1. Introduction
1. The 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.
Most bets were on a zoonotic disease,
and on a highly contagious illness
which the globalised world would find difficult to contain. However,
few – if any – countries prepared properly for a pandemic sparked
by such a novel disease.
2. “Disease X” thus hit the world largely unprepared, in the
form of COVID-19, provoked by a novel coronavirus: 2019-nCoV (also
called SARS-CoV-2). The disease “ticks all the boxes”: zoonotic
disease, respiratory illness (which can cause severe to fatal viral
pneumonia), and very contagious – including before the onset of
symptoms. First reported to the WHO Country Office in China on 31 December 2019,
the outbreak was declared a Public Health Emergency of International
Concern by WHO on 30 January 2020, and a pandemic on 11 March 2020.
At the time of writing, the virus had spread to six continents,
infecting more than 6.4 million people and causing more than 380
000 deaths worldwide
. The epicentre of the disease moved
from China to Europe (in particular, Italy, Spain, Germany, France,
United Kingdom, and the Russian Federation), the Middle East (in
particular, Iran), the USA, and Brazil, with cases in India and
Africa growing at a worrying rate. Worst-case scenarios predicted
40 million deaths worldwide
, and a collapse of health-care systems
due to an overwhelming demand of intensive-care beds and the absence
of a safe and effective vaccine. However, an effective and human
rights-compliant response to COVID-19 has the capacity to save many
lives, as well as to protect the rights which underpin our democracies.
Never has European – and indeed global – co-operation and solidarity
been more necessary to overcome a disease which knows no borders.
3. Following the Ebola epidemic of 2015-2016, the Parliamentary
Assembly adopted
Resolution
2114 (2016) “The handling of international public-health emergencies”.
In this resolution, the Assembly
made a number of recommendations to prepare the world better for
the inevitable next international pandemic, urging new ways of working
to face international health crises before they happen. While the
Assembly’s call unfortunately went largely unheeded, the Resolution
also spelled out how to design and implement public-health control
measures for disease mitigation with human rights implications (such
as quarantining, physical distancing, border controls and travel
restrictions) for them to be effective and rights-compliant at the
same time.
4. Unfortunately, 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. It has not helped that many
States seem to have realised the danger they were in too late (or
had not wanted to realise the danger), thus forcing them to take
ever more stringent and far-reaching measures as the epidemics in
their countries spiralled out of control and their health-care systems
were overwhelmed. Even at the European and international level,
including at WHO, the impression of “too little, too late” is hard
to ward off. With many countries faced with devastating unemployment
figures and a big knock to the economy, temptation has also been
rife to “open up” economies too early after lockdowns and shutdowns.
5. In fact, the global financial system and many health systems
are already buckling under the pressure, with worse to come. Other
real-world consequences include risks to European democracies through
creeping authoritarianism and/or public distrust, as well as through
the undermining of human rights, discrimination against migrants,
refugees, “foreign-looking” people, minorities (including the Roma)
the poor and the marginalised, people in institutions (such as prisons,
detention centres, psychiatric hospitals, etc.), further deepening
of inequalities (including amongst children), and a particularly
harsh impact on women, the elderly, the homeless and persons in
fragile health.
6. The focus must thus now turn to coming together to learn the
lessons of the first wave of the pandemic, and ensure an effective
and human rights-compliant response to COVID-19, as well as to future
international public health emergencies, in order to save lives
and guarantee access to health care to all those who need it, as
well as to manage the social, economic, financial and political
consequences of the pandemic in an equitable way through European
and international co-operation. The work of national, regional and international
health authorities, including WHO, as well as all national and European
decision-making, must be transparent and de-politicised, and put
human lives and rights first.
7. This report is the outcome of a motion on “COVID-19 – an effective
and human rights-compliant response” which was tabled by my colleague,
Ms Jennifer De Temmermann (France, ALDE), myself and more than 60
other colleagues on 27 March 2020.
I was appointed Rapporteur on 19
May 2020. The same day, the Committee held a hearing on the subject
with the participation of the following eminent experts:
- Ms Stella Kyriakides, Commissioner
for Health and Food Safety, European Commission,
- Ms Dunja Mijatović, Council of Europe, Commissioner for
Human Rights,
- Mr David Nabarro, Special Envoy on COVID-19 to the World
Health Organization Director-General,
- Ms Rebecca Katz, Director of the Center for Global Health
Science and Security, Georgetown University, USA.
2. What we know about the novel coronavirus
8. Despite the many conspiracy
myths swirling around the internet, and misinformation spread by
some actors, it appears that the 2019-nCoV coronavirus emerged end
of November / early December 2019 in Wuhan city
, the populous capital of China’s
province of Hubei. The original host of the virus was probably a
bat, with the intermediate host not yet clearly identified (possibly
a pangolin). In any case, human-to-human transmission began rapidly
in Wuhan, although it was not reported as such by the Chinese authorities
at first. By the end of December, the number of severely ill people
with a pneumonia looking suspiciously like the disease caused by
the SARS coronavirus and not responding to standard treatment in
Wuhan’s hospitals led to a small group of doctors blowing the whistle
– and immediately being reprimanded by the local authorities, for
“making false comments” and “spreading rumours”.
9. China (including Hong Kong) had already been exposed to a
novel coronavirus before: in 2003, with the SARS epidemic.
Other
countries – in particular Saudi Arabia, the United Arab Emirates,
and South Korea – saw disease outbreaks caused by another coronavirus,
MERS, from 2012.
However,
our knowledge of these novel coronaviruses is limited. In contrast,
there are a number of representative studies about other coronaviruses
which have been infecting human for a long time, going back to the
1960’s. They found that these coronaviruses usually cause mild disease
(such as the common cold), often even without symptoms and only
detectable by serum antibody testing
. Because the true number of
people infected by novel coronaviruses in the population is still
unknown, the reported case-fatality figures from MERS – approximately 35%
of reported patients with MERS-CoV died – and SARS – with a case-fatality
rate (CFR) of 11% – may not show the full picture. The pandemics
of the 20th century most engrained in our memory were caused by influenza
viruses, the “Spanish flu” in 1918-1919,
the “Asian flu” of 1957 and the
“Hong Kong flu” in 1968.
10. The problematic handling of the H1N1 pandemic in 2009 by WHO
and many States (considered to have “over-reacted”, with decisions
taken tainted by real or perceived conflicts of interest),
has eroded public trust in scientific
and expert opinion, as well as in international health governance.
Despite the deadly SARS and MERS epidemics, few seemed to believe
a coronavirus could be so dangerous – and some believed WHO was “crying
wolf” too soon or unnecessarily, mainly because of a perceived lack
of evidence of the comparatively high observed CFR of the new coronavirus
compared to that of the seasonal flu (due to insufficient testing
of representative samples of the population in most countries, and
wildly differing reported case-fatality and all-cause mortality
rates).
11. What we know about the novel coronavirus so far is the following:
The virus is more contagious than the seasonal flu, but not as contagious
as measles. It mainly spreads through droplet infection, although
recent studies suggest it may stay airborne for up to 3 hours in
certain circumstances,
it can be carried in the humidity
of an expelled breath
(let alone
a cough or a sneeze) and survive on contaminated surfaces for many hours.
12. The virus is estimated to have a reproductive rate of R0 in
the range of 2 to 2.5,
meaning
that, if no measures are taken to contain the virus, every person
infected with the virus will statistically infect another 2 to 3
persons. This type of contagion is exponential: It means that a
caseload of 500 can become one million within a relatively short
period – it just needs to double 11 times. WHO puts the average
growth rate – the time it takes for cases to double – at six days
(which means the million would be reached after 66 days), but some countries
temporarily reported growth rates as short as three days (which
means the million would be reached in half that time).
13. It is this capacity for exponential growth which risks possibly
overwhelming health systems, even when only a relatively small percentage
of those infected require hospital treatment, and an even smaller
percentage intensive care. Early models based on preliminary data
estimated that, although the majority of cases remain mild, up to
40% result in hospitalisation and 5% require intensive care.
The
burden of severe disease is much greater in older people, particularly
men and those with underlying health conditions. Infection occurs
across all ages but apparently proportionally less in children under
the age of 15. Among those who had lost their lives by the beginning
of April, two-thirds were male and 95% were over the age of 60,
with most of them having one or a combination of underlying conditions,
such as cardiovascular disease, diabetes, lung or renal disease
(with obesity apparently also a factor).
Most of those severely affected needed
two weeks or more of artificial ventilation in an intensive-care
unit (ICU) before recovering (if they recovered).
14. The incubation period seems to last up to 14 days. However,
most infected persons develop symptoms (fever or feeling feverish,
dry cough, headache, sore throat, muscle ache / joint pain, breathing
difficulties / tightness in the chest, diarrhoea, nasal congestion,
loss of smell and/or taste) after around 5 days. There are also
asymptomatic carriers of the disease (currently believed to make
up around 30% of infections)
,
who do not show symptoms themselves, but are capable of infecting
others. To know the number of asymptomatic infections is crucial
for an unbiased estimate of the Infection Fatality Rate (IFR). Infected
persons seem to be contagious up to 48 hours before the onset of
symptoms, and up to 7 days after symptoms subside. Many people may
thus infect others before they show symptoms (if they show any at
all), and in mild cases, also during and after the symptomatic phase,
since symptoms can be mistaken for those of the common cold or the flu.
15. According to the initial official data from China, the CFR
was estimated at 4% of confirmed cases on 19 March 2020, an order
of several magnitude of that of the seasonal flu (0,1%). The official
data from China should not be taken at face value, for several reasons.
Data becoming
available in Europe, such as in the hard-hit regions of Italy, France
or Belgium, indicate that the CFR can be far higher (up to 16,3%
) even in regions with high-quality
health-care systems, when those health-care systems become dangerously overwhelmed,
in particular when it comes to a shortage of ventilated and staffed
beds in ICUs for an ageing population with many underlying health
conditions.
In fact,
CFR of COVID-19, understood as the number of reported deaths per
number of reported cases, vary significantly between countries and
over time. They have been calculated from over 15% to less than
1%.
IFR
include all infected people and, in that sense, also mild and asymptomatic
cases. A recent systematic review of studies suggested a point-estimate
of IFR of 0.64% (0.50-0.78%) “with high heterogeneity”.
Worryingly, data coming
from Italy, Spain and the USA also suggest that the number of younger
people requiring hospitalisation because of breathing difficulties
is far higher than originally thought, putting further strain on
scarce ICU resources.
16. It is assumed that there is no natural immunity against 2019-nCoV,
since it is thought to be a novel coronavirus which has only just
crossed the species-barrier. Due to some similarities to the SARS-1 coronavirus,
however, the length of vaccine development may be shortened. It
is hoped that a vaccine may become available to the general public
in 12 to 18 months’ time. There are also voices of experts considering that
the development of a vaccine will prove impossible.
Clinical trials of medicines which
could possibly be used as treatment have already been started or
are currently being authorised, for example in a WHO-run “Solidarity”
trial, or the European study “Discovery”.
Unfortunately,
few of the trials so far have shown promising results.
17. As with all infectious diseases for which a vaccine is currently
not available, well known public health and hygiene measures are
effective and should be applied: regularly washing hands with soap
and water (or hand sanitiser if no water is available), since both
soap and alcohol destroy the coronavirus’ membrane; sneezing and
coughing into the elbow, a tissue (to be binned), or wearing a mask
when infected, to avoid droplet infection; keeping a physical distance
of 1-2 metres minimum and avoiding shaking hands, hugging or kissing; avoiding
touching one’s face, to avoid smear infection from hands having
touched contaminated surfaces. Since a strong immune system is needed
to ward off and/or overcome the infection, improvement of social conditions
and a healthy lifestyle are also important – lifting people out
of poverty, unemployment and hunger, encouraging healthy eating
habits, regular physical activity, stress-reduction, and no smoking
or vaping, amongst others.
18. What we also do not yet know about the novel coronavirus SARS-CoV-2
is how long the immunity acquired through surviving infection lasts.
It is reasonable to assume that immunity will last at least one
to two years, as with most other coronaviruses.
The hope
is also that even if immunity should only be relatively short, a
second infection would lead to less severe illness in survivors
, and that mild and asymptomatic
infection nevertheless confers sufficient antibodies to trigger
immunity. It was hypothesized that, in order for the population
in this pandemic to acquire “herd” immunity (in the absence of a
vaccine), 60-70% of the population would have to be infected
. In the absence of containment measures,
this could be expected to happen within a year. The current status
of immunity in the population of each country should therefore be
determined by multiple representative cross-sectional studies starting
immediately and repeated regularly. Since not all countries applied
the same containment measures, such comparisons could provide valuable
insights with respect to herd immunity. In the 850 million population
of the Council of Europe, a risk of millions of deaths was projected
for the strategy of pursuing herd immunity without a vaccine, with
most deaths projected to occur in the cohort of the elderly, and
those with underlying medical conditions. It is also not yet clear
whether some survivors are left with lasting lung or other damage
from the infection. It should thus come as no surprise that few
countries have chosen to try and achieve herd immunity through infection
rather than a vaccine.
3. A
preliminary attempt at contemporary history: responses and their
effectiveness
19. While first attempts to systematically
record government responses to the COVID-19 pandemic have begun,
reliable data on the effectiveness
of non-pharmaceutical interventions (NPI) to contain the spread
of the novel coronavirus SARS-CoV-2 are still too scarce to reach
final conclusions. Given that and the very short time period available
to prepare this report, the following can only be a preliminary
attempt at evaluating the responses in the current pandemic.
20. Following an initial phase of denial and an attempt at suppression,
China took drastic measures in Hubei province, locking down the
epicentre of the outbreak, Wuhan (and other cities in the province),
on 23 January 2020 – when the country was reporting 500 cases and
17 deaths. However, the horse had already bolted:
about 7 million people left Wuhan
before lockdown was enforced, and carried the virus to Beijing,
Shanghai and other major cities. International travel restrictions
came too late to be effective – the epidemic had already been seeded
(as about 85% of infected travellers went undetected), including
in New York City and Seattle (USA), Sydney (Australia), Bangkok
(Thailand), Tokyo (Japan), Singapore and Seoul (South Korea). In
the meantime, there are indications that the virus was also spreading
in Europe end 2019
.
21. A WHO delegation was only admitted to China on 16 February
2020. The Head of this delegation, Doctor Bruce Aylward, in a press
conference on 25 February 2020, praised the drastic measures taken
by the Chinese authorities.
He claimed that China had bought
the rest of the world valuable time to prepare for their own outbreaks.
However, a study by scientists from Southampton University, came
to the conclusion that an earlier response with combined non-pharmaceutical
interventions would have had a significant impact on the spread of
the virus.
22. It is a matter of debate whether valuable time was squandered
by the rest of the world. Despite the praise by WHO of China’s methods,
many of these were considered not to be possible or acceptable outside
of authoritarian systems.
Some of them were deemed effective
in turning the tide of the epidemic, others less so. But many of
those that were considered to have worked
,
probably could have been adapted to the rest of the world more quickly.
Countries besides China which were classified by Johns Hopkins University
to have been successful so far in containing the epidemic are Taiwan,
South Korea, Singapore, New Zealand and Iceland (other countries
managed to keep the mortality rate down: for example, Germany has
an observed CFR of 4,5%, and Israel of 1,7%
).
23. Measures that have been described to work well in the media
are:
23.1. Rapid
action: In the face of a pandemic, timing is crucial. Precisely
targeted, timely responses open the possibility to avoid harsher,
more drastic containment measures that can become necessary once
the spread of a virus spirals out of control. According to media
reports, drastic containment measures can allow other, less or unaffected
parts of a country, to help fight the epidemic when the outbreak
is still relatively small (less than 500 infections) and concentrated
in certain hotspots (such as Wuhan in China, or Alsace in France).
Famously, two hospitals were built in Wuhan within weeks, but the
possibly less well-known sending of 40.000 medical workers into
Wuhan from other Chinese provinces was probably as crucial to success
in containing the spread of the virus in Wuhan. In order to keep
other parts of a country relatively unaffected, it appears necessary
to enact strict containment measures quickly in these areas, as
well. In contrast, the reports argue that the Italian experience
has shown that staggering the response (for example locking down
first only the worst-affected towns, and then regions, and only
then the whole country) does not work.
It
is argued that tens of thousands of lives could have been saved
in the United Kingdom and in the USA if the lockdowns/shutdowns
had been put in place just one or two weeks earlier (indeed, restrictions
might have been lifted much earlier and in a safer way in that case,
too).
Examples
from countries like Iceland show that early and targeted measures
combined with large scale testing can be a way of containing the
virus without falling back on complete lockdowns/shutdowns.
23.2. Communication of information, and transparent decision
making: It is common knowledge that people will modify their behaviour
if they understand it is in their own best interest – or when they
are forced to do so. However, a recent report in
The Guardian on the experience in
the Indian State of Kerala suggests that adherence will be higher
in the first case
. When decision-makers downplay or exaggerate
risks, withhold information, are not seen to take scientific and
expert advice, or make decisions behind closed doors, public trust
– and thus adherence to containment measures – dwindles. This, in
turn, can possibly necessitate harsher control measures, which can
sap police resources, inspire conspiracy myths, and can create further
opposition to authority. Anecdotal evidence in the current pandemic
already shows that countries which continue to operate in an open
and democratic way have higher adherence to voluntary containment
measures, less panic-buying, etc.
23.3. Testing and contact tracing, combined with quarantine
or self-isolation: As the Director-General of WHO, Doctor Tedros
Adhanom Ghebreyesus, pointed out on 16 March 2020: “You cannot fight
a fire blindfolded”. His message to States was thus: “Test, test,
test”.
This strategy, although prone to selection
bias towards the symptomatic cases, was successfully used in South
Korea, where lockdowns could be avoided for some time through mass
testing and aggressive contact tracing (using phone and credit card
data). Infected persons are quarantined in government shelters,
while those potentially exposed are quarantined at home (with high
fines for quarantine-breakers). South Korea was assessed by the
media to have found the right balance for its population as regards
quarantine – not so restrictive that people will try to avoid or
flee quarantine, but stronger (and easier to police) than self-isolation,
and thus safer for the general population. The only remaining problem
in this situation (which was similar in China) is that quarantining
the possibly infected at home could lead to the infection of other
members of the household, thus creating small clusters of infection.
However, known clusters of infection (which accounted for up to
80% of total infections in China) are easier to contain than other
types of infection vectors. There is also an urgent need for population-based
testing for antibodies, to find out who is immune to the infection
regardless of the outcome of RT-PCR testing.
23.4. Reducing human contact through physical distancing and
shutdowns/lockdowns: In a pandemic caused by a virus which is contagious
before symptoms appear, and where there are asymptomatic carriers
and symptomatic carriers who do not know they are infected (mistaking
their symptoms for other infections), as well as sick people who
feel they cannot afford to stay home or afford to see a doctor or otherwise
get medical help, early shutdowns of places where people mingle
is crucial: sports and cultural events, restaurants, bars and cafés,
gyms, shopping malls, etc. All work which can be done from home should
be done from home. Strong shutdowns/lockdowns more or less confining
everyone to their homes – as were in place by beginning of April
for half of the world’s population – are deemed to be effective
at breaking transmission chains within two to three weeks of their
imposition.
They are applied in the expectation
that they buy time for countries to better prepare their emergency
response, and – depending on how early they are put into place –
can “flatten the curve” of the epidemic, thus helping to avoid the
overwhelming of health-care systems which drives up mortality (indeed,
New Zealand achieved not just a flattening of the curve, but practically
eradication). However, without population-based infection data,
it is unclear whether these extreme measures with severe repercussions
on countries’ economic and financial systems, and society as a whole,
are justified at all or for how long they should be left in place.
If they are lifted too soon, or if their lifting is not accompanied by
other public health measures such as effective testing, contact-tracing,
and isolation, there is a risk of “epidemic yoyo”, where the exponential
growth interrupted by lockdowns restarts once a lockdown is lifted,
possibly necessitating a renewed lockdown if local outbreaks go
undetected and/or cannot be brought under control.
Media
outlets report that 8 to 12 weeks of lockdown may suffice in those countries
where the epidemic is not too far advanced,
but scientific evidence to corroborate
these claims is currently not available.
23.5. Pandemic preparedness: Observed outcomes in Europe so
far have varied widely. While, according to media reports, an early
response is often correlated with a much lower increase (if any) during
the pandemic of the all-cause mortality rate, other factors may
also have been at play, such as the level of pandemic preparedness
(including the availability of personal protective equipment and testing
for health-care personnel), the financial health of the health-care
systems, the availability of hospital and intensive care beds, as
well as laboratory testing and contact tracing capacity.
24. Measures that do not seem to work well are:
24.1. International travel restrictions:
WHO advised against the application of travel and trade restrictions
to countries experiencing COVID-19 outbreaks from the beginning.
As its recommendations updated on 29 February 2020 state: “In general,
evidence shows that restricting the movement of people and goods
during public health emergencies is ineffective in most situations
and may divert resources from other interventions. Furthermore,
restrictions may interrupt needed aid and technical support, may disrupt
businesses, and may have negative social and economic effects on
the affected countries. […] Travel measures that significantly interfere
with international traffic may only be justified at the beginning of
an outbreak, as they may allow countries to gain time, even if only
a few days, to rapidly implement effective preparedness measures.
Such restrictions must be based on a careful risk assessment, be proportionate
to the public health risk, be short in duration, and be reconsidered
regularly as the situation evolves.”
If the virus is already circulating
in the community in a country, closing the borders makes no sense,
as the enemy is already “within”.
Experience
has shown that, in Europe, the closing of borders was ineffective
in preventing the importation of cases of COVID-19 or in slowing
the growth of the epidemic, and instead impeded the flow of goods
and weakened the solidarity of European States.
The effect of travel restrictions
in Europe was rather to promote nationalist isolation, xenophobia
and scapegoating.
25. Measures on which the jury is still out:
25.1. School/day-care closures: Almost
all countries affected by the current pandemic opted for partial or
full school closures as a means to contain the virus spread.
Closing down schools and day-care institutions
for children appear to be efficient public health measures in epidemics,
as children are usually very effective vectors of disease, as well
as in the high-risk group for severe disease and death. In the case
of COVID-19, however, children – in particular those younger than
ten – have rarely seemed to fall ill, developing only mild symptoms
or none at all even when infected
(worrying reports of
a new Kawasaki-like inflammatory disease still lack evidence of
a connection to SARS-CoV-2, which needs to be investigated further).
It is also still unclear whether children are effective vectors
of COVID-19. There are disadvantages in closing schools: requiring
many essential workers to choose between staying home to look after
children, or risk having grandparents (who are in the high-risk
group) look after them, if no alternative arrangements can be made,
for example, by the State; putting children at risk of violence in
the home
, as well as at risk of hunger
, and increasing existing inequalities
between children in access to learning opportunities and education.
There is simply not enough data at the moment to know whether the
advantages of closing schools outweigh the disadvantages. Partial
or complete school re-openings in some countries are too recent
to evaluate their effect on the propagation of the virus and should
be further investigated.
25.2. Mask-wearing: The only type of mask which can protect
someone relatively effectively from infection are masks with air
filters, such as FFP1 / FFP2 / N95 masks. However, there is some
evidence that surgical or cloth masks can provide some protection
against infecting someone else with droplets (for example from a
sneeze or a cough). This comes with so many caveats, though, with
a disease which spreads through aerosol as well as droplet infection,
and a general public outside of many Asian countries unused to handling
masks correctly, that face mask rules risk becoming politicised
.
25.3. Isolating high-risk groups: Great Britain has asked individuals
at high risk of severe illness and death from COVID-19 to self-isolate
for at least three months; most countries have put in place visiting restrictions
in old people’s and nursing homes. It is not yet clear how effective
such measures are, nor for how long they can realistically be applied.
They also come with strong downsides as such measures can lead to
discrimination, job loss, poverty, loneliness, and other negative
effects. Observed high CFR in nursing homes suggest that infrastructural
improvements such as smaller units, increased staffing and better
equipment supply might be more effective than complete isolation.
25.4. Broadcasting who is infected or places infected persons
have visited: It is only human to want to know whether one’s neighbour,
work colleague, or supermarket cashier is infected, or whether one’s path
in a restaurant or on public transport has been crossed by an infectious
person. Whether this is an effective way of avoiding infection oneself,
or finding out whether one is infected, is quite another matter. Stigmatising
or even attacking the persons whose privacy has been thus violated
is certainly not effective,
which
is why the electronic system used in South Korea only broadcasts
the places which infected persons have visited (though the anonymisation
of the data did not always work well, making some people recognisable
– including the fact that they may have been to places they were
not meant to be). It is not yet clear whether such systems are effective
as a public health measure. Any “tracking apps” also pose severe
risks of violations of data-protection rights, amongst others.
25.5. “Immunity passports”: There have been plans in some countries,
including my own country, Germany, to put in place so-called “immunity
passports” in order to allow citizens to regain fundamental rights
that have been restricted due to containment measures fighting the
virus spread, based on the immune status of a person. Such measures
can be a valid approach for essential workers such as health-care
personnel on the front lines who are immune from infection and thus
pose no danger to others, to look after high-risk patients. For
the general public, the idea is highly problematic on several levels,
though: First, there is as yet no data on whether the fact of having
antibodies in the blood protects from renewed infection, and if
so, at what level and for how long. Second, regaining rights through immunity
may give perverse incentives to try and catch the disease in order
to become immune.
4. Real-world
consequences and risks to human rights
26. From the experiences of countries
so far, it appears obvious that in the fight against the spread
of SARS-CoV-2, the only way to avoid far-reaching measures with
rights implications such as lockdowns / shutdowns is to act timely,
precisely, and effectively. The later the response to an outbreak,
the more drastic the measures have to be. But how can this be done
in the most human rights-compliant way possible, while bearing in
mind that without respect for the right to life, no other human
rights are enjoyable by definition? While there is thus a clear
hierarchy of human rights in pandemic situations which threaten
the right to life, as in this case, no fundamental right can be
considered absolute.
4.1. Right
to life and equal access to health care
27. The right to life must be protected
at two levels in pandemic situations: at the level of public health
and at the level of clinical medicine. We have already looked at
the public health measures put into place to protect people, in
particular vulnerable population groups, from infection in the first
place, in order to protect the right to life. However, once a person
is sick, and in particular if that person is severely ill, the right
to life must be protected at the level of the individual, through
access to quality health care.
28. All our member States have ratified the European Convention
on Human Rights (ECHR), most have ratified 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).
They are thus bound to uphold everyone’s right to life. No derogation
is possible from this right, not even in times of war or other public
emergencies threatening the life of the nation.
The
State should thus not discriminate in granting access to life-saving health
care to everyone in their jurisdiction in emergency situations such
as the one we find ourselves in now, regardless of their gender,
nationality, religion, other status, etc. – or their ability to
pay.
29. However, such discrimination may and will still happen, of
course, in practice. What are the ethical guidelines for making
clinical decisions of granting or refusing access to life-saving
care (for example, a ventilator in an ICU) when demand outstrips
supply? While it is practically universally acknowledged that care can
be refused if it is considered medically futile (for example the
patient will die anyway), what methods should be used to determine
who receives access amongst those with a fair chance of survival?
Again, while it is practically universally acknowledged that medical
personnel must make the final assessment and decision on the spot,
who decides on the ethical guidelines or guidance documents underpinning
those decisions – professional ethics committees, ministers, parliamentarians?
30. The answers are not that obvious. A “first come, first served”-principle,
or a lottery, may seem the fairest, but may also lead to higher
mortality rates than if patients with higher chances of survival
are given priority. Those with higher chances of survival will usually
be the younger and healthier patients. Giving these patients priority
will keep mortality rates lower, but enables ageism and ableism,
as well as possible discrimination on the basis of poverty and prior
access to health care (since the poor and marginalised, as well
as migrants and refugees, members of national minorities, etc.,
will usually be less healthy to start with because of the social determinants
of health, such as problems in accessing health care). Most people
are comfortable with giving priority access to doctors, nurses and
other essential medical personnel infected in the line of duty (estimated at
12-15% of such personnel at the moment), as well as allowing patients
to voluntarily forego life-saving medical treatment.
31. In practice, most countries already have some kind of guidance
in place. Quite often, the underlying principles are utilitarian:
preference to those who can save others (essential medical personnel),
and to those with the greatest chance of survival and the longest
remaining life spans.
This is the case, for example, in both
Italy and Great Britain. In Lombardy (Italy), some hospitals decided
no longer to admit severely ill patients over the age of 65 (in
France, over 80); in England, there was reportedly planning at one
point to hand out “palliative care packs” to such patients, who
would be left to live or die at home if the National Health Service were
overwhelmed.
It can thus be assumed that clinical
decisions would profoundly alter our society if public health measures
fail to protect the vulnerable groups of the population: the old,
the frail, the poor, the marginalised, and those with underlying
health conditions, would be the most likely to die, with difficult-to-quantify
knock-on effects to social cohesion. In fact, this is exactly what
is currently playing out in the United Kingdom and in the USA, where
members of minority groups have a far higher risk of contracting
the virus and becoming severely ill with it or dying of it.
4.2. Protecting
vulnerable groups: the situation of older persons, in particular
in care homes
32. We are not all equal when it
comes to epidemics. Some population groups are more vulnerable than others,
for various reasons, including their age or state of health (for
example pre-existing medical conditions). COVID‑19 is no exception
to that rule. The figures show that 80% of deaths linked to COVID‑19
involve older persons aged over 70, which makes them a particularly
vulnerable group.
34. The most devastating consequences of the pandemic have therefore
occurred behind closed doors, against a background of much ignorance
and indifference. Care homes have become scenes of mass fatalities. The
lack of material and human resources which had been widely recognised
yet left untackled for many years has not been resolved during the
health crisis.
While the staff of some facilities
chose to self-isolate in the homes with the residents (in Romania,
the government made this compulsory),
thereby saving lives and preserving
the residents’ dignity, some carers abandoned their posts for lack
of adequate protection.
36. It should also be stressed that the lockdown of the population,
which was vital to limit the spread of the virus, resulted in isolation
for many older persons who were left alone in their own homes
or in their rooms
in care homes, without any contact with the outside world for several
weeks (and, among other things, with no possibility of receiving
psychiatric or end-of-life care for those who needed it). The press
ran headlines like “elderly people at risk of dying of boredom and
loneliness”.
As the CCNE says, respect for human
dignity includes the right of dependent persons to maintain social
ties.
37. As the Council of Europe Commissioner for Human Rights pointed
out in her latest statement on “Lessons to be drawn from the ravages
of the COVID-19 pandemic in long-term care facilities”
, in accordance with their obligations
under Article 2 of the ECHR regarding the right to life, member
tates must shed light on all the deaths occurring in these institutions,
without exception (…) Member States must also ensure that residents
in long-term care facilities continue to have human interactions
with their loved ones, especially if they are sick. The absolute
priority right now must be to make sure that this experience is
never again repeated over the course of the COVID-19 pandemic.
38. Given the fact that older persons are especially vulnerable
to COVID-19, living and working conditions in care homes are of
the utmost importance. Europe’s care home sector is concentrated
in the hands of a few large private groups, often run by pension
and investment funds.
This can have
a significant negative impact on conditions in care homes, if profit
interests predominate over the needs of residents and health requirements of
the infrastructure. The same is true of austerity measures that
leave care homes underfunded. Understaffing, overcrowding, and huge
care homes with too little distance between residents are some of
the negative effects of that development, resulting in even higher
vulnerabilities during virus outbreaks. Member States should urgently
tackle these problems in order to protect the most vulnerable.
4.3. Proportionality
of the public health response
39. The COVID-19 pandemic has prompted
many member States to take drastic measures to protect public health.
Article 15 of the ECHR is a derogation clause that allows member
States, in exceptional circumstances and in a limited and supervised
manner, to derogate from their obligation to secure certain
rights and freedoms
under the Convention. The Convention is still adaptable to any and
all circumstances and continues to regulate the actions of member
States even in the event of national crises. Most member States
have taken measures that restrict a number of individual rights
and liberties enshrined in constitutions and the Convention, and
a fair number of them have notified the Secretary General of the
Council of Europe about their derogations to the ECHR. States must
keep the Secretary General of the Council of Europe fully informed,
and this duty will be more extensive the more extensive the derogation.
The Assembly’s
Resolution
2209 (2018) on “State of emergency: proportionality issues concerning
derogations under Article 15 of the European Convention on Human
Rights” should be fully respected in such circumstances. The response
to the threats in the pandemic must be strictly proportionate to
the threat which they are supposed to counter, and member States
should strive to limit any derogation to the Convention. The Committee
on Legal Affairs and Human Rights will be looking into this issue
in more depth in its upcoming report.
4.4. European
and international co-ordination and public health governance
40. One can be forgiven for thinking
that European and international co-ordination was “missing in action” in
the first months of the pandemic. With the responsibility for public
health usually at country level, or in federal States, devolved
to regional level (or even sub-regional level), even the European
Union has found it difficult to co-ordinate a response to this public
health emergency, as member States balk at sharing their sovereign emergency
powers, or their public health mandate.
41. The resulting cacophony of public health measures has seriously
undermined their effectiveness and has sometimes been plain counterproductive.
Borders
have reappeared in the Schengen passport-free travel zone (against
WHO advice), complicating the lives of millions of cross-border
commuters, as well as blocking goods. Some countries have even closed
their borders to foreigners altogether; countries are spending millions to
repatriate their citizens stranded elsewhere. Six member States
put in place export bans on medical equipment.
The positive stories are unfortunately
few and far between: Hospitals in countries such as Germany, Switzerland
and (in the beginning) France took in critically ill COVID-19 patients
from Alsace (France) and Lombardy (Italy). European Union leaders
are setting up a new permanent European crisis management centre
and have organised €50 million to buy needed medical equipment to
distribute to hospitals where it is most needed. By mid-May 2020,
despite its limited mandate in the field of public health, the European
Union had adopted over 200 initiatives to fight the COVID-19 crisis
, and had provided swift support to
the health systems, societies and economies of its member States.
China,
Cuba, the Russian Federation, Romania, Turkey and Albania have sent
doctors, nurses, and medical supplies to hard-hit countries.
42. On the positive side, it seems that the European Union has
learned its lesson, even if it was learned the hard way. As EU Commissioner
for Health and Food Safety, (former President of the Assembly) Stella Kyriakides,
said at the Committee’s hearing on 19 May 2020: “The overriding
conclusion here, is that we can only deal with such threats together.
Fragmentation of effort makes us all vulnerable. Looking inwards
will only decrease our chances of tackling the invisible threat.
It is only through solidarity and co-operation across borders that
we can defeat the virus.” I could not agree more. Beginning of May,
the European Commission co-convened a Coronavirus Global Response
pledging event, bringing together partners from around the world to
mobilise funds to support work on diagnostics, treatments and vaccines
for the novel coronavirus. By mid-May 2020, €7.4 billion had been
raised – €1.4 billion of which was pledged by the Commission. The Commission
is now working towards a new, dedicated EU Health Programme, with
an unprecedentedly significant budget going forward to reinforce
the block’s resilience.
43. Of course, solidarity and co-operation across borders must
not be limited to Europe. WHO was, unfortunately, also slow to react
in the beginning, its public health governance system weakened by
years of cost-cutting and down-sizing. Only 20% of its budget is
covered by assessed contributions from member States, with the balance
mobilised through voluntary contributions.
The WHO relying on just 20 contributors for
80% of its voluntary contributions poses serious questions about
its capacity to act independently.
44. Only on 25 March 2020 did the United Nations launch an appeal
for a new USD 2 billion global humanitarian response plan, with
WHO setting up a six-point action plan to prepare and respond to
the pandemic in the poorest communities: those affected by crisis,
including those “uprooted due to conflict, displacement, the climate
crisis or other disease outbreaks”.
Unfortunately, this may come far
too late to avert a humanitarian catastrophe, as the virus has started
to circulate in packed refugee camps and slums worldwide.
45. WHO’s actions (or perceived lack of action) have been criticised
particularly sharply by the President of the USA, Donald Trump,
who has also threatened to withhold the country’s membership dues
from the organisation, or to withdraw from it altogether. Our own
President of the Assembly and our Chairperson are on record criticising
Donald Trump’s stance and calling for support for WHO
. At the meeting
of the 73rd World Health Assembly on
19 May 2020 – its first-ever to be held virtually – delegates adopted
a landmark resolution to bring the world together to fight the COVID-19
pandemic, finding the necessary consensus to support the organisation.
Once this pandemic is over, WHO and its public health governance
structure urgently needs strengthening (and de-politicising) in
order to put it in a position to deliver on its mandate. As the
Chairperson of our Sub-Committee on Public Health and Sustainable
Development, Ms Jennifer De Temmerman (France, ALDE) has said: “With
more power should also come more responsibility and accountability.
Parliamentary oversight is sorely lacking at WHO. Any WHO reform
should also introduce an element of such oversight, which is essential
for building trust and solidarity.”
4.5. Saving
the economic and financial system
46. When COVID-19 started spreading
across China in January 2020, few except the specialists could anticipate
the global contagion – not only in medical terms, but also in terms
of economic and financial fallout. Yet, with China being a vital
link in the global value chains, the recipe for disaster was in
the making.
47. The fight against COVID-19, including its containment measures
to keep the population at home as far as possible, has put a serious
break on overall economic activity (notably travel, leisure and
other services; production capacity due to factory closures; cross-border
and country-wide circulation of goods, ingredients, commodities,
workers and users). The OECD expects a sharp slowdown in worldwide
growth in 2020 with the world’s GDP growth declining by 2% for every
month of strict lockdown).
48. The International Monetary Fund (IMF) warned that COVID-19
could cause a “deeper downturn than the last financial crisis” even
if the rebound could be relatively strong in 2021. But in the near
future we should be worried about sustaining the national economies
in real time. It is therefore reassuring that major international institutions
and individual countries are mobilising extraordinary economic and
monetary response measures to both fend off the epidemic and also
keep economic systems afloat.
49. The IMF has committed to providing emergency financing (about
USD 1 trillion) to over 90 countries that have already requested
its help (the emerging market economies appear to be worst hit by
the COVID-19 crisis).
In Europe, the finance ministers
of EU-27 have agreed to suspend government borrowing limits, triggering
the so-called general escape clause
of the EU fiscal framework in the face
of “a severe economic downturn in the euro area or the Union as
a whole”.
This
unprecedented decision gives member States flexibility “to take
all necessary measures for supporting our health and civil protection
systems and to protect our economies, including through further
discretionary stimulus and co-ordinated action, designed, as appropriate,
to be timely, temporary and targeted”. The European Central Bank
(ECB) also pledged to take “appropriate and targeted measures” so
that banks could cope with lending to business and households more easily
and launched a €750 billion package of quantitative easing (money
creation tool) for the eurozone market. This followed the ambitious
steps taken by the US Federal Reserve and the Bank of England.
50. That said, some Council of Europe member States will be in
great difficulty. Italy was in a delicate budgetary situation even
before the COVID-19 crisis, with the weakest growth figures in the
eurozone and very high sovereign debt (134.8% of GDP in 2019 compared
to 84.1% of GDP in euro area
); it is now the European country worst
hit by the novel coronavirus. The ECB’s targeted measures will have
to support Italy as a matter of priority. However, other eurozone
countries such as Greece, Spain and France, may need a similar prod
from the ECB. So far, the main spending priority for many governments
has been action to save lives and to reassure both the businesses
and the population, including through temporary tax relief, partial compensation
of revenue loss for those subject to “technical unemployment”, support
to small and medium enterprises to prevent bankruptcies and preserve
jobs. However, as the analysis of the Centre for Economic Policy
Research (CEPR) argues, “care must be taken to ensure that temporary
solutions don’t create long-lasting problems”.
51. It is reassuring that, by the end of March 2020, 27 European
countries (belonging to the European Union) had rolled out national
emergency programmes to sustain their economies. Ranging in size
from €300 million in Luxembourg to €1.1 trillion in Germany and
unlimited commitments in Hungary and the Slovak Republic, they provide
a mix of sovereign support (targeted grants, direct payments and
compensations; tax relief and incentives; cashflow facilitation;
loans and State credit guarantees, public investment in local corporate
bonds; deferrals in payment of rents or certain utility bills; derogations
regarding working time) to public healthcare and social services,
workers and households, vulnerable population groups, local authorities,
enterprises (notably small businesses).
As the
time goes by and the needs become clearer, those packages will probably
have to be enhanced and adjusted.
52. Moreover, by early April 2020 all the remaining Council of
Europe member States had announced economic support measures for
vulnerable population (notably income support and minimum income guarantees,
tax relief, rent deferrals, bonuses for healthcare and social workers,
bans on termination of contracts) and enterprises with disrupted
activity (credit lines and guarantees, break on bankruptcy proceedings,
moratorium on debt repayments, subsidies to tourism and transport
sectors), as well as more general macroeconomic measures (such as
lowering of reference interest rates and liquidity facilities by
central banks, public investment programmes). Some countries, such
as the Republic of Moldova, have obtained the IMF’s co-funding for
their emergency programmes.
The
Council of Europe Development Bank (CEB) issued COVID-19 Response
Social Inclusion Bonds in April, thus mobilising €1 billion; it
has already approved €300 million loans each to Italy and to the
Czech Republic and a €200 million loan to Madrid municipality (Spain)
to combat the COVID-19 pandemic
. In May, the CEB approved by fast-track
procedure eight new loans totalling close to €1.3 billion to its
member countries (Croatia, Estonia, Greece, Kosovo*
,
Latvia, the Republic of Moldova, Serbia and Turkey) to fight the
COVID-19 pandemic
. The loans are provided under the
Public Sector Financing Facility of the CEB, which offers a flexible
and timely use of CEB funds.
53. In addition, the European Investment Bank has mobilised some
€40 billion in potential financing for European companies affected
by the crisis, mainly through bridging loans or the suspension of
loan repayments. At the same time, the EU leaders struggled to agree
on the use of collective action mechanism – a credit line worth
some 2% of their economic output from the European Stability Mechanism
(ESM) fund for the eurozone (19 member countries), or, alternatively,
something that could take the form of European COVID-bonds. This
has shown the persisting divide between “the ailing south and the
fiscally conservative north”.
Jacques
Delors, a former President of the European Commission (1985 to 1995),
called those divisions a “mortal danger” for the European Union,
while the French Minister for European
Affairs, Amélie de Montchalin, warned that the European Union was
facing an existential crisis as “credibility and usefulness” of the
union rested on its collective response to the coronavirus crisis.
Although the agreement to tap
the ESM was finally reached on 9 April, the conditionalities attached
to its use remain problematic from the perspective of potential
user-countries.
54. Thereafter, the European Commission published a proposal to
use the EU budget “to protect lives and livelihoods”. It launched
an initiative called SURE (Support mitigating Unemployment Risks
in Emergency), worth €100 billion, aiming to support workers and
businesses. All available structural funds will be redirected to
the response to the novel coronavirus, while farmers and fishermen
will receive targeted support.
In a similar drive for action, the US Congress
approved a USD 2 trillion emergency package for the national economy.
This is the largest economic stimulus programme in the history of
the USA. The rescue fund will support households to compensate for
the loss of income due to temporary unemployment (USD 300 billion), hospitals
(USD 100 billion), vaccine and medication development (USD 11 billion),
loans to struggling industries including airlines (USD 500 billion),
schools (USD 30 billion), food stamps and child nutrition (USD 25
billion), as well as farmers (USD 24 billion).
55. In their turn, the G20 leaders, pledged “to do whatever it
takes to overcome the pandemic”, “both individually and collectively”,
and “to do whatever it takes and to use all available policy tools
to minimize the economic and social damage from the pandemic, restore
global growth, maintain market stability, and strengthen resilience”.
They said they were “injecting over $5 trillion into the global
economy”. G20 finance ministers and central bank governors were
mandated to develop an action plan together with international organisations
so as to “swiftly deliver the appropriate international financial
assistance”, while trade ministers were tasked to address international
trade disruptions and work towards “a free, fair, non-discriminatory, transparent,
predictable and stable trade and investment environment”.
4.6. Guaranteeing social rights and social
cohesion
56. Social rights – guaranteed
by the European Social Charter, to which practically all member
States are bound – are human rights, as well. Many of them are being
impacted by public health measures taken during the epidemic, or
their consequences: The right to work, especially for those judged
“non-essential” who cannot work from home (for example in the hospitality
or entertainment industries), or workers laid off in shutdown or lockdown
situations; the right to just, safe and healthy working conditions,
especially for “front-line” medical personnel or other essential
workers (including in supermarkets, funeral parlours, or cleaning
jobs) working long hours, often without adequate protection from
infection; the right of children and young persons to social, legal
and economic protection, impacted through closures of schools, universities,
day-care centres, with possible knock-on effects regarding their
protection from violence in the home in lockdown situations; the
right of elderly persons to social protection when asked to self-isolate
for months at a time or when deprived of in-person visits for the
protection of their health; the right of workers with family responsibilities
to equal opportunities and equal treatment when schools and day-care
centres close; the right to protection against poverty and social
exclusion, in particular as regards housing in lockdown situations.
57. Member States which have had to enact public health measures
in the pandemic that impact on these rights have sought to limit
their application in time, and to mitigate their effects by, for
example, making financial support available to businesses, workers,
and vulnerable groups,
or organising
on-line teaching. However, it is quickly becoming clear that the
pandemic is exacerbating existing inequalities: the self-employed
and workers in the platform economy often cannot access financial
support as easily as workers with permanent contracts; the poor
and less well-educated find it harder to “home-school” their children
(and may not have access to the necessary technical resources);
lockdowns are harder to bear in sub-standard or cramped housing
or in the presence of a violent partner or parent. Women, who usually
bear the largest burden of care in both families and the medical
world, are particularly at risk of being impacted by discrimination,
violence – and sheer exhaustion. The poor and the marginalised (including
the homeless, refugees, migrants, asylum-seekers, minorities such
as the Roma) are bound to suffer the most.
58. In this respect, it is particularly important that the personnel
on the front lines be properly protected from harm – and be given
their just reward (in terms of higher wages, more secure job contracts,
etc). The pandemic has made the lack of States’ preparedness for
public health emergencies painfully obvious – health-care personnel
the world over battled with a lack of personal protective equipment
(PPE), putting themselves, but also their patients, at risk of infection,
illness and death. Other essential workers – supermarket cashiers, delivery
drivers, mortuary and funeral parlour employees – were also called
upon to work long hours in dangerous conditions. It quickly turned
out that essential workers were essentially women, many of them underpaid
and overworked even before the pandemic struck. It is high time
that the inequality in pay for “caring” professions and for jobs
traditionally performed by women is addressed, as I am certain the
upcoming report by the Committee on Equality and Non-Discrimination
will do.
59. We are already living in times in which social cohesion is
sorely tested – the pandemic will constitute a supplementary burden
if we decide to isolate ourselves in our homes and look out only
for ourselves. But it doesn’t have to be that way: The pandemic
is showing us how much we depend on others, and has sparked new
social activism – members of local football clubs or churches are
spontaneously organising food deliveries for self-isolating, high-risk
persons; thousands of people are volunteering to help out in multiple
roles, such as manning phone lines; neighbours are looking out for
one another; and across entire countries people are applauding the
efforts of health care personnel every evening.
5. A brave
new world?
60. The situation we are in is
unprecedented – we have not been confronted with a pandemic on the
scale of the “Spanish flu” for a century. Our societies have evolved
significantly since then, not only in terms of medical and technological
progress. But we are basically making it up as we go along, which
hinders our ability to react rapidly and learn from others. Political
and geopolitical fault lines are undermining our willingness, and thus
our capacity for European and international solidarity and co-operation.
However, it is not too late to turn the tide: we can overcome this
epidemic together, and seed a new, better, world, based on the core
values of the Council of Europe. This would enable us to meet the
UN Sustainable Development Goals by 2030 and overcome the next big
challenge looming after the pandemic – the climate change emergency.
5.1. Overcoming the pandemic
61. First, however, we need to
overcome the current challenges posed by the pandemic. To avoid
a disastrous outcome in terms of lives lost and burden of sickness,
we need to act fast to contain the outbreaks, using the tried and
tested, effective measures outlined in chapter 3, implemented in
a human rights-compliant way while respecting the principle of proportionality.
62. For many of our member States, this means: 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 including social and economic
rights, as well as physical and mental health, and implementing measures
to offset those negative impacts; procuring protective gear for
health and other essential personnel; boosting and optimising 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; ensuring that all public
health measures respect human rights, are gender-sensitive, involving women
in decision-making in a meaningful way, and protecting vulnerable
groups of the population (in particular, persons with disabilities,
children and the elderly); putting in place of 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. It means opening borders and lifting 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.
63. For all of our member States it means: Make 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; full, clear
and timely communication of information, and transparent decision-making
on the basis of evidence-based scientific opinion (including publishing
expert advice). Active and broad community testing (not just limited
to those admitted to hospital or health or other essential personnel);
as soon as feasible, antibody testing should also be widely rolled
out, including antibody testing of representative samples of the
population, in order to identify those already immune to the disease).
Active promotion of responsible research, development and production
of medicines, diagnostic kits, vaccines, and personal protective
equipment 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. European and international solidarity,
co-ordination and co-operation should be prioritised and systemised.
Protective gear should not be horded by nation States “just in case”,
but rather distributed across Europe to where the need is greatest. Establish
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.
Health care personnel which has become immune to the disease should
help out in other countries once the need in their own country subsides.
Executive overreach, disproportionate and unnecessarily repressive
measures infringing human rights, as well as all discrimination
in the implementation of public health measures should be avoided.
Parliaments should continue to be in a position to exercise their
mandate of controlling the government’s actions.
64. Furthermore, in the face of the current pandemic, member States
should intensify efforts to evaluate the state of their health systems,
pandemic preparedness and infection surveillance systems, with a
view to ameliorating them as necessary; as well as evaluate the
effectiveness and 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. They should ensure
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.
5.2. Minimising harm to the economic and
financial system: put the people and the planet first
65. Our countries are interconnected
and interdependent – for better and for worse. The pandemic has
set in motion shock waves that have not only exposed and amplified
vulnerabilities in health-care systems, but also overwhelmed our
economies. As the OECD’s Secretary General notes, “the behaviour
of financial markets reflects the extraordinary uncertainty of the
situation”, yet “it is too early to tell how far-reaching an impact COVID-19
will have” on our countries.
We
need to keep the economy going – not least to beat the pandemic, and
to have a critical look at how to make it work better for the lasting
well-being of all. We need a more sustainable economic and financial
system that would underpin the real economy, not financial speculation
for the benefit of the few. With the unprecedented rescue packages,
governments hold the reins of regulation stronger than ever and
should use the strings attached to demand businesses to invest more
in people and “greener” development.
66. The COVID-19 pandemic is a test of our collective capacity
and solidarity – at local, national, regional and international
levels. Drawing lessons from the pandemic, I believe that our governments
should seriously rethink the strategic pillars of national economy
and well-being with long-term sustainability and security in mind.
Certain essential necessities (such as medicines, food and energy)
should be fully produced ‘close to home’, benefitting local economies
and building on European solidarity as appropriate. In the short-term,
we must shield the most vulnerable people and businesses, putting
fundamental rights first.
5.3. Upholding social rights now and in
the future
67. It is our duty to try and uphold
social rights as far as possible during the pandemic – and to make
a renewed and stronger effort to fight poverty (in particular, child
poverty and extreme poverty) once the pandemic has ended. Right
now, we must make certain that everyone’s right to equal access
to health care is respected, especially in emergency situations:
it must not be your wealth or your “connections” which determine
whether you get access to the care you need. But ultimately, we
also need to address the social determinants of health, such as
poor housing and lack of access to services – and the inequalities
which undermine the social rights and the social cohesion on which
we depend for our survival. States should step up their efforts
to make progress regarding the European Social Charter and the Oviedo
Convention which facilitate the safeguarding of social, economic
and other human rights which are the most vulnerable during responses
to a pandemic.
5.4. Looking to the future of a post-pandemic
world
68. It is clear that our world
will change, possibly beyond recognition, in the next few years.
It is up to us whether the world changes for the better or the worse.
The pandemic has already shown us that we cannot go back to where
we were before: unprepared for worldwide catastrophe, particularly
because the next worldwide catastrophe is already in the making
– the man-made climate change emergency. We have already missed several
tipping points to avert the disaster of this pandemic: we cannot
afford to miss the tipping points of the climate change emergency.
69. It is important that we learn the lessons from this pandemic
at all levels. The first lesson to be learned, as pointed out by
Professor Katz at our hearing on 19 May 2020, is: “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 us against disease.
We must strive 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, I would add, and improving policies
regulating animal agriculture and addressing human destruction of
pristine habitat. Global health security and pandemic preparedness
interventions must also be data driven, evidence-based and incorporate
human rights provisions. We must get better at using diverse sources
of data, creating unified data infrastructure, as well as modelling
for decision making; and translating these models and data into
triggers for action.
70. We must put in place a stronger, more powerful WHO, which
is properly funded and not dependent on voluntary contributions
to fulfil its essential functions. A WHO which has been reformed
in order to allow it to better fulfil its function of achieving
the highest attainable standard of health for everyone. This is
not just a question of money: WHO should also be given the necessary
power to visit member States unannounced, as can, for example, the
Council of Europe’s European Committee for the Prevention of Torture
and Inhuman or Degrading Treatment or Punishment (CPT). As proposed
by Professor Katz at our hearing on 19 May 2020, we should re-examine
and strengthen the International Health Regulations to reframe global
governance of disease, make the treaty more fit for purpose, and
explore mechanisms for compliance.
We
must also revisit how we govern information, including sample and
genetic sequence sharing. And there must also be proper, independent,
ideally parliamentary oversight of WHO with a view to building the
trust and solidarity needed for the world to be able to beat pandemics
together.
71. As proposed by Professor Katz at our hearing on 19 May 2020,
it would also be a good idea to establish enduring leadership at
the United Nations for current and future high consequence biological
events, including a permanent, designated facilitator in the Office
of the UN Secretary-General. The United Nations should also ensure
global oversight and accountability for pandemic preparedness through
an independent external entity.
72. And it is for us, at European level – and not just at the
level of the European Union – to build a regional system capable
of supporting WHO in its endeavours. This could take the form of
a regional agreement between our Assembly and WHO Europe, modelled
on our co-operation agreement with the OECD; but it should not stop
there: public health intergovernmental co-operation and co-ordination
needs to be re-established at the Council of Europe, as well.