Lessons for the future from an effective and rights-based response to the COVID-19 pandemic

1The World Health Organization (WHO) developed a special tool for determining which diseases and pathogens to prioritise for research and development in public health emergency contexts in 2015. In 2018, “Disease X” was added to this list, representing the knowledge that a serious international epidemic could be caused by a pathogen at that time unknown to cause human disease.

2Following the Ebola epidemic of 2015-2016, the Parliamentary Assembly adopted Resolution 2114 (2016) on the handling of international public-health emergencies. In this resolution, the Assembly made a number of recommendations – which remain valid – to prepare the world better for the inevitable next international pandemic, urging new ways of working to face international health crises before they happen. The Assembly’s call unfortunately went largely unheeded.

3“Disease X” hit the world largely unprepared, in the form of COVID-19, provoked by a novel coronavirus: 2019-nCoV (also called SARS-CoV-2). First reported to the WHO Country Office in China on 31 December 2019, the outbreak was declared a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020. The virus spread to six continents, infecting millions and killing hundreds of thousands within months.

4Unfortunately, in the face of a rapidly spreading virus and stark mortality predictions, some States opted for nationalist isolation and repressive and authoritarian responses, instead of cool-headed and warm-hearted, evidence-based, internationally co-ordinated, human rights-compliant, effective action. Many States also seem to have realised the danger they were in too late (or had not wanted to realise the danger). Even at the European and international level, including at WHO, the impression of a tardy reaction is hard to ward off.

5The price of the initial inaction, subsequent slow response, overhasty measures and premature re-openings may well be paid in lives lost, as well as in possibly lasting damage to our political, democratic, social, financial and economic systems, and in the non-respect of several of the rights guaranteed by the European Convention on Human Rights and other Council of Europe legally binding instruments, as well as United Nations conventions, such as the Convention on the Rights of Persons with Disabilities. Public-health control measures for disease mitigation with human rights implications (such as quarantining, physical distancing, contact tracing, border controls and travel restrictions) must be based on relevant standards and on public trust to be effective: they need to be designed and implemented in a transparent, evidence- and rights-based manner, be de-politicised, nationally, regionally and internationally co-ordinated, communicated clearly and applied fairly, as outlined in Assembly Resolution 2114 (2016).

6Although the first peak of the pandemic seems to have passed in most European countries, the health crisis is not over – and may not be for some time yet. The lessons from the suffering of the past few months must be that, to avoid a disastrous outcome in terms of lives lost and burden of sickness, and equally disastrous knock-on effects on the economy and on human rights, we need to act fast to contain outbreaks, using tried and tested, effective measures, implemented in a rights-compliant way.

7The Assembly thus recommends that member States, during outbreaks of the coronavirus SARS-CoV-2 on their territory:

7.1take rapid and sustained action to reduce human contact through physical distancing, as far as possible on a voluntary basis, and – if necessary – rights-compliant shutdowns/lockdowns for the time it takes until active community spread of SARS-COV-2 is reduced to a level controllable through rigorous testing, data protection-compliant contact tracing, quarantine and self-isolation, respecting the principle of proportionality and taking into consideration the impact such measures have on fundamental rights including social and economic rights, as well as physical and mental health, and implementing measures to offset those negative impacts;

7.2procure protective gear for health and other essential personnel, boost and optimise health system capacity by mobilising inactive health professionals, and by boosting supplies of required equipment to diagnose and treat patients safely and effectively – in particular diagnostic tests, oxygen and ventilators / respirators, as well as boosting the numbers of available acute-care beds in hospitals;

7.3ensure that all public health measures respect human rights, are gender-sensitive, involve women in decision-making in a meaningful way, and protect vulnerable groups of the population (in particular, persons with disabilities, children and the elderly);

7.4put in place conditions to isolate and care for symptomatic cases not requiring immediate hospitalisation, on a voluntary basis, with a view to preventing household/family infection clusters and having the necessary medical supervision in place to allow rapid hospitalisation when a patient’s condition deteriorates;

7.5open borders and lift unnecessary travel restrictions to allow for an unhindered emergency response across borders, within the European Union at least allowing public health measures to be designed centrally and implemented along regional rather than jurisdictional (member States) lines, as needed depending on where outbreaks are situated.

8The Assembly recommends that member States, at all times:

8.1make available reliable information on the comparative dynamic changes in the number of deaths due to different pathologies in the last three years, and the number of those infected with COVID-19 among them;

8.2communicate information in a full, clear to all, and timely manner, accessible to persons with disabilities, and make decision-making, which should be based on evidence-based scientific opinion, transparent (including by publishing expert advice);

8.3organise active and broad community testing of all persons present on their territory regardless of status, not just limited to those admitted to hospital or health or other essential personnel, and roll out wide antibody testing of representative samples of the population as soon as feasible;

8.4actively promote responsible research, development and production of medicines, diagnostic kits, vaccines, and personal protective equipment, and set prices in a spirit of solidarity, ensuring that any medicines, tests or vaccines thus developed are accessible and affordable to all, in particular to vulnerable groups;

8.5prioritise and systemise European and international solidarity, co-ordination and co-operation; protective gear should not be horded by nation States “just in case”, but rather distributed across Europe and the world to where the need is greatest;

8.6establish and keep up to date an open access transborder directory of available intensive care unit (ICU) beds, as well as ventilated and staffed beds in ICUs, and make them available to member States in need;

8.7avoid executive overreach, disproportionate and unnecessarily repressive measures infringing human rights or human dignity, as well as all discrimination in the implementation of public health measures; with special attention to discrimination against persons with disabilities and the elderly, notably avoiding discriminatory triage systems;

8.8reaffirm the fundamental role of parliaments in their mandate of overseeing government actions and ensure that they are able to fully exercise this mandate, by providing them with both the technical means and the required level of information;

8.9ensure that their economic recovery and safeguarding plans do not create the conditions for a future degradation of ecosystems likely to generate other epidemics of a zoonotic nature, and thus condition the aid put in place on the fulfilment of ambitious environmental and social criteria in line with the UN Sustainable Development Goals.

9Furthermore, in the face of the current pandemic, the Assembly calls on member States to intensify efforts to:

9.1evaluate the state of their health systems, pandemic preparedness and infection surveillance systems, with a view to ameliorating them as necessary, in order to guarantee free access to public high-quality health care guided by the needs of patients rather than interests in profit, regardless of their gender, nationality, religion, or socio-economic status;

9.2evaluate the effectiveness, as well as the collateral damage (in particular to the full exercise of human rights, including socio-economic rights), of the measures taken to confront the current pandemic, in order to apply the lessons learned to future public health emergencies.

10Beyond the current pandemic, public health preparedness and global health security must embrace a One Health approach, embracing the interactions between animals, humans and the environment which contribute to and protect against disease. Efforts must be stepped up nationally and internationally to find the next zoonotic disease before it jumps into humans, to continue to strengthen the co-ordination of animal and human systems for disease detection and response, and to protect the ecosystems that underpin human, animal and environmental health. This includes identifying and fighting climate change as a driver of emerging health threats and improving policies regulating animal agriculture and addressing human destruction of pristine habitat.

11International and European health security and pandemic preparedness interventions must also be data-driven, evidence-based, and incorporate human rights provisions. Diverse sources of publicly available data need to be brought together to create an internationally unified data infrastructure, which can facilitate modelling for decision making. These models need to be translated into triggers for action. In case of transferring sensitive data, appropriate privacy and security safeguards must be guaranteed.

12The Assembly thus recommends that the European Union build a regional system capable of supporting the responsible international institutions in their endeavours to ensure effective pandemic preparedness and reaction.

13Furthermore, the Assembly recommends a reform of WHO in order to allow it to better fulfil its function of achieving the highest attainable standard of health for everyone, which:

13.1makes WHO independent of voluntary contributions to fulfil its essential functions;

13.2gives WHO the necessary power to visit member States unannounced in a public health crisis which could become a Public Health Emergency of International Concern;

13.3re-examines and strengthens the International Health Regulations to reframe global governance of disease, make the treaty more fit for purpose (including the governance of information such as sample and genetic sequence sharing), and explore mechanisms for compliance;

13.4puts in place an effective and independent, ideally parliamentary oversight of the organisation: at international level, through the Inter-Parliamentary Union, and at regional level, through regional parliamentary assemblies, such as the Parliamentary Assembly of the Council of Europe for the WHO Europe region;

13.5binds WHO to develop regionally adaptable containment strategies to fight future health hazards, taking into account the everyday realities of countries, regions and populations.

14The Assembly proposes to member States to step up their efforts to make progress regarding the European Social Charter (ETS No. 35 and ETS No. 163) and the Council of Europe Convention on Human Rights and Biomedicine (Oviedo Convention, ETS No. 164) which facilitate the safeguarding of social, economic and other human rights which are the most vulnerable during responses to a pandemic.

15Finally, the Assembly proposes to establish an enduring system of inspection at the United Nations for current and future high consequence biological events, possibly including a permanent, designated facilitator in the Office of the UN Secretary-General. The United Nations should also ensure international oversight and accountability for pandemic preparedness through an independent external entity.

1The Parliamentary Assembly refers to its Resolution … on Lessons for the future from an effective and rights-based response to the COVID-19 pandemic.

2The Assembly believes that the Council of Europe’s human rights mandate requires the re-establishment of comprehensive intergovernmental co-operation and co-ordination in the field of public health, including with a view to building a regional system capable of supporting the responsible international and European Union institutions in their endeavours to ensure effective pandemic preparedness and reaction.

3The Assembly thus recommends that the Committee of Ministers urgently re-establish an intergovernmental steering committee on public health as a first step towards this goal, and consider how the European Directorate for the Quality of Medicines and HealthCare (EDQM) of the Council of Europe could be associated with efforts to prevent and deal with international public-health threats and to design appropriate public-health strategies.