In a letter written by Benjamin Franklin, one of the founding fathers of United States of America, he famously quoted: “Our new Constitution is now established, and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes.” However, Benjamin Franklin may have been too rash to conclude that death and taxes are the only certain things in life because an argument can be made for disease epidemics; from the time mankind has confined itself to living in densely populated cities, towns and villages and carving out civilisations all over the world, it has not been a question of if, but when with a pandemic.

Due to the explosive and unprecedented population growth over the last century, which has inadvertently led to rapid unplanned urbanisation of the world, sanitation problems, slums and polluted drinking water – which is considered a breeding ground for new infectious diseases – are serious issues. However, man’s interaction with animals has proven more dangerous, as studies have estimated that 60 percent of all infectious diseases are zoonotic diseases which includes the black plague, Bird Flu, SARS, and of course, the contemporary COVID-19. Faster transportation, airplanes and increased globalisation are all culprits in facilitating worldwide pandemics. Experts have estimated that the world is now at risk of global pandemics every 15 to 20 years, with third world countries (like Pakistan) more likely to be epicentres of such diseases.

That is why a global organisation promoting universal healthcare and a coordinated effort are needed more than ever before. A central responsibility of World Health Organisation has been the management and control of the international spread of the disease and in 1969, it introduced the International Health Regulations which specifically addressed the issue and were categorically adopted by the World Health Assembly and its Member States. The IHR 1969 was seriously flawed and lacked a number of key elements; it failed to have any significant impact or effect upon the world, more so because member states just never took it earnestly. However, after the SARS pandemic, which took more than 700 lives worldwide, it was understood that a major revision to the Regulations of 1969 was needed to effectively manage and combat a global health emergency. The International Health Regulations 2005 were introduced and made binding on all member states (including Pakistan) with the purpose, “to prevent, protect against, control and provide a public health response to the international spread in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.”

In today’s increasingly interconnected and interdependent world, where people, goods and services can move easily across borders, it is important that countries are able to respond in a timely and effective fashion in response to public health threats by effectively adopting the IHR 2005. The International Health Regulations 2005 stresses the need for a global partnership and trust as it is essential to the successful implementation of the regulations. Such a partnership is required amongst all nations to share technical skills and resources, to strengthen core capacities, to support each other in times of crisis, to build a coherent alert and response systems which cover all public health threats and of course, promote transparency which countries usually fail miserably at.

The initial articles and the first annex of the IHR 2005 directs and guides the member states to assesses their alert and response capacity, perform gap analysis and develop and implement national action plans to prevent, detect and respond to public health threats. This is because strengthening national capacities and surveillance up to international standards is crucial in eradicating and managing a public health threat, and for the prevention of spread to other countries within five years after the entry into force of these regulations.

The main goal of the World Health Organisation was to place an efficacious global alert and response systems in place which can timely and effectively counter international public health threats which require unprecedented international coordination. Preparedness and readiness are the cornerstones of the IHR 2005 thus; each member state is expected to have constituted measures relating to surveillance, risk management, and response and containment at the local, state/provincial and national levels. International mechanisms for stockpiling critical supplies (vaccines, drugs, personal protective equipment etc.) must be put in place and an adequate fund should be allocated for research and development of any potential new threat so that each member state itself have the potential to develop cures or vaccines. Of course, if a new threat arises under the regulation, the member state has to immediately notify and report such an event to the World Health Organisation through its national IHR focal point (National Institute of Health is the designated focal point in Pakistan). Predictably, countries are hesitant to report diseases, in part for fear of economic consequences and its effects on tourism and trade.

Another reason why such a system is necessary is that since the last century, man has developed technology that has enabled him to travel far and wide in a considerably less amount of time and as such, the risk of pandemics had grown greater than ever before. Therefore, IHR 2005 emphasised substantially on the need to strengthen public health security in travel and transport to prevent such a catastrophe. A number of mandatory capacities, requirements and protocols apply to designated airports, ports and ground crossings, to be instituted by all member states in adherence to the IHR 2005 which includes appropriate medical services along with adequate staff for surveillance and treatment. Additional protocols are to be invoked in case of a public health emergency of international concern which categorically provides that a national action plan should already be in place so that a prompt response may be initiated to provide emergency medical facilities, specially designated equipment along with trained medical personnel with appropriate personal protection, and appropriate space and resources to establish a quarantine centres with adequate facilities for travellers. Obviously, such protocols were ignored by our government as a senseless rant of a parent but the Taftan debacle clearly painting a clear picture of our arrogance, weaknesses and shortcomings which plunged the country into a month long ‘lockdown’ (maybe longer) and irrevocably shattering our hopes for better economic prospects in the near future. In a report prepared by WHO in 2013 regarding the implementation of IHR 2005 in member states; Pakistan severely lags behind in developing laws, surveillance, response and preparedness, risk communication, research and development, and infrastructure at points of entries, and surprising even falls behind in areas than war-torn Afghanistan!

Apparently, Pakistan was not the only country that failed at this task. The British Medical Journal and the Commission on Global Health Risk Framework for the Future in 2018 observed that the majority of member states including a number of developed nations have even failed to implement the legally binding ‘core capacities’ or requirements as provided under the IHR 2005 and the consequences of such a global failure are conspicuous. Additionally, there is a gross underreporting, under diagnosis and delayed reporting from most of the member states. Over the last decade, many prominent experts and famously Bill Gates, had warned that we were not ready for the next pandemic (which has undoubtedly proven to be true) and they said with considerable certainty that there will be a pandemic. Research tells us that there are an estimated 1.4 million zoonotic diseases in the wild, out of which only about 3000 have been identified – that is a staggering discrepancy.

It is thus perplexing that the IHR 2005 is still the only major international instrument for global health security and it is outright nefarious that with such an inevitable threat looming over world, the United Nations, WHO and its members have done the bare minimum in protecting global health. Punjab has just during the current pandemic introduced a number of problematic laws like the Punjab Infectious Disease Prevention and Control Ordinance 2020 updating policy only 62 years later (and only due to the present crisis) from the Epidemic Diseases Act promulgated in 1958, which is clearly too little too late. Evidently, there is still not a federal law addressing the matter and no new ordinance in sight. Surely, COVID-19 has made Pakistan and the rest of the world realise how devastating mother nature can be, and how important it is to implement proper counter measures, protocols and laws so that we may positively answer the question – are we ready for the next pandemic?