|
||
|
TWN
Info Service on Health Issues (Jan23/07) Geneva/Kochi, 30 January (K M Gopakumar and Nithin Ramakrishnan) – The World Health Organization’s Director-General (DG) has made proposals to strengthen the global architecture for health emergency preparedness, response and resilience (EB152/12). However, these skip critical issues required for strengthening the health emergency regime, especially to address the needs of developing countries. Document EB152/12 on “Strengthening WHO preparedness for and response to health emergencies” will be discussed today under agenda item 12.1 of the Executive Board’s 152th meeting that takes place from 30 January to 7 February in Geneva. The document contains 10 proposals to strengthen the global architecture for health emergency preparedness, response, and resilience (global architecture). It was initially presented to the 75th World Health Assembly (WHA) in May 2022 to be taken note of. The EB152/12 document is now reporting on the progress in the discussions on those 10 proposals from WHA75. There are some changes in the headlines of these proposals, but the central ideas remain more or less similar. Paragraph 4 of the document says these proposals are “designed to strengthen HEPR (health emergency preparedness, response and resilience ) under the aegis of a new WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (hereafter referred to as the pandemic accord), which is currently being developed by Member States through the Intergovernmental Negotiating Body established by the Second special session of the World Health Assembly in decision SSA2(5) (2021)(the “INB”).” Below are the ten proposals, out of which 9 are classified into three pillars of the global architecture, i.e. Governance, Systems and Finance. Governance:
Systems: 4. Strengthen the health emergency workforce 5. Strengthen health emergency coordination through standardized approaches to the strategic planning, financing, operations and monitoring of health emergency preparedness and response 6. Expand partnerships and strengthen networks for a whole-of-society approach to collaborative surveillance, community protection, safe and scalable care, access to medical countermeasures and emergency coordination Finance 7. Enhance coordination between finance and health decision-makers 8. Strengthen and fully finance the Pandemic Fund to provide catalytic and gap-filling funding 9. Expand the funds available for rapidly scalable and sustainable emergency response, including at-risk financing for the rapid development of and access to medical countermeasures Equity, Inclusion and Coherence 10. Strengthen WHO at the centre of the global HEPR architecture. The EB152 is invited to answer the following two questions: a) How can the Secretariat best work with Member States to advance the 10 proposals contained in the report? b) What gaps are there that require further work by the Secretariat with Member States? These questions attempt to seek endorsement from Member States for the proposals for which there was no earlier endorsement from the WHO governing bodies. Most importantly, these proposals on global architecture for HEPR are premature because fora like the INB and the Working Group on amendments to the International Health Regulations 2005 (WGIHR) are negotiating several important building blocks of the very same global architecture. To date, there is no consensus among WHO Member States regarding those building blocks in these fora. There are concerns that the 10 proposals “hand-picked” by the DG effectively undermine the Member States negotiations to set the architecture by promoting certain ideas, and neglecting some others. In-depth discussions should take place within fora like the INB and WGIHR, and their recommendations should be then forwarded to the governing bodies. If required, any other proposals or building blocks of the global architecture that are not addressed by the INB or WGIHR may then be considered by the governing bodies alongside the INB and WGIHR recommendations. However, seeking collaboration from Member States on the DG’s proposals at this point of time is side stepping the role of Member States in shaping the global architecture. Apart from this problematic process, the DG’s proposals on global architecture fail to address the following critical building blocks for a resilient health architecture HEPR: (1) Equity Though the document identifies equity as one of the purposes and principles of the global architecture, it is not been considered as one of the pillars of the global architecture. Further, there are no specific proposals on equity under any of the three pillars viz. governance, systems and financing. This goes against the recommendations in the Working Group on Strengthening WHO’s Preparedness and Response on Health Emergencies (WGPR). Many developing country Member States during WGPR meetings demanded that equity be treated as one of the main pillars along with governance, systems and finance, as well as to develop specific proposals on equity in each of the other pillars. The current proposals pay lip service to “equity” by recognizing it as purpose and principle in the introductory part, but there are very limited proposals to ensure the operationalisation of equity. The proposals assume that giving WHO a central role in coordinating the HEPR work alone will suffice to meet the needs of equity. However, in several other proposals, it can be seen that the role of WHO is getting further constrained by the agencies and institutions other than WHO. Further while discussing the IHR amendments, the DG’s proposals draw attention away from the need for equity within IHR 2005, which is one of most explicit gaps mandated by EB150 to be addressed thorough the IHR amendment process. (2) Health system strengthening Paragraph 35 of the document reads: “A strong HEPR architecture must be built on a foundation of strong national health systems centred on primary health care. High-quality health services and public health capacities are necessary to detect, prevent and respond to health emergencies. Resilient health systems have the resources to reorganize and redeploy existing resources in response to shocks such as health emergencies, while at the same time maintaining essential health services.” However, when it comes to the foundational idea behind these proposals the DG suggests as follows: “Investing in health security strengthens primary health care and health promotion, and vice versa, within the broader health system and multisectoral landscape” (Figure 3 caption). The proposals are silent on investing in primary health care. For example, the DG’s proposal No. 4 deals only with strengthening “health emergency workforce and corps”, but not strengthening of health systems in general, maintenance of adequate number of health workers in the facilities and all parts of the country and protecting of their rights. Investing in the latter would naturally generate co-benefits for health emergency response. Yet the DG’s proposal is in the reverse direction. On financing, the DG’s proposals allow for external agencies such as the World Bank to determine health priorities, which in turn prioritise health security ideas over health systems strengthening. (3) Equitable access to health products When it comes to equitable access to health products, the DG’s proposals seek to legitimize business-as-usual and market-based mechanisms, and fail to recognize the importance of establishing legal obligations to ensure universal equitable access. The proposals seek to promote failed models such as ACT-Accelerator. Before proposing to “Expand partnerships and strengthen networks for a whole-of-society approach to access to medical countermeasures and emergency coordination” (proposal no.6) the DG highlights “more recently, the ACT-Accelerator was established in April 2020 to support the end-to-end process of rapid development and equitable deployment of COVID-19 vaccines, tests, treatments and personal protective equipment”. Proposal No. 9 further calls for expanding the “funds available for rapidly scalable and sustainable emergency response, including at-risk financing for the rapid development of and access to medical countermeasures”. This proposal is to reform “the WHO Contingency Fund for Emergencies (CFE) to expand the size and scope of the fund to enable direct financing to facilitate rapid deployment of health work force and emergency supply chain”. Further it also calls for “sufficient at-risk financing is available early in the pandemic response cycle to ensure the timely development, production and procurement of medical countermeasures”. These proposals therefore do not make any calls for addressing structural determinants of equitable access, establishing a legally binding allocation mechanism or for mechanisms to diversify production within and outside the borders of the countries having capacity to produce. (4) Access and benefits sharing It is quite clear from the various public health emergencies of international concern outbreaks such as Ebola, COVID-19 and Monkeypox that unless a comprehensive framework is built for sharing of pathogens and their genetic sequence information, wherein utilizers of such pathogens and information are required to share fairly and equitably the benefits arising from such shared resources, there will be very little room for ensuring equitable access to health products such as diagnostics, vaccines and therapeutics. However, the DG’s proposal fails to consider this as an important element. Earlier, paragraph 28(iv) of the DG’s proposals to WHA75 understood “pre-negotiated benefit sharing agreements” as an integral component to equitable access to health products. Such an understanding seems to be strangely quite diluted in the EB152 document. (5) Relationship between IHR and new Pandemic instrument Paragraphs 4 and 13 of the EB152/12 clearly emphasise the importance of the INB process and the new pandemic instrument being negotiated there. For instance, Paragraph 13 states: “The three proposals for strengthening the global governance of HEPR outlined below have been requested by, and are driven by, WHO Member States in alignment with the development of a new WHO pandemic accord, through the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (INB)”. However, a pandemic instrument as currently envisaged only applies to a health emergency of “pandemic” scale, with no common understanding yet on what that means. Therefore, the basic structure of global architecture for HEPR must emanate from IHR 2005 – it is where the HEPR capacities are delineated and basic functions of the countries and WHO are delineated. The new instrument for pandemics is going to address the enhanced level of the coordination, enhanced equity and other mechanisms that may be triggered during a pandemic scale emergency. The relationship between the two instruments is very critical to be managed, otherwise accountability of actors such as Member States and WHO will slip into gaps between IHR 2005 and the pandemic instrument. Not addressing this structural concern will generate almost a sense of impunity to the stakeholders in HEPR for their actions and omissions. Call for strengthening WHO and the promotion of multi-stakeholderism As mentioned above, the only proposal which envisages equity as a direct outcome is the proposal No.10 to strengthen the WHO’s central role. However, this is quite inconsistent with several other proposals such as proposals Nos. 1, 3, 6, 7 and 8 which seek to maximize multi-stakeholder approaches. While multi-stakeholder platforms are openly promoted in several of the 10 proposals, it is astonishing to see that the DG fails to speak about the accountability of WHO and its partnerships or collaborative initiatives. The approach is stated in Paragraph 40 of the document: “WHO initiated an outreach process to bring together a broad range of partners and stakeholders to further develop the proposals and their application across the five Cs (collaborative surveillance, community protection, countermeasures, care and coordination) and ensure coherence, strict alignment, and open and intensive collaboration with relevant global and regional partners, initiatives and mechanisms”. Proposal 6 further elaborates on this approach: “Expand partnerships and strengthen networks for a whole-of-society approach to collaborative surveillance, community protection, safe and scalable care, access to medical countermeasures and emergency coordination”. Furthermore, proposal No.3 that calls for review and monitoring mechanisms again prominently describes the role of various stakeholders. Unfortunately, “conflict of interests” rules or the WHO Framework on Engagement with Non-State Actors do not get mentioned even once. In short, the DG did not incorporate calls made by developing countries over the last two years into his proposals. Despite the several calls for common but differentiated responsibilities in the health regime, the DG’s proposals do not explicitly address the needs and requirements of the developing countries. Most of the proposals, on the other hand, encompass the ideas advanced by countries like the United States, the European Union and other developed countries. The most glaring example would be the prioritization of the health security agenda over health systems strengthening, and also the neglect of the critical importance of access and benefit sharing mechanisms. These are promoted by the E.U and U.S respectively. +
|
||
