Competing visions for W.H.O. reforms

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All these different proposals are now being discussed with overlapping areas of interest being mapped and analysed, according to documents seen by Geneva Health Files. In this story we parse through the emerging areas of consensus among these member states on WHO reforms in the context of this pandemic. We examine a few features in some of these proposals collectively, which gives us an indication of countries’ priorities for reforms at WHO triggered by COVID-19.

THE ROLE OF WHO

GOVERNANCE OF THE EMERGENCIES PROGRAMME

Japan has suggested that countries could explore “the idea of placing a permanent independent oversight institution for the WHO Health Emergencies (Programme) outside of the WHO or under the EC, as well as improving the structure and operation of the Global Pandemic Monitoring Board (GPMB) to ensure independence from the WHO.”

India has made one of the most comprehensive arguments in linking the governance process of the emergencies work to the wider governance discussions at WHO overall — essentially pushing for greater member states participation in all levels of governance, specifically on technical matters. (Do note that the other countries have also in the past raised concerns on improving the role of the EB within WHO)

ON FUNDING

“… Ensuring transparency of funding mechanism and accountability framework: Presently, only broad-based priorities are discussed with member states and in respect of selection of activities, their expenditure and concurrent monitoring, there is no regular and institutional mechanism involving the member states. There is no collaborative mechanism wherein the actual projects and activities are decided in consultation with member states, there is no review with respect to value for money and whether projects are being done as per the member states priorities or if there are abnormal delays. Without the same, the technical assistance to member states primarily is neither transparent nor adding the required value to the member states. There is an urgent need for effective involvement of Member States in discussions on budget implementation and spending. This is imperative to strengthen efforts towards enhancing cost efficiencies and value for money proposition.”

ON IHR REFORMS

There also seems to be alignment between countries on considering a periodic joint external evaluation (JEE) of the state’s public health capacities, to assess core capacities and preparedness. (Japan suggests making such external evaluations compulsory.)

Korea representing the G4IDR suggests, “…we should first focus on strengthening the implementation of the existing IHR but should also be open to discussions on the amendment of the Regulations in the long term.”

Korea and partners also highlight review of digital technologies and implications on human rights: “… the IHR’s provisions on human rights (e.g., Articles 32 — Treatment of travelers and 42 — Implementation of health measures) and the treatment of personal data (Article 45) can be strengthened by providing more detailed guidelines to States Parties on using digital technologies for public health purposes in accordance with international human rights law. “

ON SHARING INFORMATION UNDER IHR

EMPOWERING THE IHR EMERGENCY COMMITTEES

Korea on behalf of G4IDR suggests, “The group believes that the transparency of the deliberations should be enhanced by requiring the Committee to produce a detailed report of its proceedings, similar to the WHO SAGE Immunization reports, keeping in mind legitimate reasons to protect the confidentiality of certain types of information that the Committee has considered…. requiring members of the IHR Expert Roster to complete periodic, online training on the IHR and lessons learned from past Emergency Committee meetings. The Committee member’s declarations of interest should also be published together with the meeting report to increase accountability and build confidence.”

ON THE DECLARATION OF A PHEIC

Korea and its partners, propose “Director-General should have the option to issue — following the advice of the Emergency Committee, an intermediate level of PHEIC. The benefit of this approach should be carefully considered against the risks posed by a delayed international response to a localized outbreak. Such a modified alert system should include clear criteria for determination of the intermediate level, as well as the scale of coordination of an international response.”

ON TRAVEL AND TRADE RESTRICTIONS

Lessons from the COVID-19 outbreak indicate that “IHR’s provisions on additional health measures can be improved by requiring States Parties to provide more detailed information about the public health rationale behind such measures. Such additional information could include, for example, the risk assessment criteria used to implement different levels of restrictive measures to combat a public health threat,” Korea says in its proposal.

SAMPLE SHARING OF PATHOGENS

ON EQUITABLE ACCESS

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