The Covid-sceptic world has been claiming that the World Health Organization (WHO) plans to become some sort of global autocratic government, removing national sovereignty and replacing it with a totalitarian health state. The near-complete absence of interest from mainstream media would suggest, to the rational observer, that this is yet another ‘conspiracy theory’ from a disaffected fringe.
The imposition of authoritarian rules on a global scale would normally attract attention, and WHO is fairly transparent in its machinations. It should therefore be straightforward to determine whether this is all misplaced hysteria, or an attempt to implement an existential change in sovereign rights and international relations. We would just need to read the document. Firstly, it is useful to put the amendments in context.
The changing role of WHO
WHO was set up after the Second World War as the health arm of the United Nations, to support efforts to improve population health globally. Based on the concept that health went beyond the physical and encompassed “physical, mental and social well-being”, its constitution was premised on the concept that all people were equal and born with basic inviolable rights. The world in 1946 was emerging from the brutality of colonialism and international fascism, the results of overly centralised authority and of regarding people to be fundamentally unequal. The WHO constitution was intended to put populations in charge of their health.
In recent decades, WHO’s core funding model has changed. Originally, its support base of core funding was allocated by countries based on GDP, but this has evolved into a model where most funding is directed to specified uses, and much is provided by private and corporate interests. The priorities of WHO have evolved accordingly, moving away from community-centred care to a more vertical, commodity-based approach. This inevitably follows the interests and self-interests of these funders. Understanding these changes is important in order to put the proposed amendments to the existing International Health Regulations (IHR) in context. More detail on this evolution can be found elsewhere.
Of equal importance, WHO is not alone in the international health sphere. While certain organisations such as Unicef (originally intended to prioritise child health and welfare), private foundations, and non-governmental organisations have long partnered with WHO, the past two decades have seen a burgeoning of the global health industry, with multiple organisations, particularly ‘public-private partnerships’ (PPPs) growing in influence. In some respects, these organisations are rivals, and in some respects they are partners of WHO.
Notable among PPPs are Gavi – the Vaccine Alliance (focused specifically on vaccines), and CEPI, an organisation set up at the World Economic Forum meeting in 2017 by the Bill and Melinda Gates Foundation, Wellcome Trust and the Norwegian Government specifically to manage pandemics. Gavi and CEPI, along with others such as Unitaid and the Global Fund, include representatives of corporate and private interests directly on their boards. The World Bank and G20 have also increased their involvement in global health, and especially pandemic preparedness. Even though WHO has stated that pandemics occurred just once per generation over the past century and killed a fraction of those who died from endemic infectious diseases, they have nonetheless attracted much of this corporate and financial interest.
WHO is primarily a bureaucracy, not a body of experts. Recruitment is based on various factors, including technical competency, but also country and other equity-related quotas. These quotas serve a purpose of reducing the power of specific countries to dominate the organisation with their own staff, but in doing so they require the recruitment of staff who may have far less experience or expertise. Recruitment is also heavily influenced by internal WHO personnel, and the usual personal influences that come with working and needing favours within countries.
Once recruited, the payment structure strongly favours those who stay for long periods, militating against rotation to new expertise as roles change. A WHO staffer must work 15 years to receive their full pension, with earlier resignation resulting in removal of all or part of WHO’s contribution to their pension. Coupled with large rental subsidies, health insurance, generous education subsidies, cost of living adjustments, and tax-free salaries, this creates a structure within which protecting the institution (and thus one’s benefits) can far outlive the staffer’s initial altruistic intent.
The Director-General (DG) and Regional Directors (RDs), of which there are six, are elected by member states in a process subject to heavy political and diplomatic manoeuvring. The current DG is Tedros Adhanom Ghebreyesus, an Ethiopian politician with a chequered past during the Ethiopian civil war. The amendments proposed would allow Tedros to independently make all the decisions required within the IHR, consulting a committee at will but not being bound by it. Indeed, he can do this now, having declared monkeypox a Public Health Emergency of International Concern (PHEIC), after just five deaths globally, against the advice of his emergency committee.
Like many WHO employees, I personally witnessed and am aware of examples of seeming corruption within the organisation, from RD elections, to building renovations and importation of goods. Such practices can occur within any large organisation that has lived a generation or two beyond its founding. This, of course, is why the principle of the separation of powers commonly exists in national governance: those making rules must answer to an independent judiciary according to a system of laws to which all are subject. As this cannot apply to UN agencies, they should automatically be excluded from direct rulemaking over populations. WHO, like other UN bodies, is essentially a law unto itself.
WHO’s new pandemic preparedness and health emergency instruments
WHO is currently working on two agreements that will expand its powers and role in declared health emergencies and pandemics. These also involve widening the definition of ‘health emergencies’ within which such powers may be used. The first agreement involves proposed amendments to the existing IHR, an instrument with force under international law that has been in existence in some form for decades, and was significantly amended in 2005 after the 2003 SARS outbreak. The second is a new ‘treaty’ that has similar intent to the IHR amendments. Both are following a path through WHO committees, public hearings and revision meetings, to be put to the World Health Assembly (WHA) – the annual meeting of all country members or ‘States Parties’ of WHO – scheduled for 2024.
The discussion here concentrates on the IHR amendments, as they are the most advanced. Being amendments to an existing treaty mechanism, they only require approval of 50% of countries to come into force (subject to ratification processes specific to each member State). The new ‘treaty’ will require a two-thirds vote of the WHA to be accepted. The WHA’s ‘one country, one vote’ system gives countries like Niue, with fewer than two thousand residents, equal voice to countries with hundreds of millions (e.g. India, China and the USA), though diplomatic pressure tends to corral countries around their beneficiaries.
The IHR amendment process within WHO is relatively transparent. There is no conspiracy to be seen. The amendments are ostensibly proposed by national bureaucracies and collated on the WHO website. WHO has gone to unusual lengths to open hearings to public submissions. The intent of the IHR amendments – which is to change the nature of the relationship between countries and WHO (i.e. a supra-national body ostensibly controlled by them), and fundamentally change the relationship between people and this centralised, supra-national authority – is open for all to see.
Proposed major amendments to the IHR
The amendments to the IHR are intended to fundamentally change the relationship between individuals, their countries’ governments, and WHO. They place WHO as having rights that override the rights of individuals, erasing the basic principles developed after World War Two regarding human rights and the sovereignty of States. In doing so, they signal a return to a colonialist and feudalist approach that is fundamentally different to that to which people in relatively democratic countries have become accustomed. The lack of major push-back by politicians, the lack of concern in the media, and the consequent ignorance of the general public, are therefore both strange and alarming.
Aspects of the amendments involving the largest changes to the workings of society and international relations are discussed below. Following this are annotated extracts from the WHO document. Provided on the WHO website, this document is currently under revision to address obvious grammatical errors and improve clarity.
Resetting international human rights to a former, authoritarian model
The Universal Declaration of Human Rights was agreed upon by the UN in 1948, in the aftermath of World War Two and in the context of much of the world emerging from the colonialist yoke. It is predicated on the concept that all humans are born with equal and inalienable rights, conferred by the simple fact of their birth. The Declaration was intended to codify these rights to prevent a return to inequality and totalitarian rule. The equality of all individuals is expressed in Article 7:
All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.
This understanding underpins the WHO constitution, and forms a basis for the modern international human rights movement and international human rights law.
The concept of States being representative of their people, and having sovereignty over territory and the laws by which their people were governed, was closely allied with this. As peoples emerged from colonialism, they would assert their authority as independent entities within boundaries that they would control. International agreements, including the existing IHR, reflected this. WHO and other international agencies would play a supportive role and give advice, not instructions.
The proposed IHR amendments reverse these understandings. WHO proposes that the term ‘with full respect for the dignity, human rights and fundamental freedoms of persons’ be deleted from the text and replaced with the vague terms: ‘equity, coherence, inclusivity’. The applications of these terms are then specifically differentiated in the text according to levels of social and economic development. The underlying equality of individuals is removed, and rights become subject to a status determined by others and based on a set of criteria that they define. This entirely upends the prior understanding of the relationship of all individuals to authority, at least in non-totalitarian states.
This is a totalitarian approach to society, within which individuals may act only on the sufferance of others who wield power outside of legal sanction; specifically, it is a feudal relationship, or one of monarch-subjects without an intervening constitution. It is difficult to imagine a greater issue facing society, yet the same media calling for reparations for past slavery are silent on a proposed international agreement that is consistent with its reimposition.
Giving WHO authority over member States
This authority is seen as being above States (i.e. elected or other national governments), with the specific definition of ‘recommendations’ being changed from ‘non-binding’ (by deletion) to ‘binding’, in a specific statement that States will undertake to follow (rather than ‘consider’) the recommendations of WHO. States will accept WHO as ‘the authority’ in international public health emergencies, elevating it above their own ministries of health. Much hinges on what a Public Health Emergency of International Concern (PHEIC) is, and who defines it. As explained below, these amendments will widen the PHEIC definition to include any health event that a particular individual in Geneva (the DG of WHO) personally deems to be of actual or potential concern.
Powers to be ceded by national governments to the DG include quite specific examples that may require changes within national legal systems. These include detention of individuals, restriction of travel, the forcing of health interventions (e.g. testing, inoculation), and the requirement to undergo medical examinations.
Unsurprising to observers of the Covid-19 response, the proposed restrictions on individual rights, which are at the DG’s discretion, include freedom of speech. WHO will have power to designate opinions or information as ‘misinformation’ or ‘disinformation’, and require country governments to intervene and stop such expression and dissemination. This will likely clash with some national constitutions (e.g. the USA) but will be a boon to many dictators and one-party regimes. It is, of course, incompatible with the Universal Declaration of Human Rights, but these seem no longer to be guiding principles for WHO.
After self-declaring an emergency, the DG will have power to instruct governments to provide WHO and other countries with resources, including funds and commodities. This will include direct intervention in manufacturing to increase production of certain commodities produced within their borders.
Countries will cede power over patent law and intellectual property (IP) to WHO, including control of manufacturing knowhow, of those commodities that the DG considers to be relevant to the potential or actual health problem he/she deems to be of interest. This IP and manufacturing know-how may be then passed on to commercial rivals at the DG’s discretion. These provisions seem to reflect a degree of stupidity and, unlike the basic removal of fundamental human rights, vested interests may well insist on the removal of these amendments from the IHR draft. Rights of people should of course be paramount, but with most media absent from the discussion, it is likely that less effort will be applied to reversing provisions that impact human rights, compared to those that threaten commercial interests.
Providing the WHO DG with unfettered power, and ensuring it will be used
WHO has previously developed processes that ensure at least a semblance of consensus, and evidence-based decision-making. Their process for developing guidelines requires, at least on paper, a range of expertise to be sought and documented, and a range of evidence to be weighed for reliability. The 2019 guidelines on management of pandemic influenza are an example, laying out recommendations for countries in the event of such a respiratory virus outbreak. Weighing this evidence resulted in WHO strongly recommending against contact tracing, quarantining of healthy people, and border closures. The evidence had shown that these were expected to cause more overall harm to health in the long term than any benefit gained from slowing the spread of a virus. These guidelines were ignored when an emergency was declared for Covid-19 and authority was switched to an individual, the DG of WHO.
The IHR amendments further strengthen the ability of the DG to ignore any such evidence-based procedures. Working on several levels, they provide the DG, and those delegated by him/her, with exceptional and arbitrary power, and put in place measures that make the wielding of such power inevitable.
Firstly, the requirement for an actual health emergency, in which people are experiencing measurable harm or risk of harm, is removed. The wording of the amendments specifically removes the requirement of harm to trigger the DG assuming power over countries and people. The need for a demonstrable ‘public health risk’ is removed, and replaced with a ‘potential’ for public health risk.
Secondly, as discussed also in the pandemic preparedness documents of the G20 and World Bank, under these amendments a surveillance mechanism will be set up in every country and within WHO. It will identify new variants of viruses, which constantly arise in nature. All of these, in theory, could be presumed to pose a potential risk of outbreak until proven not to. The global workforce running this surveillance network, which will be considerable, will have no reason for existence except to identify yet more viruses and variants. Much of their funding will originate from private and corporate interests that stand to gain financially from the vaccine-based responses they envision to infectious disease outbreaks.
Thirdly, the DG has sole authority to declare any event related or potentially related to health an ‘emergency’. The six WHO RDs will also have this power at a Regional level. As seen with the monkeypox outbreak, the DG can already ignore the committee set up to advise on emergencies. The proposed amendments will remove the need for the DG to gain consent from the country in which a potential or perceived threat is identified. In a declared emergency, the DG can vary the Framework of Engagement with Non-State Actors (FENSA) rules on dealing with private (e.g. for-profit) entities, allowing him/her to share a State’s information not only with other States but also with private companies.
The surveillance mechanisms being required of countries and expanded within WHO will ensure that the DG and RDs will have a constant stream of potential public health risks crossing their desks. In each case, they will have power to declare such events a health emergency of international or regional concern. This will enable them to issue orders, supposedly binding under international law, to restrict movement, detain, inject on a mass scale, yield IP and know-how, and provide resources to WHO and to other countries that the DG deems may require them. Even a DG uninterested in wielding such power will face the reality that they put themselves at risk of being the one who did not try to ‘stop’ the next pandemic, while being pressured by corporate interests with hundreds of billions of dollars at stake, and huge media sway. This is why sane societies never create such situations.
What happens next?
If these amendments are accepted, the people taking control over the lives of others will have no real legal oversight as they have diplomatic immunity from all national jurisdictions. The salaries of many will be dependent on sponsorship from private individuals and corporations with direct financial interests in the decisions they will make. These decisions by an essentially unaccountable official will create mass markets for commodities, or provide know-how to commercial rivals. The Covid-19 response illustrated the corporate profits that such decisions will enable. This situation is obviously unacceptable in any democratic society.
While the WHA has overall oversight of WHO policy, with an executive board comprising WHA members, these operate in an orchestrated way. Many delegates have little depth of understanding of the proceedings, whilst bureaucrats draft and negotiate policy. Countries not sharing the values enshrined in the constitutions of more democratic nations have equal votes on policy. Whilst it is correct that sovereign States have equal rights, the human rights and freedoms of one nation’s citizens cannot be ceded to the governments of others, nor to a non-State entity placing itself above them.
Many nations have developed checks and balances over centuries, based on an understanding of fundamental values. These have been designed specifically to avoid the sort of situation we now see arising where one group, which is law unto itself, can arbitrarily remove and control the freedom of others. Free media developed as a further safeguard, based on principles of freedom of expression and an equal right to be heard. Just as these values are necessary for democracy and equality, their removal is necessary in order to introduce totalitarianism and a structure based on inequality. The proposed amendments to the IHR are designed explicitly to do this.
The proposed new powers sought by WHO, and the pandemic preparedness industry being built around it, are not hidden. The only subterfuge is the farcical approach of media and politicians in many nations who seem to pretend that the proposals do not exist or, if they do, will not fundamentally change the nature of the relationship between people and centralised non-State powers. The people who will become subject to these powers, and the politicians who are on track to cede them, should start paying attention. We must all decide whether we wish to cede so easily that which has taken centuries to achieve, to assuage the greed of others.
The World Health Organization is currently revising drafts of the proposals for amendments to the International health regulations, for approval by the World Health Assembly (WHA). They are expected to be presented at the 77th WHA meeting in May, 2024. As they are amendments, rather than a new regulation, they require only a simple majority of countries to pass. The IHR has force under international law. If passed, they will fundamentally change the power structure between WHO, Member States, and individuals within those states.
Quotes from WHO draft are inset. In keeping with the draft, new wording is bolded and underlined. Deleted words are indicated by