The thorny and unresolved issues of how to incorporate health equity measures and supportive finance for low and middle income countries into revisions of the WHO International Health Regulations (IHR), are set to be two key items on the agenda of an IHR negotiating body when talks resume again in early October. 

This was one of the key messages at the close of the fourth meeting of the WHO Working Group on Amendments to the International Health Regulations, which concluded today after a week of discussions. 

Although most negotiations took place behind closed doors, the meeting report that was discussed briefly in a public session on Friday provided a snippet of the talks so far and the envisioned way forward.  

The IHR are binding rules governing countries’ behaviour during global public health emergencies.  Revisions to the rules are being negotiated in parallel with a new WHO pandemic accord. 

Equitable distribution of health products in global health emergencies 

In the wake of the COVID-19 pandemic, more equitable distribution of health products has  been a key pillar of conversation in the pandemic accord negotiations. 

However, LMICs have stressed that they face the same kind of barriers accessing diagnostics, treatments and vaccines in any kind of health emergency – and those barriers would have to be addressed in IHR revisions. 

Recent examples include Ebola and Mpox, when essential diagnostics, vaccines, and treatments were slow to reach groups in lower-income countries than in their higher income counterparts – even though the lower income countries were on the front lines of fighting both viruses. 

So even if new mechanisms for ensuring access to health products and finance for LMICs wind up being incorporated into a final pandemic accord, similar provisions would have to be incorporated in parallel, into the IHR, some countries have argued.    

“I think we agree that two areas we really want to discuss again in October are articles 13 A and 44, financing mechanisms,” said the IHR co-chair, Ashley Bloomfield of New Zealand, during Friday’s final discussion. Bloomfield is a co-chair of the Working Group for the amendments to the IHR, along with Abdullah Asiri of Saudi Arabia.

Talks on the two points will also be held jointly with the Intergovernmental Negotiating Body that is debating the details of a pandemic accord, the IHR working group members agreed.

“Discussion jointly with the INB … we see that as a very important way to help progress,” Bloomfield added.  

Equitable drug distribution and finance in proposals  for IHR revisions 

A 2022 compilation of proposed IHR amendments etches out some of the proposals submitted by countries regarding both measures – although there is wide disagreement between member states on how to handle the two issues. 

In the draft compilation, some of the proposals for a new Article 13 A, covering “Access to Health Products, Technologies and Know-How for Public Health Response”, call for the establishment of an “allocation plan/mechanism”… for health products, in the event of the declaration of a public health emergency “to avoid any potential shortages of health products and technologies”.   Some of the proposals also would remove many IP restrictions on needed health products, and mandate WHO to commission their production from manufacturers.   

A proposed new Article 44 A, meanwhile, on Financial mechanisms for equity in health emergency preparedness and response, calls for the establishment of  “a mechanism … for providing the financial resources on a grant or concessional basis to developing countries.” 

At the same time, there has been considerable concern among members of both the INB and the IHR Working Group about ensuring that the new pandemic accord and the IHR revisions complement each other, rather than overlapping or, worse yet, creating conflicting sets of rules and obligations.

This is particularly important since a pandemic is inevitably going to evolve out of a global public health emergency, as declared under the IHR.  So new finance and equity mechanisms would need to be consistent under both agreements. 

Process for determining a global health emergency

Among the key topics addressed during this week’s session, the Working Group report noted, were, proposed revisions to: 

• Responsible authorities – Article 4
• Notification, verification and provision of information (Articles 5; 6-11, and Annex 2); 
• Determination of a public health emergency of international concern (Article 1) 
• Emergency committee (Articles 48, 29)
• Temporary and standing recommendations (Articles 15, 16, 17, 18)  

More prompt notification of emerging threats, as well as stricter requirements for verification and provision of information, have been the other issues at the heart of the debate over the IHR reforms. 

Proposed amendments, submitted by the United States last year, set out a tightly-paced timeline with as little as 48 hours for countries to notify WHO of an emerging threat, and then a similar window of time in which they could choose to either accept WHO support for an investigation, or in the absence of that, a WHO notice to other countries of the emerging threat. 

But some countries, led by China and Russia, have baulked at the US proposals, seeing them as an infringement on their sovereignty. Developing countries have meanwhile sought measures that link prompt notification to the sharing of “benefits” from any treatments developed as a result of their sharing of pathogen information. 

Another key question discussed this week was the WHO determination of a global public health emergency of international concern (PHEIC). Member states are considering whether such a declaration should continue to be a “binary” yes/no declaration – or if a “yellow light” of warning should be inserted into the system to cover emergencies at a regional level or with other kinds of of potential, short of a full-blown global crisis.

There were no updated draft texts released, however, on the points covered by the IHR Working Group this week.  And such texts are likely to be a long time in coming. Even with regards to the draft meeting report, displayed on a screen during the closing session, several member state delegations stressed that it was an informal summary of the week’s actions, and not a formally agreed-upon text.  See the draft meeting report here. 

Image Credits: PMO Barbados.