France and International Health Security
Planet-wide, many factors increase epidemic risks. This may be due to the multiplication of trade, or movement of persons, climate change, the deterioration of the environment (erosion or the loss of biodiversity) and the encroachment on natural habitats which causes contact between humans and animals.
Major pandemics (HIV/AIDS, tuberculosis and malaria), epidemics (such as flu viruses) and emerging diseases (such as MERS-CoV, SARS, Ebola, Zika and COVID-19) have reminded the international community of the importance of health security and the difficulty in ensuring it is protected. They also show the extent of the consequences – human, social, diplomatic and economic – that public health crises can have.
Public health crises also show us the interdependence between the environment and living species, and the need to better take into account this interconnection in the fight against epidemics. The cross-cutting “One Health” approach should be brought to the fore internationally to improve the preparation for and management of public health crises. France has proposed two initiatives to this end: the High-Level Expert Council and the PREZODE project.
International health security covers all activities, both preventive and corrective, carried out to reduce the vulnerability of populations to health events. It includes prevention, monitoring, detection and assessment of health risks, and the defining and application of preparation, alert, response and management measures for these risks with global public health in mind. International health security is closely linked to strengthening health systems because it is only guaranteed if it is founded on a resilient health system that is capable of preventing, detecting and responding to risks.
The “One Health” approach emerged in the early 2000s and refers to the idea that human health and animal health are interdependent and linked to the health of the ecosystems in which humans and animals live and co-exist.
Recent decades have been marked by an increase in public health crises. This highlights the close ties between human and animal health: 60% of known infectious human diseases originate in animals. This is also true for 75% of emerging human diseases; for example, cases of human infection by certain bird flu viruses; human infection with MERS-CoV; vector-borne diseases (Zika, dengue fever, chikungunya); the Ebola virus disease epidemic and today, COVID-19.
Based on this observation, the United Nations Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the World Health Organization (WHO) launched their tripartite collaboration taking the “one health” approach.
These organizations work together on health risk management by studying the interactions between animals, humans and ecosystems. For example, environmental protection actions have an impact on communicable diseases. More generally, this approach functions across all aspects of human and animal health by encompassing all pathologies that have an impact on public health and food security.
The “One Health” approach to fight the COVID-19 pandemic
The COVID-19 pandemic has illustrated the urgent need to highlight the “One Health” approach and to set up a structure that can alert public opinion and policy-makers to the interaction between human, animal and environmental health.
In response, France, in partnership with Germany, proposed setting up a One Health High-Level Expert Council ahead of the World Health Assembly (WHA) in May 2021. This Council will bring together experts from the four international organizations in charge of monitoring zoonotic diseases – WHO, FAO, OIE and the United Nations Environment Programme (UNEP) – alongside independent experts. It will be responsible for disseminating reliable scientific information about the links between human, animal and environmental health and to issue recommendations to help public leaders to make the necessary decisions to respond to future health crises.
The Expert Council’s action will be carried out in close coordination with the PREZODE project, supported by scientific bodies and announced by France at the One Planet Summit on 11 January 2021. PREZODE will combine research and operational actions to mitigate the risks of the emergence of infectious diseases of animal origin by reducing pressure on biodiversity.
One of France’s priorities in global public health is to improve international health security, in coordination and in cooperation with its partners, especially the World Health Organization (WHO) with which it has a successful strategic partnership on this topic.
International health security and the fight against epidemic and pandemic diseases are one of the five priorities of the Framework Agreement between France and WHO for the 2020-2025 period. During its term on the WHO Executive Board (May 2015-May 2018), France also committed to strengthening international health security, in particular through the implementation of the International Health Regulations (IHR).
To reach this main goal, France’s action is centred on the following three areas:
- Supporting state capacity-building efforts, taking a preventive approach for the implementation of the International Health Regulations (IHR) in collaboration with WHO;
- Strengthening the action of the European Union in international health security;
- Promoting the fight against emerging diseases and ensuring access to essential products for public health.
The role of the International Health Regulations
The International Health Regulations (IHR) is the only legally-binding international health security instrument. It is the key means of protecting the global population from new and resurgent diseases, microbial shocks and other threats to public health and health security.
Concretely, through IHR, States commit to acquiring and maintaining a minimal set of operational capacities to detect, alert and respond to risks. These capacities are essential so that a State may respond to a public health emergency and avoid spread to other countries.
France supports the full application of IHR, adopted in 2005 by 196 States Parties, and which entered into force in 2007. However, today, just one third of States Parties to the IHR comply with them and have the necessary capacities to prevent, detect and respond to a large-scale public health risk.
To ensure that international health security is long-term and sustainable, the implementation of the IHR must be effective and verified. France supported the development of a new monitoring and evaluation framework for the implementation of the IHR. It helps implement this framework, in particular by mobilizing its experts to take part in the evaluating missions organized by WHO, at countries’ request.
It has volunteered to take part in the pilot phase of the peer review on preparations for public health emergencies. This initiative, which will soon be launched by WHO, aims to improve the implementation and follow-up of the IHR in response to shortcomings highlighted by the COVID-19 pandemic.
To support, defend and revive the multilateral system, France is mobilized and supports, alongside Germany and its European partners more generally, WHO’s efforts to coordinate the health and humanitarian response to the COVID-19 crisis, both financially and politically.
French and German reflection also contributed to the European Union’s proposal to strengthen the role of WHO in preparedness and response in health emergencies, adopted on 20 January 2020 at the WHO Executive Board session. On the basis of this decision, the European Union may propose another resolution at the World Health Assembly (WHA) in May 2021, consistent with the ongoing evaluations by the Independent Panel for Pandemic Preparedness and Response (IPPR), the Independent Oversight Advisory Committee (IOAC) on WHO’s response to COVID-19, and the Review Committee on the Functioning of the IHR.
Faced with the COVID-19 pandemic, France contributes to the international response through its direct development assistance and its support to multilateral institutions. It provides active support to multilateral international institutions that use their expertise and financial capacity in close collaboration and under the coordination of WHO.
Read our article on this topic: Covid-19: assistance for Africa
On 16 April 2020, the President of the French Republic held a conference call with the heads of the main international organizations concerned with global public health, which are active in the response to COVID-19 (WHO, Global Fund, UNITAID, GAVI, CEPI, Wellcome Trust, Bill & Melinda Gates Foundation, World Bank and the Medicines Patent Pool) and with 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.
- 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.
- 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.
-# 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.
The Act-A facility
This call resulted in the launch of the Access to COVID-19 Tools Accelerator (ACT-A) on 24 April 2020, during a public video conference with several Heads of State and Government and major stakeholders in global health.
It is a strong multilateral response to an unprecedented public health crisis. ACT-A brings together all the major actors of global public health around a common goal: accelerate development, production, and equitable access to COVID-19 diagnostics, therapeutics and vaccines, alongside support for health systems.
The Coronavirus Global Response pledging summits organized at the initiative the European Commission in May and June 2020 raised €15.9 billion for the global response, and the first financing for ACT-A. Of this amount, €11.9 billion was pledged by the Member States, the Commission and the European Investment Bank, €510 million of which by France (increased to €560 million since then).
Political mobilization in favour of equitable and universal access to healthcare products to treat and prevent COVID-19 – which should be considered global public goods – is also crucial. To this end, France promoted a Charter for Equitable Access to COVID-19 Tools which was adopted on 9 February 2021 by the members of the ACT-A Facilitation Council.
The organizations working on this initiative include:
- 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 public 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 €1.15 billion (€150 million in grants and €1 billion in loans), this initiative implemented by the Agence Française de Développement (French Development Agency, AFD) has provided effective support to health systems, regional epidemiological monitoring networks and NGOs in Africa, the Indian Ocean, the Caribbean and the Middle East. By the end of December 2020, the AFD had already dedicated €1.119 billion, 97% of which was for Africa, to help developing countries.
Updated: February 2021