Covid-19.
Kochi/ New Delhi, 4 October (Nithin Ramakrishnan and K M Gopakumar) – There are “real differences” of views among World Health Organization member states with regard to the possibility of a pandemic treaty proposed by the European Union and strengthening of the existing International Health Regulations (IHR).
This emerged at the second meeting of the Working Group on Strengthening WHO Preparedness and Response To Health Emergencies (WGPR) and is recorded in the WGPR Bureau’s summary of the records.
The second WGPR meeting was held on 1-3 September at WHO Headquarters in hybrid (online and onsite) mode, and the next one will start today (4 October)
[The WGPR was established by the World Health Assembly Resolution WHA74.7 in May this year, with the mandate to assess the benefits of developing a new pandemic treaty under WHA 74(16). The first meeting of the WGPR was held on 15-16 July.]
The draft summary of the second meeting states: “While discussing agenda items 4 and 5, Member States engaged in a rich and substantive discussion that identified several areas of clear priority both where there is significant convergence of views and where real differences remain”.
The summary was released on 1 October, just 2 days before the third meeting of WGPR. Several documents as discussed below have also been circulated over the past week, giving Member States very little time to analyse and prepare for the third meeting. At the same time, some steps taken by the WHO Secretariat do not reflect the divergent views of Member States.
The two relevant items on this matter in the second WGPR meeting were as follows:
Item No. 4: Consideration of the findings and recommendations of the Independent Panel for Pandemic Preparedness and Response, the IHR Review Committee and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme, taking into account relevant work of WHO, including that stemming from resolution WHA73.1 (2020) and decision EB148(12) (2021), as well as the work of other relevant bodies, organizations, non-State actors and any other relevant information.
Item No.5: Prioritization of the assessment of the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response.
Sources disclosed to TWN that both the United States and China opposed the idea of a new pandemic treaty during the recent WGPR meeting. The US position was already clear prior to the meeting. In a viewpoint published in the Journal of American Medical Association (JAMA) US State Secretary stated:
“Some major strides to advance global health security may take years to accomplish, for example, the creation of a new international instrument on preparedness and response, which the WHO and a number of other countries have endorsed. But it is not necessary to choose between a new instrument and a revised standing legal framework; immediate steps can make a meaningful difference. One is strengthening the WHO’s International Health Regulations (IHR), adopted by the World Health Assembly in 1969 and revised in 2005.”
The Bureau’s summary provides a snapshot of discussions on five thematic areas: Strengthening the effectiveness and implementation of, and compliance with, the IHR (2005); governance; finance; equity; benefits of a new treaty; and coordination with other UN agencies.
Regarding the strengthening of IHR the summary states: “There is significant divergence on how best to accomplish this goal, and it will require more work to find consensus. Potential challenges of amending the International Health Regulations (2005), including areas that cannot be covered in the Regulations, should be explored”.
Regarding governance, the summary notes that there is convergence on the potential improvements in WHO governance focusing on the Executive Board and its sub-committees and also the need to link the improvements of WHO to an effort to improve global health architecture.
On finance, the summary states that there is a convergence of views that the current model of WHO financing is inadequate for effective preparedness and response to a pandemic. However it further identifies “a clear direction that the WGPR needs to coordinate its work with the Working Group on Sustainable Financing to promote sustainable and flexible financing for WHO”. Thus the finance discussion will now effectively take place in the Working Group on Sustainable Financing.
Though the summary notes the agreement of Member States to address equity including the supply of countermeasures, there is no clarity with regard to the way forward. It states: “… Member States agreed that equity, both within and between countries, is a critical principle for success in improving global pandemic preparedness and response. It will require more work to develop specific measures to address inequalities in access by WHO and its Member States”.
An analytical paper was prepared earlier by the WHO secretariat (A/WGPR/2/3) compiling all the recommendations from various committees such as the Independent Panel for Pandemic Preparedness and Response (IPPPR), the International Health Regulations Review Committee (IHR Review Committee), the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (IOAC) and the Global Preparedness and Monitoring Board (GPMB) under three categories i.e. leadership and governance, systems and tools, and finance.
The summary also notes that the Universal Health Preparedness Review (UHPR) has strong support across Member States and regions, and is currently being piloted by WHO and several Member States. The idea of a universal periodic review (based on the current human rights mechanism), i.e. to have periodic reviews of IHR core capacities, is touted as a new idea to ensure reporting and peer review regarding the implementation of IHR.
However, it is interesting to note that there is already an obligation on WHO Member States to report annually on IHR implementation. Apart from the reporting requirements set out in Article 54 of IHR, Article 62 of the WHO Constitution obligates Member States to report to the WHO on the actions taken with respect to recommendations given by the Organization.
[Article 62 states: “Each Member shall report annually on the action taken with respect to recommendations made to it by the Organization and with respect to conventions, agreements and regulations”.]
IHR is a set of regulations adopted under Article 21 of the WHO Convention and therefore Member States are already under a legal obligation to submit the annual report regarding the implementation of IHR. However, there is no evidence of proper implementation of Article 62 in the IHR context. Thus there are already two legally established mechanisms to report the implementation of IHR (Article 54 of IHR and Article 62 of the WHO Constitution) yet there is no transparency with regard to their implementation.
The UHPR mechanism presently being tried is a model based on the Universal Periodic Review Mechanism (UPR) of the implementation of human rights obligations of parties of various human rights treaties. UPR was established under 2006 United Nations General Assembly Resolution 60/251. That mechanism is more elaborate by which the progress and the fulfilment by each State of its human rights obligations and commitments is peer reviewed through an interactive dialogue between the state concerned and other UN Member States. The States declare their actions and then questions based on the declarations as well as information collected from other stakeholders can be raised to the State. Following the discussions recommendations are made to the State concerned. The actions undertaken to implement these recommendations shall then be reviewed in the second review meeting. Also, the international community will assist in implementing the recommendations and conclusions regarding capacity-building and technical assistance, in consultation with the country concerned.
In contrast, the UHPR mechanism piloted in the WHO cannot ensure the achievement of core capabilities without international financing to establish such capability in developing country Member States. The majority of developing countries lack functional health systems. Further, strengthening and sustainable financing of WHO are also required for the proper monitoring of IHR implementation.
It is also interesting to note that while the WGPR Bureau’s draft summary was being finalized, the WHO Secretariat had already moved ahead with forming the panel of experts for the pilot UHPR. A call for experts has been issued to and the last date for application was 17 September.
Despite the clear admission of significant divergence on the idea of a pandemic treaty the summary states: “There is strong support for exploring the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response that could complement existing instruments, including the International Health Regulations (2005). In developing such a convention, agreement or other international instrument on pandemic preparedness and response, a cautious approach should be taken, recognizing both potential benefits and potential challenges”.
The draft summary also contains a list of identified gaps which includes:
(a) funding gaps at both domestic and global level;
(b) building core capacities for the implementation of and compliance with IHR at national and subnational levels, and strengthening mutual accountability, through regular country reviews and potential mechanisms like a Universal Health Preparedness Review;
(c) surveillance and early warning systems;
(d) zoonotic and environmental risks prevented and managed as part of a One Health approach;
(e) regional capacity on preparedness and response;
(f) strengthening laboratory capacities, enabling transparent immediate sharing of data on outbreaks, sharing pathogens, and promoting equitable sharing of benefits arising from shared information and resources;
(g) strengthening WHO’s authority, including for access to outbreak sites with due regard to and respect for the sovereignty of states;
(h) clear guidelines for action when a public health emergency of international concern is declared with potential to establish intermediate alerts issued at global or regional levels;
(i) interdisciplinary health emergency workforce, immediately deployable, to identify health emergencies and respond;
(j) digital systems to enable direct exchange of data and genetic sequence data;
(k) zoonotic and environmental risks prevented and managed as part of a One Health approach including for global surveillance systems and processes;
(l) national commitment on investment in inter-ministerial planning and preparedness, including precautionary measures to acquire and stockpile resources and on financing health systems;
(m) national, regional and global capacities to develop, produce and distribute vaccines, diagnostics, therapeutics and medical supplies;
(n) improving equitable access to countermeasures, through knowledge and technology sharing, better governance of intellectual property rights on pandemic/epidemic countermeasures and supply chain systems.
The summary was released on 1 October just 2 days before the third meeting of WGPR that will begin on 4 October. The summary states that “the Bureau will investigate the possibility for thematic deep dive sessions focused on the priority areas described in paragraph 2 and on the gaps in paragraph 3, taking into account challenges for all countries in the virtual setting”.
However one of the deep dive sessions was already over on 30 September. This delay in releasing the Bureau’s report that shows lack of consensus over the proposed pandemic treaty raises concerns on the transparency of the process.
Further, the Secretariat also released the following documents between 29 September and 1 October, giving very little time for Member States to carry out a proper analysis of the content of these documents:
• WHO collaboration with United Nations entities that operate during a health emergency, with a focus on the COVID-19 response (A/WGPR/3/3);
• Secretariat analysis for consideration by the Working Group to further identify the incentives for a new instrument on pandemic preparedness and response and the options for strengthening the effectiveness of the International Health Regulations (2005), including a consideration of the benefits, risks and legal implications (A/WGPR/3/6);
• Funding streams for health emergency preparedness and response in the context of COVID-19 (A/WGPR/3/4);
• Update of the preliminary findings from COVID-19-related recommendation mapping (A/WGPR/3/5).
A twitter message was also posted that published the guiding questions prepared by the Bureau for the deep dive session on IHR Strengthening and a potential new WHO instrument. These questions were leading questions aimed at compromising objective discussions, according to observers.+
- Third World Network