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TWN Info Service on Health Issues
7 June 2024
Third World Network
www.twn.my
WHO: Member States term amendments to international health regulations as “historic”
Kochi, 7 June (Nithin Ramakrishnan) – Several WHO Member States termed amendments to the International Health Regulations (IHR) 2005 as historic.
The 77th Session of the World Health Assembly (WHA77) adopted a package of amendments to IHR 2005 last week in Geneva, concluding a 2-year long process.
Several Member States, who spoke during the adoption of IHR on the last day of the WHA77, recalled the failures and deficiencies of the WHO’s COVID-19 pandemic response pursuant to IHR 2005 which triggered the process for amendments.
They stated that the amendments to IHR 2005 are historic in nature and expressed their conviction that the amended IHR will make the world “safer”. Several of them stated that the amended IHR 2005 will improve the management of public health emergencies in the future.
IHR 2005 is the successor to the 1951 International Sanitary Regulations, which revised and consolidated several then existing International Sanitary Conventions and other similar arrangements adopted during the colonial period aimed at maximum security against the international transmission of communicable diseases with minimum interference with world traffic. Though adopted in 2005, the regulations retained remnants of its colonial legacy that in turn maintained the IHR as nothing but a mere tool for collection and verification of information, without providing for concrete measures to provide aid and assistance to affected countries and populations.
These regulations did not take into serious account the development divide between developing and developed countries and did not address the challenges faced by the developing countries not only in building the IHR core capacities but also in accessing critical health products such as diagnostics, vaccines, and medicines.
Moreover, any international financial assistance available was done outside the legal framework of IHR 2005 and followed donor interests without taking into account the actual health priorities of developing countries.
Similarly, IHR failed to ensure equitable access to critical health products in developing countries during various public health emergencies of international concern (PHEICs) such as Ebola, Mpox and COVID-19 pandemic.
There are several amendments adopted at WHA77, including in Articles 1 – 3, 13, 15-18, 44 and 54 and Annex 1 to address these gaps. These amendments if well implemented could make further inroads to decolonise international health laws. For a brief overview of the major amendments adopted during WHA77, especially those relating to equity, please see “IHR 2005 amendments adopted, includes equity-related provisions”.
The unbalanced nature of IHR 2005 is claimed to be finally changing through the amendments that explicitly incorporate the principles of equity and solidarity into the regulations as well as the adoption of the provisions aiming to secure equitable access to vaccines, medicines and diagnostics, along with other amendments.
The package of amendments, as finalised by the drafting group of WHA77, was annexed to a draft resolution co-sponsored by France, Indonesia, Kenya, New Zealand, Saudi Arabia and the United States of America. The resolution was adopted during the plenary without any objections.
Several countries such as Japan, Ethiopia, Kenya, Egypt and other States of the Africa Region, Bangladesh and Singapore etc. called for the better implementation of health regulations following the amendments.
Bangladesh, one of the proponents of major amendments to IHR 2005 for addressing gaps in equity, stated that “Adoption of the amendments to IHR is a historic moment… With normative measures in place, it should be our Collective responsibility to demonstrate sincerity to achieve Health Equity for everyone, everywhere. We firmly believe the failure that triggered the amendment of the IHR will not be repeated to the extent that we experienced in the wake of the COVID-19 pandemic”.
The Africa Group, another major proponent of the amendment proposals to improve equity in health emergency preparedness and response, recognized the event as marking an “an important milestone in global Health”.
Ethiopia on Behalf of the Africa Group and Egypt said “While we celebrate the collective work and opportunities to have generational amendments and a lot is to be done to operationalise equity and leaving no one behind. As we endorse the amendment of the IHR, we recognise the significance of solidarity and cooperation. Health security is a shared responsibility. We call upon all member states to reaffirm their commitment to multilateralism, transparency, and trust and work collaboratively towards effective implementation”.
The U.S. stated that “we knew each of us had a responsibility for making the world better, safer and stronger. That’s what these amendments do enhance, transparency and timeliness of information to improve equitable access to critical health products and make Global Health security architecture overall more fit for purpose, while maintaining full respect for sovereignty of individual states.”
The European Union thanked the co-chairs and other WGIHR Bureau members recognizing their efforts were pivotal, without which consensus would not have been possible. The E.U. stated, “Today is a historic day for Global Health. Following three years of very intense negotiations this agreement underscores the continuing strength of international cooperation, and solidarity for Global Health.”
Singapore said that it looks forward to the successful implementation of the amended IHR by all State Parties, as the IHR core capacities, which each State Party needs to maintain, remain a backstop to prevent the cross-border spread of disease.
According to a developing country negotiator, developing countries have been successful in entrusting certain legal duties onto WHO to facilitate equitable access to medical products such as vaccines, diagnostics, and therapeutics during public health emergencies and pandemics. The States Parties are also obliged to support the activities of WHO in this regard. The negotiator, however, added the following: “… however the real merit of the amendments can only be gauged when they enter into force and are implemented. We (developing countries) also succeeded in establishing an all-inclusive implementation committee to oversee the effective implementation of the regulations. We believe this is a pretty decent package of amendments.”
Several delegations both developed and developing countries also opined that the success of the WGIHR will or should inspire and contribute to the momentum in the Intergovernmental Negotiation Body process to conclude negotiations on the WHO Pandemic Agreement as early as possible.
Note of dissent and caution
Slovakia disassociated itself from the amendments to IHR 2005 after the adoption without explaining their concerns.
Russia stressed upon the rights of the States Parties to reject and reserve amendments.
Iran, Switzerland, Argentina and the Holy See said that they will have to examine the amendments through an internal process at their national level.
The U.K. informed the WHA about their upcoming elections and the Netherlands about the caretaker status of their current government, with both delegations saying that they would now wait for the incoming governments in their capitals to decide upon the acceptance of the amendments nationally.
Iran explained its concerns in these words:
“We value the IHR as a cornerstone of international public health law, but several areas need improving if we are to be better prepared for the next pandemic. My delegation through the Working Group on amendments to the International Health Regulations tirelessly has worked to that end to improve the HR.
We are concerned that the outcome text of the WGIHR does not fully address the long-standing concern raised by a number of States and is far from what we expected through this process, namely on equity and development-related issues. Accordingly, my delegation would like to emphasise under the IHR, State Party rights for internal consideration of the IHR amendments annexed to this resolution in accordance with national rules and regulations and if required as stipulated in the resolution to need to notify the Director-General of the possible rejection or reservation pursuant to Article 59, 61 and 62 of the IHR…
Finally, we reiterate that nothing in this resolution and its annex should be construed as expanding the authority of WHO and other international organisations to the detriment of the sovereignty of the States Parties.”
Argentina was more worried about the way in which the consensus on the amendments were arrived at the last minute. According to Argentina, there are several amendments which are complex and they explained they will take their decision as a sovereign member.
Switzerland stated that “Adoption by consensus of amendments to the IHRs is a crucial stage for better protection of health throughout the world and for international cooperation to combat communicable diseases. We worked for equity and learnt from the pandemic. We continue to be committed to a future where we have robust mechanisms to protect our populations. Switzerland, like other signatory countries, will now launch internal procedures and verify whether the amendments can be implemented at national level. These amendments must be implemented at national level to protect public health”.
Most of the IHR States Parties, except for the few who have not rejected an earlier set of amendments made in 2022, have 10 months to either reject or reserve on the current amendments. For these States Parties, after 12 months from the date of notification to the WHO Director-General of these amendments adopted by the WHA77, the amendments will come into force for all those States Parties who have not rejected or reserved them. The Parties that have rejected the amendments of 2022 such as Iran will have 18 months to reject or reserve the amendments, thereafter it will come into force for them after 24 months.
States Parties reserving the amendments need to provide reasons to the WHO Director-General under Article 62 of the WHO Constitution; however, there is no such requirement for rejection under Article 61. According to Article 62 rejection in part of an amendment is also considered as a reservation and the State Party making such reservation should communicate the reservation to the Director-General with reasons.
[According to Article 61, if a State Party notifies the Director-General of its rejection of an amendment thereto within the period set out in Article 59 about entry into force, then the amendment concerned shall not enter into force with respect to that State Party. However, it must be noted that under Article 62 a partial rejection is considered a reservation.]
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