Some provisions of the WHO’s health regulations and draft Pandemic Agreement impinge on the sanctity of the doctor-patient relationship. Photo: David Harrison
The World Health Organisation (WHO) will convene its 78th World Health Assembly (WHA) in Geneva from 19 to 27 May. It will be held a year after the 77th WHA voted in favour of amendments to the International Health Regulations (IHRs) on 1 June amid protests from health freedom activists that the amendments were a threat to state sovereignty — the right of a state to conduct its internal affairs without any interference from other state and non-state actors.
However, during that WHA, the WHO failed to get member-states to vote in favour of a draft of its Pandemic Agreement, to the delight of health freedom activists who also saw it as a threat to state sovereignty. Many of the activists hold that despite the numerous amendments to the Pandemic Agreement, the draft scheduled for a vote at the 2025 WHA remains a threat to state sovereignty.
A key aspect of the internal affairs that a truly sovereign state freely administers is health. However, several pertinent issues have arisen around the question of health sovereignty with regard to amendments to the IHRs and the draft Pandemic Agreement.
First, there is the centralisation of medical care in the name of public health mitigation. Medical care has to do with the doctor-patient relationship, which for more than two millennia has been considered private and governed by the promotion of the patient’s highest good. On the other hand, public health has to do with efforts to create conditions that promote the well-being of whole populations. Thus the provision of clean water and efficient waste disposal are both instances of the promotion of public health rather than medical care.
The WHO has developed the International Health Regulations and the draft Pandemic Agreement as instruments to promote global public health. However, some of their provisions impinge on the sanctity of the doctor-patient relationship. For instance, they aim to vest health authorities with power to give directions on vaccines, therapies and medical devices during pandemics.
This is reminiscent of the situation in the advent of Covid-19, when the WHO discouraged the use of indigenous therapies as well as repurposed drugs such as Ivermectin, Azithromycin and Hydroxychloroquine.
It is therefore not surprising that both the IHRs and the draft Pandemic agreement seek to establish a worldwide system of medical surveillance, that is, the close monitoring of health events not only in communities, but also in online communication. Such regulations and surveillance not only violate the sanctity of the doctor-patient relationship, but also reduce doctors to mere medical clerks, and the ministries of health of various supposedly sovereign states to mere agents of the WHO.
Second, the two WHO instruments require states to commit substantial finances to pandemic preparedness and response (PPR). As early as 2022, the WHO and the World Bank had estimated the total annual financing needed for the future PPR system at $31.1 billion. Article 20 of the 2024 version of the draft Pandemic Agreement had very assertive provisions in this regard, and their implementation would have meant that African states would have had to allocate large proportions of their health budgets to PPR at the expense of their own immediate health priorities such as the fight against malaria, tuberculosis and HIV/Aids.
As a 2024 University of Leeds Reppare Report correctly observes, “public health investments cannot be determined in isolation, but must also be weighed against competing health, social and economic priorities, since the recommended investments for pandemic preparedness carry broad implications for global health”. The 2025 draft Agreement has toned down language regarding states’ requisite contributions to PPR, but the protocols to the Agreement, that are yet to be negotiated, might claw back on this gain. Besides, the draft Agreement is categorical that it is compatible with the IHRs that retain the power of the WHO director-general to declare public health emergencies of international concern on his/her sole discretion.
Third, over the past four decades or so, the proportion of the WHO’s budget received from member-states has been dwindling, while that from private individuals, philanthropic organisations and big pharmaceutical companies has been rising phenomenally (some estimate up to 80% currently). As David Bell explains, Most of the finances from private entities are strictly tied to projects chosen by the financiers.
The import of this is that the influence of unelected entities over the WHO is increasing while that of the peoples of the world through their elected representatives is dwindling, and this is, in effect, the erosion of state sovereignty in the name of “public-private partnership”.
In the 19th century the peoples of Africa lost their sovereignty when their kings and chiefs signed treaties designed to work against them. Are the present African political office-bearers not repeating the same mistake by signing the numerous “international legal instruments” similarly designed?
Reginald MJ Oduor is an associate professor of philosophy at the University of Nairobi, a member of the Pan-African Epidemic and Pandemic Working Group and a member of the International Health Reform Project.
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