|
||
|
TWN
Info Service on Health Issues (Oct23/03) WHO: “Early harvest” to side line negotiations on equity proposals in IHR through Co-chair proposals Geneva, 3 October (TWN) – There is an attempt, through Co-chairs’ proposals, to press for an early harvest approach to side line negotiations on equity proposals to amend the International Health Regulations 2005 (IHR). The Co-chairs of the Working Group on IHR (WGIHR), the negotiating body mandated to consider IHR amendment proposals, have made proposals on Article 4 during the 5th session that is currently taking place in Geneva from 2 to 6 October. However, on 29th September, Member States received Co-Chairs’ proposals on five Articles and one Annex. These are: Article 4: Responsible authorities Article 5: Surveillances Article 18: Recommendations with respect to persons, baggage, cargo, containers, conveyances, goods and postal parcels Article 48: Terms of reference and composition Article 49: Procedure Annex 2: Decision Instrument for assessment and notification These proposals from the Co-chairs are part of an attempt to exert pressure on developing countries to agree to the early harvest, citing that the mandate of WGIHR is to submit its report to the World Health Assembly (WHA) through the Executive Board. The Secretariat also cited on the first day of the 5th WGHR that amendment proposals are to be submitted four months prior to the WHA under Article 55. However, what is not stated clearly is that Article 55 does not require consensus among Member States to submit amendment proposals to WHA. It merely requires amendment proposals to be submitted to WHA and these must be circulated to Member States at least four months prior to the WHA that are considered. The early harvesting approach takes away the pressure on developed country Member States to engage in equity proposals because it provides an opportunity to postpone such negotiations and slowly undermine consensus within IHR. It is noteworthy that many developed countries, especially the U.S. and the E.U., have many times stated that it is important to maintain the technical nature of IHR and they prefer to address equity under the proposed pandemic instrument, which is currently also under negotiation. This approach is problematic due to two reasons. First, the scope of the pandemic instrument is limited to pandemics and excludes all other emergencies of international concern, which occur more frequently than pandemics. Thus, the exclusion of equity provisions especially those related to equitable access to health products leave a big hole in the health emergency response. Second, the legal nature of the pandemic instrument is still not clear, and a considerable number of Member States push for adopting the instrument under Article 19 of the WHO Constitution, which requires ratification. The ratification requirement allows developed countries to not abide by their responsibility by not ratifying the instrument. On the other hand, IHR is an existing legal instrument and 196 WHO Member States are parties to it and the amendments, if any, do not require ratifications to come into force. Further, side-lining of equity violates the spirit and letter of the Executive Board Decision which provides the mandate for the IHR amendment process. EB150.3 states: “Such amendments should be limited in scope and address specific and clearly identified issues, challenges, including equity, technological or other developments, or gaps that could not effectively be addressed otherwise but are critical to supporting effective implementation and compliance of the International Health Regulations (2005), and their universal application for the protection of all people of the world from the international spread of disease in an equitable manner”. Thus, it is mandatory to address equity as one of the issues and early harvest undermines the mandate. As shown below some of the proposals of the Co-Chairs camouflage developed country proposals as technical and minor in nature but substantially change the nature of IHR. Article 4 The Co-chairs’ have proposed two important changes to Article 4. First, it obligates State Parties to either create or designate national IHR authorities and competent authorities in accordance with national circumstances and laws along with the national IHR focal point. The national IHR authority is the “the entity responsible for the overall coordination of the implementation of these Regulations by the State Party”. Second, the proposal creates an obligation on State Parties to provide financial and human resource support for all the three institutions without creating obligations on developed countries to make any commitments to provide financial and technical assistance. The proposal reads: “States Parties shall, as necessary and appropriate, take measures to enable the above-referenced entities to discharge their responsibilities effectively, including by providing them with adequate financial and human resources and enacting or adapting existing domestic legislation or administrative arrangements, as necessary and appropriate. WHO shall provide technical assistance and capacity building to States Parties, upon their request, to support these entities, in particular in support of the National IHR Focal Points, through training and regular exercises.” Article 5 The Co-chair’s text proposal in Article 5 replaces the proposal from Malaysia to obligate developed country State Parties to assist developing countries to build surveillance capacity. Malaysia’s proposal is based on the principle of common but differentiated responsibilities (CBDR) by imposing a concrete obligation on developed countries. The proposal states: “Developed State Parties and WHO shall offer assistance to developing State Parties depending on the availability of finance, technology and know-how for the full implementation of this article, in pursuance of the Article 44.” The new proposal from Co-chairs removes the CBDR element and reads: “Pursuant to Article 44, State Parties and WHO shall, to the extent possible and upon request, collaborate and assist each other in developing, strengthening and maintaining this capacity”. The offer to assistance is also made subject to qualification “to the extent possible”. Another detrimental change in Article 5 is that the Co-chairs’ propose to delete paragraph 3 that obligates WHO to provide assistance upon request. Paragraph 3 reads: “WHO shall assist States Parties, upon request, to develop, strengthen and maintain the capacities referred to in paragraph 1 of this Article”. It must be noted that this is an existing legal provision in IHR 2005 which imposes a concrete obligation on WHO without any qualification. Article 18 The Co-chairs’ textual proposals add three new paragraphs to Article 18 which speaks about recommendations with respect to persons, baggage, cargo, containers, conveyances, goods and postal parcels. The Co-chairs, taking into account the discussions, propose to have an enabling clause such that “WHO DG may with consult relevant international organizations, as appropriate, in order to avoid unnecessary interference with international traffic and trade” while developing the recommendations. The Co-chairs also propose to add paragraphs 4 and 5, of which the first suggests WHO recommendations to take into account the need for ensuring unrestricted international movement of certain categories of persons such as health workers and the need to maintain uninterrupted international supply chains for essential medical products and food supplies. Paragraph 5 requires States Parties to develop contingencies arrangements for the purposes of paragraph 4. Article 48 The Co-chairs under Article 48 take into account the calls made to avoid conflict of interests and to address gender balance in the composition of the Emergency Committee. However, on addressing “conflict of interests” directly, the Co-Chairs propose to make the Regulations for Expert Advisory Panels and Committees applicable to the selection process of the members of emergency committee. This in turn addresses issue of conflict of interests. Article 49 There are two major proposals in the Co-chairs’ text about Article 49 which deal with the procedure of Emergency Committee. First, it mandates the WHO Director-General to provide a detailed agenda to the committee, and to include a recurrent set of standard items for consideration of the Emergency Committee aimed at ensuring specificity, completeness and coherence of the advice provided. Secondly, a new paragraph 3bis is proposed by which if the Emergency Committee is not unanimous in its findings, any member shall be entitled to express his or her dissenting professional views, anonymously, in an individual or group report, which shall state the reasons why a divergent opinion is held and shall form part of the Emergency Committee’s report. Annex 2 The Co-chairs’ text proposal in Annex 2 is to ensure mandatory reporting of severe acute respiratory disease of unknown cause, irrespective of domestic assessment on whether there is potential for the disease to become a public health emergency of international concern or not. Equity first approach v. Early harvest Approach The Co-chairs who had earlier circulated the above text proposals were keen to initiate negotiation based on them either under Agenda item 2 or after the completion of other agenda items, with a view to achieve consensus. However, developing countries firmed up their “equity first” approach i.e. the need for negotiating IHR amendments proposals for achieving equity first. Kenya delivered the Africa Group statement on behalf of its 47 Member States. It stated “As we move closer to the deadline set by the Assembly for conclusion of our work, the Africa group wishes to reiterate that, in view of the inter-related nature of the IHR articles and annexes, the comprehensive discussion and adoption of a single package of amendments by the Health Assembly remains our preferred approach. This will ensure that we address the equity gaps identified, in line with this Working Group World Health Assembly mandate.” Ethiopia, calling for “equity first” negotiations, explained thus: “we want to be very cautious that we started with very important articles at first, but we are not moving that fast as we wished on those articles which very much relate with equity. Then our mandate for this working group includes specifically the amendments which should be including the equity related provisions which were lacking from previous IHR and also, it's very clear from the working group that was established before WGIHR and also every works of independent organs in this process. So I think it's the right time to focus on the remaining ‘equity-related articles first’…. if we put those major amendments for latter stage then I think in my country's capacity it will be very much challenging to accept.” South Africa’s intervention aligning to the statement of the Africa Group stated: “Having listened carefully to the advice of the legal counsel, and looking what do we have to do as member states in terms of coming up with what is required of us, one, update or amend the IHR and secondly, consider including issues of equity, which was the most missing link that made the world not be able to really implement IHR quite well even during the pandemic. We therefore would like to support the proposal by Ethiopia that we might have to even work smartly and address the mandate that this committee has. The mandate on issues including issues of equity and we therefore propose that articles that have got equity in it be reviewed first. We finalise them first, that at the end of the work, if there's anything that would have been achieved, is to ensure that equity is included in the new IHR. That is a mandate that we have and I guess by ensuring that equity is addressed will not just be addressing for one country but addressing for all countries across the board. Because equity affects us all.” Nigeria on the other hand, pointed out that the WGIHR is “aware that the main challenge that necessitated the review of the amendment of the IHR is the lack of compliance and implementation by some parties. And so as a result of this, it's very important that those areas that cover, like some colleagues have mentioned, equity, financing, and of course the issues of core capacities… are addressed…forefront. Because that will enable countries that are unable to implement and comply with relevant outlines of IHR, in particular capacities for many of the developing countries that have been unable to comply with all of the provisions.” Nigeria further recalled attention to some amendments proposed by the delegation of the United States in December 2021 and stated that “in approaching that (U.S. proposals), so many members mentioned the need to have a holistic approach and that prompted the need for other member states to bring forward their proposals”. Nigeria reiterated that it is important for the WGIHR to continue to work and look at the entire proposals as a package. Namibia stated that they are however concerned that the WGIHR might be headed towards an early harvest approach for some proposed amendments. They said: “Whilst significant progress is lacking on some of the proposed amendments, especially those seek to mainstream equity into the international health regulations. Cochair, there was broad support for the inclusion of proposals that seek to operationalize equity under both instruments, i.e., the pandemic accord and the International Health Regulations. To quote my distinguished colleagues from the European Union, they said that there is no constitutional barrier to accommodate equity in both instruments. Even (with) this broad consensus among member states, we need to see significant progress on the equity proposals. To this end we know that at the second meeting of the working group, we agreed to follow a certain structure when we started these discussions. I think we started with a consideration of proposed amendments to Article 53, Article 13 A, 44, and 44A, among others. We believe that there was a reason why we decided to follow the structure for the formal meetings of the working group. This reason was to ensure adequate consideration for all proposed amendments and to try and avoid what the African group at the time termed as a low hanging fruit approach. The similar consideration should therefore apply to proposed amendments for the second round of negotiations. We therefore urge the bureau to take this into consideration in the development of work programs and the agenda for subsequent meetings of the formal meetings of the working group”. Bangladesh recalled that the amendment of IHR actually was triggered by the lessons learnt during the COVID-19 pandemic. It went on to argue that they are not looking forward to any kind of status quo. Responding to some of these proposals, Co-chair Dr Ashley Bloomfield of New Zealand also stated that “If we agree to continue our work beyond January or beyond our scheduled meeting in December, that does not mean we slow down. Or take our eye off the ball. We need to keep making progress and in particular and I've heard the interventions from the African region from member states of the African region from Bangladesh, we need to make progress on those challenging issues. And we will make time to make sure we discuss them further this week.” It is noteworthy that the floor generally accepted the call made by the certain developing countries, and the WGIHR Co-chair, Dr Abdullah Asiri of Saudi Arabia, concluded the agenda item by saying: “From now until the deadline is there, then we'll have to report whatever we agree on whether it is preferably a consensus on the amendments or report on, the, that concludes the work of the WGIHR to the World Health Assembly. However, we will all agree what should be amended in the IHR. I think the question now is how to address these - I mean proposed amendments - how to make them or to include them or to reach a consensus on including them into the IHR. Everybody agrees on equity. Everybody agrees on the importance of addressing financing and addressing the benefit sharing and all these difficult issues that we were really afraid at the beginning of this process that they will not go forward but luckily with your support and understanding, we are now at an advanced stage of understanding your position on including them into the IHR. So I would urge all of us to continue the momentum discussing what we have on the plate.” Despite these statements, the Co-Chairs circulated their text proposals and have a plan to undertake discussions in WGIHR5.+
|
||
