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WHO wants sanctions against countries for mishandling epidemics

UN health agency wants to punish countries for mishandling epidemics like Ebola, but some experts call idea misguided

United Nations health officials said Tuesday they want to impose sanctions on countries that do not comply with public health regulations meant to avoid the spread of dangerous epidemics, such as the Ebola outbreak that killed more than 9,000 people and ravaged domestic health care systems in West Africa last year.

World Health Organization Director Margaret Chan said she is investigating ways to reprimand countries that disobey the International Health Regulations (IHR) — a set of rules adopted in 2005 and mandate that countries set up epidemiological surveillance systems, fund local health care infrastructure and restrict international trade and travel to affected regions deemed unsafe to the public, among other provisions.

Chan is on a panel set up by U.N. Secretary General Ban Ki-moon, who instructed the group to think of ways to hold countries accountable for how they manage public health crises and punish those who violate the IHR.

Some countries imposed unnecessary travel restrictions during the Ebola epidemic, Ban said. Australia's decision, for example, to forbid all travel to Ebola-affected regions — Liberia, Sierra Leone and Guinea — at the height of the epidemic to appease rising panic at home hurt West African economies and slowed their recovery, said Joshua Michaud, an associate director of the global health policy team at the Kaiser Family Foundation and a lecturer at the John Hopkins University School of Advanced International Studies.

“There is no epidemiological need for such measures to be in place, yet countries often adopt them for political reasons,” Michaud said.

Another case that has drawn criticism was China's handling in 2002 of an outbreak of severe acute respiratory syndrome (SARS), the origins of which were initially shrouded in secrecy because Beijing refused to disclose information to the WHO, he said.

“This goes back to governments,” Chan said at a news conference Tuesday. “If they sign up to the International Health Regulations, they need to honor their commitment. Because if they don’t do their part, they pose a risk to their neighbors and beyond.”

The idea to create legal measures to increase accountability is not new, said David Fidler, a senior fellow at the Council on Foreign Relations and the author of the book “International Law and Infectious Diseases.” He said proposals for such regulations are unlikely to be accepted, since countries need to agree to regulatory mechanisms under international law. So far, no one has made any concrete suggestions.

Not only would such measures be unrealistic, he added, but they don’t have any political traction. “Because the WHO did not fulfill its responsibility in the [Ebola] outbreak, it’s not going to credible,” he said. “It strikes me as an idea born out of desperation, as opposed to cold-eyed analysis of the way international politics and global health works.”

Chan faced intense criticism for allegedly failing to respond to the Ebola outbreak quickly, with the medical charity Doctors Without Borders calling for institutional changes at the WHO, the world’s top public health body.

Rather than punish countries for noncompliance, Fidler said, the WHO should adopt incentives that would encourage countries to abide by the IHR. A chronic lack of resources underlies many countries’ inability to manage epidemics, he noted.

“Ebola really exposed the lack of domestic public health capacity,” he said. Only about one or two doctors were available to care for every 100,000 people in Liberia, whose national health care system was ravaged during the country’s civil wars in the 1990s.

“However, the IHR involves no obligation for developed nations to provide resources to developing countries to scale up and improve their public health capabilities," Fidler said.

Increasing the flow of resources to those countries would go a longer way toward avoiding another Ebola outbreak than imposing sanctions, he added.

Punitive measures are a “very 19th century thinking about a 21st century health problem,” Fidler said.

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