THE U.S. & BRAZIL TEAM UP TO MAP W.H.O. REFORM
Originally published November 5th, 2020 on Geneva Health Files
The U.S. and Brazil have teamed up to lay out a governance reform proposal for WHO in the context of the urgencies that COVID-19 has wrought upon. The timing of such a proposal is bemusing given the uncertainties around American engagement at WHO.
It is expected that this proposal, along with others, will be discussed at the margins of the upcoming World Health Assembly next week, Zsuzsanna Jakab, Deputy Director-General, World Health Organization said at an event today.
While there are some convergences with the earlier proposal put forth by Germany and France (such as on independent access to outbreak areas), on certain issues including on funding for WHO emergencies programme or greater transparency for the workings of the IHR Emergency Committees, or “delinking” travel from trade restrictions during health emergencies, for example, there are some new approaches.
In a document titled, “Reviewing COVID-19 Response and Strengthening the WHO’s Global Emergency Preparedness and Response,” it sets out a roadmap for WHO.
“…this roadmap sets out areas where we believe there is an opportunity to strengthen the WHO by increasing accountability and its ability to be impartial and objective, improve transparency and its overall effectiveness, by providing it with a more comprehensive set of tools that are fit-for-purpose to address new and emerging threats….,” according to the document, seen by Geneva Health Files.
The proposal is divided into areas for short term progress under existing mandates and areas for medium and longer term action.
PROPOSED SHORT TERM ACTIONS
As has been discussed over the last few months, the proposal suggests that WHO consider a new designation — the Intermediate Public Health Alert (IPHA) or “amber light” for the declarations of Public Health Emergency of International Concern (PHEIC).
The document says, that WHO must issue updated guidance for itself, Member States and non-state actors building on the existing provisions in the IHR framework.
“Increased objectivity and impartiality of WHO, including the membership and scope of an EC, tailoring each to a given outbreak and adapting as needed, over the course of each event as new evidence emerges provide a pathway to an improved EC. Additionally, more transparent public accounting of proceedings is important to understand decision making around PHEICs. The ECs should hold additional meetings, including if requested by an appropriate number of Member States, and be responsive to Member States’ inquiries. Providing written summaries of the discussion in all EC meetings would help build confidence.”
Greater transparency on emergency committee meetings are significant. (See below our analysis on this.)
In addition, the proposal also asks WHO and World bank to beef up processes around Independent Oversight and Advisory Committee (IOAC) and Global Preparedness Monitoring Board (GPMB) asking them to “review and secure their permanent mandates, terms of reference, defined scope of activities and sufficient resourcing.”
It also seeks ways to empower the Chief Scientist’s Office with sufficient budget and staffing, and “make global expertise available to all levels of WHO.”
The proposal also has language on access to medical products in the context of the pandemic. But it is not sufficiently clear in the proposal itself, on how access to medical products can be streamlined.
“Once COVID-19 countermeasures are developed, all countries must benefit from equitable access. Based on the experiences with access to medical products for COVID-19, strategies for medical countermeasures for future pandemics could be developed,” the document says.
“MEDIUM TO LONGER TERM ACTION”
The proposal suggests an overall approach to revamping health security including addressing matters on compliance to IHR, on preparedness, detection and response.
“…we propose consideration of a universal review mechanism for IHR compliance, to encourage countries to view preparedness as fundamental to national and health security as well as incentivize fulfillment of IHR obligations,” according to the proposal.
The U.S. and Brazil, adopt a strong position on accountability and oversight in the context of health security, also hinting at a wider role for “other global health partners and the public”.
The proposal says,“…Especially for public health risks with the potential to spread globally, we need to consider how best to strengthen Member State reporting to WHO, and empower WHO leadership to articulate Member States’ responsibilities in an impartial and objective manner when they are not meeting obligations.”
On the somewhat contentious matter of access to outbreak areas, it asks the independent review panel “to consider mechanisms to facilitate more rapid access to outbreak areas for WHO-led response teams to the extent required for a robust public health response, including in the assessment phase…” It argues that such access is crucial to the early containment of outbreaks, and therefore recommendations should include “ways to empower the DG to report and incentivize Member State compliance”
The proposal underscores the need to de-link travel from trade restrictions under emergency conditions in order to minimize economic impacts while maximizing public health measures.
“Ensuring open and safe global transportation routes and securing supply chains to allow delivery of essential products, guaranteeing humanitarian aid access to people in need and continued travel for responders are necessary,” the proposal says.
It asks WHO to work on an evidence-based process in conjunction with relevant organizations “to develop recommendations on the appropriate role of domestic and international travel restrictions within a suite of preparedness and response interventions…”
Pitching in support for the crucial WHO’s emergencies programme by initiating budget reforms, to make it sustainable, the proposal says “The WHO Solidarity Fund and the WHO Foundation are helpful in broadening the donor base, but any new funding sources need Member State oversight.” This is significant and can be read as an effort to have a great say in who controls the financial resources for the emergencies work.
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