Paths to Global Health: The World Health Organization's Role in Confronting COVID - 19 Challenges
Kevin Ramadhani Dinamika Universitas Brawijaya
INTRODUCTION
In December 2019, there were reports of several people having pneumonia symptoms of unknown cause which were epidemiologically related to the wet market in Wuhan, China (Na Zhu, 2020). The interaction between humans and animals, one of which occurs through the consumption of food derived from wild animals such as pangolins, encourages the spread of infectious diseases from animals to humans or also known as zoonotic . Diseases that arise from interactions between animals and humans allow viruses to mutate quickly and can create a new types of viruses. The cause of the newly discovered pneumonia symptoms is the novel coronavirus (SARS-CoV-2 or nCoV-2) through a surveillance mechanism for " pneumonia for unknown etiology " which was previously used to handle the outbreak of SARS back in 2003. The virus that causes COVID-19 is one of the viral strains or genetic variations of the Coronavirus family (Di Wu, 2020). However, even though the cause of the disease has been determined, the lack of dexterity in dealing with COVID-19 has made this disease a pandemic. This is driven by mutations that occur so that the coronavirus in COVID-19 is different from the cause of SARS and MERS.
On March 11, 2020 WHO determined that COVID-19 could be categorized as a pandemic. The determination has gone through several stages and assessments seen from the level of spread and the impact of the damage caused plus the world's unpreparedness in dealing with the pandemic. WHO as a world health organization has also issued recommendations for countries exposed to the disease to take preventive measures in the form of quarantine such as lock down and/or social distancing to prevent the spread of the virus. Information updates about COVID-19 are also continuously reported by WHO as a form of global coordination in dealing with the pandemic. Each country also provides data updates related to COVID-19 from the number of victims, the number of cases found, patients recovering and various related information.
[corresponding author: [email protected]]
ABSTRACT
This study aims to analyze the role played by WHO as a world health institution in overcoming the COVID-19 pandemic. Using the concept of Global Health Governance and Reordering Health to Health Security from Annmarie Bindenagel ehović, this study wants to see changes in the arrangement of health as a vital aspect and agreed by all countries. The findings in this study showing that WHO has made significant changes to the global health order aspects in stages as seen from the way WHO has handled pandemics and epidemics that occurred before COVID-19. However, from the research there is founding that WHO's siding with one country, which is an obstacle according to other countries.
Keywords:COVID – 19, Pandemic, WHO, China, Global Health Governance
Coordination and communication between countries and WHO are important in dealing with this universal problem. In order to deal with the COVID-19 pandemic, WHO and countries cooperate with each other in providing information and also following up on readiness to deal with the disease. The existence of information from the beginning of the detection of new diseases and forming a timeline for the COVID-19 pandemic is basic information that can be provided to the public. China as the first country to detect the presence of a new virus that causes the disease to inform the WHO-related outbreaks that occur (WHO, 2020). From the news, WHO and China also coordinated by providing information updates, responses from public health and also suggestions from WHO to take action and control the disease.
Actions that have been taken by WHO since the beginning of 2020 have provided impetus for the implementation of Global Health Governance . The emergence of Global Health Governance is a development of Global Governance . The purpose of the formation of a governance itself is to unite various parties who work together to achieve the goal, namely to be able to inhibit the pandemic that occurs. The concept of Global Governance continues to develop and has derivatives that are more detailed and focused as is felt by the world today, namely the issue of health problems so that it is called Global Health Governance . WHO as a world health organization is taking action to collect, conduct research and also broadcast information related to the COVID-19 pandemic. Actions taken such as direct visits to Wuhan, China to conduct further research are actions to be able to collect and broadcast information. The role of WHO as a focal point in Global Health Governance is to be able to bring together not only state governments to make information transparent, but also groups of experts in health to be able to work together in dealing with the COVID-19 pandemic. And also the goal of WHO as the core of Global Health Governance is to reduce state domination by encouraging groups that are experts in addressing health issues.
With this study, the author tries to analyze the role of WHO as a world health institution in overcoming the COVID-19 pandemic by analyzing WHO's activities and responses in handling the pandemic using the concept of Global Health Governance. In addition, the author will see how the steps taken by WHO are analyzed using the concept of Reordering Health to Health Security. With this research, it is hoped that it can explain the activities carried out by WHO as a response to the handling of the COVID-19 pandemic.
CONCEPTUAL FRAMEWORK
In this study, the author uses two concepts. First, the concept of Global Health Governance initiated by Kelley Lee and Adam Kamradt-Scott, and the second concept initiated by Annmarie B. ehović called Reordering Health to Health Security was used by the author as a tool in analyzing the role of WHO in dealing with the COVID-19 pandemic in year 2019-2020. The concept of Global Health Governance requires the existence of norms or regulations within the framework of cooperation or institutions to ensure the implementation and achievement of the objectives of Global Health Governance.
Then in the concept of Reordering Health to Health Security , the first variable, namely Conceptual Health Response, has two indicators, namely The Role of Professional/Specialist Language and The Role of Trust and Distrust . In the first indicator, the role of professional/specialist
language, the author wants to find out how the role of professional language has an important role because the use of language contains knowledge and can also explain the causes of certain phenomena such as the COVID-19 pandemic. The operationalization of this indicator is by looking at how the naming of the virus that causes the pandemic is determined, namely COVID-19 which was previously named SARS-CoV-2 or nCoV-2 by WHO. This virus planting aims to avoid inaccurate explanations and contains ambiguity with similar viruses but different strains . The second indicator, namely the role of trust and distrust, sees that response actions related to health threats can be carried out by having accurate information. This information is obtained by identifying threats, communicating and assessing to take appropriate action to prevent the spread of health threats (Annmarie, 2017). The operationalization of this indicator examines how accurate information related to the COVID-19 pandemic is broadcast and also the process of gathering information that requires mutual trust between the parties that doing identification, policy makers and the general public. Communication is also carried out through appeals and knowledge related to how to prevent, detect the spread and control of COVID-19 to the community and also the state.
The second variable from the concept of Reordering Health to Health Security is Philosophical Health Response which looks back at how health is a right for each individual. This variable has an indicator of Redefinition of Health and Securing Health . This indicator looks at how the health aspect is actually a right for each individual, but in practice to be able to ensure the right to health still depends on the commitment, ability and coordination of each country (Annmarie, 2017). The operationalization of this variable is how rights to health are the main thing in the health aspect. WHO also reiterated that fulfilling the right to health is a priority for countries, especially in dealing with the COVID-19 pandemic.
The third variable is the Allocation of Responsibility which explains the importance of the relationship between the state and citizens' health responsibilities and rights. The allocation of responsibilities is also carried out in the form of interventions in the field of public health and also limits on the role of non-state actors and also limits on the rights of individuals in the category of non-citizens. The operationalization of this variable sees the need for an intervention action through international institutions, one of which is carried out by WHO by forming a task force to gather information and help deal with the COVID-19 pandemic.
From the two concepts that have been described, an understanding can be drawn that in creating and implementing a Global Health Governance , awareness and commitment to the health sector are needed from global actors. In building awareness and commitment from global actors, it is necessary to rearrange the level of understanding and implementation related to the health sector. According to Annmarie, restructuring in the health sector is carried out in three aspects, namely the conceptual dimension, this section discusses how health is viewed and categorized as a risk or threat. The second is restructuring on the philosophical dimension, in this case focusing more on the right to regulate health or also in intervening for health reasons. The third is restructuring on the practical dimension, which focuses on the division of tasks in responsibilities and also the
need for intervention in dealing with problems related to the health sector (Annmarie, 2017).
Image 1. Conceptual Operation
From the chart above, we understand that the concept of Global Health Governance is related to the concept of Reordering Health to Health Security, by seeing that Global Health Governance will be implemented properly if there is understanding and commitment from global actors through Reordering Health. The process of Reordering Health To Health Security requires reordering on three dimensions, namely conceptual, philosophical and allocation of responsibilities. This rearrangement can help build understanding and commitment in implementing Global Health Governance through the WHO institution as an important actor and having regulations, norms and directions to ensure the achievement of the goals of Global Health Governance.
Table 1. Conceptual Operation
Then, to be able to take a deeper look at the variables in the Reordering Health to Health Security concept, it can be seen in the table above. In this concept, each variable has indicators that can explain the relationship of the three variables in the Reordering Health to Health Security concept . On the conceptual dimension, it is necessary to use specialist/professional language in discussing the health sector. The use of professional language can contain accurate and credible information. the aspect of credible and accurate information helps to form 'trust' in the information obtained. Then the philosophical dimension sees the need for a redefinition of the right to health. The redefinition can be carried out if global actors have accurate knowledge and information related to the health sector. So that the right to health can be exercised at the international to national level. In the dimension of the allocation of responsibilities, it aims to be able to make the health sector available to each individual. Accurate information, a sense of 'mutual trust' from each actor as well as a clear definition of the health sector and its rights to be able to take intervention actions aimed at ensuring the right to health can be made available to each individual.
RESULT AND DISCUSSION
With the spread of the COVID-19 pandemic, as a first step, WHO produced an investigative protocol that aims to collect information and knowledge related to distribution patterns, risks due to transmission, immune immunity and several other causative factors (WHO, 2019). To find the answer of the unknown COVID-19, WHO formed a joint step to make it easier for state actors to deal with the spread of COVID-19 with various conditions of their resources. With the Early Investigation Protocol from WHO, countries can take action, especially in supervising the early spread of COVID-19 at the country level. WHO in collaboration with several parties has formed 6 protocols that can be used and adapted at the country level as a form of policy in monitoring the spread of COVID-19.
The protocol is based on the population that is the object of investigation by WHO. The first protocol was made based on the distribution of the virus in the general population by age classification. The second protocol from WHO is based on First Few X cases or contact transmission or people who were first exposed to a population, so that transmission patterns can be found and also the narrowing of the object of investigation from COVID-19 victims. The third protocol is based on more specific matters, which is seen from the transmission of COVID-19 through close contact on a household scale. The fourth protocol from the Early Investigation Protocol is to look at the spread of COVID-19 in groups of medical workers. The fifth protocol is based on the spread of COVID-19 in school groups or scientific institutions and the last protocol is seen from the impact of the spread of COVID-19 on the environment by looking at contamination on environmental surfaces.
In addition to the Early Investigation Protocol which was made to become a policy recommendation at the country level, WHO also continues to conduct research related to COVID-19. One of the documents published on the WHO website on January 17, 2020 contains provisional findings related to the process of detecting COVID-19 through tests. WHO and health experts who were involved in the study stated that to be able to detect COVID-19, a Polymerase Chain Reaction (PCR) test was needed . The document with the title Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases has the aim of providing temporary recommendations for laboratories and parties involved in laboratory tests to be able to detect COVID-19 through a test mechanism on patients (WHO, 2019). WHO also emphasized the importance of data disclosure so that countries that do not have adequate facilities can send samples to laboratories that have specifically researched COVID-19 with mediation from WHO. Not only doing research related to the outbreak that occurred, WHO also gave a warning signal to the world that COVID-19 is a common threat. On January 30, WHO declared a Public Health Emergency of International Concern(Xingguang Li, 2020). The warning is based on the characteristics of the virus that is easy to spread quickly and widely (WHO, 2020). There needs to be international coordination to be able to deal with health threats on an international scale. Although the PHEIC declaration was considered too late by many parties and became a criticism for WHO in dealing with COVID-19 (Emily, 2020).
China's failure to control the disease within its borders to spread to several countries and the WHO's belated pandemic warning were the biggest factors in the widespread spread of COVID-19. The WHO just decided on March 11, 2020 that COVID-19 was categorized as a pandemic. This indicates the stage of handling during the pandemic. WHO as a world health institution provides recommendations for all member countries. This recommendation with the aim of inhibiting the spread and transmission of the COVID-19 virus explains the importance of hand hygiene and the availability of hygiene facilities that should be pinned at every entry or exit point in public places. In the Recommendations to Member States document to improve hand hygiene practices to help prevent the transmission of the COVID-19 virus , WHO also mentions state health authorities to assist in inhibiting the transmission of COVID-19 by providing hygiene facilities as mandatory. So that people can have access to health facilities, especially hand hygiene.
A review was also carried out by WHO on the Strategic Response and Preparedness Plan (SPRP) issued on February 3, 2020 (WHO, 2020). This document contains the preparedness plans and response actions in dealing with COVID-19 runs from February 1 to June 30, 2020. There have been at least 3 impacts that have been felt globally since the emergence of COVID-19 until it became a pandemic, namely the rapid and widespread spread of the COVID-19 virus. 19, the number of victims of COVID-19 is in a severe condition and also the emergence of disturbances in social and economic aspects. The purpose of the establishment of the SPRP is to increase international cooperation and support, increase preparedness and response actions at the country level, and lastly, increase developments in research and innovation. With the occurrence of the COVID-19 pandemic with an impact that is felt globally, it is necessary to have a health management that can ensure cooperation to deal with global problems such as a pandemic.
The actions taken by WHO in dealing with the COVID-19 pandemic are through research that produces vaccines. Developing vaccines serves to reduce the replication of disease-causing viruses (Annmarie, 2017). Since August 2020, vaccine research and development has begun. And in December 2020, the vaccine that has been tested has begun to be circulated (John, 2020). The actions taken by WHO in coordinating these international actors yielded quick results. This can be seen from the rapid development and circulation of vaccines. WHO, in collaboration with GAVI and CAPI, also launched COVAX, a collaborative framework to ensure vaccine development and even vaccine distribution (Berkley, 2020).
The role of WHO as an actor in Global Health Governance
With its capabilities, WHO has a role as an actor of Global Health Governance and invites other actors such as countries to be open to each other and work together to be able to resolve the COVID-19 pandemic which has become a common problem. Apart from member countries, WHO also cooperates with other international organizations such as the United Nations, United Nations World Food Program (WFP), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), International Federation of Red Cross (IFRC), regional organizations such as ASEAN , African Union , European Union, to several international financial organizations including the World Bank and IMF (WHO, 2020).
International cooperation is believed by WHO to be important in dealing with the crisis. Coordination at the international level aims to support response actions from countries in dealing with COVID-19, support is provided from the beginning of planning to the stage of policy implementation. In addition, international coordination is needed to create transparency in the process of formulating policy recommendations for response actions, distribution of aid as well as real-time data from countries regarding the number of cases and victims. With the transparency of data, especially regarding the number of cases and also the capability of the country, it will make it easier for WHO as an important actor in Global Health Governance to provide equitable assistance.
The spread of the COVID-19 virus is the cause of the actions and policies that have been carried out by both the Chinese government and affected countries as well as the WHO as a world health institution. The emergence of COVID-19 to become a pandemic requires global attention. Problems that have a massive impact on a global scale such as a pandemic require global solidarity. International cooperation carried out by state governments and international organizations such as WHO aims to solve common problems by putting aside differences that arise from state interests (Slavoj, 2020).
In this chapter, the author will analyze the role of WHO as an important actor of Global Health Governance as a form of response from the emergence of the COVID-19 virus in China to becoming a pandemic. In addition, China's efforts to cooperate with the WHO are an important meeting point. This is the first step for WHO in building an idea of global solidarity in the face of an extraordinary problem, namely the COVID-19 pandemic. Problems related to health have made WHO as a world health institution an important actor in the formation of Global Health Governance by seeing the pandemic as a severe condition that encourages WHO and other actors to cooperate in dealing with pandemics with limited and unequal resources (Kelley, 2014). To be able to carry out its
role in Global Health Governance , WHO needs to educate all actors, especially state governments to make changes to the health order.
The concept from Annmarie Bindenagel ehović, Reordering Health to Health Security explains the importance of making changes to the health order in the face of increasingly complex health problems such as the current COVID-19 pandemic. In this concept, there are three variables that explain the importance of reforming the health system, including Conceptual Health Response , Philosophical Health Response and Allocation of Responsibility . In accordance with the operationalization of the concept described in Chapter II, there is a correlation between Global Health Governance and Reordering Health to Health Security , where Reordering Health to Health Security is important in building awareness and commitment from global actors so that a governance can be created in health sector on a global scale.
Conceptual Health Response
To be able to deal with the rapid and widespread spread of COVID-19, cooperation at the global level is needed (Slavoj, 2020). Cooperation at the global level is needed to be able to reduce differences both in terms of knowledge and resources. Trimming the difference in knowledge has a very important role. Differences in knowledge create differences in taking action in response to a phenomenon. Each country certainly has different capabilities, especially in science, so there are different actions taken by countries in dealing with COVID-19 which is a common threat. WHO as a world health institution plays an important role in creating global solidarity in the face of COVID-19. One of WHO's actions in reducing scientific differences is to conduct research directly. In addition, WHO continues to provide updates on research related to the COVID-19 virus which is disseminated through the WHO website and can be accessed by all parties.
The purpose of direct research conducted by WHO through the Early Investigation Protocol is to increase knowledge about the COVID-19 virus (WHO, 2020). An understanding of the pattern of spread, the level of risk to deep knowledge related to the virus is important in dealing with a pandemic. The Early Investigation Protocol carried out by WHO also encourages all global actors, especially countries, to increase knowledge, deal with and also identify COVID-19 through available data. That way the country can improve the quality of public health in the face of a pandemic.
In an effort to build global awareness, in-depth knowledge is useful to be useful for WHO to explain and disseminate information to the world community with different backgrounds and levels of knowledge. So that the information and data distributed by WHO can be widely understood and can also increase global awareness of the common threat, namely the COVID-19 pandemic. Conceptual Health Response relates to the use of professional language from the information disseminated by WHO and will also play a role in creating trust in global actors.
a. The Role of Professional/Specialist Language
Facing a common threat such as a pandemic, it is important to take collective action as well. The first step in taking action is to identify the cause first. The COVID-19 virus,
which first appeared in China, became the starting point for a threat whose source and cause of transmission were not yet known for certain. To be able to catch up in terms of knowledge, WHO as a world institution together with medical experts and state actors has conducted research since the beginning of the COVID-19 outbreak . Research conducted from an early age was carried out to increase understanding and information related to the virus that causes the pandemic.
Knowledge gained from research and expressed through the use of vocabulary and medical terms plays an important role in helping to see and assess a health threat and health risk. The role of professional language or medical terms also contains a detailed explanation of a disease. That way the information contained in these terms can be understood by the world community.
Documents issued by WHO related to COVID-19 such as Laboratory testing for the 2019 novel coronavirus (2019-nCoV) in suspected human cases as an example. The document explains that the causes of a series of lung diseases that occurred in Wuhan have similarities to the causes of SARS and MERS. Through a series of studies, the virus that causes lung disease comes from the coronavirus . And to break the confusion between SARS and MERS, the virus that emerged in Wuhan, China is referred to as 2019-nCoV which indicates the year of appearance was at the end of 2019 and the cause of the disease came from a virus of the novel coronavirus family.
The cause of the pandemic, previously called SARS-CoV-2 or 2019-nCoV, has been changed to COVID-19. The naming of the virus is intended to be easy to pronounce and related to the derivative of the virus that causes the disease. The Director General of WHO, Tedros Adhanom Ghebreyesus, said that the importance of choosing a name was to avoid inaccurate designations or names as well as certain stigmas. In addition, with an accurate naming, it will help the process of solving other disease outbreaks caused by the coronavirus.
The role of language professionals or specialists is not only contained in the vocabulary used, a statement also has an important role in explaining the existence of a threat. Since the initial notification from China regarding a series of lung diseases, WHO declared COVID-19 as a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 (Xingguang Li, 2020). The Director General of WHO together with the Emergency Committee of the International Health Regulation (IHR) agreed to declare a PHEIC by looking at the total number of confirmed COVID-19 cases as many as 7818. The PHEIC declaration carried out by WHO aims to warn the international community of the dangers that can spread worldwide and need to be the existence of an international cooperation to overcome these threats.
The application of professional or specialist language helps in providing explanations that are more general and acceptable to all circles. In this way, the commitment and awareness of all global actors with various backgrounds will be formed by understanding the condition of an existing threat and assisting the implementation of global health governance.
b. The Role of Trust and Distrust
Facing a new, unknown threat creates fear. Ongoing research related to the causes of the pandemic is needed to make it easier to formulate response actions in dealing with threats. In addition, with accurate knowledge and information, it will be easier to conduct education, so that trust is built between actors.
WHO encourages the implementation of global health governance by increasing awareness and commitment of global actors in dealing with health threats together. Trust can also be increased by using professional language that serves to explain the existence of a threat to the world community (Annmarie, 2017). WHO builds trust from the world community by declaring the outbreak in China to be a common threat through the PHEIC declaration. By building trust from global actors, it will help to increase awareness and commitment of global actors to the importance of health aspects and protect them from threats through global health governance.
The COVID-19 pandemic, which has yet to be resolved, is colored by the diversity of information that can make it difficult for the public to filter valid information. The circulation of large amounts of information, some of which are invalid, can reduce the trust of the world community. The decrease in trust will also have an impact on the awareness and commitment of global actors to the importance of health aspects. Since the beginning of the COVID-19 outbreak until now, a lot of information has been circulating and is easily accessible. There needs to be a processing center and media that broadcast reliable information. To broadcast valid information, WHO launched the WHO Information Network for Epidemics (EPI-WIN). WHO also engages the community to be able to disseminate filtered information in order to restore public confidence from the abundance of information that is not necessarily true.
Although WHO has processed various information through EPI-WIN and also countries such as Indonesia, which through the COVID-19 task force website have a hoax busters mechanism to counteract deviant information, in fact this is less helpful in increasing the trust of citizens. Since the beginning of the spread of COVID-19 outside China, the Indonesian government stated that COVID-19 did not enter Indonesia (Mardika, 2020) . This statement is supported by the reason that COVID-19 is not strong enough to survive in Indonesia's hot weather, however, people must start to be careful by starting to keep their distance. The Indonesian government is trying to convince citizens not to panic.
The statement by the Indonesian government, which is still at the prediction stage, has caught its eye in the absence of serious preparations from Indonesia in dealing with the pandemic (Slavoj, 2020). In addition to statements from the Indonesian government, the public also always gets information regarding the rapid increase in the number of COVID-19 victims in several countries. In fact, to be able to take action to deal with a pandemic requires accurate information and trust between policy makers and citizens (Annmarie, 2017). f the information circulating cannot be trusted and the public increasingly distrusts the government, it will be difficult to take serious action to deal with threats.
The president of the United States, Donald Trump, has also taken a similar action. Since January, President Trump has been getting a warning from his economic adviser, Peter Navarro. The warnings were heeded and President Trump also downplayed
the threat from COVID-19. Even President Trump blamed China for his country's inability to control the virus and accused the WHO of siding with China (Donald, 2020). President Trump has also taken no clear action regarding the threat of COVID-19 and appears to be dismissive. In fact, America is the country most affected by COVID-19. Several state governments have also expressed criticism of the WHO's performance, which is considered unable to control this pandemic. Australia through its prime minister wants a transparent review related to the early emergence of COVID-19 (Jenny, 2020). Japan also considered the WHO too sided with China. Not only that, WHO was also criticized for trying to cover up the COVID-19 outbreak that occurred in Wuhan and the WHO Director General's slow decision in announcing a Global Health Emergency (Javier, 2020). This of course has an impact on the country's readiness to face the pandemic.
Although the WHO's performance in providing information and resources to countries is considered good, the WHO is less firm in taking some actions (Bayram, 2020).
In addition to being less assertive, WHO has also issued statements that contradict and are considered misleading. The recommendation to use masks as an example, in April the WHO Secretary General stated that masks were only used for sick people and health workers. But in the following month there was an update that each individual was also required to wear a mask. This of course made the trust of WHO member countries decrease and questioned the WHO's performance in overcoming the COVID-19 pandemic.
Several member states agreed with President Trump's criticism of the WHO for trusting China too much. WHO instead showered the Chinese government with praise regarding the disclosure of data on the spread of COVID-19 without further verification (Emily, 2020). In early January, WHO received and used data from China without verification, which resulted in a delay in responding to the pandemic. As an example, China announced the findings of the pattern of spread between humans on January 20, where the number of victims soared in Wuhan and has spread to several countries. Whereas in the International Health Regulations agreement WHO has the ability to go beyond state sovereignty for data disclosure related to the emergence of diseases and their handling. In addition to being given the authority to coerce states, WHO also has the right to consider information from non-state actors with the aim of reducing the occurrence of hiding data (David, 2020).
The events described above pose challenges in dealing with the COVID-19 pandemic. Citizens who do not receive accurate and transparent information and the government's efforts to control panic through restricting information actually backfire. Trust can be built from awareness of threats and accurate information. Efforts are needed to build public trust in the state government so as to produce optimal response actions and policies. WHO also needs to take back the trust of member countries regarding the response to the pandemic so that coordination of response actions can be carried out accurately and efficiently.
Philosophical Healh Response
In the concept of Reordering Health to Health Security , Philosophical health response emphasizes on reforming the understanding of the right to health. In fact, the right
to health depends on international agreements and each country fulfills this right based on the country's capabilities and available resources. And to be able to increase the ability to fulfill the right to health, again, it depends on how the state coordinates. This of course creates a gap in the understanding of the right to health which is reflected in the capabilities and resources.
WHO as a world health institution calls for increasing awareness and commitment to member countries and other parties on the importance of health aspects. The current world conditions are starting to change due to the pandemic, making all global actors in the same condition, so it is important to improve global coordination (Slavoj, 2020). This redefinition of the right to health has an important role in building awareness and commitment from global actors, so that pandemics can be overcome together. In addition, the commitment and awareness of global actors on health will help implement Global Health Governance.
To be able to make changes in the health sector, we should know that the right to health in the WHO constitution in 1946 became an important foundation for the health sector. The right to health is the most important thing that becomes the identity of WHO (Tedros, 2017). The preamble of the WHO constitution states that health is a fundamental aspect that can be met with full coordination between individuals and countries. Capabilities, commitments and cooperation between countries also play an important role in improving world health (Annmarie, 2017). The COVID-19 pandemic that has occurred has also encouraged cooperation between actors, not only state but also non-state actors to be able to deal with COVID-19 together. In this way the awareness and commitment of global actors will be formed which will then help the implementation of global health governance.
As an important actor in global health governance , WHO plays a role in helping to make cooperation at the global level successful, to ensure that health is accessible to all individuals without exception (Tedros, 2017). Ensuring the health of individuals is the responsibility of the state government, but in reality the fulfillment of the right to health is interpreted differently based on the capabilities and resources of each country. Seeing the imbalance in the country's resources and capabilities in dealing with the COVID-19 pandemic, WHO also continues to call for and participate in global cooperation. Through the WHO COVID-19 preparedness and response progress report , it describes the actions that have been taken to deal with COVID-19 from February to 30 June. Increasing international support and cooperation is an important thing that WHO emphasizes in dealing with the pandemic. In addition, increasing knowledge through research as well as ease and disclosure of information are important in dealing with the pandemic. One of the forms is the preparation of Operational Planning Guidelines to support the development of COVID-19 National Plans by WHO which aims to help provide guidelines that can be used by state governments in formulating policies related to COVID-19 on a national scale.
In order to increase international cooperation and support, WHO also launched the COVID-19 Partners Platform, which is said to be a tool to improve governance. The COVID-19 virus, which has the ability to spread quickly and on a wide scale, is one of the biggest threats. The partnership platform launched by WHO in collaboration with state
governments, United Nations Country Teams and health experts to be able to exchange information and provide real-time support in dealing with the COVID-19 pandemic. Indirectly, this real-time collaboration also helps the state government in fulfilling the right to health. The COVID-19 pandemic that has spread to all parts of the world has awakened the WHO and other global actors to take more action. Various new forms of cooperation were carried out to overcome the pandemic together. WHO not only cooperates with health experts, state governments as well as international and regional organizations, WHO also forms cooperation with the World Bank , IMF and various other multilateral financial institutions. This collaboration aims to help countries, especially developing countries, in allocating funds and operations to take action in response to COVID-19. So that the formed cooperation can increase awareness and commitment of global actors to the importance of health aspects.
In terms of fulfilling the right to health, in practice it is faced with an obstacle. The state's ability to provide support related to health is a big problem in fulfilling the right to health. To be able to overcome these differences in capabilities, WHO provides online training through the OpenWHO platform with the aim of increasing the response to health threats. Through OpenWHO, scientific information can be accessed for free and special training has been provided to respond to COVID-19. In addition, several countries, especially in the African region, lack medical experts, which makes the handling of COVID-19 less than optimal. To be able to handle these problems, WHO has collaborated with Emergency Medical Teams (EMTs) consisting of health experts (WHO, 2020). By the end of June, 66 EMTs had been deployed to various countries. In addition to providing support in the form of guidance and coordination, EMTs are also deployed to operate on a national scale, especially in Africa such as Ghana, South Africa, Senegal, Zambia, Cameroon, Republic of the Congo and several other African countries. In addition, many EMTs were also deployed to European countries.
The cooperation carried out by WHO with world financial institutions such as the World Banks , IMF and regional financial institutions can also assist countries in increasing their country's capabilities in dealing with the pandemic. The impact of the economic downturn due to the COVID-19 pandemic has also become a driving force for world and regional financial institutions to take part in dealing with the pandemic. The economic program of the Center for Strategic and International Studies (CSIS) has monitored the performance of world and regional financial institutions during the pandemic, both from approvals, commitments and disbursement (Stephanie, 2020). From the data collected by CSIS, International Financial Institutions (IFIs) and Regional Financing Arrangements (RFA) approved loan assistance of 182.8 billion dollars to fund efforts related to COVID-19 and of this figure, 124.2 billion dollars has been disbursed. This assistance is useful to support developing countries in increasing the country's capabilities in dealing with the pandemic.
In addition to the challenges in terms of state capabilities, the state's interpretation of the obligation to provide and guarantee public health is only limited to fulfilling citizens' needs is also a challenge in dealing with the pandemic. With high migration flows, individuals who are not citizens are not guaranteed the right to health outside the territory of their original country (Annmarie, 2017). This will certainly create new challenges and make it more difficult to control the spread of disease or face a pandemic. The Office of the
High Commissioner for Human Rights (OHCHR) also stated that non-citizens often face unnecessary lengthy bureaucracy just to access health facilities.
There is a need for swift and decisive action in the face of the COVID-19 pandemic. Harmonious cooperation between WHO, state governments and other actors will make it easier to deal with health problems such as a pandemic. However, WHO is hampered by limits on power over each country, so that response actions to the pandemic are less than optimal (Javier, 2020). In the preamble to the 1946 WHO Constitution, it was stated that the state government was responsible for the health aspects of its citizens. This implies that the state government has the power and freedom to carry out responsibilities for the health aspects of its citizens.
The state government guarantees the health of the people of its country in accordance with the capabilities of the country itself. Since December, COVID-19 has been in Wuhan, China. However, the WHO only acted after the report from the Chinese side. This can then be seen as one of the weaknesses if WHO cannot act beyond state power. WHO as a 'leader' in global health needs to be able to intervene on health-related problems (Lawrence, 2015). Thus, the emergence of a disease can be responded quickly and precisely. Awareness of the importance of health aspects also needs to be enforced through binding norms. But in fact the WHO in dealing with the COVID-19 pandemic actually uses a more 'subtle' approach through a recommendation or guideline. Incidents like COVID-19 should be dealt with firmly. WHO in its constitution also binds all member countries to cooperate to ensure individual health. Even though the constitution was signed by member countries, there has not been any firmness in carrying out the health aspects.
Several countries have also criticized the WHO's performance in dealing with the COVID-19 pandemic. One of the criticisms from Australia is that it wants a transparent review of the beginning of the pandemic (Jenny, 2020). In addition, President Trump also said that the WHO trusted China too much. And even member countries also have ideas to reform the WHO. If we look deeper, WHO is hampered by its poor governance, such as institutional structure, transparency, accountability, management and funding (Lawrence, 2015). The magnitude of the influence of the state in the WHO makes this institution less than optimal and is even seen as under the state as a provider of assistance. WHO needs to have higher authority than the state to ensure the health of each individual and to implement global health governance . For this reason, it is necessary to take an action in allocating responsibilities, especially in the face of the COVID-19 pandemic which is easily transmitted with a wide scale of virus spread.
Allocation of Responsibility
Apart from aiming to ensure that health is available to all individuals, WHO also plays a role in leading and coordinating international health matters. Collaborating with state governments, the United Nations, international organizations, researchers and academics to assist WHO in implementing global health governance through international coordination. In addition, cooperation with various parties will assist in the allocation of responsibilities in dealing with a health threat.
Dalam konstitusi WHO pada tahun 1946, dikatakan bahwa pemenuhan hak akan In the WHO constitution in 1946, it was stated that fulfilling the right to health and ensuring access to health were the responsibility of state governments. The fulfillment of the right to health by the state government can be carried out if the state can provide certain steps in dealing with health threats. However, judging from the implementation, each country has a different application according to their ability to fulfill the right to health. That way, intervention can be carried out by WHO if the country has not been able to provide qualified health facilities for its citizens, especially in the face of a pandemic.
The response action was taken by WHO when it received a report from Wuhan, China regarding the emergence of respiratory diseases on January 1, 2020. WHO sent representatives to investigate further regarding the emergence of the disease in the city of Wuhan. Research continues to be carried out by WHO together with health experts and countries to be able to provide the latest information and data related to COVID-19. The latest data regarding the number of cases and victims sent by member countries must also be validated and checked by WHO so that the data can be made available in a timely and accurate manner. With this mechanism, the data becomes centralized and the accuracy of the information contained is guaranteed.
Facing the COVID-19 pandemic requires quick and appropriate action. To be able to ensure that appropriate response actions are taken, WHO also provides a laboratory that functions to detect cases and take preventive measures such as the implementation of isolation. In order to ensure that states can fulfill and carry out health rights including actions related to health threats, WHO works hard to be able to provide laboratories for all WHO member countries with the aim that member countries can identify viruses quickly and accurately, especially for countries that do not yet have health facilities. WHO's actions in handling the pandemic are considered slow because WHO cannot force countries to share information related to the pandemic (Tulip, 2020). This information is only obtained if the country reports the occurrence of the disease, so that response action becomes too late. The WHO response action when the outbreak appeared in Wuhan was the right thing and was carried out as soon as possible after reporting from the Chinese side. However, China's actions have been in the spotlight because when they first emerged they did not immediately report to the WHO and resulted in a pandemic.
The form of implementation of the allocation of responsibilities is by looking at coordination at the national level. To be able to maintain public health, the state government needs to issue appropriate and fast policies. WHO as a world health institution always provides support. To be able to reach various regions, WHO through the WHO Regional Office provides training support and also assistance according to the circumstances of each region. One example is the establishment of the Incident Management Support Team (IMST) by the South-East Asia Region Office of WHO to improve coordination at the national level. The widespread and fast-spreading COVID-19 prompted the state government to immediately form a unit that focuses on dealing with COVID-19 on a national scale.
The Strategic Preparedness and Response Plan prepared by WHO aims to provide updates and support country policies in dealing with the COVID-19 pandemic. The
application of the guidelines into the country's response policies will increase the best support to countries and community groups affected by the virus. International coordination in dealing with the pandemic will run well if the country's readiness can be met. The state's readiness is seen from the rapid identification of the circulation of the virus, controlling cases affected by COVID-19, preventive measures through policies and supervision and also building awareness among citizens through fast and accurate communication and information.
The role of the state as the person responsible for fulfilling the right to health is tested when a pandemic occurs. In addition, business people and organizations are also affected by the pandemic. The appointment and formation of a unit at the national level devoted to dealing with the pandemic helps in optimizing the response actions taken. With the support of guidelines from WHO, response actions at the national level can be carried out quickly and in line with international coordination. In this way, awareness and commitment of global actors can be increased so that global health governance can be implemented properly.
Although WHO has given a good performance in efforts to support country capabilities through the assistance of medical equipment and performance in tracking the spread of COVID-19 by providing a lab, WHO has not fully intervened related to the early handling of COVID-19. Unlike the previous pandemic case, namely SARS, WHO acted more firmly on China regarding the SARS outbreak and issued a travel warning to areas affected by SARS (David, 2020). Even though the WHO's action had not yet received approval from member countries and at that time the International Health Regulations had not yet been formed. Seeing this incident, WHO then got the authority to be able to fight against state sovereignty in the interests of global health through the International Health Regulations . However, in dealing with the COVID-19 pandemic, WHO does not seem to have a big influence in being able to force China to overcome the outbreak that occurred through intervention measures and instead trusts the data provided by China without further research (Emily, 2020). The actions taken by WHO at the beginning of the spread of COVID-19 caused a lot of criticism regarding the actions that were not decisive and fast
CONCLUSION
Problems related to individual health are no less important than economics and politics. The emergence of the disease caused by the COVID-19 virus and spreading to various parts of the world is a slap in the face that the health aspect has so far received little attention. The sudden emergence of a new type of disease with a fast and easy transmission rate makes the world community in an unprepared state. In fact, if judging from history, the world has been attacked by several diseases that ended up as pandemics such as SARS and MERS. WHO as a world health institution is trying to tackle the COVID-19 outbreak . On-site research by sending a team has been carried out by WHO as a form of response action to the emergence of the disease. In collaboration with health experts, state governments and academics, WHO conducts various studies so that information on diseases such as causes, ways of spreading, and preventive measures can be known. That way data related to disease can be processed to be published to the world
community with the aim that the world community has an understanding of the threats that exist.
By seeing COVID-19 as a common problem and the need for response actions carried out through collaboration, this study seeks to determine the response actions taken by WHO from the emergence of the COVID-19 virus. As a leader who coordinates to ensure international health, WHO can be seen as an important actor in Global Health Governance . The concept of Reordering Health to Health Security initiated by Annmarie Bindenagel ehović is used as a measuring tool in building awareness and commitment of global actors to health aspects. So that it can be seen the role of WHO in dealing with the COVID-19 pandemic by implementing Global Health Governance . Conceptually, Reordering Health to Health Security emphasizes that health threats cannot be underestimated. There needs to be a restructuring of health-related policy making to be able to produce appropriate and fast response actions. The role of health experts which is still minimal needs to be reorganized so that the response to health is more optimal. In addition, by restructuring health-related policy making, it helps to ensure that public health can be met.
The actions that have been taken by WHO in an effort to deal with the pandemic are considered to be able to create a restructuring of policy making. The research contained in the issued document contains professional language that contains in-depth explanations regarding the disease. Updates to data and knowledge regarding the COVID-19 pandemic also foster public confidence and global actors in the threats perceived by WHO. In this way, the educational role carried out by WHO through data transparency and document distribution will encourage global actors to be able to coordinate in dealing with the pandemic.
Positioning COVID-19 as a common threat will also increase the role of the state in meeting public health. The obstacle that arises when the pandemic occurs is the rapid movement of people so that the fulfillment of public health is only limited to citizens. With international coordination and support provided by WHO, it is necessary to allocate responsibilities to support the fulfillment of public health without exception. The allocation of responsibilities helps in the success of health fulfillment through response actions and health-related policies. The establishment of a task force on a national scale supported by knowledge and resources from WHO and partners, aims to ensure that health fulfillment can be carried out quickly and precisely.
However, WHO as a world health institution cannot be separated from several notes or criticisms of its performance in overcoming the COVID-19 pandemic. At the beginning of the emergence of COVID-19, WHO only published data sent by China without going through a further verification stage. In accordance with the IHR, WHO has the authority to be able to trust data or information from non-state actors, but in the case of COVID-19, WHO is only waiting for a report from the Chinese government. WHO is considered less decisive in dealing with the COVID-19 pandemic, when compared to handling SARS. In fact, WHO gets more authority through the IHR amendments. The lack of firmness shown by WHO has an impact on delays in giving warnings through PHEIC and pandemic status and also has an impact on delays in handling.
From the explanation above, it can briefly describe the relationship between Global Health Governance and Reordering Health to Health Security as seen from WHO's actions in dealing with the COVID-19 pandemic, although at the beginning of the spread, WHO acted less firmly. The emergence of COVID-19 to become a pandemic is the cause of increased awareness and commitment of global actors. WHO plays an important role in coordinating response actions in the face of COVID-19. The role of WHO has described the implementation of Global Health Governance.
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