TWN Info Service on Health Issues (Mar22/09)
28 March 2022
Third World Network

WHO: WGPR Bureau marginalises International Health Regulations Amendment Process

Geneva 28 March (Nithin Ramakrishnan and K M Gopakumar) – The Bureau of the Member States Working Group on Strengthening WHO Preparedness and Response of Health Emergencies (WGPR) is marginalising the IHR amendment process.

The Bureau’s Summary Report on the 7th Session and its draft programme of work for its 8th Session meeting are clear indication of this direction.

The WHO Executive Board (EB) in its decision EB150(3) (2022) dated 26 January had required the WGPR to provide dedicated time to allow for discussions on strengthening of the IHR 2005, including through implementation, compliance and potential amendments. However, the Summary Report and draft programme of work neglect to implement this mandate.

[The WGPR was established in 2021 by the World Health Assembly (WHA) Resolution 74.7 to consider 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, organisations, non-State actors and any other relevant information.

[The functions of the WGPR Bureau includes (a) to propose working methods of the Working Group; (b) to draw up the provisional agenda of Working Group meetings; (c) to consider documents prepared in advance of Working Group meetings, including to facilitate the timely dispatch of working documents; (d) to coordinate work among subgroups, if any; (e) to propose to Member States for their consideration ways forward on substantive matters, including, for example, through “Chair proposals” (but not to decide substantive matters); and (f) to prepare the draft reports of the Working Group, based on the proceedings and discussions during the Working Group sessions.]

The 7th Session of WGPR was held on 21-24 February. The Bureau’s Summary Report was published on 18 March.

The draft programme of work for the 7th Session, published on 16 February, has a clear agenda item on the “consideration of Member States’ proposals for action, including at the 150th session of the Executive Board” at the 7th session. There was a repeated demand from several developing countries for a process to submit proposals for amending IHR 2005, based on the EB150(3) decision. Nevertheless, the Co-Chairs, who preside over the meeting, did not make any effort to drive this demand for process from developing countries to a decision point.

Furthermore, the Bureau’s Summary Report does not report anything on this agenda item, especially the demand for a timeline to carry out discussion on the IHR amendment. The report only mentions the critical role of strengthening IHR 2005.

On the other hand, during the previous meeting of the WGPR, the U.S. was pushing ahead an agenda for taking into consideration its own IHR amendment proposals circulated before the EB decision in January. The U.S. is insisting that its proposals for amending IHR 2005 should be taken on a priority basis to facilitate their consideration at the upcoming WHA75 in May. This means the amendment proposals of other Member States will not be treated on an equal footing with the U.S. proposals on amendment of IHR and those will be considered only during WHA76 in 2023.

If the U.S. has its way, it then gets an edge to press other countries to discuss its proposals without any alternative texts, thus blocking the adoption of other amendments proposals. It must be noted that the U.S. amendment proposal has nothing to address the concerns of equity in health emergency preparedness and response.

On the other hand, The EB decision has given a specific mandate to address the issue of equity within the scope of amendments. It states: “Such amendments should be limited in scope and address specific and clearly identified issues, challenges, including equity, technological or other developments…”

The U.S. strategy is to fast track its amendment proposals and then block proposals for the equity-related amendment proposals which may come from developing country Member States.

The U.S. is relying on Article 54 of the IHR 2005 which states that the text proposals for amending IHR 2005 must be submitted four months prior to the WHA session at which the proposals will be considered.

The WGPR Bureau’s Summary Report of the 7th Session of the WGPR and the organisation of the intersessional informal meetings between the 7th and 8th sessions is essentially promoting the U.S. approach.

Despite the call by several developing countries, which requested the WGPR to adopt a timeline and process for submitting proposals for amending IHR 2005 and for its consideration, the Bureau’s summary report is devoid of any mention to such calls. Member States such as India, have also raised a concern in the WGPR meeting against the compartmentalization of the proposals to amend IHR, i.e. for WHA75 and for WHA76. Even this is not reflected in the Summary Report.

Nigeria had asked for a timeline for other Member States to submit the proposals.

Paragraph 4 of the Bureau’s Summary Report simply states: “Member States also requested the Bureau to provide a clearer timeline of WGPR’s activities until the Seventy-fifth World Health Assembly, taking into account other processes such as the deliberations of the Working Group on Sustainable Financing and the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response.”

There is no mention of Decision EB150(3) in the summary report. The Bureau’s reluctance to fix or propose a timeline for submission of IHR amendments is thus delaying the submission of amendment proposals pursuant to Decision EB150(3) and serving the U.S. interest.

The U.S. is one of the Vice-Chairs of the WGPR Bureau.

On 25 March, the WGPR draft programme of work for the 8th Session meeting schedule for 28-30 March was published and it reads as follows on strengthening IHR 2005:

“d) Discussion on strengthening the International Health Regulations (IHR) (2005)

– Capturing progress so far, including potential amendments to the IHR (2005) with a focus on enabling the rapid sharing of information

– Discussion of a possible inclusive, transparent path forward for negotiations on strengthening the IHR (2005), to be potentially included as a proposed action in the report discussed in (3) below

– Efforts to strengthen country core capacities and compliance

– Follow-up on discussion of the Universal Health and Preparedness Review”

Th draft programme of work therefore contains no indication on establishing a timeline or process inviting proposals for amending IHR 2005 in the WGPR as per the 150th EB decision. It merely indicates a possibility of having a path forward for negotiations on “strengthening the IHR 2005” as a proposed action in the WGPR’s “final outcome report”. On the other hand, it is not clear whether the mandate of the WGPR will be extended beyond WHA75.

The strengthening of IHR according to the 150th EB discussion means including through implementation, compliance, and potential amendments. Thus, amendment of IHR is one of the ways of strengthening those regulations. However, fixing a timeline for the amendment process now depends on the persistence of the Member States since the Bureau is clearly abdicating its responsibility of taking the mandate of the EB decision to its logical conclusion. As of now, it is not very clear that there would be a transparent process, including a time line and opportunity for all Member States to submit their proposals on IHR amendments to the WGPR.

There might be proposals to shift IHR amendment to the mandate for an international negotiating body (INB), which is established to negotiate the proposed new instrument on pandemic. The Bureau’s proposal for the outline of the final report of WGPR to the 75th WHA states: “… proposed recommendations to be taken up by the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (INB)”.

This may be an indication of shifting IHR amendment to the INB, but the critical question is whether the U.S. amendment proposals will also be shifted to the INB. Such a shift of forum could result in the marginalisation of the IHR amendment agenda due to the already prioritised timeline for the new instrument in the INB.

While there is no mention on the mandate in the EB Decision EB150(3) in the draft programme of work for the 8th WGPR Session, it is interesting to note that the draft purports to capture the progress of negotiations on potential amendments to IHR 2005 “with a focus on rapid sharing of information”, meaning the U.S. proposals. Whereas Decision 150(3) has called for amendments with few other focus areas including “equity”. In other words, the WGPR Bureau is ignoring its mandate from the EB, and is acting according to the interests of the U.S.

Guiding Questions Disregard the legitimate interests of Developing Countries

Meanwhile, on 15 March the Bureau circulated a set of guiding questions to shape the agenda of the intersessional informal meetings of WGPR on 18 and 24 March on four themes: equity, leadership and governance, systems and tools and finance. Strengthening IHR 2005 is addressed under the theme of “leadership and governance”.

The second question on the strengthening IHR is a conspicuous disregard of the views expressed by several Member States during the 7th Session of WGPR on prioritising certain IHR amendment proposals against others:

“Some amendments currently before the WHA in May address these high priority areas such as notification and alerts, risk assessments and information sharing. Do those proposed amendments address the gaps raised by the recommendations or can they be improved? Are there other relevant aspects of these high priority areas that should be addressed by WHA75 in some other way?”

The term “some amendment currently before WHA” refers to the U.S. proposals submitted before the EB mandate to WGPR. Ideally this question should have come after the start of the process for submission and consideration of IHR amendment proposals.

It is noteworthy that EB Decision 150(3) clearly stipulates the primacy of “equity” and “the universal application [of IHR 2005] for the protection of all people of the world from the international spread of disease in an equitable manner”. However, the guiding questions on IHR 2005 amendment do not address the issue of equity at all.

The other guiding questions on “strengthening IHR” include:

• “Based on the recommendations from the panels/committee and the survey results, IHR strengthening in these areas was identified as a high priority and feasibility item: Role and functioning of NFPs; Core capacity requirements for preparedness, surveillance and response; National notification and alert system; Risk assessment and information sharing. Are there any concrete ideas on how to implement the recommendations either through WHO`s normative work and/or IHR amendment?
• Many Member States, both through WGPR statements and survey responses have prioritized in particular for States Parties to share the relevant public health information needed by WHO to assess the public health risk and for WHO to be empowered to respond effectively to outbreaks, while some Member States have expressed caution that such efforts should not compromise national sovereignty. How should we finalize recommendations on this critical area?
• What obstacles need to be addressed and/or support required in order to strengthen national and regional core capacities that could improve IHR (2005) implementation and compliance?”

Similarly, the guiding questions on the “equity” theme also does not cross refer to the need for amending IHR 2005 in realising equity in the health emergency preparedness and response.

The guiding questions on IHR strengthening also explain in its fifth bullet point that “the Bureau intends to propose a way forward through its final report so there will be agreement and clarity on how the IHR strengthening work will be taken forward, and we continue to seek Member State input to inform that proposal”.

While it is not for the WGPR Bureau to decide on the way forward, by postponing the development of a way forward for the work related to strengthening IHR 2005, to its final outcome report, the Bureau is effectively delaying the submission of proposals from developing countries to ensure equity in the IHR 2005, and prioritising the U.S. amendments instead.

The guiding questions are also seen as aggressively promoting the WHO’s programmatic tools such as ACT-A and WHO Bio-hub, undermining the need for translating equity into legal commitments and obligations under the IHR. It must be noted that structural and working principles of these programmatic tools are not prepared through Member States process. The WGPR Bureau’s actions also undermine several areas of priority such as diversification and promotion of local production of health products, and fair and equitable sharing of the R&D outcomes, etc.

Furthermore, the agenda of the WGPR meetings are often published a few days ahead of a meeting without giving much time for the countries to prepare. There is no clarity on the process by which guiding questions are drafted and agreed upon. In their current form such questions are clearly leading questions soliciting Member States to respond in a particular way which promotes the priorities of the developed countries to the detriment of the legitimate needs of the developing countries.+