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TWN
Info Service on Health Issues (Jun22/08) WHO: Secretariat’s “white paper” aligns with developed country interests 16 June, Geneva (TWN): The World Health Organization Secretariat’s “white paper” containing an annotated draft outline for a new pandemic instrument carefully uses language that aligns with the interests of the developed country Member States. The white paper which was first introduced on 7 June 2022 during the resumed first session of the Intergovernmental Negotiating Body (INB) tasked to develop a pandemic instrument. It was uploaded to the INB website on 14 June with very few modifications. The document A/INB/1/12 is now titled as “Draft annotated outline of a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response”. The document will be used for consultations with relevant stakeholders other than Member States on 15 June. Member States will be discussing the document on 16 - 17 June, and are also invited to submit written inputs on the document until 24 June. The white paper is essentially a list of proposed structural elements (subject matters and their components that demand attention of the international community at large) developed by the Secretariat for the new instrument. It includes a reader’s guide, table of contents, and proposed elements categorised into the following 13 parts:
White paper Process The Secretariat developed the white paper based on the inputs received from the survey among Member States and Relevant Stakeholders as well as from a public hearing. It must be noted that the response rate to the survey is low at 33 percent. The Secretariat reportedly made a claim that the white paper is an attempt to consolidate all that has been proposed by the Member States and there is essentially nothing which has gone out of the purview of the paper. It is primarily composed of the elements that had been surveyed, the language of the elements is claimed to be altered on the basis of inputs provided by Member States and Stakeholders in the survey. The text in italics in document A/INB/1/12 refers to such alterations. The document also says in the beginning that it should be read along with A/INB/1/8, which is the “Draft consolidated outline document of the substantive elements”. Unfortunately, even after the modification of the text of the elements, the language of the elements suits the approach of the developed countries. Although it is orally asserted that these elements do not fix the scope of the contents in the INB June 7 meeting, there is currently no such explanation in the document. Essentially once a text is formulated even if for tentative purposes, it fixes the framework of the discussion. When viewed from this perspective the Secretariat’s use of developed country friendly language is detrimental to the developing country interests as they are losing out in the agenda setting or initial scoping of the instrument. It is reported that South Africa on behalf of the Africa region had requested the INB on 7 June to insert a footnote explaining the tentative nature of the document and that it would not prejudice Member States’ prerogative to submit new elements on the instrument as well as to propose amendments to the International Health Regulations 2005. However, this footnote is missing in the 14 June version; perhaps amendments are yet to be fully carried out. Concerns The white paper and its developed country friendly language, in the absence of a limiting clause as proposed by the Africa region, raise several concerns. First, there is no distinction between developing and developed countries in the White Paper, as recognized under the Alma Ata Declaration and International Health Regulations 2005. The common but differentiated responsibilities (CBDR) of the developed and developing countries are critical in identifying measures that promote fairness and equity in pandemic prevention preparedness response and recovery (PPRR). Second, the central element of fully functional health systems and their resilience is missing from the White Paper. A reference to resilient health systems is found in element 3.17 and repeated four times, once each in the sections relating to PPRR. It reads very simply: “Resilient health systems for universal health coverage and health security”. Another distantly relatable element is found: “Access to lifesaving, scalable and safe clinical care, including mental health care, continuity of health services and palliative care.” This language, however, does not take into account the establishment of fully functional health systems as the basic step in the preparedness towards any illness and disease, not just diseases with a potential of human-to-human or international spread. Such health systems are lacking in many Member States. Therefore, reference to fully functional health systems and their resilience would have been in the interests of these developing countries. The resilience of health systems in the face of pandemic and waves of infection is a critical component not only of the pandemic preparedness and response, but also that of the recovery section where the rebuilding of Health Systems disrupted by a pandemic should be a primary concern. Third, there is no proposal on financial assistance anywhere in the white paper. A peculiar usage of language was reportedly pointed out by the delegate of Bangladesh at the 7 June meeting. Bangladesh stated that the word “finance” appears a number of times in the text, but nowhere is “financial assistance” found. There are references to the mobilisation of the financial resources to the affected countries, but this does not ascertain the nature of the funds provided to such countries. The sub-theme of finance is repeated in Parts III to VI, i.e. parts relating to PPRR; however the elements are inadequately worded as follows: “4.1. Enhanced collaboration between health and finance sectors in support of universal health coverage, and as a means to support pandemic prevention, preparedness and response. 4.2. Financing national capacity strengthening, including through enhanced domestic resources. 4.5. Sustainable funding to WHO to support its work. (53) Establishing an international social, economic, and health fund to support injured communities and societies as a result of a pandemic.” Fourth, the white paper conspicuously avoids the phrase “fair and equitable”, where it speaks about the sharing of benefits derived from access provided to pathogens and related genetic sequence information. Element 1.14 repeated multiple times reads as follows: “Rapid, regular and timely pathogen and genomic sequence sharing and related benefit sharing, including for the development and use of diagnostics, vaccines and therapeutics.” Similarly, the explanatory paragraph provided to Part VIII dedicated to access and benefit sharing also does not use the phrase “fair and equitable”. While element 1.14 speaks about both pathogens and genetic sequence information and related benefit sharing, PART VIII is silent on the benefit sharing emanating from genetic sequence information. Fifth, Part VI listing elements under the title “Measures relating to Recovery” is blank with no specific suggestions or creative content as to what Member States or WHO need to do in order the smoothen the recovery process of Member States health systems and economy after the shocks of a pandemic. It must be recalled that it is at the insistence of developing countries that Part VI has found place in the white paper. The European Union and certain other developed country Members have already raised questions on the utility of having this section. Finally, and most importantly the white paper raises concerns by leaving out several components which are highly crucial to any PPRR regime on health emergencies including pandemics. They are:
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