Legal regulation of cooperation in the field of health protection within the framework of the Shanghai Cooperation Organization

Yadgarov Shakhrukh Shavkatovich ORCID: 0009-0001-8354-7233 Postgraduate student of the International Law chair, Diplomatic Academy under the Ministry of Foreign Affairs of Russia 53/2 Ostozhenka str., Building 1, Moscow, 119021, Russia sh.yadgarov@gmail.com Other publications by this author

At the present stage, the importance of global and regional integration processes in the field of public health protection is increasing. The coronavirus pandemic, colossal in its tragic consequences, actualized the need for serious reform of the interaction of states in the field of medical care, further strengthening the international legal framework in this direction. It is obvious that effective counteraction to viral infections is possible only in the case of close cooperation and interstate interaction without regard to the difference in economic development, standard of living, degree of development of medical services, political interests, since viral diseases in the conditions of current globalization, the current unprecedented development of transport infrastructure, which makes it possible to move relatively quickly even between distant countries are a serious threat health and even the life of humanity.

 International intergovernmental organizations play a special role in the mechanism of establishing and further strengthening cooperation in the field of healthcare, since they are a unique institutional platform for accumulating the efforts of States in the field of international law-making, assisting the latter in fulfilling international legal obligations, and constantly monitoring the implementation of contractual and "soft" law. It is necessary to agree with A.I. Karpenko, who noted that "international governmental and non-governmental organizations are among those in whose power it is to overcome these problems. It is not surprising that in addition to attempts (successful or unsuccessful) to overcome threats and challenges to human security, organizations should propose a number of rules for international medical cooperation." (1). In our opinion, the use of the potential of international intergovernmental organizations in the field of deepening mutual integration of states in the field of healthcare is an objective necessity, on which the effectiveness depends crucially efforts to ensure the right to health at the global and regional levels.

The sharp increase in the relevance of cooperation between states in the field of public health has attracted the attention of the scientific community to this problem. International legal research in this direction covers both the mechanism of legal regulation of the interaction of states in the field of health, and the human right to health. Scientists in these studies rightly note that a person from birth has a natural and universally recognized right to health, enshrined in the relevant universal documents, which is provided by states both by concluding agreements on cooperation in specific areas of medical care, and by implementing these agreements into national legislation, while in foreign and domestic science it is reasonable and The idea is reasonably put forward in the actual formation of such a branch of public international law as international health law (2). Meanwhile, there are no special scientific studies devoted to the comprehensive study of issues of cooperation between states in the field of public health protection within the framework of the Shanghai Cooperation Organization, which led to the choice of the topic of this article.

There is no doubt about the need to strengthen cooperation between the SCO member states in the field of healthcare. Experts note that the geographical region occupied by these countries is at high risk (especially South-East Asia) of the occurrence and spread of epidemic infectious diseases of bacterial and viral etiology (pandemics of plague, cholera, influenza), of the new diseases - SARS, avian influenza A/H5NI/, Nina viral encephalitis, etc.), as well as natural disasters (3). In this regard, despite the initial focus of the SCO on ensuring security in the border territories, combating terrorism, extremism and separatism, the founding states of this intergovernmental organization laid the legal prerequisites for the development of cooperation in the field of healthcare already in the statutory documents. Thus, the SCO Charter states as the main goals and objectives of the organization the promotion of comprehensive and balanced economic growth, social and cultural development in the region through joint actions on the basis of equal partnership in order to steadily raise the level and improve the living conditions of the peoples of the member States; promotion of human rights and fundamental freedoms in accordance with international obligations of states- members and their national legislation; joint search for solutions to problems that will arise in the XXI century (4). The issue of cooperation between the SCO states in the field of public health protection is also indicated in the treaty on long-term good-neighborliness, friendship and cooperation of the Shanghai Cooperation Organization member states, article 19 of which states that the above-mentioned countries develop between exchanges and cooperation in the fields of culture, art, education, science, technology, healthcare, tourism, sports and other social and humanitarian spheres (5).

The issues of cooperation of the SCO states in the field of healthcare received more substantive legal regulation in the Agreement on Cooperation in the Field of healthcare, concluded in 2011 in Astana, the Agreement defines such areas of cooperation as science and innovative technologies; prevention and control of infectious diseases; safety and quality of medicines and medical products; informatization of healthcare and telemedicine, primary health care and high-tech medical care; maternal and child health care, etc. (6)

In accordance with article 5 of the Agreement, the coordination of cooperation on the implementation of its provisions is carried out by an expert working group, whose activities are regulated by the relevant regulations. The parties bear the costs of fulfilling their international legal obligations under this agreement independently and take all necessary measures to protect intellectual property objects obtained during the implementation of the Agreement (Article 3). The parties may also conclude additional contracts during the execution of the terms of the Agreement (Article 6).

The regulations of the expert working group were approved at the meeting of the Ministers of Health of the Shanghai Cooperation Organization member states on November 18, 2010 in Astana, where the plan of the main measures for cooperation of the SCO member states in the field of healthcare was approved, also at the initiative of the Kazakh side, a draft Agreement between the governments of the SCO member states on cooperation was presented to the participants of the meeting in the field of healthcare (7).

The analysis shows that the above agreement is a framework agreement that establishes only general areas of cooperation, which is implemented through specific organizational and legal measures, in particular, the exchange of experience, determining further areas of cooperation, professional development, provision of necessary medicines, etc. Thus, in June 2021, an expert group meeting was held with the participation of specialists from the Ministry of Health of the Russian Federation (8), in which experts discussed the situation with the fight against COVID?19 in the SCO member states, and also identified the main directions of the main directions for the development of cooperation in the field of healthcare for 2022-2024.

A certain effectiveness of the SCO's activities in the field of establishing cooperation in the field of healthcare is noted by prestigious universal organizations, including the UN. Thus, the UN General Assembly resolution A/75/L.69 of March 17, 2021 "Cooperation between the United Nations and the Shanghai Cooperation Organization" noted the constructive role of the Shanghai Cooperation Organization in ensuring peace and sustainable development ... promoting regional cooperation in various fields, such as trade and economic development ... education, health, environmental protection and disaster risk reduction, as well as in other related areas (9).

Despite the fact that the SCO has already established a certain experience of cooperation between states in the field of healthcare, there are still a number of serious organizational and legal problems in this direction that need to be solved. The formation of a single legal space in the SCO region is objectively hindered by such problems as the existing huge gap in the economic development and potential of the organization's member countries in maintaining the infrastructure of medical institutions, the difference in the nomenclature and quality of medical services, the level of professional training of medical workers, the mechanism of medical care. E.I.Safronova notes that in the Central Asian states that are members of the Shanghai Cooperation Organization, the state of the medical and inpatient base remains unsatisfactory, there is a shortage of qualified personnel, especially in the poorest SCO member states - Tajikistan and Kyrgyzstan, the awareness of medical professionals is low, and the awareness of highly vulnerable to diseases of the population generally leaves much to be desired. In many rural hospitals, there are no conditions for isolating contagious patients, and equipment for high-quality sterilization of surgical instruments may be missing or faulty (10).

A.A.Arastanbek notes that for a long time problems in the field of health and health development have been solved at the national level, but in the process of intensive regional integration and the ever-increasing scale of population migration, ideas about the forms and methods of international governance are being reassessed. The development of the institutional system of the economy often takes the form of the import of institutions from other countries. However, their direct transfer is rather difficult, since, for example, due to significant differences in socio-economic development, foreign institutions are often not optimal for another country and will not find implementation mechanisms in new conditions" (11).

The analysis shows that within the framework of the SCO, the organization of international legal cooperation follows a standard scenario: the consolidation in declarations and other sources of "soft law" of commitment to joint cooperation in the field of healthcare, followed by the adoption of cooperation programs in specific areas in the field of medicine and, at the moment, in connection with which the legal basis of integration processes within the SCO in the field of healthcare, at the moment, it is actually limited by the above-mentioned framework agreement on cooperation in the field of healthcare and the annual development of a plan of basic measures for the development of cooperation in this direction, since significant socio-economic differentiation in the healthcare system, unfortunately, hinders deeper integration in this direction.

It should be noted that the above problems are typical not only for cooperation in the SCO, but also for other regions. So, for example, in Europe, general issues remain within the competence of the member states of the European Union (EU), and other countries and the EU can carry out activities to support, coordinate or provide additional services without violating the independence of the country in this matter. To date, a number of issues have not yet been resolved — there are problems with interaction between EU member states, in particular, who should provide medical care if a citizen lives in one country and works in another. This problem is compounded by the difference in the methods of financial provision of health systems and their functioning (12).

Meanwhile, significant achievements have been achieved at the European level with regard to the formation of mandatory acts to regulate certain issues of public health protection. Within the framework of the Council of Europe, it was possible to adopt the Convention on the Development of the European Pharmacopoeia of 1964; the Convention of the Council of Europe on Combating the Falsification of Medical Products and Similar Crimes of 2011. (The Medicrim Convention), Threatening public Health; the Convention on the Protection of Human Rights and Dignity in Connection with the Application of Advances in Biology and Medicine (the Convention on Human Rights and Biomedicine) (13).

A certain experience of integration processes in the field of healthcare can be used in the SCO, based on the analysis of the activities of the Commonwealth of Independent States in this direction. in the Agreement on the Provision of Medical Care to Citizens of the CIS Member States (Moscow, March 27, 1997), where citizens are guaranteed emergency and emergency medical care freely, free of charge and in full on the territory of the State of Temporary Stay by medical and preventive institutions, regardless of organizational and legal forms, departmental affiliation and forms of their ownership in the following cases: in case of sudden acute conditions and diseases that threaten the patient's life or the health of others, accidents, poisoning, injuries, childbirth and emergency conditions during pregnancy. From the moment when the threat to the patient's life or the health of others is eliminated and his transportation is possible, further medical care is provided on a paid basis (14).

Experts rightly point out that "the collapse of the USSR and the formation of new independent states brought to life centrifugal forces caused by the desire to ensure their independence from the once-existing center. Nevertheless, the neighborhood and the need to solve common regional problems force the former Union republics to look for new forms of interaction and cooperation. Last but not least, this concerns the human right to health protection and medical care" (15). In connection with the above, in our opinion, a promising direction for deepening cooperation between the SCO states may be the conclusion of special international legal agreements on specific areas of healthcare, including using modern information technologies. Thus, the President of the Republic of Uzbekistan Sh.M.Mirziyoyev put forward a proposal to create a concept of cooperation in the field of telemedicine (16), which will effectively use the accumulated professional experience in the field of medicine by the SCO leading states, primarily Russia and China, to organize high-quality medical care in other countries, organize the exchange of experience between medical professionals, improve the level of efficiency of interaction in the field of healthcare to a qualitatively higher level. We believe that a separate point of the above-mentioned concept should be the conclusion of an international agreement on cooperation in the field of telemedicine, which will consolidate specific international legal obligations of states in this direction, go beyond organizational and legal measures, create a more reliable legal basis for deepening the integration of SCO member states in the field of healthcare, become the legal basis for the implementation of international-legal obligations of the SCO member states in the field of telemedicine.

 Of course, the most urgent item on the agenda of strengthening cooperation in the field of healthcare is the optimization of interaction in the field of sanitary and epidemiological welfare. It is necessary to agree with V.Y. Smolensky, who noted that the scientific provision of international cooperation in the field of sanitary and epidemiological welfare of the population in modern conditions is one of the extremely urgent health problems. The priority in this area is the fight against infectious diseases, primarily new, returning, spreading to new territories (17). It is particularly relevant to establish international cooperation to combat the coronavirus that has raged on the territory of the SCO member states. As of 2020, in Southeast Asia, an increase in the number of registered patients was observed in countries with the most developed system of laboratory diagnostics. In India, there was an active uncontrolled spread of infection, there was a steady trend towards an increase in the number of cases registered daily.

In the Russian Federation, the incidence of COVID-19 has been registered since January 31, 2020, starting with isolated imported cases from China. At the same time, until the beginning of April 2020, the number of identified infected persons did not exceed 500 people per day, most of which accounted for Moscow. Further dynamics was characterized by a constant increase in daily reported cases of COVID-19 until reaching peak values in the first decade of May 2020. In the CIS countries, the incidence rate per 100 thousand population varies from 18.9 in Uzbekistan to 619.1 (18).

Taking into account the threat of coronavirus infection to the well-being of the population of the region, the SCO member states actively cooperate with each other in the format of adopting comprehensive action plans to combat epidemics on a periodic basis, which, although it allows for joint organizational measures, but from the point of view of the need to create more fundamental legal bases for cooperation to combat epidemics, in our opinion, is not quite sufficient. We should agree with E.Safronova, who noted that it seems necessary to create a legal environment for the implementation of a strategy to combat infectious diseases on the SCO scale, including preventive work with risk groups, and a decision-making process based on high-quality epidemiological data (19). The development of an international convention on combating epidemics and ensuring the sanitary and epidemiological well-being of the population, in our opinion, will allow the SCO to fully realize the potential of ensuring the right of the population of the countries of the region to health, will create a more solid legal foundation for cooperation between the SCO member states in this direction, create a closer legal framework for integration within this organization in the field of healthcare.

Based on the above, it can be concluded that international cooperation in the field of health is becoming increasingly relevant due to the need to ensure the fundamental right to health and the serious threat posed by epidemiological diseases. However, socio-economic differences in health systems prevent full integration in this direction. This situation is also characteristic of the cooperation of the SCO member states in the field of public health protection. In order to deepen cooperation and increase the effectiveness of cooperation within the SCO in the field of healthcare, it is necessary to further strengthen the legal framework towards the concretization of medical care, including the adoption of international treaties in the field of telemedicine and epidemic control.