Policy brief

The failure of global public health governance: a forensic analysis

In this Policy Contribution, we seek to understand the reasons for these failures of global collective action.

Publishing date
17 February 2022

The authors thank Max Sorensen for research assistance and Bruegel colleagues for insightful comments made at a research seminar in November 2021.

COVID-19 has underlined that in a context of recurring pandemics, public health is a basic global public good, the provision of which presupposes effective and timely collective action at global level. It has exposed the limitations of the prevailing framework.

This Policy Contribution positions global public health governance in the wider debate on the reform of international governance arrangements. It distinguishes between the ‘before’ phase of pandemic preparedness, characterised by ‘denial and neglect’; the first phase (‘addressing the outbreak’), with scientific cooperation and an uncoordinated response to the outbreak; the second phase (‘responding and containing’), with a scaling up of testing, but also competition for scarce equipment and slow development of tests; the third ‘protecting’ phase, with the exceptional development of new vaccines but also rival vaccine diplomacy; and the final ‘exit’ phase, with ramping up of vaccine distribution, but also a glaring failure to vaccinate poor countries.

In the evolution of global governance arrangements in different policy areas, six ingredients have been important, and two were clearly present in public health: joint identification of the problem, and shared expertise, as demonstrated especially in the scientific and institutional response. This was much less the case with two others: common action principles, and transparent reporting mechanisms. Finally, there have been significant problems with the last two ingredients: there is no accepted outcome-evaluation process to assess results and adapt instruments, while trust issues continue to hamper the work of the World Health Organisation.

The decision to work towards a new pandemic treaty should be assessed against the reform agenda of global health security governance. Four proposals can be made. The WHO should be turned it into a strong and independent standard-setting and surveillance authority for preparedness, prevention, and response, while existing institutions and initiatives should be streamlined and consolidated to better provide essential medical supplies globally.

Meanwhile, a G20-type body should be established to provide leadership and ensure a whole-of-government approach that repositions global health governance in the world order and puts it on par with economic interdependence or financial stability in terms of governance, institutional backing and resources. Adequate funding should be provided through a self-standing fund to address the shortfalls COVID-19 has revealed in preparedness of national health systems, detection and containment, and shortages and misallocations of critical medical supplies.

Recommended citation
Bucher, A., G. Papaconstantinou and J. Pisani-Ferry (2022) ‘The failure of global public health governance: a forensic analysis', Policy Contribution 03/2022, Bruegel

About the authors

  • Jean Pisani-Ferry

    Jean Pisani-Ferry holds the Tommaso Padoa Schioppa chair of the European University Institute. He is a Senior Fellow at Bruegel, the European think tank, and a Non-Resident Senior Fellow at the Peterson Institute (Washington DC). He is also a professor of economics with Sciences Po (Paris).

    He sits on the supervisory board of the French Caisse des Dépôts and serves as non-executive chair of I4CE, the French institute for climate economics.

    Pisani-Ferry served from 2013 to 2016 as Commissioner-General of France Stratégie, the ideas lab of the French government. In 2017, he contributed to Emmanuel Macron’s presidential bid as the Director of programme and ideas of his campaign. He was from 2005 to 2013 the Founding Director of Bruegel, the Brussels-based economic think tank that he had contributed to create. Beforehand, he was Executive President of the French PM’s Council of Economic Analysis (2001-2002), Senior Economic Adviser to the French Minister of Finance (1997-2000), and Director of CEPII, the French institute for international economics (1992-1997).

    Pisani-Ferry has taught at University Paris-Dauphine, École Polytechnique, École Centrale and the Free University of Brussels. His publications include numerous books and articles on economic policy and European policy issues. He has also been an active contributor to public debates with regular columns in Le Monde and for Project Syndicate.

  • Anne Bucher

    Anne Bucher was Director-General in the European Commission until October 2020, first as the Chair of the Regulatory Scrutiny Board since 2016 and as a Director General for Health and Food Safety. Having joined the Commission in 1983, Anne Bucher held a number of senior management positions and worked in various fields of European policies: macroeconomic forecast and models, governance of the eurozone and structural reforms; digital economy;  EU tax policy;  Structural funds, research funding, evaluation of employment policies, enlargement and development aid.

  • George Papaconstantinou

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