Global Health

Decolonizing Global Health: The opportunities and pitfalls presented by reform of the Health Emergency Preparedness, Response, and Resilience (HEPR) Architecture

  • By Dena Kirpalani

On 4 May 2022, the World Health Organization (WHO) published a draft white paper outlining the Director-General’s proposals for Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience (the “White Paper”), asking for inputs ahead of discussions at this year’s World Health Assembly (WHA). The White Paper and the agenda item on Strengthening WHO preparedness for and response to health emergencies (Agenda Item 16.2) presents an opportunity to address the persistent influence of coloniality that we’ve seen manifest during the covid-19 response. As Büyüm and their colleagues wrote in the BMJ Global Health in what now feels like the early part of the pandemic, the global response to covid-19 reinforced long-standing colonial injustices – but here and now is the window of opportunity to transform global health.

The White Paper makes references to equity and inclusion, as key principles in any future health emergency preparedness, response, and resilience (HEPR) architecture. It highlights the importance of these two principles in the realisation of any form of effective governance. Whilst there is much to agree with this sentiment, even within the White Paper we see (perhaps not unexpectedly) an attempt to de-politicize the field of HEPR, diverting attention away from the responsibilities of powerful nations to rectify the shortcomings of the global political economy and global governance which we continue to see writ large in the response to the pandemic, not least in the on-going controversies over vaccine equity. A controversy that seems even more egregious (if that were possible) given that, as Melissa Coyle has found in her work, the development of the adenovirus platform would have not been possible but for the testing done on black bodies during the Ebola crisis. The attempt to remove this political context from the HEPR architecture can be found in other examples throughout the White Paper, for example, the White Paper states that “[t]he risk of new health emergencies continues to increase, driven by the escalating climate crisis…disproportionately impacting the poor and most vulnerable”. This passive language focussing on the impact of the trends in the climate crisis but silent on those who bear responsibility for the current state of affairs obfuscates the balance of power between those with power and those marginalised. Earlier this year, the sixth report of the Intergovernmental Panel on Climate Change (IPCC) finally named colonialism as a driver of the climate crisis and as an ongoing issue in the marginalisation of communities, making them more susceptible to the effects of climate change. Populations are not marginalised in a vacuum. To be serious about equity and inclusion in any reform of the HEPR architecture means addressing head on the legacies of colonialism embedded in the global health security infrastructure, and the North-South dynamics at play.

The White Paper puts forward ten proposals to provide a framework for pandemic prevention, preparedness, and response, some of which are governance related e.g., scaling up of a Universal Health and Preparedness Review (UHPR), which was modelled on Human Rights Universal Periodic Review (UPR), perhaps with elements of the Joint External Evaluations (JEE) mixed in. The JEE was, alongside the Global Health Security Index (GHSI), supposed to give countries an idea of their capacities to prevent, detect and rapidly respond to public health risks, however these reviews appear to have had no predictive value on a countries’ effectiveness in their covid-19 response. Despite the proposal for the UHPR originating with the African Union, it should be noted that the UPR has come under criticism for reproducing colonial dynamics in the form of Global North countries schooling those in the Global South. If a UHPR is to build mutual trust, solidarity and accountability, it cannot be built on a foundation that assumes that there are universal systems that can tackle pandemics, that presupposes knowledge and expertise originating in the Global North has a greater insight into pandemic preparedness, nor ignores the legacies of colonialism on the health structures present in the Global South both through legal frameworks and economic systems.  

The White Paper’s proposals include plans for the development of a global health workforce that can be scaled and rapidly deployed, other surveillance measures, and proposed financing solutions. While the proposal is silent about the make-up of the rapid deployment force, such a proposal should be aware of possible colonial dynamics in the form of the deployment of experts to fix or save marginalised populations, which overlooks the expertise marginalised peoples have in their own lives and how knowledge from marginalised peoples’ is extracted and transformed into credentials in the Global North. Also overlooked in this White Paper is the way in which the health workers, and their knowledge and expertise, are  already drawn away from locations in the Global South to service health systems in the Global North.

The White Paper has closed for general consultation (although the e-mail address is still available on the WHO website) and now goes to member states for feedback. Reform of the HEPR Architecture is needed in the wake of the covid-19 pandemic, but such reform should be taken as an opportunity to rectify the colonial legacies of the past and not simply brush past them. Many of the students at the Institute take the minor or classes in Global Health, and since the start of the pandemic, the interest in global health and global health diplomacy has only increased. For those of you attending the WHA, WHA side events, or going on to careers in Global Health, consider the colonial hangover that even the WHO Director General has acknowledged underpins the way the global community approaches Global Health, and the proposed solutions. The White Paper in its current form represents a return to a pre-pandemic, business as usual approach to Global Health, while acknowledging the importance of equity and inclusion, it remains silent on topics such as redistribution and reparation. 

Photo by National Cancer Institute in Unsplash

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