Across the globe, many factors are increasing the health risks of epidemics including greater trade and travel, climate change, environmental degradation (biodiversity erosion) and encroachment on natural habitats that leads to animals and human interacting more closely.
The major pandemics (AIDS, tuberculosis and malaria), epidemics (influenza viruses) and emerging diseases (MERS, SRAS, Ebola, Zika and COVID-19) have reminded the international community of the importance of health security and the difficulties of ensuring it. They have also shown the far-reaching human, social, diplomatic and economic consequences that this type of crisis can generate.
Health crises have also highlighted the interdependence between the environment and living species, and the need to change how we deal with epidemic health crises. That is why the international community has chosen a cross-cutting One Health approach.
International health security consists of all preventive and corrective activities being conducted to make populations less vulnerable to health crises. It involves the prevention, surveillance, detection and evaluation of health risks as well as the definition and implementation of preparedness, alert, response and management measures of these risks with a view to improving global public health. International health security is closely linked to strengthening health systems since it can only be ensured if it is based on a resilient health system that is able to prevent, detect and respond to risks.
Created in the early 2000s, the “One Health” concept refers to the following idea: human health and animal health are interdependent and connected to the health of ecosystems in which they live and co-exist.
The past few decades have been marked by an increase in health crises. This highlights the close connection between human health and animal health: 60% of known human infectious diseases are of animal origin. This is the case of 75% of emerging human diseases, including human infections from certain avian influenza viruses, human infections from MERS-Cov, vector-borne diseases such as Zika, dengue fever and chickungunya, as well as Ebola and COVID-19.
These are the reasons that the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO) began their collaboration in 2010 on the One Health approach. These organizations are working together on health risk management by studying animal-human-ecosystem interactions. For example, environmental protection actions have been conducted and have an impact on communicable diseases. More generally, this approach works from every human and animal health aspect by including all pathologies that have an impact on public health and food security.
One of France’s global health priorities is to improve international health security in cooperation and coordination with its partners, particularly with the World Health Organization (WHO), with which it has developed a fruitful partnership. That is why international health security and the fight against epidemic and pandemic diseases are one of the five priorities of the 2020-2025 Framework Agreement between France and the WHO. While serving its term on the WHO Executive Board (May 2015-May 2018), France also strove to strengthen international health security, focusing on the implementation of the International Health Regulations (IRHs).
To achieve this main aim, France is focusing on three areas:
1. Assisting in capacity building of States in a preventive approach to implementing the IHRs in liaison with WHO;
2. Strengthening EU action in the field of international health security;
3. Promoting the fight against emerging diseases and ensuring access to essential public health products.
The role of the International Health Regulations
The International Health Regulations (IHRs) are a binding legal instrument that is key to protecting the global population from new and re-emerging diseases, microbial attacks and other threats to public health and health security.
In concrete terms, with the IHRs, States commit to acquiring and maintaining a minimum number of operational capacities for detecting, alerting and responding to risks. These capacities are needed so that a State can respond to a public health emergency and prevent its spread to other countries.
France supports comprehensive implementation of IHRs, which were adopted in 2005 by 196 States Parties and entered into force in 2007. However today, only one-third of IHR States Parties adhere to them and have the capacities required for preventing, detecting and responding to a large-scale health risk.
To ensure international health security sustainably, IHRs must be implemented effectively and this implementation must be verified. France supported the design of a new monitoring and evaluation framework for implementing IHRs. It has helped launch the framework by having its experts participate in evaluation missions organized by WHO at the request of countries.
In the face of COVID-19, which is affecting the whole world, France is contributing to the international response with its direct development assistance and its support for multilateral institutions (see COVID-19: assistance to Africa).
It provides active support to international multilateral institutions that are mobilizing their expertise and their financial contribution in close collaboration and coordination with the WHO.
On 16 April, the President of the French Republic held a conference call with the heads of the main international organizations concerned with global health, which are active in the response to COVID-19 (WHO, Global Fund, UNITAID, GAVI, CEPI, Wellcome Trust, Bill & Melinda Gates Foundation, World Bank, Medicines Patent Pool, and Françoise Barré-Sinoussi, Chair of the Analysis, Research and Expert Committee) to step up international coordination with WHO and build a multilateral initiative. The participants agreed on the need for a coordinated, comprehensive initiative, focusing on both efficiency and equity.
These discussions led to the creation of a call for support, with the aim of accelerating development of and access to diagnostics, therapeutics and vaccines, including in the most disadvantaged countries.
This call is built around four pillars:
- Support for health systems in the most vulnerable countries.
1. Speed up the development and production of diagnostics, therapeutics and vaccines. This is particularly urgent as an increasing number of countries and territories are gradually lifting the restrictive measures taken to slow the spread of the virus.
2. Ensure safe, equitable and universal access to diagnostics, therapeutics and vaccines. We must immediately develop a comprehensive approach to ensure no one is left behind and adopt a fair, transparent, equitable, effective and prompt international response.
3. Consolidate healthcare systems to combat COVID-19 and continue to fight other diseases. The COVID-19 pandemic has had a major impact on the world’s most vulnerable people. It is essential to strengthen healthcare systems worldwide to help countries fight the pandemic, prevent these systems from becoming overwhelmed by the crisis, and not undermine progress made in combating AIDS, tuberculosis and malaria.
To this end, France has committed to creating a global cooperation platform called Access to COVID-19 Tools (ACT) to accelerate and scale-up research, development, access and fair distribution of vaccines and other vital therapeutics and diagnostics as well as to strengthen health systems.
The following organizations working on this initiative must be mentioned:
- The World Health Organization (WHO), which has a coordinating role;
- The Global Fund to Fight AIDS, Tuberculosis and Malaria;
- Gavi, the Vaccine Alliance
In addition, on 9 April 2020, France launched the “COVID-19 – Health in Common” Initiative to address the health crisis caused by the pandemic in the most vulnerable countries in Africa, the Indian Ocean, the Caribbean and the Middle East. With a budget of €1.2 billion, it will help to quickly support health systems, regional epidemiological monitoring networks and NGOs working on the ground.
Updated: April 2020