The United Nations in the fight against Covid

The nature of the global Covid pandemic cries out for a multilateral intergovernmental resolution. Yet so far nothing has been proposed. The World Health Organization does not have legal authority to undertake the necessary role. The legal mechanics for vaccine passports and coordinating the distribution of vaccines to countries unable to afford them might benefit from a Security Council Resolution under Chapter VII of the UN Charter. There are credible grounds for thinking that a consensus of the P5 permanent members of the UN Security Council could be reached to achieve these goals. But the existing United Nations bureaucratic architecture may be too frail for so comprehensive a mandate, and strict accountability mechanisms must be put in place for the United Nations to achieve so complex a set of goals.

By Matthew Parish

At the time of writing there are three mechanisms being adopted by wealthier and middle-income nations to fight the Covid-19 crisis. These are vaccination programmes; lockdown measures (i.e. compelling people not to interact with one another); and restricting international travel. It is obvious that taken together, these measures will not work; they will just create indefinite wave after wave of lockdowns rippling across countries, progressively destroying the world’s more substantial economies. It is important to understand why this is so.

Viruses mutate. This means that they change, in accordance with Darwin’s theory of evolution. Some do this extremely quickly, such as HIV, Covid-19 and influenza. Darwin’s theory of evolution posited that in the progress of any species of flora or fauna over time, there would be variations between different newly born living beings each after the other. These variations may be assumed to be random, and are understood today as small and arbitrary changes in a being’s genetic makeup as each member of a species creates another progeny member of the same species. Some of these changes will be more apt for survival in a given environment than others. These more successful variants will therefore propagate more successfully than others. In this way different species, down the generations of procreation, adapt to their environments.

Viruses are doing much the same thing, except that in some cases their life cycle of procreation is far more truncated than for regular flora and fauna. Viruses are tiny organisms that live as parasites off their hosts, which in the case of Covid-19 include human beings. Covid viruses multiply at an extraordinary rate; but their hosts, the human body, is as a general matter very effective at attacking these parasites, using a body-wide mechanism called the immune system, a principal feature of which are antibodies. Antibodies are Y-shaped proteins in the blood stream throughout the human body, that attack parasitic bacteria and viruses living in the body. The human body must recognise specific pathogens (the microbial parasites living off it) that cause the body to become ill. It does this by way of marking part of the pathogen as a so-called antigen. Antibodies then know which foreign objects in the body are for attack, and they attach themselves to the pathogens identified with antigens to neutralise them. At this point the pathogen, in our case Covid-19 (in this article also referred to inaccurately as “the Coronavirus”, because there are many Coronaviruses that are not dangerous or are far less dangerous than Covid-19), is neutralised and the human body infected with the Coronavirus gets better.

The system of antibodies (a class of proteins called immunoglobulins) also works remarkably well to kill Covid-19, which is not a very deadly disease. Global death rates are hard to calculate, because each country measures deaths in different ways; but it has been estimated at approximately 2 to 2.7%. However the story is more complex than that, because Covid-19 has an extended incubation period before its most virulent attack upon the human body which is to prevent the lungs from their usual uptake of oxygen. In persons with typically strong immune systems, the virus is destroyed by immunoglobulins before serious symptoms ever occur, and the greater majority of those who contract the virus recover rapidly suffering few or no symptoms at all. That is why mortality rates for Covid-19 are exceptionally low in persons under the age of 50. Nevertheless the virus represents a risk to those with compromised immune systems: typically either those with illnesses that affect the efficiency of the immune system (such as HIV-AIDS), those taking medicines to suppress the efficiency of the immune system (typically used in conjunction with transplant surgery, to prevent rejection of the transplant by its recipient), or the elderly – as one ages, it is common for the immune system’s efficiency to deteriorate, particularly if one has led an unhealthy life. For people with immuno-deficiency disorders, i.e. the unhealthy and the elderly, Covid-19 may kill its host through causing the body to be starved of oxygen via uptake through the lungs before the host’s immune system has neutralised the virus. Nevertheless even this is rare; the mortality rate amongst persons over 75 is still calculated as less than 13%. In other words, the vast majority of the very elderly who contract Covid get better as well. One’s immune system must be seriously compromised in order that Covid presents a mortal risk.

The two features that make Covid so challenging a pandemic disease are that it is highly and perhaps uniquely transmissible (it is now established that this is principally through water droplets, whether coughed or breathed out or via tiny molecules of sweat that humans leave on every object they touch); and that it has so extended an incubation period – up to 14 days – that people may be infected with Covid without knowing it for long periods of time because they are having no symptoms. Contrast this with influenza, a virus (very different from Covid) that is transmitted using similar means to Covid, and can also kill people with diminished immune systems; but that displays its (more pronounced) symptoms far more quickly – typically within 24 to 48 hours of transmission. One of the reasons that influenza is far less problematic than Covid-19 is that people start to feel much more sick much more quickly, and rapidly isolate themselves from others so as to halt transmission. Influenza is far less deadly than Covid, so that notwithstanding its high transmissibility there is no temptation to use government coercion to keep people apart. Society just lives with influenza, because its mortality rate may be in the region of 0.1% or less. By contrast Ebola virus, that emerged in western Africa, is easy to contain because its mortality rate (as high as 90%) makes it so containable. It is relatively simple to isolate people who show extreme symptoms and then quickly die. Covid-19 spreads more quickly because the logic of isolation of hosts is so much less compelling given its fractional mortality rate compared with Ebola.

Nevertheless Covid-19’s mortality rate is too high for societies to suffer without extraordinary domestic political ramifications. If, left unchecked, a virus is so transmissible that it must be assumed everyone will catch it eventually and 2% will die, the pressure on politicians in a state of 10 million people is to do something to prevent 200,000 deaths. That is all the more the case if the death rate might go higher because people can contract Covid-19 more than once. Because Covid-19 is a rapidly mutating virus, it may very well be possible that Covid, like influenza, adapts to the fact that infected people have developed antibodies recognising Covid antigens; and it returns in waves of mutant variations without the identifiable antigens. Therefore the immune system may have to start all over again, as it were.

The other problem with Covid is that it is barely treatable by medical practitioners. The disease would be far less problematic from a political economy perspective (i.e. the damage its propagation does to economy and political institutions) if, much like influenza (whose symptoms can be treated but which cannot itself be attacked using pharmaceuticals), Covid were totally untreatable; persons who contract it must simply go home and wait either to die (the tiny minority) or get better. In those circumstances, the policymaker would not face a resource problem. But as it is, oxygenation and even ventilation procedures have been shown to make a substantial difference to mortality rates for those who have contracted Covid with life-threatening symptoms. These are hugely expensive activities for any national system of healthcare, and it is difficult if not impossible to assess which of those with more severe symptoms of Covid-19 would benefit from the use of these expensive procedures (i.e. those procedures would make the difference between life and death). Because there are so many cases of Covid, even if there are relatively few actual deaths in statistical terms, this creates pressure for expensive hospital admissions where in the vast majority of cases those admissions will not make the difference between life and death. The result is that everyone who has more serious symptoms of Covid-19 wants to be admitted to hospital; but the numbers of such patients are so high that hospital resources are overrun.

This may be the principal political factor driving restrictions upon civil liberties: not the risk of transmission or death per se (there is now sufficient public information about the Coronavirus and its risks that individuals may be presumed able to undertake their own self-assessments of risk in deciding to what extent to self-isolate as a means of protecting themselves and their loved ones) but rather the pressure on hospitals, to the extent that they are considered as public resources. Covid hospitalisation and treatment is costly, and those who work in national healthcare systems may be effective political lobbyists. There may be insufficient staff, hospital beds, equipment of protective clothing to manage the numbers of desired hospital admissions. This may entail any or all of massive short-term investment in public healthcare facilities; sending people home who say they are sick and denying them treatment (a course that bears political costs only the most highly authoritarian regimes seem able to pay); and/or keeping people under so-called lockdown restrictions not to protect themselves per se but to prevent hospitals from being overloaded, by spreading infections over longer periods of time. Throughout this process of diverting hospital resources to treat Covid, the availability of medical care for citizenries’ healthcare problems has dropped dramatically as resources have been redirected towards Covid treatment: something that is comparatively inefficient in saving lives in a public healthcare system on a dollars-per-life basis.

These civil liberties restrictions have caused enormous economic damage, because preventing people from going about their daily lives and forcing them to stay at home prevents vast swathes of the economy from functioning properly. Governments have to borrow to subsidise the incomes of all those people who find themselves out of work because the area of the economy in which they work has been snuffed out by government restrictions. Countries inevitably plunge into recession as a result. Because Coronavirus is so transmissible and can mutate where its transmissibility is blocked by people who have been infected by and recovered from Coronavirus. This situation of downward economic destruction might in principle persist indefinitely; or it might continue over several years, leading countries to economic doom. The route that has been touted to escape from this recurrent plague has been vaccinations, and it is the mechanism by which these vaccines were developed and are now being distributed that cries out for multilateral intervention not currently taking place.

As soon as Covid-19 was recognised as a serious global public health crisis, virtually every substantial pharmaceutical company worldwide started research on vaccines, inevitably funded to varying degrees by government subsidies. The initial spirit was one of healthy competition, as each of the global pharmaceutical companies raced against the others to be the first to invent a vaccine that could survive efficacy and safety trials. The race began in early 2020, and at the time of writing in March 2021 there are now 12 vaccines approved by different national authorities, of which six are approved by what the World Health Organization, a specialised agency of the United Nations, has categorised as a “stringent regulatory authority”. Stringent health authorities are every EU / other western European state; the United States; and Australia.

The vaccines vary in price, and in the quality of the medical studies that have been undertaken. Many or even most states in the world have introduced vaccine roll-out programmes. None of the studies undertaken suggest that any vaccine provides 100% protection. The purpose of the vaccine roll-out programmes is to ensure that the people most vulnerable to Covid-19 have increased levels of protection (the vaccines are intended to stimulate the antibody / antigen process against Covid-19); and that fewer people can become carriers because stimulation of the same process in them prevents transmission. Administration of vaccines has been undertaken on a state-by-state basis, with each country deciding upon the terms of its vaccination programme. Some countries have decided to prioritise people susceptible to serious Covid infection (i.e. the elderly and those with otherwise compromised immune systems); other governments have tried to vaccinate all members of the population as quickly as possible without putting in place a system to prioritise some people over others. It is as yet unclear which model is better in reducing either hospital admissions or deaths. Because each government is undertaking its own unilateral course, each using different vaccines and different methods for compiling priority lists for who gets vaccinated first, there have not so far been any sensible international comparisons of which approach is more effective.

The relative effectiveness and safety of different vaccines has been the subject of international media and even legal combat, because the pharmaceutical companies are making huge amounts of money as different states aim to vaccinate the entirety of their populations with one vaccine or another. A Russian vaccine, Sputnik-V, was initially condemned as not having been sufficiently tested for efficacy but subsequently was commended as highly effective by a study in a highly respected international medical journal. The so-called Oxford-AstraZeneca vaccine originating from the United Kingdom, one of the cheapest vaccines and one of the easiest to transport and store, was the subject of a legal dispute when the European Union (from which the United Kingdom has recently left) complained that the pharmaceutical company had not delivered sufficient quantities to Europe to meet its contractual responsibilities. The lawyers got involved; then, embarrassingly, it turned out that Italy had misplaced 29 million doses of the British vaccine which it later found. In the interim, German authorities made statements asserting that the British vaccine might be dangerous in causing blood clots and for a period Germany banned the British vaccine from being administered to persons over the age of 65. It later transpired that there was no evidence for the blood clots assertion. Now Pfizer, an American vaccine, is lobbying to keep the AstraZeneca vaccine out of the United States on purported efficacy grounds, presumably because the AstraZeneca vaccine is only a fraction of the cost and therefore can compete vigorously within the US market-based system for purchase of pharmaceuticals.

The race to vaccinate has created some unusual winners and losers. Some smaller countries, such as Israel and Serbia, have managed to achieve relatively very high rates of inoculation by abandoning altogether principles of prioritisation; everyone who moved would be vaccinated. The United Kingdom has run a prioritisation programme for vaccination that nevertheless has been very effective. The European Union tried to create an international vaccination programme under its own superstate infrastructure, but vaccination rates in the European Union have been far lower and the EU’s bureaucracy has so far proven unequal to the task. (The EU model of internationalism centralises regulation but not execution, which may be why the EU has been ineffective on the ground in purchasing and distributing vaccines.) Some countries have found substantial so-called vaccine hesitancy amongst their populations, such as France and Russia. Statistics from some of the world’s biggest countries by population, China and the United States, have been considered unreliable for various asserted reasons. The principal reason must surely be that it is exceptionally difficult for any country with a large population, whose government structures inevitably if in different ways involve substantial degrees of federalism, to collate massive quantities of data reliably when each federal region is doing something slightly different.

For each country, the decision to purchase vaccine shots from one or more pharmaceutical companies has been undertaken in a different way. Middle-income countries have sometimes had to rely upon the largesse of wealthier nations, or international loans of various kinds, to afford vaccination programmes for their entire populations. The pharmaceutical companies continue to try to find deficiencies in one-another’s products, so as to increase their market shares. New proposals for still more effective vaccines (for example, most current vaccines require two shots spaced in time for maximum efficacy but now pharmaceutical companies are racing to find more reliable single-shot vaccines) are constantly being developed. Russia has recently announced that it has three vaccines rather than just one; at the time of writing very little is known of the other two. Most fundamentally for the purposes of this essay, lower-income countries are falling behind the rest because they cannot afford the costs of population-wide vaccination programmes, in particular the logistical costs of distributing vaccines to people across areas where infrastructure may be poor. The net result is that there will be a ranking of effectiveness of vaccination programmes between states. There is virtually no consistency at all in approaches. The World Health Organization has done little except issue vague and often delayed recommendations to the UN member states. A cumbersome bureaucracy that has failed in previous pandemics, little is expected of it.

There is a fundamental problem with this patchy approach to vaccination programmes: Coronavirus strains in countries with differing levels of effective vaccination may mutate in differing ways. The hope in a country that aims for full vaccination of its population is to ensure that the Covid-19 strain(s) present in that country cannot be transmitted effectively because everyone is immune. Mass vaccinations can take place more quickly than Covid-19 can mutate to defeat the vaccine, and therefore the Coronavirus will be wiped out. The problem is that if the same standards of rigour are not applied across the board, in other countries, then a strain of the virus in another country where the same approach is not being applied will have further opportunities to mutate. Some of those mutations are at risk of defeating the vaccines now being used in high and middle-income countries. And so it has proved. Differing mutations of the Coronavirus, with more effective transmission, incubation periods and/or vaccine resistance, have been developing in parts of the world (or even regions of specific countries) where less emphasis has been placed upon a mass inoculation process. In other words, the Coronavirus is mutating itself into vaccine resistant strains in countries where insufficient effort has been taken in vaccinating. Hence the fight against Coronavirus has turned into a sort of fight by each country to prevent the frailties of other countries’ vaccination programmes from undermining theirs.

The way this is being done is by increasingly restricting international travel. The medium by which a mutated Coronavirus might undermine a country’s vaccination efforts is international travellers. Hence borders are being sealed; taking international flights now requires a mountain of paperwork demonstrating that one has had a negative Covid test; and there is ever more talk of “vaccine passports”. This is documentation proving to anyone from the owner of a bar or nightclub, to an airline or the immigration authorities of a foreign country, that one has been vaccinated. To this day, everyone is talking about how unethical it would be to introduce vaccine passports, because they discriminate. They may discriminate against the young, in countries where priority in vaccination schemes is given to the elderly. They may discriminate against the poor, because while currently vaccination schemes in most countries are mostly free, that will surely change and private vaccination regimes, for which one pays, will arise. This is particularly inevitable, as newly-published research data will reveal some vaccines to be more effective than others. Multiple vaccine passport schemes might arise; as the world struggles to reopen the hospitality business, each different country might have its own standards for the vaccine passport required for a specific person to be able to enter a bar or restaurant.

We are already at the stage at which international coordination is imperative. Who is to set the standards for vaccine passports? How are they to work? How will falsification or forgery be prevented? How are we to ensure that persons in low-income countries have access to vaccines? If we ignore that issue, then those people will, sooner or later, travel and they may do so with vaccine-resistant Covid mutations. The idea that we close all our borders indefinitely and leave some countries to struggle with Covid without us, because they are too poor to afford either vaccines or loans to pay for vaccines, is not only morally reprehensible but short-sighted and immature because restrictions upon travel from perceived high-risk (low-vaccination) countries cannot be indefinitely maintained without ruin of the global economy. The world in 2019, before the Covid crisis began, was one based upon international trade and that requires international movement of people. We cannot credibly return ourselves to the autarchies of the 1930’s without economic ruin and consequent civil conflict. Therefore the current policies of countries isolating themselves must be phased out as quickly as possible. This requires multilateral coordination of global programmes of vaccination. Covid-19 is a global problem and it needs a global solution. Where is the United Nations?

The answer is that very few people are thinking of the problem in these terms. As people start talking about vaccine passports (or any other system of asking for evidence of vaccinations as a precondition of restarting normal life), countries are each imposing their own regulations in different ways and this will not do. It will encourage a race to the bottom; private businesses desperate to re-open and admit customers will accept any piece of paper. And it will encourage a race to the top; public authorities will accept nothing but pieces of paper that bear the stamps of those countries. Bilateral and regional arrangements might cause imagined progress; but as with “trade-shifting” arrangements in which countries create preferential regional trading arrangements outside the auspices of the World Trade Organization, this will just create regional silos in stand-off each against the other in terms of healthcare standards. There is a reason why the foremost premise of the World Trade Organisation is that a state must treat each other member as well as It treats the member it treats the best (the so-called “most favoured nation” clause of the General Agreement on Trade Tariffs). That is because permitting regional agreements to arise undermines the principal benefit of trade: the intimate inter-relations of all the states in the globe. The world needs to create a public health regulatory system that avoids autarchy and regionalisation. That is because global trade, and the global movement in persons, was the source of the world’s economic growth and success in 2019 before all this began. That is what we must aim to recapture.

The alternative is that the world will develop into states and regions who have dealt with one version of Covid successfully, who aim to cut themselves off from those who did not do so well; and other, mostly poorer, areas in which mutations of the virus may progress and those mutations will travel one way or another to the wealthier parts of the world because it is of course impossible absolutely to restrict people from moving around and therefore to prevent the transmission of new mutations of the virus. It only takes one person. Then the wealthier and middle-income countries will need to find new vaccines, engage in new lockdowns, and perpetuate the economic and public health damage from which we have already suffered so gravely. It follows that there are two issues upon which urgent multilateral collaboration are needed. One is the importance of extending comprehensive population-wide vaccination programmes to less developed countries (including logistical assistance) as a matter of priority; the second is to develop a comprehensive system of vaccine passports so that everyone is working to the same standards, howsoever those standards may develop.

What mechanism of multilateral cooperation ought to be used? While the World Health Organisation has so far proven itself somewhat ineffective, it does have the advantages both of being pre-existing (so we do not have to create a new institution from scratch) and having in place medical professionals in its organisational structure. It lacks knowledgable economists, and if we are to use the World Health Organisation for our multilateral imperatives then we will need to restructure radically the institution. Nevertheless in a time of crisis this can be done. The United Nations Charter is a remarkably flexible document where the P5 member states can find common cause. Everyone has a common cause here. Chapter VII of the UN Charter gives the UN Security Council comprehensive authorities to make binding decisions for action “with respect to threats to the peace”. Traditionally this set of provisions of the UN Charter has been used by reference to imminent or existing war or civil conflict. But the Covid crisis is also a threat to the peace. At the time of writing some 2.75 million people are estimated to have died globally as a result of this virus in barely one year. This is far more destructive than any contemporary war or civil conflict. The bloodiest armed conflicts in 2020 were the Afghan and Yemeni civil wars, each of which consumed slightly more than 19,000 lives. The Syrian Civil War consumed approximately 7,000 lives in that year. The last act widely recognised as genocide in Europe, the war in Bosnia and Herzegovina, took approximately 100,000 lives. The Covid crisis Is a colossal killer by contemporary standards, and it merits the attention of the Permanent Members of the Security Council who should negotiate to establish an international regime that pursues the multilateral goals essential to restore the world to the standards as we know it.

If anyone doubts whether 2.75 million deaths globally in the course of a year constitutes a threat to the peace, they should look back over the history of the twentieth century. It is not just the deaths, but the violent economic contractions and personal desperation of a substantial proportion of the world’s population, that creates the ruminants for conflict. One barely speaks to a person at the current time who is not profoundly concerned about their own future, that of their family and of their loved ones. In times of fear and paralysis in the face of uncertainty, people become ever more attracted to extreme and unreasonable ideas. This is what we learn persistently from history. There must now be leadership in pursuing common goals, to mitigate the worst effects of the Covid pandemic still to come. And there must be an understanding of the need for mutual cooperation to return the world, as quickly as is possible, to its senses. Every step we continue to take in the darkness is a step we take on our own. Despite all the failings of the United Nations over its history, now is the time to turn to multilateral cooperation. All of a sudden, the world really needs it.

The author is an international lawyer based in Geneva, Switzerland. He is the author of four books and over 300 articles in the fields of international law and international relations, and has been named as one of the 300 most influential people in Switzerland and a Young Global Leader of the World Economic Forum. He is Honorary Professor at the University of Leicester, Senior Fellow at the Institute of Comparative Law in Belgrade, and the Chief Executive of the Foundation for Development. He has been inoculated with the Oxford-AstraZenica Covid-19 vaccine.

The views expressed in this article do not necessarily reflect the views of TransConflict.

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