the IHR Review Committee alike.22 The need to break the silos between natural hazards and other hazards in the management of risk has also been highlighted in the academic literature.23 This brings us to the discussion of the relevance of paradigms pertaining to disaster risk reduction with regard to the establishment of integrated EWS.
3 Disaster Risk Reduction
Disaster risk reduction has been identified as one of the policy approaches which should guide the operationalization of integrated EWS.24 Central to this policy area is the Sendai Framework for Disaster Risk Reduction 2015–2030 (Hereinafter: the Sendai Framework). The Sendai Framework was adopted at the Third United Nations World Conference on Disaster Risk Reduction, held from 14 to 18 March 2015 in Sendai, Japan. It draws from and replaces the Hyogo Framework for Action (2005–2015). The Sendai Framework has been endorsed by the UN General Assembly in its Resolution 69/283.25
The overarching objective of the Sendai Framework is to achieve ‘the substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries’.26 Its aim is to provide increased multisectoral, multi-hazard engagement and integration.27 The Sendai Framework attributes particular emphasis on preventing and reducing risk and to the enhancement of resilience and early warning capacities.28 The Framework can therefore be read as offering an integrated approach to emergency preparedness and EWS. Seen in this light, a successful prevention strategy in light of the Sendai Framework would have to rely on ‘inclusive economic, structural, legal, social, health, cultural, educational, environmental, technological, political and institutional measures’.29 The Framework notes that effective disaster risk reduction requires an all-of-society engagement and partnership, through empowerment and inclusive participation, with special attention paid to people most affected by disasters.
Although not a legally binding instrument, the Sendai Framework constitutes a widely acknowledged set of principles concerning disaster risk reduction and contains references to disasters in the context of health. It is complemented by the Bangkok Principles for the implementation of the health aspects of the Framework (the Bangkok Principles) elaborated in 2016 by an international meeting convened by Thailand, UNDRR and WHO.30 The Bangkok Principles provide for the integration of health systems into disaster risk reduction programmes and, vice versa, for the integration of disaster risk reduction into health systems. They call for the incorporation of ‘disaster-related health data into Early Warning Systems and indicators, fostering transboundary information sharing for all hazards, and promoting policy coherence at all levels’.31
As the Sendai Framework is not a legally binding instrument, its success ultimately depends upon its normative traction and the extent of its implementation by States. The Bangkok Principles provide guidance for the implementation of health-related aspects of the Sendai Framework. Their main purpose was to transplant the principles enshrined in the Sendai Framework into the health sector, by framing the document around seven broad principles and adapting them through tailored measures to the health sector.32 The Bangkok Principles thus highlight the importance of a whole-of-government, whole-of-society approach with an important role reserved for EWS. The principles restate the need to promote systematic integration of health and disaster risk reduction plans and strategies. This is to be done through the integration of biological hazards and diseases at the human-animal-ecosystem interface into multisectoral disaster risk management. The principles call for further integration and coherence between policies, institutions and legal frameworks which address human, animal and environmental health.
We have identified three disaster risk reduction principles which are particularly relevant for the discussions of integrated EWS in the context of ongoing negotiations over a new PPR instrument.
3.1 Multi-hazard Approach towards Vulnerability
According to paragraph 7 of the Sendai Framework, ‘disaster risk reduction practices need to be multi-hazard and multisectoral, inclusive and accessible in order to be efficient and effective’. Paragraph 27(g) further restates the need to identify sectoral and multisectoral disaster risk, build awareness and knowledge of disaster risk through sharing and dissemination of non-sensitive disaster risk information and data and contribute to and coordinate reports on local and national disaster risk. Given the multi-hazard approach of the framework, each of these steps could be read as entailing the need for further integration of environmental and health data.
A multi-hazard approach based on an open exchange of disaggregated data is particularly relevant in the early stages of a public health emergency.33 The facilitation of access to non-sensitive information would play a role in designing effective solutions to public health emergencies.34 The cooperation with and between scientific communities and the support of information-sharing platforms is particularly relevant in this context.35 Disaster-related mortality, morbidity and disability data can be integrated into multi-hazards early warning systems, health core indicators and national risk assessments.36 The assessment and mitigation of risk could take into consideration factors such as sex, age, and disability and be supported by policies addressing sustainable development, food security, health and safety and climate change.37 The latter point is of particular relevance, as climate change could potentially result in novel patterns of the outbreak and spread of diseases.
Principle 5 of the Bangkok Principles stipulates the need to ‘incorporate disaster-related mortality, morbidity and disability data into multi-hazards early warning system, health core indicators and national risk assessments’.38 Key actions in this area include the collection and integration of disaggregated data on exposures, vulnerabilities and capacities for all types of hazards. The need to integrate data concerning biological hazards, zoonotic diseases, as well as chemical and radiation hazards is also mentioned in the text. Principle 6 refers to transboundary collaboration in relation to information sharing, which could include the promotion of innovative communication solutions for the dissemination of early warning messages, as well as targeted operational research for all-hazard emergency and disaster risk management. Fundamental to the achievement of integrated EWS for zoonoses is the pairing of indicators related to biological, environmental, animal and human hazards and the mobilization of multisectoral collaboration which ensues from reporting on multi-hazard indicators. In that context, a pandemic treaty would provide an opportunity for integrating existing dispersed toolsets into a single, mandatory reporting and peer review process, which could adopt a multihazard approach to public health and feature the involvement of external experts in the assessment of the country PPR capacities (see Section 4.5 of this article for the proposals to establish a One Health science-policy structure through a treaty).
Academic commentators have also recognized the need to bridge the tension between technical and societal approaches towards the operationalization of EWS and have advocated for approaches which would incorporate all of the relevant factors of risk, whether arising from natural hazards or social vulnerabilities, and from short-term to long-term processes.39 For example, from a technical viewpoint, high-quality climate information is necessary in order to conduct accurate seasonal forecasting. Meanwhile, from a societal perspective, a multi-hazard approach to risk reduction can help highlight specific vulnerabilities of communities at different seasons and their exposure to threats.40 It has been noted that the integration of data concerning climate change risk and adaptation capacity into EWS can support pandemic preparedness and response, and promote more resilient economic development.41 What connects these points is the need to move beyond the narrow, anthropocentric, conceptualization of risk by creating linkages between environmental, animal, and human health and reflecting them in institutional solutions.42 While a pandemic treaty deals primarily with human health, it should feature a section on “One Health” and provide for mechanisms which build upon the notion of mid-stream prevention (see Section 4 of this article).43
3.2 Multi-stakeholder Coordination
The Sendai Framework also envisages the enhancement of vertical and horizontal coordination and organizational structures with a clear delineation of responsibilities and authority.44 The Framework prescribes for the domestic risk reduction responsibilities to be shared between relevant national authorities, sectors and stakeholders, with responsibilities delineated in accordance with the local system of governance.45 In the context of ‘Prevention, Preparedness and Response’ (PPR), the need to empower local authorities and stakeholders may be particularly relevant in the early detection and prevention of the spread of pathogens.46 Para. 19(h) of the Sendai Framework restates the need to develop, strengthen and implement measures aiming at greater coherence and consistency of standards across different sectors and consequently at closer coordination of actors responsible for them: sustainable development and growth, food security, health and safety, climate change and variability, environmental management and disaster risk reduction agendas. Academic commentators have argued that there’s further potential for integration of biological hazards into national and local disaster risk reduction strategies and vice versa, for the integration of disaster risk reduction perspectives into national health plans.47
Para. 24 of the Sendai Framework refers to the priorities regarding the collection, analysis, and dissemination of disaster risk data. It calls upon stakeholders at the national and local levels to record, evaluate and share data related to the economic, social, environmental and health losses. It seeks to promote education regarding disaster risk on all levels and to involve the use of traditional and local community knowledge in complementing the scientific framework for disaster risk assessment. Para. 27 of the Sendai Framework further addresses the mainstreaming and integration of disaster risk reduction within and across all sectors through, inter alia, strengthening of national and local disaster risk capacities, coordination with local communities and designation of focal points for the implementation of the framework. While paragraphs 24 & 27 of the Sendai Framework constitute a good starting point for multisectoral coordination, they remain vague and aspirational about the operationalization of integrated EWS.48 For this reason, it is important to supplement the disaster risk perspective with the “One Health” approach discussed in Section 4 of this article.
3.3 International Assistance and Capacity Building
Another important point raised by the Sendai Framework concerns the capacity of developing countries to implement efficient risk reduction programmes, which can be enhanced by means of international cooperation. The international support could take the form of capacity-building assistance, provision of resources, training programmes and investment in people-centred multi-hazard EWS, risk modelling, assessment and monitoring capacities.49 It could also include investment and collaboration in scientific research, technology transfer on concessional and preferential terms and the sharing of non-sensitive data and good practices to enable flows of skills, technology and know-how.50 For example, one of the key actions under the Bangkok Principles envisages the promotion of investment in research and development and the use of modern technologies and modelling for managing disaster risks including biological hazards. In the case of PPR, also the sharing on a multilateral basis of samples of pathogens and related genetic sequence data is of particular importance for the early detection and containment of a disease outbreak and the development of necessary medical countermeasures such as diagnostics and vaccines.51
The availability of advanced technology protected by intellectual property (IP) laws is essential in ensuring effective preparedness and response to the ongoing and future public health crises.52 It is particularly important to ensure investment in and provision of multisectoral forecasting technology, disaster risk and emergency communications mechanisms, as well as hazard-monitoring telecommunications systems.53 Such systems should be designed through a participatory process, with the involvement of local manufacturers. They should be tailored towards local needs and capacities and could prioritize simple, low cost and energy-efficient early warning equipment and facilities. While a successful risk reduction strategy requires an investment in capacity building in developing countries, such investment represents a fraction of the costs of a post-disaster pandemic response and its economic fallout.
A pandemic treaty would present an opportunity to embrace principles enshrined in the Sendai Framework and the Bangkok Principles with regard to the establishment of integrated Early Warning Systems. However, as the above-mentioned points make clear, the Sendai Framework and Bangkok Principles rely on a broad and overarching set of principles and aspirational policy objectives. They have been criticized for being too broad and vague in terms of commitments required of states and other relevant actors.54 Chan and Shi mention that ‘the lack of multidisciplinary, agreed indicators and definitions’ challenges the successful implementation of the Framework.55
To pursue further integration of Early Warning Systems in the context of negotiations of a pandemic treaty, “One Health” has been suggested as another approach which could guide the design and implementation of integrated EWS. We now move to discuss the “One Health” approach to integrated EWS and the proposals which have been made concerning a pandemic treaty.
4 “One Health” Approach
Human pathogens of animal origin pose a particularly significant threat to global health. Up to 75% of emerging infectious diseases result from pathogens of animal origin that may also be able to infect and spread among humans.56 According to the available evidence, SARS‑CoV‑2 constitutes one of the infectious agents which have originated from a zoonotic spill-over from an animal to a human host; other examples include SARS, Nipah, MERS, H7N7 influenza, Ebola, and H1N1.57 The pathogens which originate in animals are notoriously difficult to eradicate because of their ability to live on and reproduce in an animal reservoir and to jump and reassort among different species, including humans.
The COVID-19 pandemic has demonstrated the importance of monitoring the interconnections between human, animal and environmental health.58 Despite the importance of the topic, a recent analysis of gaps in pandemic prevention and preparedness highlights that ‘countries are failing to address the environmental components of current health threats’.59 The study of Machalaba et al. has shown that only a small fraction (8%) of the latest National Biodiversity Strategies and Action Plans submitted by the parties to the Convention on Biological Diversity (CBD) included references to wildlife health and zoonotic risks.60 For these reasons, it has been argued that the best ways to prevent future catastrophic pandemics should imply detecting and containing emerging zoonotic threats in line with the “One Health” approach.61
The “One Health” approach is based upon the recognition that ‘the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent’.62 According to the definition agreed upon by the One Health High Level Expert Panel (OHHLEP) established by the WHO, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the United Nations Environment Programme (UNEP), “One Health” proposes ‘an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems’.63 To achieve its objectives, the “One Health” approach aims to mobilize:
[M]ultiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.64
“One Health” therefore constitutes a useful ‘set of principles to guide and structure policy and actions, including the development and implementation of practical guidelines and interventions’, which allows for the recognition of the linkages between human, animal and environmental health and a more comprehensive approach towards zoonotic risk for the purposes of integrated EWS.65
Indeed, at the second special session of the World Health Assembly, several member States mentioned the importance of integrating the “One Health” approach into a future international instrument.66 Solid preventive measures, prompt detection and notification of risks,67 as well as the importance of cross- sectoral approaches to the work of authorities in health-related areas68 have been identified by several delegations as issue areas which require particular attention in the context of negotiations of a pandemic treaty. Accordingly, the working draft presented by the Bureau of the INB in July 2022 has featured “One Health” as one of the ‘specific provisions/areas/elements/obligations’ that are to be included in the future treaty.69
Currently, elements relevant to the “One Health” approach remain spread across multiple international legal instruments and legal regimes, which need to be identified and analysed first. Below, we consider several issue areas where a “One Health” approach could be employed to achieve further integration of EWS: we outline relevant legal frameworks and review suggestions made by academic commentators with regard to the creation of an integrated “One Health” approach towards EWS.
4.1 Assessment, Notification and Dissemination of Cross-Sectoral Information
Timely notification and comprehensive assessment of developments relevant to PPR constitute a cornerstone of prevention. To be effective, assessment and notification of events should not be limited exclusively to human health considerations but should also include the international exchange of information relevant to environmental and animal health. International law already features some principles which, although not wholly sufficient, could be mobilized to facilitate the exchange of information related to the human- animal-environment interface. The International Court of Justice (ICJ) has affirmed that it is ‘every State’s obligation not to allow knowingly its territory to be used for acts contrary to the rights of other States’.70 The ICJ also held that the prevention of transboundary harm constitutes part of customary international law and that States are obliged to use all the means at their disposal in order to avoid events in their jurisdiction which could cause significant damage to the environment of another State.71
These pronouncements have been taken to signify an obligation of States to conduct as minimum Environmental Impact Assessments (EIA s).72 Such assessments are of particular value from the perspective of the “One Health” approach to EWS: EIA s could include information concerning the effects of a planned project on habitat degradation, deforestation, water and waste management and on human-animal interaction. Although EIA s play an important role in assessing the risk and scope of transboundary damage, they must also be followed by consequential risk management in line with the principles of the Sendai Framework. With the help of the proposed “One Health” scientific structure (see Section 4.5 below) such EIA s could be standardized to include elements relevant to zoonotic risks, such as the observed pre-existence of zoonotic threats in a given area, as well as the assessment of measures resulting in deforestation, effects on biodiversity, land use and antimicrobial use. The application of such EIA s to foreign investments could also be promoted by means of the “One Health” scientific structure which could provide model EIA s that would include said indicators of zoonotic risk. As noted by Rapporteur Shinya Murase in his report to the Institut de droit international, there also exists a clear analogy between the requirement to provide EIA s and the duty to establish adequate health systems supported by institutional infrastructure: ‘states constructing hospitals, laboratories, and medical production factories must consider how those installations will effectively prevent and contain epidemic outbreaks’.73
Under international law, the duty to prevent harm is accompanied by the duty of States to notify other parties which could be affected by their actions.74 The duty to notify is currently reflected in several multilateral conventions. For example, art. 5(1) of the Aarhus Convention75 stipulates a number of general obligations on public authorities with respect to the collection and dissemination of environmental information. Art. 5(1)(c) stipulates an obligation for States Parties to disseminate information to the public affected by an imminent threat to human health or the environment caused by human activities or natural causes. Art. 5(2) and art. 5(3) further stipulate the need to make environmental information easily accessible to the public through the means of electronic databases. According to art. 5(4) each State Party should, at regular intervals not exceeding three or four years, publish and disseminate a national report on the state of the environment, including information on the quality of the environment and information on pressures on the environment. Along similar lines, the Convention on Early Notification of a Nuclear Accident76 establishes a duty on States parties to notify other States of the actual or potential release of radioactive material which could result in transboundary harm. Art. 2 of the Convention prescribes that such notification can be done directly or through the International Atomic Energy Agency (IAEA). The aforementioned provisions contained in multilateral treaties could serve as a point of reference for a future pandemic treaty, including a provision concerning the collection and dissemination of data. The draft prepared by the INB Bureau currently states the need to include ‘timely and transparent sharing of information, data and other factors necessary to ensure countries are able to carry out a robust response’, ‘timely information sharing and alert mechanisms’, ‘early warning, information sharing’ and ‘sharing of information among experts, scientific bodies and networks’.77
Communication and free exchange of information across animal, environmental and human health surveillance systems are key to effective EWS.78 Ruckert et al. argue that integrated “One Health” surveillance systems should contain and connect data outlining risk factors for disease emergence in wildlife, livestock, companion animals, the environment (soil and water), and humans.79 Such data should be easily accessible to the public. A preventive and integrated approach to EWS and surveillance should include risk assessment focused on monitoring the presence and distribution of infectious agents across species to monitor the risk of zoonotic spillover. Social media data could be used to detect health emergencies for event-based EWS.80 Ruckert et al. note the need to ensure access to data through data sharing agreements between governments and other relevant actors. The ‘WHO Hub for Pandemic and Epidemic Intelligence’, launched in 2021 in Germany, represents one of the latest examples of collective and collaborative intelligence gathering and sharing initiatives. Speaking at the launch of the Hub, the Executive Director of the WHO’s Health Emergencies Programme stated that the currently limited local surveillance capacity needs to be strengthened and connected globally in an interlinked system.81
4.2 Integration of Toolsets in Animal, Environmental and Human Health Sectors
Another opportunity for a pandemic treaty would lay in its potential to integrate existing toolsets across human, animal and environmental health sectors. Ruckert et al. argue for an inter-disciplinary and cross-sectoral approach that would address disease prevention and surveillance, as well as biodiversity conservation, climate change, and sustainable development.82 The authors argue that a new pandemic treaty could engage and create linkages with existing international agreements, such as the Convention on Biological Diversity (CBD) and the United Nations Convention to Combat Desertification. It has also been argued that, from the perspective of the “One Health” approach, the ‘midstream deep prevention’83 of pathogen spill-over and the monitoring of emergent threats through integrated EWS could form part of a prevention strategy to be included in the prospective pandemic treaty.
The implementation of the “One Health” approach through an international treaty would allow for the integration of EWS by including considerations related to the animal-human-ecosystems interface. It could take into account factors and indicators related to emerging and endemic zoonoses, antimicrobial resistance (AMR), food safety, ecosystem health, wildlife, host species management, land use, and biodiversity.84 A pandemic treaty would constitute an opportunity to integrate the existing “One Health” assessment tools by establishing a stronger obligation to report and by designating a clear set of integrated human-animal tools and criteria for the purpose of reporting. The working draft of the INB Bureau recognizes some of these concerns by stating that ‘promoting coherence among all relevant actors, instruments, initiatives and issues, such as climate change and antimicrobial resistance, insofar as they relate to pandemic prevention, preparedness and response’ should be taken into account for the purposes of a prospective treaty.85
A more detailed obligation to provide reports, which would include considerations of zoonotic and environmental risk, could be expressed in the new pandemic treaty. This could be achieved through the promotion and adaptation of the WHO Benchmarks86 and the Joint External Evaluation (JEE) models.87 The WHO Benchmarks include technical benchmarks dealing with antimicrobial resistance (3.1–3.4), zoonotic disease (4.1–4.2), food safety (5.1–5.2), national laboratory systems (7.1–7.4), biosafety and biosecurity (8.1–8.2), and surveillance (9.1–9.3). With regard to the monitoring of capacities about zoonotic diseases, evaluation should be based on ‘(1) Agreement by the animal health and public health sectors on a common list of zoonotic diseases/pathogens of greatest national public health concern’ and ‘(2) Existence of functional capacities in the animal health and public health sectors and of collaboration, coordination and communication between them for preparedness, detection, assessment and response to zoonotic diseases’.88 Benchmark 4.1 provides for the measuring of capacities with regards to the existence of coordinated surveillance for priority zoonotic pathogens.89 The level of capacity assessed through the benchmark will depend, inter alia, on the identification of key stakeholders and designation of focal points for animal health, human health, environmental health and other key sectors; development of surveillance strategies; development of laboratory standards and capacities; training of staff in surveillance of zoonotic diseases, as well as interoperability and intersectoral accessibility of information. Meanwhile, the JEE constitute a voluntary tool which allows for the involvement of external experts in the country’s capacity evaluation process. JEE s feature assessment of capacities related to AMR, zoonotic disease, food safety, biosafety and biosecurity, national laboratory system and surveillance.90 Materials such as the Handbook for the Assessment of IHR Capacities at the Human-Animal Interface were also designed to be taken up by countries in their health security plans in order to facilitate the implementation of IHR core capacities.91 The Handbook for the Assessment of IHR Capacities at the Human-Animal Interface highlights synergies between JEE and the OIE’s Performance of Veterinary Services (PVS) Pathway and includes specific information on how to use the data contained in a PVS Evaluation report to assist in the implementation of the JEE.92 The Handbook recommends prioritization of specific zoonotic diseases of relevance for the country in question, as well as the establishment of specific surveillance systems for zoonotic diseases of importance in animal health, human health and collaboration.93 It also contains guidelines concerning the sharing of data and the existence of functional links between public health laboratories and animal health laboratories as key indicators for the assessment of capacity for the prevention of zoonotic diseases.94 The IHR-PVS and National Bridging Workshops (NBW s), hosted by the WHO and OIE, have previously provided opportunities for the animal and human health sectors to jointly review the results of IHR monitoring and to identify operational actions to address any gaps in the coordination between the two sectors and the integration of a One Health approach in their implementation.95
The added value of a prospective pandemic treaty could be precisely in the inclusion of clear references to zoonotic risk, coupled with cross-sectoral mobilization and the integration of tools such as JEE and WHO Benchmarks. The current voluntary reporting under the JEE and WHO Benchmarks could be made mandatory and subject to external review, in line with the IHR Review Committee’s recommendation to establish a peer-review mechanism modelled after the UPR.96 The peer-review process could allow for the involvement of external experts in the process and the information provided in the evaluations could be verified, for example, against available satellite and scientific data.
4.3 Technology Transfer and Financing
The establishment of integrated EWS will require innovative solutions with regard to the transfer of technologies, know-how and resources. Under the section dedicated to the Sendai Framework, we have discussed the principles concerning international assistance and capacity building. Other important aspects concern the transfer of technology and cross-cutting financing of obligations. While an in-depth analysis of these issues is beyond the scope of this article, it is worth mentioning several initiatives in these areas.
Concerning technology transfer, it is worth mentioning examples from the field of environmental law. The imperative and challenges of facilitating the transfer of technology on favourable terms to developing countries have characterized the implementation of multilateral environmental agreements. Art. 5 of the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer includes an obligation to transfer technology and a related financing mechanism to help countries transition quickly away from ozone-depleting chemicals to alternative technologies. More recently, the 2010 Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC) created a ‘Technology Mechanism’.97 The mechanism consists of a ‘Technology Executive Committee’ which provides guidance on technology transfer policies and of ‘Climate Technology Centre and Network’ which oversees implementation.
In the context of One Health, it is of particular importance to ensure that international cooperation and technology transfer generates investments in training and upkeep of qualified personnel, provision of multisectoral forecasting technology, monitoring of lab capacity and establishment of effective communications systems. Solutions in these areas should allow for local participation, with the possible involvement of local manufacturers and communities. They should be tailored towards local needs and capacities and could prioritize simple, low cost and energy-efficient early warning equipment and facilities.
The question of how to finance commitments in the afore-mentioned areas will be of critical importance in the coming years. At the time of writing, we are expecting the creation of a Financial Intermediary Fund (FIF) for pandemic preparedness and response at the World Bank.98 Some of the FIF funds could be channelled towards the creation of integrated EWS capacity. Another key issue concerns the tracking of investments: it has been proposed that metrics to track “One Health” investments could form part of monitoring arrangements under the new pandemic instrument.99
4.4 Regulation of the Wildlife Trade
The implications of trade in wildlife species for the spread of zoonotic diseases remain largely unaddressed. Except for animal diseases listed by WOAH, there currently exists no obligation to report on emerging zoonotic risks connected with the wildlife trade.100 While states are encouraged to conduct voluntary reports through the OIE World Animal Health Information System (OIE-WAHIS), few countries follow up with diseases falling outside of WOAH’s standard list of 117 diseases.101
Ruckert et al. argue for further integration of international standards, guidelines and recommendations governing animal, plant and human health through a pandemic treaty grounded in “One Health” principles.102 Gallo Cajiao et al. propose a Pandemic Prevention Protocol which would include a system of self-reporting and third-party audits focusing on ‘(i) characterization of the entire supply chains and networks of the wildlife trade from a biophysical and socio-cultural standpoint; and (ii) characterization of the corresponding regulatory frameworks and funding available for their implementation’.103 The assessment of supply chains should include descriptions of the entire process, ranging from harvest, the point of sale and the end consumer and include variables such as the stage at which slaughter – if applicable – took place, shipping conditions, animal density and interspecies mixing, as well as the overall descriptions of market size and the length of the entire supply chain.104 The authors have suggested that the Global Health Security Index (GHS) could be used for the purpose of assessing risks stemming from the wildlife trade.105 The GHS is a capacity assessment index which benchmarks the factors critical to fighting disease outbreaks.106 The latter include political and security risks, the overall strength of the health system, and the country’s adherence to global norms. More specific metrics could also be proposed through the science platform which could be established as part of a pandemic treaty.
All of the above-described proposals for integrated EWS will necessitate the creation of sustainable “One Health” communication channels at all levels.107 This would include vertical cooperation, from local communities to central governments, as well as horizontal cooperation between medical, public health, veterinary, agronomy, social sciences, legal and environmental disciplines, as well as between the public and private sectors. To facilitate the coordination, a permanent “One Health” structure has been proposed as a potential feature of a pandemic treaty.108
4.5 Establishment of One Health Science Structure through a Pandemic Treaty
Several academic commentators have also argued for the establishment of a “One Health” science-policy structure by means of a pandemic treaty. Multiple authors have argued that the new structure could be modelled after the science-policy interfaces which exist in the environmental context: the Intergovernmental Science-Policy Platform for Climate Change (IPCC) and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES).109 However, questions arise about the scope of responsibilities of the new structure. Decisions would have to be made whether, following the model of IPCC and IPBES, the role of the new structure would be only to curate and promote scientific knowledge for the purposes of policy-making or whether the new structure should also be involved in the establishment of technical norms and standards.110
The academic literature so far has favoured an expansive role for the new science-policy structure. Ruckert et al. argue that a pandemic treaty should establish a permanent “One Health” structure to provide technical and scientific support and to ‘review and resolve evolving policy issues and to contribute to negotiations of pandemic protocols and guidelines’.111 They argue that a new “One Health” body should also develop “One Health” capacity assessment methodology and be allowed to provide recommendations, and guidelines and oversee external evaluations. In carrying out these activities, the new science-policy structure should collaborate with relevant initiatives including the “One Health” High-Level Expert Panel (OHHLEP) and other global entities. Gallo-Cajiao et al. argue that the self-reporting mechanisms and third-party audits in relation to the wildlife trade could be devised by the new science platform.112
5 Conclusion
This article has sought to provide a review of proposals which have been made by academic commentators in relation to integrated approaches toward Early Warning Systems. We have conceptualized the relation between EWS and the ongoing negotiations of a pandemic instrument in light of two approaches: disaster risk reduction and “One Health”.
Disaster risk reduction provides us with an overarching set of principles which outline priorities regarding the establishment of multistakeholder and multi-hazard EWS. The lens of disaster risk reduction is relevant to health, but it also takes a variety of social and environmental factors into consideration, therefore allowing for an integrated approach that could guide the future implementation of EWS.
Meanwhile, “One Health” constitutes a multisectoral approach which seeks to mobilize resources and address the interconnection between human, animal and environmental health. For the purposes of EWS, this translates into the integration of tools from animal, human and environmental health sectors, including the integration of reporting and capacity assessment, better regulation of wildlife trade and the establishment of surveillance systems which take better account of zoonotic risks. Finally, the proposals for the establishment of a “One Health” science-policy structure through a new pandemic instrument have been discussed.
A few concluding observations are in order. Any new pandemic instrument should clearly define its scope and relation to the IHR. On the one hand, care should be taken to avoid fragmentation of efforts and to work towards the integration of toolsets from different sectors. On the other hand, the integrated EWS should move beyond the limited scope of surveillance and capacity reporting currently enshrined in IHR (2005). To achieve these objectives, more will have to be done with regard to the financing of capacity building and technology transfer to low- and middle-income countries. While reaching an agreement on these issues may be challenging, it must be noted that the establishment of an effective, integrated EWS represents only a fraction of the costs of post-emergency pandemic response.
Researcher, Global Health Centre, Geneva Graduate Institute. Global Fellow, NYU School of Law (2023).
Adjunct Professor of International Law, Academic Adviser in the Global Health Centre, Geneva Graduate Institute.
This article was developed as part of the Governing Pandemics Initiative, a project of the Global Health Centre at the Geneva Graduate Institute. We thank the authors of our series of policy briefs, whose valuable contributions have been cited in this article. We also thank the editors of the Yearbook for their valuable comments upon earlier drafts of this article.
WHA Decision SSA2(5) ‘The World Together: Establishment of an Intergovernmental Negotiating Body to Strengthen Pandemic Prevention, Preparedness and Response’ (1 December 2021) WHA74(16).
For the sake of simplification, the new international instrument will therefore be referred to as a ‘pandemic treaty’.
WHO, ‘Working draft, presented on the basis of progress achieved, for the consideration of the Intergovernmental Negotiating Body at its second meeting’ (13 July 2022) A/INB/2/3.
UNDRR, “Early Warning System” (2022), available at <https://www.undrr.org/terminology/early-warning-system#:~:text=A%20multi%2Dhazard%20early%20warning,and%20monitoring%20for%20multiple%20hazards>, last accessed (as any subsequent URL) on 02 August 2022.
Katja L.H. Samuel and Rosalind J. Cornforth, ‘Disaster Risk Reduction, Early Warning Systems, and Global Health: Critiquing the Current System-Based Approach’ in Katja L.H. Samuel, Marie Aronsson-Storrier and Kirsten N. Bookmiller (eds), The Cambridge Handbook of Disaster Risk Reduction and International Law (CUP 2019); Giulio Bartolini, ‘The Failure of “Core Capacities” under the WHO International Health Regulations’ (2021) 70 International and Comparative Law Quarterly, 233–50; Arne Ruckert et al., ‘One Health as a Pillar for a Transformative Pandemic Treaty’, Policy Brief – Global Health Centre, Geneva Graduate Institute (2021), at <https://www.graduateinstitute.ch/sites/internet/files/2021-11/policybrief-onehealth-v3.pdf>. Recently, calls have been made to establish permanent response and mobilization structures under auspices of WHO, see Bill Gates, How to Prevent the Next Pandemic (Alfred A. Knopf 2022).
Samuel and Cornforth (n 6) 390.
Bartolini (n 6) 236.
Ibid.
Ibid.
WHO, ‘Questionnaire for Monitoring Progress in the Implementation of IHR Core Capacities in States Parties’ (2015) WHO/HSE/GCR/2015_8.
WHO, ‘State Party Self-Assessment Annual Reporting Tool’ (2018) WHO/WHE/CPI/ 2018.16.
Bartolini (n 6) 239.
‘Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response’ (2021) A74/9 Add.1. For the summary of institutional response to the 2014–2016 Ebola outbreak, see Gian Luca Burci and Jakob Quirin, ‘Implementation of the International Health Regulations (2005): Recent Developments at the World Health Organization’, ASIL Insight 22, no. 13 (2018).
‘Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response’ (n 14) para. 23.
Ibid., para. 26.
Ibid., 53.
For development of capacities under JEE, see Elizabeth Bell et al., ‘Joint External Evaluation – Development and Scale-Up of Global Multisectoral Health Capacity Evaluation Process’ (2017) 23 Emerging Infectious Diseases, 33–39.
For WHO Benchmarks, see WHO, ‘WHO Benchmarks for International Health Regulations (IHR) Capacities’ (2019), at <https://apps.who.int/iris/handle/10665/311158>.
Bartolini (n 6). This point is also reflected in the recommendations contained in the ‘Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response’, which states that ‘WHO should continue to review and strengthen tools and processes for assessing, monitoring and reporting on core capacities’.
Samuel and Cornforth (n 6); Marco Toscano-Rivalta, ‘Disaster Risk Reduction in Light of the COVID-19 Crisis: Policy and Legal Considerations’ (2020) 70 QIL, Zoom-Out, 37–57; Bartolini (n 6); Ginevra Le Moli, ‘One Health and the Prevention of Pathogens’ Spillover’, in this volume of the Yearbook; Pedro A. Villareal, ‘Pandemic Risk and International Law: Laying the Foundations for Proactive State Obligations’ (2021) 3 Yearbook of International Disaster Law, 154–79.
Ibid.; ‘Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response’ (n 14) paras. 24 and 144.
Ibid.
Bartolini (n 6); Adam Strobeyko, ‘Disaster Preparedness and Response in International Law: Implications for a Prospective Pandemic Treaty’, Policy Brief, Global Health Centre, Geneva Graduate Institute (2021), at <https://www.graduateinstitute.ch/sites/internet/files/2021-11/PolicyBrief3.pdf>; Villareal (n 21); Le Moli (n 21).
UNGA Res 69/283 (23 June 2015) A/RES/69/283.
Sendai Framework (2015) para. 16.
Para. 7 of the Sendai Framework; Samuel and Cornforth (n 6).
Samuel and Cornforth (n 6) 380.
Sendai Framework (2015) para. 17.
The International Conference on the Implementation of Health Aspect of the Sendai Framework for Disaster Risk Reduction 2015–2030 (Bangkok, Thailand, 10–11 March 2016), ‘The Bangkok principles for the implementation of the health aspects of the Sendai framework for disaster risk reduction 2015–2030’.
Sharon Tsoon Ting Lo et al., ‘Health Emergency and Disaster Risk Management (Health- EDRM): Developing the Research Field within the Sendai Framework Paradigm’ (2012) 8/2 International Journal of Disaster Risk Science, 147.
Giulio Bartolini, ‘Epidemics and the Future of International Disaster Law’ (2022) 24 International Community Law Review, 263.
Sendai Framework (2015) para. 19(g).
Ibid., para. 24(f).
Ibid., para. 31.
Bangkok Principles, Principle 5.
Sendai Framework, paras. 19(g) and (h).
Ibid., para. 5.
Reid Basher, ‘Global Early Warning Systems for Natural Hazards: Systemic and People- Centred’ (2006) 364 Philosophical Transactions of the Royal Society, 2167–2182; Samuel and Cornforth (n 6) 381; Villareal (n 21) 169.
Samuel and Cornforth (n 6) 383.
Ibid., 381.
Villareal (n 21) 163.
Le Moli (n 21).
Sendai Framework (2015) para. 27.
Ibid., paras. 19(b) and (e).
Ibid., para. 19(f).
Toscano-Rivalta (n 21) 42; Bartolini (n 32) 265.
Ruckert et al. (n 6) 8.
Sendai Framework (2015) paras. 25, 33, 34 and 38.
Ibid., paras. 25(c)–(i) and 40.
Marie Wilke, ‘A Healthy Look at the Nagoya Protocol – Implications for Global Health Governance’ in Elisa Morgera, Matthias Buck and Elsa Tsioumani (eds), The 2010 Nagoya Protocol on Access and Benefit-Sharing in Perspective: Implications for International Law and Implementation Challenges (Martinus Nijhoff 2012).
Sendai Framework (2015) para. 25(h).
Ibid., para. 33(b).
Ruckert et al. (n 6); Bartolini (n 32).
Emily Ying Yang Chan and Peijun Shi, ‘Health and Risks: Integrating Health into Disaster Risk Reduction, Risk Communication, and Building Resilient Communities’ (2017) 8 International Journal of Disaster Risk Science, 107.
Peter Daszak, Andrew A. Cunningham, and Alex D. Hyatt, ‘Emerging Infectious Diseases of Wildlife – Threats to Biodiversity and Human Health’ (2000) 287, n. 5452 Science, 443–449; Louise H. Taylor, Sophia M. Latham and Mark E. Woolhouse, ‘Risk Factors for Human Disease Emergence’ (2001) 356 no. 1411 Philosophical Transactions of the Royal Society B: Biological Sciences, 983–89; Mark E. Woolhouse and Sonya Gowtage-Sequeria, ‘Host Range and Emerging and Reemerging Pathogens’ (2005) 11/12 Emerg Infect Diseases, 1842–47; Kate E. Jones et al., ‘Global Trends in Emerging Infectious Diseases’ (2008) 451, 990–993; Ruckert et al. (n 6) 5. For an extensive review of academic literature relevant to the “One Health” approach, see Le Moli (n 21).
Edward C. Holmes, ‘The Origins of SARS-CoV-2: A Critical Review’ (2021) 184 no. 19 Cell, 4848–4856; Karl Gruber, ‘Preventing Zoonotic Pandemics: Are We There Yet?’ (2021) 2/8 The Lancet Microbe; Villareal (n 21).
Holmes E.C. et al. (n 57).
Catherine Machalaba et al., ‘Gaps in Health Security Related to Wildlife and Environment Affecting Pandemic Prevention and Preparedness, 2007–2020’ (2021) 99/5 Bull World Health Organ, 342–350.
Ibid., 344.
Le Moli et al. propose the notion of midstream deep prevention in: Ginevra Le Moli, Jorge Viñuales, Gian Luca Burci, Adam Strobeyko, and Suerie Moon, ‘The Deep Prevention of Future Pandemics Through a One Health Approach: What Role for a Pandemic Instrument’, Policy Brief (Geneva: Global Health Centre, Geneva Graduate Institute, forthcoming); Le Moli (n 21); Christopher Elias, John N. Nkengasong and Firdausi Quadri, ‘Emerging Infectious Diseases – Learning from the Past and Looking to the Future’ (2021) 384/13 The New England Journal of Medicine, 1181–84.
World Organization for Animal Health, ‘One Health’ (2022), available at <https://www.oie.int/en/what-we-do/global-initiatives/one-health/>.
Joint Tripartite (FAO, OIE, WHO) and UNEP Statement, Tripartite and UNEP support OHHLEP’s definition of ‘One Health’, FAO, OIE, WHO and UNEP (2021), at <https://wedocs.unep.org/bitstream/handle/20.500.11822/37600/JTFOWU.pdf>.
Ibid.
Ruckert et al. (n 6) 13.
Our taxonomy has identified WPRO members, Belgium, India, Lebanon, Mexico, Morocco, Spain, EU as the delegations that made statements on “One Health” in the context of a new international instrument. See Anna Balcazar Moreno, Gian Luca Burci and Adam Strobeyko, ‘Taxonomy of Substantive Proposals for a New Instrument on Pandemic Prevention, Preparedness and Response’, Policy Brief (Global Health Centre, Geneva Graduate Institute, 2022) 16, at <https://www.graduateinstitute.ch/sites/internet/files/2021-11/PolicyBrief3.pdf>.
Namely, Belgium, Botswana, Fiji, India, Kenya, Spain, and Suriname, ibid.
WPRO members, Guatemala, and Mexico, ibid.
‘Working draft, presented on the basis of progress achieved, for the consideration of the Intergovernmental Negotiating Body at its second meeting’.
ICJ, Corfu Channel Case (UK v Albania) (Merits) [1949] ICJ Rep 4, 22.
ICJ, Legality of the Threat or Use of Nuclear Weapons (Advisory Opinion) [1996] ICJ Rep 226, para. 29; ICJ, Pulp Mills on the River Uruguay (Argentina v Uruguay) (Judgment) [2010] ICJ Rep 14, para. 101; Samuel and Cornforth (n 6) 387.
Pulp Mills on the River Uruguay (n 71) para. 201.
Shinya Murase, ‘Epidemics and International Law’ (Institut de droit international 2021) 108–9.
Samuel and Cornforth (n 6) 387.
Convention on Access to Information, Public Participation in Decision-Making and Access to Justice in Environmental Matters, Aarhus (Denmark), 25 June 1998.
Convention on Early Notification of a Nuclear Accident, Vienna, 26 September 1986.
WHO, ‘Working draft, presented on the basis of progress achieved, for the consideration of the Intergovernmental Negotiating Body at its second meeting’ (13 July 2022) WHO, A/INB/2/3.
Ruckert et al. (n 6) 15.
Ibid.
Ibid., 16.
WHO, ‘Dr Michael Ryan’s Remarks at the Launch of the WHO Hub for Pandemic and Epidemic Intelligence’, (2021) <https://www.who.int/news/item/01-09-2021-who-germany-open-hub-for-pandemic-and-epidemic-intelligence-in-berlin>.
Ruckert et al. (n 6).
Jorge Vinuales et al., ‘A Global Pandemic Treaty Should Aim for Deep Prevention’ (2021) 397 no. 10287 Lancet; Le Moli et al. (n 61); Le Moli (n 21).
Le Moli et al. (n 61); Sara N. Garcia, Bennie I. Osburn and James S. Cullor, ‘A One Health Perspective on Dairy Production and Dairy Food Safety’ (2019) 7 One Health, 100086.
WHO, ‘Working draft, presented on the basis of progress achieved, for the consideration of the Intergovernmental Negotiating Body at its second meeting’ (n 4).
WHO, ‘WHO Benchmarks for International Health Regulations (IHR) Capacities’ (2019) available at <https://apps.who.int/iris/bitstream/handle/10665/311158/9789241515429-eng.pdf?sequence=1&isAllowed=y>.
WHO, ‘Protocol for Assessing National Surveillance and Response Capacities for the International Health Regulations in accordance with Annex 1 of the IHR. A Guide for Assessment Teams’ (2010).
WHO, ‘WHO Benchmarks for International Health Regulations (IHR) Capacities’ (n 86) 36.
Ibid., 37.
WHO, ‘Joint External Evaluation’. Third Edition (2022) available at <https://www.who.int/emergencies/operations/international-health-regulations-monitoring-evaluation-framework/joint-external-evaluations#:~:text=A%20Joint%20External%20Evaluation%20(JEE,to%20deliberate%20or%20accidental%20events>.
Ibid.
WHO, Handbook for the Assessment of Capacities at the Human-Animal Interface (World Health Organization, 20172) at <https://www.who.int/publications/i/item/handbook-for-the-assessment-of-capacities-at-the-human-animal-interface-2nd-ed>.
Ibid., 17.
Ibid.
Ruckert et al. (n 6) 10.
WHO, ‘Report of the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 response’, 53.
UNFCCC, ‘Technology Mechanism’ (2015), at <https://unfccc.int/ttclear/misc_/StaticFiles/gnwoerk_static/TEM/0e7cc25f3f9843ccb98399df4d47e219/174ad939936746b6bfad76e30a324e78.pdf>.
World Bank, ‘Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response – Engagement’ (2022) at <https://projects.worldbank.org/en/projects-operations/products-and-services/brief/financial-intermediary-fund-for-pandemic-prevention-preparedness-and-response-engagement>.
Le Moli et al. (n 61).
For the OIE-listed diseases, see <https://www.oie.int/en/what-we-do/animal-health-and-welfare/animal-diseases>.
Mariana Marrana et al., ‘Lessons Identified from before and during the Pandemic: How the OIE Can Support Veterinary Services to Achieve One Health Resilience’ (World organisation for animal health, 2021); Ruckert et al. (n 6) 11.
Ruckert et al. (n 6) 12.
Eduardo Gallo-Cajiao et al., ‘A Pandemic Treaty and Wildlife Trade’ (SSRN, 2021), at <https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3966292>.
Ibid.; Bing Lin et al., ‘A Better Classification of Wet Markets Is Key to Safeguarding Human Health and Biodiversity’ (2021) 5/6 Lancet Planet Health, 386–94.
Gallo-Cajiao et al. (n 103); for the Global Health Security Index, see <https://www.ghsindex.org/>.
For the 2021 edition of the Index see Jessica A. Bell and Jennifer B. Nuzzo, ‘Advancing Collective Action and Accountability amid Global Crisis’, GHS Index (Nuclear Threat Initiative, 2021), at <https://www.ghsindex.org/wp-content/uploads/2021/12/2021_GHSindexFullReport_Final.pdf>.
Ruckert et al. (n 6) 15.
Ibid.; Gallo-Cajiao et al. (n 103).
Ibid.
Le Moli et al. (n 61).
Ruckert et al. (n 6) 13.
Gallo-Cajiao et al. (n 103).