The following is a hypothetical future scenario that revolves around possible international efforts to counter another pandemic. It is by no means supposed to be a blueprint for an international response mechanism. Nevertheless, the author hopes that it will provide both food for thought, and impetus for the international community to take bold and anticipatory steps in order to be better prepared for future pandemics.
Dr Babacar is on duty the third Sunday of January, his sixth overnight shift since the beginning of the month. He has been working in this small town hospital for the past three years. It is under staffed and poorly equipped. The town is forty miles away from the capital in a West African country. His colleague, who was on duty yesterday, mentions to him that three strange cases, two women and a boy of eleven from different families, came in with the same symptoms; fever, nausea and eczema-like lesions. He prescribed some basic medicines and sent them home. Dr Babacar is therefore prepared to receive more patients with similar symptoms. But he was not expecting so many. Fifteen patients of different genders and ages come throughout the day. Two of them are seriously ill and have to be hospitalized. Dr Babacar realizes that they are facing an unknown infectious disease and that he has to report it to the Ministry of Health. He chooses not to wait until Monday morning and right away calls the Director General of the Department of Infectious Diseases, whom he already knows. The Director then calls Odette, another colleague who has recently participated in a training course given by the Organization for Rapid Response Against Pandemics (ORRAP), wich was created in the wake of the COVID-19 crisis. Together they contact the Minister of Health and advise her to convene a staff meeting. The meeting takes place at the Ministry at 10pm with all relevant personnel present. The Director informs them about the reported disease and the Minister asks for the views of his staff. Odette shares what she learned at the ORRAP’s recent training and says that time is of the essence and they should take measures immediately. In particular, she advises, they should inform the ORRAP in accordance with the terms of membership. She also suggests inviting the ORRAP’s Rapid Response Team (RRT), which can be deployed swiftly to help them contain the disease, determine the cause and treat the patients.
The country joined the ORRAP a few months ago and the relevant rules and regulations are not yet in place. In order to receive the RRT they need the authorization of the President. The Minister, fully aware of the risks after the experience of COVID-19 eight years ago, decides to call the President. The latter gives instructions to contact the ORRAP and start implementing the necessary measures following their advice. Odette is asked to make the first contact with the Situation Center (SITCEN) of the ORRAP.
2020 – 2025: The COVID-19 crisis and the creation of ORRAP
The COVID-19 pandemic in 2020 had devastating consequences; a huge number of human losses worldwide and enormous economic suffering. It took more than two years to control the disease and about five years for the world to return to a semblance of normality. Economic hardships were still faced by many after eight years, especially in, but not limited to, developing countries.
However, important lessons were drawn from this terrible experience. After a flurry of seminars, workshops, conferences and studies, an expert and policymaker consensus formed around one primary lesson: “pandemics are a global threat and no country is immune, and there is therefore a need for a global response with close coordination between states.” The international community coalesced around other key lessons as well. The cause of pandemics could be deliberate, accidental or natural. No state would deliberately or rationally use such a biological weapon knowing that its own people could also be hit. Hence, deliberate use by a state was considered unlikely. Terrorists, organized or acting alone, could still carry out such an attack. But regardless of the cause, the response would be the same and the fundamental goal would be to save human lives.
Exploratory talks were held among the representatives of interested countries in the fall of 2020. One of the primary issues that experts addressed was “whether a rapid and effective response at the very initial stage would help contain and eradicate the disease at its source” – akin to fire brigades isolating and extinguishing a fire before it spreads. Lengthy discussions took place among virologists, epidemiologists and diplomats. They all finally agreed that such a mechanism would be possible, provided that some conditions were met and arrangements were made:
- Full transparency: The country where an infectious disease emerges should immediately inform the relevant international body and other countries, beginning with the neighbors. Experts also addressed the timing of the notification, in view of the risk of false alarms and unnecessary disruption. They concluded that this was too important an issue to be left to the sole judgement of local healthcare personnel. All healthcare institutions and staff in every country should be instructed to immediately inform their central authorities about the first indications of any unknown (or known to be a pandemic risk) infectious disease. The national authority should consult with the relevant international body and discuss whether external assistance would be useful. Final judgement on this should be left to the international institution. Politicians should not interfere and all countries should be open to cooperation with the outside world. Some experts argued that continuous international monitoring for early warning would be helpful. But this idea was opposed by several countries as they saw it as “an interference in their sovereignty”. It was agreed to address this issue at a later stage.
- Required capabilities for early and effective response: Experts agreed that some countries already possessed the necessary capabilities for early intervention against an infectious disease with a view to preventing its spread. However, the number of such countries was limited and it wasn’t clear whether they would make available their capabilities to be used elsewhere. There was also no certainty regarding countries being willing to accept such assistance. Hence, the view emerged that it would be highly preferable to build an international response capacity, which could serve the needs of all nations. This would be much less costly for a large number of countries that could not afford to create and sustain their own capacities.
In view of the COVID-19 experience, developed countries well understood that there was no room for loopholes in any part of the world and it was in their best interest to cover all nations with an effective response mechanism against pandemics. However, many of them were still skeptical about the success of multilateral institutions: they were considered politicized and under the influence of certain countries, thereby undermining their impartiality and independence. They were also considered cumbersome and too slow to act.
Some participants advocated the establishment of an ad hoc group of experts from different countries who could meet and train periodically and be called upon to take part in an international mission at short notice. This would be less costly than creating a team composed of permanently-employed international staff.
Others disagreed, arguing that the main goal was to ensure an effective response, not just a cost-effective one. Given the disruption and economic losses that COVID-19 caused, the costs of such a robust international initiative would be comparatively minimal. Furthermore, there was no guarantee that on-call national experts in an ad hoc arrangement would abide by their commitments when a real crisis occurred. In 2014, for example, the Organisation for the Prohibition of Chemical Weapons (OPCW) had not been able to fill certain gaps for a mission in a conflict zone when it called upon national experts from an established roster. The lesson being that an ad hoc team of national experts was no substitute for a well-trained, well-equipped group of international ones. This camp argued, therefore, that a team of first responders should be “standing,” and not ad hoc – regularly conducting tabletop and field exercises and ready to act swiftly when deployed in the field. As to the composition of the team, competence in the relevant fields should be the key factor. It would be a mistake, they argued, to seek even national distribution for such a technical job, as is traditionally done in international institutions.
- Deployment of the team of experts: Participants in exploratory talks agreed that necessary arrangements should be made by states in order to receive an international team for assistance at any given time. No time should be wasted for customs or immigration formalities at their arrival, nor for ensuring the cooperation of local authorities. A memorandum of understanding should be signed earlier with the international body. The rules and regulations should be developed at national levels according to certain model texts to be provided. A point of contact or a national authority (as is the case at the OPCW) should be designated. Ministries of Health would likely be the most appropriate offices to coordinate the efforts for response. They should be authorized by law to assume this role. Other structures, including the military, should follow their guidance.
- Samples: Collection and analysis of samples are essential in identifying the pathogen causing the disease. Biomedical-samples to be collected by the international team should be transported to designated laboratories without delay. Analyses at two different laboratories would help achieve a reliable determination of the appropriate treatment of patients and other necessary measures to be taken.
Some participants stated that their national legislatures would not allow the sharing of samples with external actors. They would be analyzed by their own laboratories. Lengthy discussions were held on this seemingly thorny issue. Several experts argued that the implementation should be equal without any exception. A potentially global threat did entail a unanimous, transparent and coherent response. A transitional period of five years during which legislative amendments could be made was proposed as a compromise. But those states should still commit to sharing the results of analyses with other countries and relevant international institutions in a timely manner during the transitional period.
A central laboratory which would help to create and sustain a network of designated laboratories should be established. States would be encouraged to nominate such laboratories, which would go through proficiency tests every two years in order to keep their certificate.
- Investigation: Several participants at the exploratory talks thought that the mandate of the first responders should cover investigation and identification of the source of the infectious disease. Others argued that the priority was saving lives rather than apportioning blame, if any. It was already assumed that there was a very low likelihood of a state deliberately using such a weapon. If the source could be a terrorist attack or an accidental release, it should be up to national security authorities to conduct such an investigation, not this team. However, the international team of experts could offer its assistance and support the investigation with the consent of the receiving state. The state concerned should be transparent in sharing the outcome of the investigation with other countries. Ultimately, however, there was no consensus on this issue.
- Involvement of the scientific community and civil society: Participants in exploratory talks agreed that the team of first responders should be supported by a group of scientists. It would be desirable to form a board of eminent experts who could meet at least twice a year and help develop and maintain some guidelines for the response against pandemics. These experts from different countries would follow technological and scientific developments and help the rapid response team keep abreast of them. A regular interaction with the global scientific community would be useful.
It would also be in the interest of the international community to involve the pharmaceutical industry as well as nongovernmental organizations (NGOs) and relevant foundations in these endeavors. Modalities of this partnership should be worked out. It was interesting to see that several countries who traditionally seemed allergic to the involvement of civil society in intergovernmental initiatives did not object to the idea in this domain.
- Funding: There was a general agreement that the funding of a new international initiative should be shared among parties according to the UN scale. It was also made clear that voluntary contributions by states or donations by individuals, foundations, NGOs and the private sector would be welcome. Some countries still expressed reservations at the idea of establishing a new international institution or permanent mechanism. They would seek instructions from their political leadership.
- Tasking an existing international organization or creating a new one: Views were diverse on this issue. Some participants were severely critical of how the World Helath Organization (WHO) handled COVID-19. They thought that establishing a small, compact and red tape-free international institution for early response against the risks of pandemic would not be a waste of resources. The mandate of the new institution should be limited to early response at the very initial stage of the outbreak. If it failed and the epidemic appeared to turn into a pandemic, the WHO should take over the responsibility of the coordination of international efforts. The definition of the initial phase should be made by experts at a later stage.
Some legal experts who took part in the talks advised using an existing legal instrument as a basis for a new institution. Otherwise it could take years to develop a new treaty or convention and ensure its entry into force. Some participants proposed to emulate the Joint United Nations Programme on HIV/AIDS (UNAIDS) and build a new program under the United Nations Economic and Social Council (ECOSOC). Others suggested drafting a protocol for the implementation of Article X of the Biological Weapons Convention (BWC). This could be a basis for an autonomous organization with its own budget and decision-making organs, with the involvement of civil society.
Some countries who had strong objections to any institution related to BWC implementation stated that they could consider this option provided that this would not lead to any additional verification mechanisms of the BWC. The new organization should only deal with early response and help build national capabilities in state parties to that effect.
One lawyer proposed an out-of-the-box idea: a legally binding text could be drafted, leaving the question of how to name the instrument to a later stage.
Exploratory talks in various national capitals, lasting two weeks, were found useful. Civil society showed great interest. Most governments were encouraged by the emerging consensus on several critical issues and they were optimistic that an international response mechanism could be set up in a short time. Others maintained their skepticism. Particularly, populist leaders in certain key countries were against any international enterprise. They thought that they could enhance their own capabilities and manage any crisis internally. Nevertheless, they were cautious not to reveal their positions in view of their failures in managing the COVID-19 crisis. The enthusiasm shown by civil society and the public at large towards a new international initiative which looked promising was another factor for them to remain low key. But their acrimony towards multilateralism remained largely unchanged.
NGOs extensively lobbied in capitals for an international response mechanism to be developed by an intergovernmental organization. They were able to convince several key governments, and others followed. Negotiations on an international legal instrument started in Geneva before the end of 2020. The aim was to develop a work program before the holiday season. Most participants were hopeful that they could wrap up within a few months in the new year. It didn’t happen. Some countries were adamant in denying any supranational role -as they perceived it- to an international institution. Others insisted on allowing a large space of action to the new institution for the common good of humanity. Delegations from countries that had shunned multilateralism over the past few years were not able to receive clear instructions from their capitals. Scientists and technical experts were bewildered by the attitude of diplomats, including their own. The efforts of the European Union, ASEAN and the African Union were not sufficient to achieve a breakthrough. A recess of three weeks was decided in early April, which was later extended.
Negotiations could have lasted for years if some populist leaders didn’t leave the political scene as a result of election losses to those more amenable to multilateralism. Other populists who stayed in power chose to moderate their views due to public criticism of their COVID-19 responses. Strong NGO pressure on governments, and awareness-raising among key populations, were also decisive factors in accelerating a positive outcome in Geneva. The delegates were finally instructed to resume negotiations in late May and to finalize the draft text by the end of October 2021. It was done with a delay of a few weeks. The governments finally decided that this should be a standalone Convention and it was signed by Foreign Ministers in early January 2022.
The ratification processes were necessarily left to individual countries, but with a strong recommendation to complete them as early as possible. Some countries would take it to their parliaments, and others would ratify it with cabinet decisions or presidential decrees. Indeed, the Convention was available for the establishment of a new organization in less than a year.
That is how ORRAP was born in early 2023. It took, however, another two years to recruit the professional staff. A Scientific Advisory Board (SAB) of fifteen eminent experts, virologists and others was established. The number of the international staff was kept at minimum while paying utmost attention to competence. ORRAP, a compact, agile, science-based small organization was fully operational as of March 2025.
The telephone of the ORRAP’s Situation Center (SITCEN) rings at five minutes before midnight. This has never happened before apart from periodic exercises. Odette introduces herself and is pleasantly surprised to find out that the official on duty is one of the instructors at the training course she recently participated in. The official remembers her too.
Odette describes the situation in her country. She reports the number of suspected cases as 25, but increasing every hour. Odette also asks whether the Director General of ORRAP would be available for a phone call with her Minister. The official says he will make this happen.
Later, the Minister of Health asks the DG whether she can send the RRT as early as possible and whether she already has some advice for immediate measures. The DG responds that she’ll be sending the team the next morning and advises to seal the town, halt all entries and exits, and if possible, keep people at home.
Indeed, the RRT is on a plane provided by the UN early the next morning. The timelines practiced during exercises were observed. Six hours were sufficient for preparing the team and its equipment for departure. The team also takes some additional protective equipment for use by the local health care staff at their destination. The same morning the DG asks the Chairperson of the SAB to convene a virtual meeting and provide her with their recommendations.
The RRT arrives at the capital around noon. Odette and her Director are waiting at the airport. Vehicles for transportation of the team are made available. After a short break at the airport the RRT goes to the town that is now under a mandatory lockdown. The team arrives at the town’s hospital in the early afternoon and immediately starts working in collaboration with Dr Babacar and the other local staff. Patients are examined and samples are collected and properly packed before sending them to the airport, so that the UN plane can take them back to the ORRAP’s HQ and its central laboratory. Results of the analysis can take a few days. Meanwhile the RRT will help the local authorities introduce the necessary measures to contain the disease and treat the patients. The RRT must also keep the SAB informed of the developments.
The ORRAP central laboratory splits the samples into four sets and immediately sends two of them to designated laboratories. Results of the analysis are received in approximately 60 hours and they corroborate each other. Therefore, the result can be considered as final and there is no need for a third round of analysis. The whole world has held its breath during these two and a half days. ORRAP was reluctant to issue a statement but there were leaks. Stock markets tremble during the wait.
Experts in labs determine that the virus which caused the disease is a mutated version of another pathogen detected fifteen years ago in a neighboring country. After some struggling at the initial stage, the health care personnel were successful in finding the right treatment at that time. The SAB, which preferred to receive results of analyses before giving its advice, recommends a similar treatment in this case, with slight amendments. It is also advised to undertake a vaccine campaign in the town using the same one from fifteen years ago. The RRT and the local health care staff follow the SAB’s recommendations. The results of the treatment of about 200 patients are promising. There are no fatalities. The measures of confinement taken by the government are also effective and prevent the further spread of the disease. The vaccine campaign starts immediately.
Everything is under control in a few weeks. The confinement measures are lifted. This is a great relief for the whole world. Many countries are still struggling to heal the wounds of the 2020 pandemic and they are not ready to counter a new disaster.
This is the first rapid response mission carried out by the ORRAP, and it is deemed very helpful by the receiving country. The President thanks the Director General of ORRAP for the prompt and effective response, as well as the local health care staff for their courage and dedication.
The RRT briefs the representatives of states parties at an extraordinary session of the Executive Council about their first real life mission. The Council commends the team for their success. States Parties and civil society representatives acknowledge that the investment in ORRAP was well worth the resources. Their strong support continues in the years ahead…
Ambassador Ahmet Üzümcü is a Senior Advisor with the Council on Strategic Risks and the former Director-General of the Organisation for the Prohibition of Chemical Weapons (OPCW)
* This post is part of the Council on Strategic Risks’ “Responsibility to Prepare and Prevent” Blog Series, designed to increase the tempo and scale of relevant and useful analysis during a time of crisis