TWN Info Service on Health Issues
23 May 2022
Third World Network
www.twn.my

WHO: EU says “no” to equity in Health Emergencies in the WGPR Recommendations

23 May, Geneva (TWN) – The European Union has said no to expanding the scope of equity-related measures to “health emergencies” and insisted to limit it to “pandemics” as part of the recommendations of the Member States Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR).

This blocked consensus on the adoption of the WGPR Report and the WGPR had to the same for the silence procedure with reservations. TWN learnt that two Member States broke the silence and blocked its adoption. As a result, WGPR Bureau carried out a few more textual edits and placed the document for another round of silence procedure.

[The “silence procedure” was first introduced in the United Nations General Assembly as a temporary method to accommodate decision-making during the COVID-19 period when intergovernmental negotiations were forced to be held in virtual format. The usual process is that a draft of a decision or resolution is circulated to all Member States, specifying the deadline for raising an objection and allowing at least 72 hours. In the absence of any objection the draft is considered to be adopted.]

The 9th Session of the WGPR was held on 4 to 6 May to finalise its report to the 75th World Health Assembly (WHA) as mandated under WHA 74.7 but failing to reach a consensus on the draft report the session was suspended without finalisation of the text. Resumed meetings spread across the last two weeks was concluded on 17 May.

The replacement of the word “pandemic” with “health emergency” expands the scope of equity and has the potential to address the current inequities in the global health emergency regime. Limiting to pandemics will reduce its scope to only extreme health emergencies of the scale of COVID-19, which occurs rarely. Pandemics occur much more infrequently, when compared to the frequency of public health emergencies in general. Capacities developed solely for pandemic response cannot therefore be put in use regularly and this will further result in the deterioration of the capacities as well.

Contrary to the consensus reached on the first day of the 9th session to replace “pandemics” with “health emergencies”, except in the paragraphs relating to a new pandemic instrument being developed in the WHA-mandated intergovernmental negotiating body, the EU refused to use the term “health emergencies” in several crucial parts of the WGPR report. Interestingly, the WGPR Bureau also supported the EU and asked developing countries not to press their demand citing the lack of time. Several Member States (both developed and developing countries) recalled that the mandate of the WGPR was “health emergencies” not just “pandemics”. As a result, Brazil has kept a reservation on two paragraphs, 3 and 4(a) the WGPR report to the 75th WHA. These paragraphs refer to the tables containing possible actions that are recommended for further consideration for action by Member States, the WHO Secretariat, and non-State actors.

Paragraphs 3 and 4(a) of the document put forward for discussion on 17 May, read as follows:

“(3) To encourage Member States to continue reviewing the actions contained in Tables XX, including through relevant ongoing WHO governing body processes.

(4) To request the Director-General to: (a) submit a report to the Seventy-sixth World Health Assembly on (i) the Secretariat’s progress to implement actions which have been previously mandated by WHO’s Governing Bodies and which are related to the activities mentioned in paragraph 3, in accordance with existing reporting requirements; and (ii) as appropriate, views from the WHO Secretariat on possible modalities for carrying forward the activities mentioned in paragraph 3 which are not presently under implementation; and…”

The EU’s opposition to the term “health emergencies” casts doubt on their professed intentions behind their advocacy for addressing equity through a new instrument specifically for pandemics. The intention of the EU is now clear, in that it wants to limit equity by using the language of “pandemic” such that several other health emergency events like Ebola or Zika virus outbreaks can be excluded from the scope of equity provisions of the new instrument.

The Zero Draft Report and State of Play During the 9th WGPR

The Zero Draft Report from the WGPR Bureau was circulated to Member States for their written inputs from 19 to 26 April, with a view to incorporate the comments and make the draft report fit for negotiations during the 9th Session of the WGPR. However, many Member states, especially developing countries, noted that their written inputs were not yet incorporated into the text of the published draft on 3 May.

The Zero Draft had four sections and 2 annexes. The Sections included: (1) background, mandate, and scope of WGPR; (2) short summary of process and analysis, including pathways for implementation of recommendations; (3) recommendations to WHA75; and (4) the decision point. The Annexes provided some inferences from a WGPR survey, which was another attempt by the WGPR Bureau and developed country Member States to blindside deliberations in the WGPR. It must be noted that these annexes carry no significance since the WGPR survey failed to be truly representative of Member State opinions.

The third section contained various recommendation addressing Member States, the WHO Secretariat and Non-state Actors (NSAs) under the following headings: (1) political leadership, (2) cooperation and collaboration; (3) WHO at the Centre; (4) financing; (5) sustainability of the WHO initiatives during COVID-19 response: (6) global surveillance; (7) strengthening the International Health Regulations (IHR); (8) universal health and preparedness review; (9) travel measures; and (10) equity. Under each heading, there are paragraphs describing the general understanding on the recommendations and then tables reflecting specific actions that are proposed for the consideration of WHA75.

However, many of the recommendations prepared by the WGPR bureau in the Zero Draft contained recommendations favouring the interest of developed countries. For instance, recommendations under the strengthening of IHR reflected the IHR amendment proposals of the USA, currently separately considered.

Other shortcomings of the Zero Draft are as follows:

• Many recommendations were limited to “pandemics” inconsistent with the mandate of the WGPR, which requires the Working Group to address health emergencies;
• The report did not contain any reference to WHO Executive Board (EB) Decision 150(3), which describes the nature of the IHR 2005 amendments to be pursued;
• It promoted several WHO Secretariat initiatives such as WHO Biohub and Hub for Pandemic and Epidemic Intelligence without adequate reference to the requirement of fair and equitable benefit sharing obligations under the Convention on Biological Diversity and its Nagoya Protocol;
• It promoted multi-stakeholder engagement without adequate reference to the principles of the WHO Framework of Engagement with Non-State Actors (FENSA); and
• Many recommendations on equity were general in nature and did not contain concrete deliverables. Above all, according to EB Decision 150(3), one of the identified issues to be addressed in the IHR Amendments is the equity issue. However, not only recommendations on equity were half-baked but also the reference to this decision was conspicuously absent in the draft report.

During the first day of the 9th WGPR session almost all developing countries took the floor to reiterate the need to stick to the WGPR’s mandate, i.e. to replace “pandemics” with “health emergencies” and thus expand the scope of the applicability recommendations not only to pandemics but also to health emergencies.

The WGPR Bureau then sought to discuss other topics and promised to change the language in the revised version. The developing countries, believing the Bureau, continued their efforts to make other textual edits and submit new textual suggestions to the report in order to make it a true reflection of their recommendations. They were able to place specific discussion and action points for future, to buy time for submitting IHR amendment proposals and pushed back on several recommendations favouring the USA and EU.

The developed country Member States, especially the EU and USA, were alarmed at seeing developing countries from various regions speaking with one voice, cited “lack of time” to argue that there should be very minimal negotiations on the report. This led to the opening up of two parallel tracks of work in the WGPR, after initial inputs by the Member States. Colin McIff, the USA Co-Chair of the WGPR Bureau, along with a few others, reportedly worked on the basis of inputs received from Member States and revised the tables containing the possible actions, while the rest of the WGPR negotiated on the report, excluding the tables.

EU’s Opportunism

When the resumed sessions continued on 12, 13 and 17 May, a revised text of the draft report was circulated, which was substantially altered based on inputs received from Member States during the initial three days. The major negotiations continued to focus on the parts other than the revised tables on the first two days. It was only on the last day, 17 May, that the tables and the corresponding decision points were brought into the discussion. Member States were generally accommodative of the draft tables produced under the Bureau leadership, however they were later moved from the main text to Annex 3.

Though these amended tables contained various suggestions of developing countries, in certain crucial recommendations, such as on equity, the scope of the recommendation was again limited to the pandemic context. On 17 May during the last day of the resumed session many developing countries, including Brazil, Bangladesh, India, Paraguay, Argentina, China and whole of the African Region demanded the replacement of the term “pandemic” with “health emergency” in those recommendations as well. They requested the Bureau to stand by their word and commitment. Russia too reportedly supported this stance.

The EU, however, stormed the floor with opposition. The EU said in order to address concerns over “lack of time”, the language developed by the Bureau in the tables must be adopted into the report without negotiations. According to the EU, the Bureau has done a fabulous job of taking into account various suggestions made by all countries in the initial days and the tables represent a decent capture of “possible actions” that could be further discussed. The USA and other developed countries extended support to the EU.

Brazil pointed out at least two specific actions mentioned in the report and stressed upon the relevance of the need for change the wording – they were actions affecting equity, transparency, solidarity, research collaboration and cooperation. It requested the Bureau to review the table texts once again to carry out the changes which should have been made even before the negotiations began on 17 May.

The two actions pointed out by Brazil in the table are:

Table 2a. Action 8: “WHO to develop or strengthen guidelines to promote transparency in public funding research and development related to pandemics to promote measures to support technology transfer and commitment to voluntary licensing.”

Table 5 Action 3: “R&D and all other relevant processes in Member States to be driven by a goal and strategy to rapidly and effectively respond to health emergencies in a manner that prevents pandemics and promotes equitable and effective access at national and international levels, especially in developing countries”

Some other actions in the table also use the word “pandemics” instead of “health emergencies”, such as:

Table 3 Action 1: “Member States to support research efforts to inform and expand capacity for effective public health and social measures during pandemics to underpin preparedness & readiness efforts, including in the formulation of emergency guidance and advice.”

Table 3, Action 4: “WHO Secretariat to facilitate and support efforts to build evidence and research on the effectiveness of public health and social measures and non-pharmaceutical interventions during pandemics to underpin preparedness and readiness efforts, including the formulation of emergency guidance and advice.”

It must be highlighted that Table 2a is on “equity”, Table 5 is on “sustainability of WHO Innovative mechanisms” and Table 3 is on “cooperation and collaboration”. However, immediately after the Brazilian request, the EU took the floor and said that the text inside the table cannot be altered at any cost. The USA, Monaco, Australia and the UK supported the EU.

A developing country delegate reported that the WGPR Bureau behaved as if they were helpless on the last day. “If this was their capacity, they should have let us known in the initial days itself, we would have marked all the references to the pandemics in the report and ensured the changes are made in the meeting room itself”, the delegate remarked.

India supporting Brazil stated that there is nothing wrong in altering the text in the table, because it would only be consistent with other paragraphs which are already agreed upon. India also pointed out that to use “pandemics” inside the table would create inconsistencies between the two parts of the report. The EU then came up with a suggestion to acknowledge the said inconsistency in the chapeau to the tables. This was a further attempt to weaken the success developing countries made in altering the text.

Brazil finally requested the Bureau to add a sentence in the chapeau that the word “pandemics” in the table 2(a) action 8 and table 5 action 3, may also be read as “health emergencies”. Russia also supported Brazil and said incorporating “for example”, before the sentence suggested by Brazil could solve the concern. However, the EU and the WGPR Bureau reportedly pushed to delete that sentence as well.

The chapeau after negotiations read as follows:

“The section below is provided for further consideration for action by Member States, the WHO Secretariat, and non-State actors, especially ones that could be taken up, as appropriate, through MS-led processes and through the technical work of WHO. The WGPR recognized that these actions need to take into account national context, addressing conflicts of interests and the application of FENSA for WHO-related actions. The WGPR emphasized that the tables represent a snapshot of the progress made as a work product of the bureau, they may have differences with the language in the main body of the report and acknowledged that a number of issues identified below will require more discussion by Member States through relevant ongoing WHO governing bodies processes including in the INB (on a new pandemic instrument) and WGIHR (Working Group on IHR amendments).”

Bangladesh reportedly pointed out that countries from more than three regions are making their request to abide by the consensus. It further explained that these countries cover more than 60 percent of the world population, and in the interest of providing them equity, the WGPR must stick to the consensus and its mandate. The EU reportedly responded by saying that “population size does not make any country or region right or correct in their argument.”

The vice-chair in the WGPR Bureau, a representative of France, suggested to ask the floor whether there is any opposition to alter the text, and changes should not be made if there is a single Member State opposing it. The WGPR co-chair quickly asked the question and the EU opposed. Russia told the co-chair and vice-chair that the question asked was wrong. Russia explained that the question should have been whether “there is any Member State wishing to go back on consensus made on the first day”. The WGPR Bureau reportedly did not to respond to Russia at this instance.

Brazil eventually kept its reservation on the paragraphs in the decision point pertaining to the tables, paragraph 3 and 4(a). The report was therefore finalized without obtaining consensus and put into the silence procedure. Reportedly two countries broke the silence, and a second round of silence procedure was initiated until 5:30 PM CET on 21 May.

According to sources, the WGPR Bureau reconvened itself and has since circulated a revised chapeau to the tables as well as paragraph 3 of the decision point.

The revised chapeau now includes a footnote which reads “The WGPR noted that some of the terms used in the tables, including inter alia “health emergencies” and “pandemics”, have not been defined for the purposes of this report.”

The chapeau also additionally contains a clause which says the language of the tables does not prejudge the results of discussions that may happen in relevant governing bodies or other forums such as the intergovernmental negotiating body on a new pandemic instrument or the Working Group on IHR amendments (WGIHR).

The revised decision point further reads as follows: “Ad ref (3) To encourage Member States to continue to review and consider the possible actions contained in Annex 3, in relation to health emergency prevention preparedness and response, including through relevant ongoing WHO governing body processes, while noting that those possible actions are complementary and additional to existing mandates already under implementation by the Secretariat;”

At the time of publishing this article, it is reported that the second silence procedure was completed without challenges, and the final report is now available in the WHA75 documents web page. The phrase “ad ref” qualifying paragraphs 3 and 4(a) indicating Brazilian reservations has been removed in the final report+