Assembly Approves Process to Update International Health Regulations on Pandemic Response World Health Assembly 75 28/05/2022 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Dr Hiroki Nakatani joins in the applause after the resolution’s passage Diplomats approve the complex process they will use to update the legally binding rules among nations for responding to global health emergencies like the coronavirus pandemic. GENEVA – The 194-nation World Health Assembly approved a resolution on Friday that halves the two-year period for amendments to the International Health Regulations (IHR) to take effect down to just one year. The move is part of a highly technical package of US-proposed measures that picked up support as the most practical way of kickstarting the reform process in pandemic response. Broad applause broke out just after one of the Assembly’s main committees adopted the resolution. “I’m so excited,” said the committee’s president and veteran public health specialist Dr Hiroki Nakatani, “that we could adapt this very important resolution by consensus.” Just before the respolution’s adoption, Colin McIff, deputy director of the US Department of Health and Human Services’ Office of Global Affairs, explained a series of technical changes that had been reached to ease passage of the resolution. Those included giving nations “additional time for consideration” – up to 10 months, rather than nine, to reject or voice reservations over any future amendments that would be adopted. Nations also would have up to 12 months – double the previous suggestion of six months – to ensure they implement any IHR amendments that newly enter into force of law. A paragraph also was added, he said, that urges nations “to collaborate with each other in the provision or facilitation of technical cooperation and logistical support, particularly in the development, strengthening and maintenance of the public health capacities required under the International Health Regulations.” Resolution reflects “our produtive work together”: Colin McIff, Deputy Director of the Office of Global Affairs at the U.S. Department of Health and Human Services. The entire resolution reflects “our productive work together over the past several days here at the Health Assembly and reflects the consensus of member states,” said McIff. “We would like again to thank member States for working together on this historic effort to strengthen the IHRs.” The Biden administration, supported by countries as diverse as Colombia and Thailand, has long contended that changes to IHR would complement, rather than be a substitute for a pandemic treaty. The changes to IHR would be targeted to topics already covered in the global health rules like procedures around outbreak notification, and could take effect within three years. A treaty would likely address a broader set of issues, but also take far longer to negotiate, approve and be ratified by individual member states. IHR revisions urgently needed More than a year ago the Independent Panel on Pandemic Preparedness and Response concluded the IHR badly needed updating from the “analogue” to “digital” era of information sharing to ensure that WHO and its member nations more quickly react to global health risks. Under current IHR rules, for example, there is no clear deadline for countries to report suspected outbreaks to WHO or for WHO, in turn, to report them to member nations. In a recent wild poliovirus outbreak in Malawi, it took months for a report on it to be published. While such concerns weren’t directly addressed by this Assembly, the decisions made this week set in motion a process for updating the vague and often indirect 2005-era IHR rules, while negotiations proceed over a broader pandemic treaty. Earlier in the week, that procedurally-oriented resolution ran into unexpected resistance from some nations, including the African Group, which was concerned that changes might be introduced to the IHR without sufficient study or input. Working Group on IHR reform paved the way McIff told the committee that those concerns were addressed during intensive discussions as part of a Working Group that paved the way for the resolution’s adoption by consensus. One key breakthrough, diplomats said, was the Assembly’s approval late Tuesday of the companion WHA decision that sets in motion a two-year process for substantive rule changes that are the ultimate goal. The aim is to have a package of reforms ready for the World Health Assembly 77 in 2024 and for any new rules that are approved to take effect as of May 2025. The task of collecting and assessing nations’ proposals for amending the IHR will be managed by a new member state “Working Group on IHR reform (WGIHR)” that replaces the “Working Group on Pandemic Reform” that operated over the past year. In tandem, WHO’s Director-General Dr Tedros Adhanom Ghebreyesus has been asked to convene an IHR expert review committee to provide more studied inputs into the WGIHR about the most needed and useful reforms. According to the timeline agreed to on Tuesday, any and all member states may submit their proposals for revising the IHRs to the new WGIHR group by 30 September 2022. The WGIHR group will sift through the proposals and draft a report to be reviewed by the WHO Executive Board in January 2023. In parallel, the expert IHR Review Committee will make its own recommendations by then. “The rebranding of the WGPR to the WGIHR gives all member states an equal opportunity to put their ideas forward,” a senior US official, said of the process, in an interview with Health Policy Watch. The fact that an IHR expert review committee will also provide input means that “there’s going to be a member state political component that’s backed up by an expert level review commissed by the DG,” the official said. Interface with the pandemic convention negotiations One key concern has been the potential overlap of the IHR reform process and the parallel process already underway of negotiations on a potential new pandemic convention, treaty or other instrument – which can potentially address a broader set of issues and concerns, such as medicines and vaccines equity and related to that, support for better emergency preparedness and response in low and middle-income countries. The negotiations on the pandemic instrument are already underway under the guidance of an Intergovernmental Negotiation Board (INB), mandated by a special session of the World Health Assembly in November 2021. Diplomats hope that by the time the negotiations over IHR reform get underway in serious in early 2023, the INB will have made some progress – and specific pandemic reform issues can be allocated to one or the other of the processes without too much overlap. The aim is to make the two processes complementary, the senior US official said, with the IHR revisions starting later, but also concluding more rapidly – while the pandemic convention or treaty process continues. “There’s been very strong engagement with the African group, and also with the Europeans and others, a lot of back and forth around this discussion of should there be a treaty or an international instrument,” the official said. That dialogue contributed to “a lot of consensus-building over the course of this year, starting with the Executive Board in January, which endorsed in Decision 150(3), the concept of targeted, limited [IHR] amendments, without opening up the whole IHR for renegotiation. So that’s what we’ve been building on, and that’s what was adopted.” Timeline for moving ahead on IHR reform According to the timeline set out in the the decision on Tuesday, any and all member states may submit their proposals for revising the IHRs to the new WGIHR group by 30 September 2022. The WGIHR group will sift through the proposals and draft a report, to be reviewed by the WHO Executive Board in their meeting of in January 2023. In parallel, the expert IHR Review Committee of experts will also complete its work – and make recommendations by early 2023. The aim, the senior US official told Health Policy Watch, is to then “put all that into the mix, and then the member state negotiation process can really begin in earnest.” While the IHR negotiations will still take at least two years, not including the year for any new amendments to take force, there is a delicate balancing act that must be observed, the official said, referring to concerns that had emerged in talks with the African Group and other nations over the past week: “We have to move with a sense of urgency and a sense of purpose. But frankly, these are also technically complex issues, relating to a lot of implementation challenges, not only in the executive branch, but legislative branches of governments. So we have to give due consideration to the topics as well.” Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.