Apolitical decision-making is a myth

Read Time: 9 minutes

Politics determines factors that affect our daily lives, from the price of eggs and tax rates to the air we breathe and our health choices. Politics permeates every aspect of our well-being and our collective well-being, perspectives, and opportunities. The options we perceive and the decisions we make regarding our health, a seemingly apolitical area, are heavily influenced by the forces of political will. 

How do we conceptualize this statement? We don’t need to look far. The labeling of food products, the availability and prices of drugs, and immigration policy are all influenced by politics. On a global scale, politics tends to influence whether the international community declares an outbreak of a disease a health emergency, i.e., a Public Health Emergency of International Concern (PHEIC), or whether a country declares a famine. Another example would be the slow access to vaccines in lower-income countries. However, what is interesting about these examples is the fact that they influence or are influenced by individual and community health outcomes. This reveals an essential truth: global health policy is not just a matter of science and medicine—it is deeply political. The choices made by governments, international bodies, and influential stakeholders determine which health issues are prioritized, how resources are allocated, and who has access to care. Understanding global health policy requires us to not just look at clinical needs and scientific evidence but also be conscious of the political forces that shape health outcomes around the world. 

Origins: Politics and Global Health Policy 

So why exactly do state perspectives have priority over public or global health concerns rather than focusing on individuals or non-state actors with more experience or knowledge? 

Some might trace this back to the International Sanitary Conference in 1851. During this period, competing economic interests led to a negotiation deadlock over quarantine requirements on trade ships between colonial powers. The spread of cholera and yellow fever in tropical zones also coincided with colonial territories’ diminished productivity and trade outcomes, causing the push to quarantine trade ships entering Europe, which faced opposition from countries such as Britain as it increased costs. Thus resulting in a clash between economic interests and public health. This dispute was finally settled through the International Sanitary Convention in 1892, which regulated the quarantine system in the Suez Canal. The key takeaway is that this negotiation and subsequent negotiations set the standard for state interests and concerns to be the central focus of health governance rather than global or collective health concerns.  

The next century and a half saw the transformation of global health governance with the establishment of the WHO in 1948. The WHO set standards for global surveillance and public health responses. However, it did so within a framework established by imperial and colonial powers. In many ways, this represented a continuation of historical priorities and supremacy of colonial powers, where economic considerations of erstwhile imperial and developed nations often outweighed purely public health objectives, carrying forward the historical divisions between the imperial powers, industrialized states, and the rest of the world. 

Playing the Game 

The next few decades saw a shift in the perspective towards disease control and global health policy. There was a move towards disease prevention, emphasizing strengthening primary healthcare and surveillance systems rather than controlling at state borders. This realization in the 19070s came with the push from the Global South for a human rights-based framework, leading to an initiative for strengthening health systems and primary health care Declaration of Alma-Ata in 1978. Unfortunately, This was timed with the New International Economic Order from newly independent countries that were seen as a threat by the traditional powers and summarily rejected. WHO was then mostly restricted to vertical programs, i.e., such as vaccination programs, and failed to address the underlying dependency on wealthy nations. 

In the 1980s and ‘90s, during a period of economic uncertainty for Latin America, Asia, and Africa, it also coincided with the rise of HIV/AIDS. During this period, failing economies relied on the World Bank, which, through its conditional loans, made health a market-based good, leading to the collapse of multiple health systems. During this period, Sub-Saharan Africa was and remains to be the worst affected by HIV/AIDS, causing over ten million deaths in the region. It also saw the deaths of many in developed countries, which drew attention to the disease. 

However, this created a shift in approach. The Global South and advocates and partners in the Global North now played the economic interests against health concerns narrative to achieve their goals. They positioned the access to ARV (HIV/AIDS drug treatment)  as “life or death” and the issue of providing access as a dichotomy between “corporate profits” versus “human rights,” and by doing so, they challenged the orthodox market. They made equity of access a central principle. Through this, the role of activists, philanthropists, and the World Bank expanded the sphere of decision-making or influential actors beyond states. Finally, international health became what we know as global health. 

Framing of Global Health Concerns 

 Many would call the 2000s the Golden Age of Global Health. It saw a dramatic increase in funding and institutional development to solve national and transnational health crises. New institutions such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) were involved, and public-private partnerships advanced, bringing the private sector into global health governance. 

However, something that brought the international community that usually thinks along the lines of trade, power, and national security to consider global health concerns as more than increasing costs with pesky and tedious consequences to economic productivity. The Clinton Administration framed public health as a security threat, leading to the UN Security Council Resolution 1308, which recognized HIV as a threat to international peace. While this change was primarily due to the impact of infectious diseases on wealthy nations, it brought a positive change, which was noticeable in the global response to the SARS Outbreak in 2002. 

COVID-19 and Lessons 

COVID-19 made states confront the gaps in their health systems and made the international community and bodies recognize the inadequacy of the present structure. Wealthy nations prioritized their interests and undermined initiatives such as COVAX (COVID-19 Vaccines Global Access) and efforts for a people’s vaccine through WTO Negotiations. The politics of states, power, and the sheer force of corporations lobbying with governments made the fissure and power dynamics between the Global South and Global North starkly apparent. 

Issues that came up during the pandemic were:

1. Wealthy Nations secured the majority of vaccine supplies early, and many hoarded vaccines and medical equipment. By 2022, 80% of the population in wealthy nations will be vaccinated, compared to 10% in low-income countries. 
2. COVAX uses a donation-based model, and Wealthy nations have refused to waive Intellectual Property rights, which directly affects the accessibility and availability of vaccines. 

Pandemic Accord 

In May 2021, the WHO proposed a pandemic Treaty or Pandemic Accord to address shortcomings such as the lack of international cooperation and hoarding in the collective and individual state response to the pandemic. So, how does politics play a role in this? To provide a brief answer: the terms of the pandemic treaty may conflict with national interests like the ones mentioned below: 

1. Temporary waivers of IP Rights to allow equitable access concern pharmaceutical companies in wealthy countries, particularly the United States, as they fear reduced innovation incentives.
2. Wealthy nations resist technology transfer and non-exclusive licensing. 
3. Call for “common but differentiated responsibilities” (CBDR), requiring more prosperous nations to undertake greater obligations. 
4. A pooled funding mechanism through CBDR to support a global response to pandemics raises concerns about the increased burden on the state and its taxpayers. 
5. Wealthy countries are wary of ceding a state’s decision-making power to the WHO 
6. Power dynamics between state administration, companies, and international bodies create a dilemma between corporate investments and equity goals. 
7. The rift between China and the United States may also influence willingness to cooperate. 

These concerns have stalled the signing of the Pandemic Treaty. A treaty without the participation of wealthy nations is pointless, and an agreement that doesn’t necessitate cooperation is futile and symbolic without any real value. Perhaps a good question is whether the Pandemic Accord is the only solution to the problem. Regardless, the next few months and the following year are crucial as the Treaty hangs by a thread. 

To conclude, governments naturally prioritize their regional and national interests over those of other countries or the global community, and to a large extent, this prioritization is logical and reasonable. However, a nuanced approach is essential when balancing the interests of corporations against the health of communities.

Why? Because it involves the health of millions, both domestically and globally, which should, by any moral and pragmatic measure, take precedence over corporate profits. Contracting infections, illness, and deaths on such a large scale not only devastates lives but also has severe repercussions for economic productivity and trade, potentially harming even those countries that oppose equitable global health measures. The interconnected nature of global health means that cooperation and fairness are not just ethical imperatives but practical necessities. While supporting domestic interests is vital, it cannot always come at the expense of the health and well-being of individuals, particularly those in the most vulnerable sections of society and the global population. By fostering global cooperation and balancing equity with national priorities, we can build a more resilient global health system capable of protecting all communities.

References 

From Imperialism to the “Golden Age” to the Great Lockdown: The Politics of Global Health Governance  Read here.

The politics of a WHO pandemic treaty in a disenchanted world, G2H2 report, Geneva, December 2021. Read here. 

The ‘Pandemic Agreement’: What it is, What it isn’t, and What it Could Mean for the U.S. Read here.