An open letter to the Executive Board of WHO from the surgical and anaesthesia community

An estimated 28 million surgeries were cancelled worldwide during the first 3 months of the COVID-19 pandemic, a number which might now be as high as 115 million—more than a third of all surgeries annually.1, 2 We applaud the work of WHO over the past 2 years in managing and reducing the impacts of the pandemic, but are critical about the efforts taken to mitigate the impact of cancelled surgeries despite the recognition of surgery as an essential part of universal health coverage. Given the unequal impacts the pandemic has had across clinical disciplines, countries, and populations, we strongly support the development of a binding worldwide pandemic treaty.

With the sharp rise in non-communicable diseases worldwide, the demand for surgical care is rapidly increasing. Surgical interventions are needed for 80% of injured patients and more than half of patients with cancer.³ Given the high versatility and the clear value surgical teams and infrastructure have added to the pandemic response, it is surprising that surgical system strengthening has not received more attention as part of pandemic preparedness initiatives thus far. We suggest a paradigm shift where access to surgical care is mainstreamed into pandemic preparedness policies. A mainstreaming approach would entail that the pandemic treaty assures that every policy adopted or implemented from this treaty has been evaluated for its impact on national-level surgical care provision. Only policies that do not harm surgical care provision should be included in the final version of the treaty so as to avoid detrimental impact. While novel in global surgery discourse, this would entail a policy approach similar to WHO's Health in All Policies.

As defined by the UN General Assembly at the beginning of the pandemic, this approach involves considering the systemic impact of policy decisions on health and making those decisions across different sectors to achieve synergy, equity, and improved health outcomes.⁴ By mainstreaming surgery into pandemic preparedness policy, we suggest that surgical care provision is taken into consideration for every policy recommendation or operative paragraph. This way, true health systems strengthening can take place to achieve a system where no-one is left behind before, during, or after a pandemic.

The 150th WHO Executive Board established a Standing Committee on Pandemic and Emergency Preparedness and Response to draft and negotiate the Pandemic Treaty under the sole auspices of the Member States.⁵ We urge the committee to recognise the importance of surgery as an essential part of health systems by: (1) ensuring participation of civil society, including the surgical community, as key stakeholders in the treaty negotiation process; and (2) mainstreaming surgical care into the final draft of the Pandemic Preparedness Treaty.

The surgical and anaesthesia communities stand ready to be involved in this process.