The World Health Organization (WHO) has welcomed the decision of the US states of California, Illinois, New York and New York City to join its Global Outbreak Alert and Response Network (GOARN).

GOARN is a global network of public health institutions, governments, academic bodies and laboratories that helps to detect and control infectious disease outbreaks and public health emergencies throughout the world.

Dr Maria van Kerkhove, WHO Director of Epidemic and Pandemic Threat Management, said that GOARN is an “asset to the world” that currently has over 360 members.

Established 20 years ago, members include national and sub-national institutions with public health and field experience in outbreak response and preparedness, she explained.

“We welcome anyone who wants to be part of GOARN to see our website and fill in the application. It’s an incredible network of national and sub-national institutes, student and academic organisations that meet regularly and share information. They are sometimes deployed to outbreaks around the world,” Van Kerkhove told a media briefing on Wednesday.

Trump’s ‘reckless decision’

On 23 January, the day after the Trump administration completed its withdrawal from the WHO, California Governor Gavin Newsom announced that his state would join GOARN.

“The Trump administration’s withdrawal from WHO is a reckless decision that will hurt all Californians and Americans,” said Newsom in a statement. 

“California will not bear witness to the chaos this decision will bring. We will continue to foster partnerships across the globe and remain at the forefront of public health preparedness, including through our membership as the only state in WHO’s Global Outbreak Alert and Response Network.”

Illinois Governor JB Pritzker followed suit on 2 February, stating that US President Donald Trump’s withdrawal of the country from the WHO “has undermined science and weakened our nation’s ability to detect and respond to global health threats”.

By joining GOARN, “we are ensuring that our public health leaders – and the public – have the information, expertise, and partnerships they need to protect the people of our state”, Pritzker added. 

Safety during FIFA World Cup

Last week (5 February), the New York City Health Department also announced that it was joining GOARN, and on 10 February, New York State also reported that it would be joining GOARN.

“To best prevent disease outbreaks and public health emergencies and to protect New Yorkers and visitors from them, the NYC Health Department is joining hundreds of public health institutions worldwide that share critical public health information to support life-saving prevention and response efforts,” said Dr Michelle Morse, NYC’s Acting Health Commissioner.

“Infectious diseases know no boundaries, and nor should the information and resources that help us protect New Yorkers,” she said, adding that GOARN membership would give the city direct access to information and partners during “major events with high levels of international travel, such as the 2026 FIFA World Cup”.

Kathy Hochul, Governor of New York State, also announced her state’s membership: “By joining GOARN, we’re sharing our expertise, laboratories and highly skilled workforce to detect and respond to outbreaks worldwide while helping prevent global health threats from reaching New York State and the United States.”

GOARN members hold weekly meetings, exchange reports on international global health issues, provide support, technical assistance and even send people to assist during outbreaks, if requested to do so.

MOUs in place of multilateralism?

The Trump administration has tried to ameliorate its withdrawal from the WHO by signing health Memorandums of Understanding (MOUs) with former health aid recipients, trading ongoing health support for immediate access to all information about pathogen outbreaks.

This is in keeping with its America First Global Health Strategy, published last September by the US State Department, which aims to “make America safer” by “continuing to support a global surveillance system that can detect an outbreak within seven days”.

“We will accomplish this through bilateral relationships with countries,” according to the strategy.

But the US has only signed health MOUs with 16 countries, and it has not yet translated any of these into bilateral agreements. In addition, the 16 countries are all based in Africa and do not appear to have been targeted because of their disease outbreak profiles.

SARS-CoV2, the virus that caused the COVID-19 pandemic, originated in China – an unlikely candidate for an MOU. Meanwhile, a recent European Commission Joint Research Centre report identifies Latin America as the region at highest risk of outbreaks of the diseases identified by the WHO as the most likely to cause epidemics and pandemics. Oceania is the second most likely area. The most risky countries are Papua New Guinea and the Republic of the Congo.

In contrast to the bilaterals that will be time-consuming to manage, the WHO’s 193 member states are bound by the International Health Regulations (IHR), a legal framework that defines their rights and obligations in managing public health risks, events and emergencies that have the potential to cross borders.

In addition, negotiations between WHO member states are at an advanced level about a global pathogen access and benefit-sharing (PABS) system, the final piece of the Pandemic Agreement adopted by the WHO last May.

WHO Director-General Dr Tedros Adhanom Ghebreyesus reiterated this week that bilateral agreements between countries are “not a new phenomenon”, and he did not think that the US-driven MOUs can replace the multilateral system.

“Any member state can have any MOU with any country it wants. This is between sovereign countries, and they know best for their respective countries,” said Tedros.

Tedros also shrugged off concerns that these MOUs will undermine the PABS system being negotiated as part of the WHO’s Pandemic Agreement.

“I don’t see that there will be any impact on the PABS negotiations. We’re not really worried… There can be bilateral agreements, and there can also be multilateral agreements. It’s not one or the other. Both can exist without any problem.”