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Info Service on Health Issues (Aug26/03) WHO: Draft ToR of IHR Implementation Committee Risks Compromising States Parties’ Oversight Kochi/New Delhi, 31 August (Nithin Ramakrishnan and K M Gopakumar) – The draft terms of reference for the implementation entities of the International Health Regulations (IHR) risk compromising the role of the States Parties in the oversight of the IHR implementation. Three draft terms of reference (ToR) for the States Parties Committee for the Implementation of the International Health Regulations (SPCIHR), its Subcommittee and the Coordinating Financial Mechanism have been circulated for the consideration and the adoption at the first meeting of the SPCIHR. This will take place at the Word Health Organization (WHO) Headquarters in Geneva from 31 August to 2 September 2026. The three draft documents for consideration are: (i) draft ToR for the States Parties Committee for the Implementation of the IHR (SPCIHR/1/2), (ii) draft ToR for its Subcommittee (SPCIHR/1/3) and (iii) draft ToR for the Coordinating Financial Mechanism (SPCIHR/1/4). The SPCIHR was established through the 2024 amendments to IHR 2005, to improve the States Parties role in the IHR implementation through a separate institutional structure. The proposed draft ToRs however risk weakening State Parties oversight over IHR implementation and accountability of the WHO Secretariat. This is because contrary to the intentions of the 2024 amendments, the proposed governance architecture in the draft ToR undermines the effective participation of States Parties and their oversight of the IHR Implementation. Draft ToR for SPCIHR This document (SPCIHR/1/2) contains 27 paragraphs set out in the sections: ● Purposes and functions ● Membership ● Working Modalities A. Officers B. Operation and decision-making C. Meetings D. Reports and reporting E. Subsidiary bodies F. Observers G. Cooperation and coordination H. Secretariat of the Committee. Paragraph 4 sets out major work areas and subject matters under the consideration of the SPCIHR: “Consistent with Article 54 bis (1)(a) of the IHR, the Committee will facilitate the effective implementation of the Regulations and provide a forum and a community of practice promoting and supporting learning, exchange of best practices and collaboration among States Parties. Its work, based on collaboration and peer-learning approaches, will encompass, and not be limited to, the following areas: (a) modalities and scope of technical cooperation and collaboration among States Parties for the implementation of the IHR, including but not limited to those outlined in Article 44 – develop, strengthen and maintain core capacities to prevent, detect, assess, notify and report events and respond promptly and effectively to public health risks and public health emergencies including through cross-border collaboration; (b) institutional positioning, operational arrangements, and legal and administrative instruments empowering responsible authorities set forth in Article 4; (c) arrangements for the management of acute public health events, including public health emergencies of international concern including pandemic emergencies, as per the provisions under Part II – Information and public health response of the IHR; (d) planning and financing instruments to sustain core capacities across hazards and government sectors; (e) domestic institutional and operational arrangements, across government sectors and with conveyance operators, concerning border health-related provisions and including international traffic-related measures; and (f) adherence to requirements set forth by provisions of the IHR of an administrative nature, and use of related digital platforms.” The draft ToR is thus silent on the oversight of WHO activities in the implementation of IHR, including the critical obligations with respect to facilitating equitable access to relevant health products. Paragraph 4 does not explicitly mention any WHO activities or collaborative arrangements, while it specifically highlights the arrangements to be put in place by States Parties and other actors such as conveyance operators with respect to administrative functions, use of digital platforms, international traffic related measures and management of public health events. Article 44 Paragraph 2 of the IHR itself is a standalone provision detailing the WHO obligations to collaborate, provide assistance and support financing. Additionally, several provisions across a number of parts of IHR such as Part II, III, IV, VI, VIII identify activities WHO should pursue, coordinate and support. Without the oversight of WHO activities, some of these functions may be overlooked as in the case of equitable access to health products mentioned above. Moreover, as per Articles 13, 14 and 44, many public health responses to PHEICs are coordinated by WHO through multiple channels and agencies. If the reports from these coordination activities and the implementation by other agencies are not overseen by the SPCIHR, the IHR implementation risks fragmentation and losing not only accountability but also visibility and transparency. Without an explicit provision giving the SPCIHR oversight and review over the functions of WHO in the implementation of ToR, including the measures taken to facilitate equitable access to relevant health products, the IHR will continue to be predominantly an instrument of disease outbreak surveillance and little about public health response and access to health care and health products. For instance, in the recent announcement of Ebola PHIEC the Secretariat has not provided any information publicly regarding the availability of required medical products as required under Article 13.8 that states: “… (a) conduct, and periodically review and update, assessments of the public health needs, as well as of the availability and accessibility including affordability of relevant health products for the public health response; publish such assessments; and consider the available assessments while issuing, modifying, extending or terminating recommendations pursuant to Articles 15, 16, 17, 18, and 49 of these Regulations”. The draft ToR also does not mention how the SPCIHR would instruct the Subcommittee, how it would consider the technical advice from the Subcommittee and how the SPCIHR would oversee the functioning of the Coordinating Financial Mechanism, although it talks about adoption of ToRs for both these entities. While these shortcomings could compromise the work of the SPCIHR, the draft TOR for the Subcommittee reveals a threat of the Secretariat and experts (as proposed for the Subcommittee membership) hijacking the work of the SPCIHR and themselves setting the agenda framework of IHR Implementation. Draft ToR for the Subcommittee of SPCIHR The draft TOR (SPCIHR/1/3) provides around 14 paragraphs in the following sections: ● Purpose and functions ● Membership ● Working Modalities ● Reporting ● WHO Secretariat Composition of the Subcommittee: The draft ToR proposes that the Subcommittee compromises experts with very little role for IHR States Parties in appointing the members of the Subcommittee or setting agenda and matters under the consideration of the Subcommittee. Article 54bis of the IHR establishes the SPCIHR as comprising all IHR States Parties and provides for a “Subcommittee” to provide technical advice to the SPCIHR. The
word “subcommittee” was used in Article 54bis, instead of However, the draft TOR envisages the Subcommittee to be composed of experts drawn from the IHR Roster of Experts, WHO Expert Advisory Panels and Committees, and WHO Advisory Groups, selected by the SPCIHR’s Officers (i.e. chair and vice chair of the SPCIHR), with the Secretariat support. Paragraph 4 of the ToR states: “The Subcommittee will be composed of […] persons, selected from the IHR Roster of Experts (hereinafter, “the Roster”), WHO Expert Advisory Panels and Committees and WHO Advisory Groups by the Committee’s Officers, with the support of the WHO Secretariat.” Para 5 of the draft ToR states: “The composition of the Subcommittee will take into account, to the extent possible, the principles of equitable geographic representation, gender balance, interdisciplinary balance and representation of a diversity of scientific knowledge, experience and approaches as well as whether the expert has been appointed to the Roster upon the proposal by the Director-General of WHO or designation by a State Party.” Thus, as per the draft ToR there is no role for the IHR States Parties in the appointment of the Subcommittee, except to propose experts’ names for the roster. It must be noted that the roster may also include experts and professionals from a Non-Party to the IHR as amended in 2024. Undefined Scope and lack of transparency in the work of Subcommittee: The scope of function of the Subcommittee is not mentioned anywhere in the draft TORs. The draft TOR in paragraph 2 simply states that the Subcommittee will provide technical advice: “The Subcommittee, in accordance with Article 54 bis (1)(b) of the IHR, will provide technical advice to the Committee”. However, the Paragraph does not specify the issues, questions or subject matter upon which the Subcommittee will be providing advice. Without any mention of the questions or agenda referred to the Subcommittee by the SPCIHR, the draft TOR bears the dangers of the Subcommittee or WHO Secretariat developing autonomous work programmes and questions preferred by the Secretariat or the Subcommittee members themselves. In the absence of clarity on the scope of work of the Subcommittee the WHO Secretariat could effectively determine the agenda of the Subcommittee and in turn, even control the agenda of the SPCIHR, through the technical subsidiary body. It
must be further noted that Paragraphs 3 and 11 of SPCIHR/1/3 state
that reports of the Subcommittee may be delivered through a presentation
to the SPCIHR and not necessarily as Draft ToR for Coordinating Financial Mechanism (CFM) The CFM’s draft TOR (SPCIHR/1/4) contains 9 Paragraphs in the following sections: ● Objective and functions ● Principles of Operation ● Governance ● Scope ● Cooperation and Coordination ● Support from the WHO Secretariat This draft document raises similar concerns as the other 2 ToRs. Article 44bis of the IHR places the Mechanism under the authority and guidance of the World Health Assembly (WHA) and makes it accountable to the WHA. Yet the proposed ToR does not propose membership for any States Party in the CFM. It does not envisage any role for States Parties in the operations of the CFM either. In fact, there are no particulars in the draft about who governs the CFM’s operations, what decisions are taken through the CFM, how States Parties participate in those decisions, and what actions remain subject to States Party guidance and oversight. Instead, Paragraph 5 of the draft ToR simply states: “In accordance with Article 44 bis (3) of the IHR, the Mechanism shall function, in relation to the implementation of the Regulations, under the authority and guidance of the World Health Assembly and be accountable to it.” Paragraph 9 also states that “the WHO Secretariat will act as the Secretariat for the Mechanism by providing technical, operational and administrative support and expertise, including convening of its meetings, and providing the necessary services and facilities for the performance of the work of the Mechanism.” Nevertheless, it is not clear in the draft ToR as to who is meeting whom, when and what will be the purposes of these meetings, and how decisions will be taken. Further Paragraph 7 says that the WHO Secretariat “may establish, as appropriate, working arrangements with relevant international, regional and other bodies, including within the United Nations system, and with other relevant stakeholders.” This is also different from the understanding of Article 54bis of the IHR, which empowers the SPCIHR to adopt necessary working arrangements with relevant international bodies, which may support its operation as appropriate. All these indicate that the States Party membership and role in CFM is being chiseled out in the draft ToR. It must be noted that States Parties membership and role in CFM decision making are important because financing priorities can materially determine how the IHR are implemented. States Parties’ oversight is necessary to ensure that international financing supports the full range of IHR capacities, including preparedness, response and equitable access to health products. One of the major objectives of the IHR amendments with respect to financing and CFM was to prevent international financial assistance from continuing to be disproportionately oriented towards donor priorities such as surveillance and information-sharing, through IHR States Parties control and oversight. The draft ToRs proposed for consideration fall far short of that. .
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