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WHO: Africa Region calls for amendment of IHR for equity

Medicine 2022-03-02, 11:51pm


An infant receives a polio vaccine during a campaign that targeted over six million children in Afghanistan. (file) Unicef - K Shah

Geneva, 1 Mar (TWN) – Member States from the WHO Africa Region called for the inclusion of equity provisions within the potential amendments to the International Health Regulations (IHR) 2005 during the 7th meeting of the Member States Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR).

The 7th Meeting of the WGPR took place on 21-23 February at the WHO Geneva Headquarters in a hybrid mode.

Following decision EB150(3) adopted at the 150th Session of the Executive Board, the WGPR is now discussing potential targeted amendments to IHR 2005.

Botswana, who spoke on behalf of 47 States from the WHO Africa Region, stated that “it is critical that the IHR (2005) address the current inequities in order to ensure balanced rights and obligations in health emergency response including to facilitate availability and affordability of health products, and to address the unilateral decisions like travel bans, restrictions on movement [of] goods, (once the) information on diseases outbreaks that has been reported under the IHR (2005).”

The Africa Group recommended “that Equity should be addressed both within the potential IHR (2005) amendments as well as the new international instrument. Therefore, Equity provisions proposed in the IHR (2005) should be complemented in zero draft prepared by the INB with cross referencing to relevant IHR provisions. Therefore, we share the views as were just expressed by the distinguished colleague from Indonesia.”

[The INB is the Intergovernmental Negotiating Body, mandated to develop a new WHO instrument on pandemic prevention, preparedness and response, and started its work on 24 February. Indonesia has also reportedly sought a division of work on equity between the WGPR and the INB.]

Meanwhile, the Africa Region submitted an indicative list of proposals on improving equity under IHR as follows:

1. Equity in obligations on prevention, detection and control of pandemic threats;

2. Provision of financial assistance and technology transfer to developing countries;

3. Subjecting all WHO actions in a pandemic under the provisions of the IHR and a complementary future international instrument;

4. Obligation to provide support to WHO to coordinate the response;

5. Obligations to facilitate production, availability and access to medical countermeasures;

6. Ensuring equal footing of pathogen and genomic sequence sharing and benefit-sharing;

Decision EB150(3) has urged Member States to consider potential targeted IHR amendments including for improving equity.

Operative Paragraph 2 of EB150(3) specifically requires Member States to consider amendments to IHR which “address specific and clearly identified issues, challenges, including equity, technological or other developments, or gaps that could not effectively be addressed otherwise but are critical to supporting effective implementation and compliance of the International Health Regulations (2005), and their universal application for the protection of all people of the world from the international spread of disease in an equitable manner” (Emphasis added).

Several developed countries including Canada, the Netherlands and Denmark requested for the written statement of the Africa Region to study further the elements of their proposal.

Japan, on the other hand, reportedly asked Botswana to detail further on how they intend to achieve equity through amendments to IHR 2005.

Several delegates involved in the proceedings raised a concern about the work of the Bureau trying to treat equity outside the work-stream relating to IHR amendments, as well as to lead the discussions of the WGPR based on a survey conducted by the Bureau and Secretariat in which more than 60 percent of the Member States did not participate.

Botswana has squarely rejected any prioritisation based on the results of such a survey, while several other countries expressed their reservations on the way the survey results have been handled by the Bureau and the Secretariat.

While making it clear that the survey results on priority recommendations cannot be generalised across all regions for implementation, Botswana stressed that any work in modernising the notification and alert systems for enhanced sharing of information, including genome sequences, must adhere to the principles of the Nagoya Protocol on access and sharing of benefits derived from genetic resources.

It also called for increased capacity-building in relation to genomic sequencing.

It must be noted that some other developed countries reportedly moved to park equity issues for future work of the INB, exactly opposite to what Botswana has proposed on behalf of the Africa Region, i.e. “to adopt amendments to IHR on equity, and then cross-refer the same in the new instrument being developed by INB”.

It must be noted that the World Health Assembly (WHA) Special Session decision WHASS2(5) which provides the mandate for the INB supports the view of the Africa Region.

Operative Paragraph 1.4 of the decision reads as follows: “… that the process referred to in paragraph 1(3) [INB] should be informed by evidence and should take into account the discussions and outcomes of the Member States Working Group on Strengthening WHO Preparedness and Response to Health Emergencies [WGPR], considering the need for coherence and complementarity between the process of developing the new instrument and the ongoing work under resolution WHA 74.7, particularly with regard to implementation and strengthening of the IHR (2005);”

Currently, the United States is the only Member State which has proposed amendments to IHR 2005 along with draft textual changes.

The US proposals on IHR amendments have nothing concrete on issues relating to equity. Nevertheless, the US is aggressively promoting the texts of those proposed amendments through both formal discussions in the WGPR and through informal consultations with the Member States, with a view to get them adopted at the 75th Session of the World Health Assembly (WHA 75) that will take place on 22-28 May.

According to Article 55(2) of the IHR 2005, the text of any proposed amendment needs to be communicated to all States Parties by the WHO Director-General at least four months before the WHA at which it is proposed for consideration.

Although the WGPR received its mandate to discuss potential targeted IHR amendments only on 26 January, the US is relying on its early circulation of the text of proposed amendments to argue that WHA 75 can consider its proposed textual amendments, according to some delegates.

On the other hand, these delegates also reported that Article 55 of IHR 2005 has been repeatedly brought into the discussion to discourage immediate proposals from other countries.

At one point of the meeting, there were even suggestions to submit the US proposals to WHA 75 for consideration in May and for other proposals to be tabled for WHA 76 to be held in 2023.

Nevertheless, Member States like Botswana (on behalf of the Africa Region), China, and India reportedly opposed such moves.

China highlighted the legally binding nature of the IHR and stated that any proposal to amend must happen through a collective process, and after Member States sit together on the same. The process should allow for proposals from all Member States.

India also responded that a piecemeal process which compartmentalises certain IHR amendments to one period and others to another period is not desirable.

Botswana made it very clear by saying that going forward, the WGPR should establish a process with a timeframe for receiving textual proposals on targeted IHR amendments, to develop a consolidated draft text with attributions to Member States, and that all proposals are treated on an equal footing.

Botswana reportedly stated that “Only after this process can the substantial discussions commence”.

Algeria, supporting the Africa Region statement, also said there will be some amount of duplication of the work between the WGPR and the INB on equity, and that is quite obvious given equity is the central issue.

- Third World Network