TWN Info Service on Health Issues (May22/08)
23 May 2022
Third World Network

WHO: Attempt to limit equity in health emergency to pandemics

23 May, Geneva (TWN) – The survey on an indicative list of substantive elements for a new pandemic instrument raises concerns that it strengthens attempts to limit equity to a pandemic context and thus generally legitimises existing inequities in the global health emergency preparedness and response regime.

The Bureau of the Intergovernmental Negotiating Body (INB) established pursuant to the World Health Assembly (WHA) Special Session decision (WHASS 2.5) had initiated the survey. The questionnaire seeks the response of WHO Member States and Non-State actors in official relation with WHO on 58 substantive elements and the deadline for response was 29 April.

These 58 elements in the survey are categorised into five as follows: (1) 16 elements on “equity”, (2) 10 on “leadership and governance”, (3) 20 on “systems and tools”, (4) five on “finance”, and (5) seven as “elements from other WHO instruments”.

The equity elements are limited to the pandemic context. This raises doubts on whether the proposed pandemic instrument is another attempt to limit the equity question only to pandemics and thus whitewash the failure to address issues related to equity in health emergencies including the COVID-19 response.

The WHO deliberations on the scope of a new instrument are limited to a new pandemic instrument. Though relevant bodies such as the INB or the Member States Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR) have not provided any clarity on the scope and meaning of the term “pandemic”, the limited scope of pandemic would limit the preparedness and response elements of a new instrument to pandemic or potential pandemics. As a result, the equity elements contained in the new pandemic instrument may not be applicable to other health emergencies including a public health emergency of international concern (PHEIC) that is the basis of the International Health Regulations (IHR).

The following 16 elements are listed in the survey:

1. Access to lifesaving, scalable and safe clinical care, including mental health care
2. Access to quality, agile, and sustainable health services for universal health coverage
3. Access to technology and know-how
4. Affordability of pandemic response products, including medical countermeasures
5. Availability of and timely access to pandemic response products, including medical countermeasures
6. Equitable access to emergency financial mechanisms
7. Equitable gender, geographical and socioeconomic status representation and participation in global and regional decision-making processes
8. Equitable representation in global networks and technical advisory groups
9. Increased national, sub-regional and regional manufacturing capacity for pandemic response products, including medical countermeasures
10. National capacity strengthening to prevent, prepare for and respond to epidemics and pandemics, including for R&D
11. Pandemic countermeasure strategic stockpiles and their equitable distribution
12. Policy to safeguard vulnerable populations most affected by pandemics
13. Prioritise access to pandemic response products, including medical countermeasures for healthcare workers
14. Rapid, regular and timely pathogen and genomic sequence sharing and related benefit sharing, including for the development and use of diagnostics, vaccines and therapeutics
15. Scalable scientific and technical cooperation and collaboration
16. Strengthened national regulatory authority capacity on licensing medical countermeasures

The equity elements listed above do not take into consideration the developmental divide existing between Member States and are couched in general language without any specific reference to the special needs of developing countries. Though IHR 2005 recognizes the needs of developing countries, this is in a vague and limited fashion and fails to translate the equity elements into concrete deliverables.

There are no specific, differentiated, and concrete obligations in the IHR 2005 on the developed countries to provide financial and technological assistance to developing countries, either to build health emergency preparedness and response capacities or to strengthen their health systems resilience to infectious disease outbreaks. Moreover, the provisions for collaboration and assistance in IHR 2005 are triggered only when there is a chance of international spread of infectious diseases leaving Member States without adequate assistance to address their local outbreaks of diseases. Interestingly, the preamble of the Constitution of the WHO states that “the achievement of any State in the promotion and protection of health is of value to all” and identifies “unequal development in different countries in the promotion of health and control of disease, especially communicable disease”, as a common danger.

Nevertheless, IHR 2005 failed to recognize these common values and danger except for Article 44(2)(c) wherein the WHO is required to collaborate with States Parties upon request in mobilisation of financial resources specifically for developing countries for capacity building in the core areas identified in the IHR. The indicative list of the equity elements in the INB Survey shows no difference and does not rectify the existing failure. There is absolutely nothing indicative of more binding concrete commitments from developed countries.

The WHO Executive Board (EB) Decision 150(3) requires issues of equity to be addressed in the IHR amendments, and this is reinforced in certain Member State statements in the WGPR sessions following the EB150 Session.
.
For instance, during the 8th session of the WGPR, Botswana on behalf of 47 African States had reiterated their position which the African Region expressed during the 7th session. It stated as follows: “As we have indicated during the 7th meeting of the WGPR, the Africa Member States propose that Equity should be addressed both the within the IHR (2005) amendments as well as the new international instrument (INB). Therefore Equity provisions proposed in the IHR (2005) should be complemented in zero draft prepared by the INB with cross referencing to relevant IHR (2005) provisions. 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 accessibility, availability and affordability of health products including the sharing of technology and know-how for scaling up local production, as well to address the unilateral decisions like travel bans, restrictions on movement of goods and information on diseases outbreaks that has been reported under the IHR (2005).”

However, the list of equity elements in the survey shows no preference to cross-refer to IHR 2005 or to public health emergencies of international concern (PHEIC). This shows the new pandemic instrument is being envisaged as a super-specialized instrument dealing with only pandemic-scale health emergencies, further verticalizing the public health policy of the WHO. This is alarming as it would further earmark and fragment the financial, technical and technological resources available with WHO to address public health emergencies.

The highly inadequate response of the international community to health emergencies like Ebola and COVID-19, and their almost neglect of the regional or small-scale outbreaks of diseases is well-documented. When the Ebola outbreak in the Democratic Republic of Congo was declared a “PHEIC”, after the fourth emergency Committee meeting, one of the major considerations was that the global community has not contributed sustainable and adequate technical assistance, human or financial resources for outbreak response, despite previous recommendations for increased resources by the Committee. The Committee specifically stated that the declaration of a PHEIC is a measure that recognizes “the need for intensified and coordinated action to manage them.”

It must be noted that therefore a pandemic is much beyond an extraordinary event with potential risk of international spread of disease, and it requires presence of disease in multiple regions of the world, perhaps an intercontinental spread of disease. Amongst the six PHEICs declared after the adoption of IHR 2005 only H1N1 and SARS-CoV-2 were identified as pandemic. A pandemic instrument without adequate reference to IHR 2005 is going to create an entire new set of governing institutions, systems and tools, and financial mechanisms to be earmarked and untouched except for rare outbreaks.

Limiting equity to pandemic or potential pandemic outbreaks would directly legitimise the existing inequities in the health emergency preparedness and response regime, including the lack of legal obligations on common but differentiated responsibilities, access to medical and health products, finance etc. Accordingly, the efforts to incorporate equity in the health emergency regime would be limited in scope and ignore the urgent needs of developing countries to address health emergencies other than pandemics and potential pandemics.