Although a draft pandemic agreement may take weeks or months longer to conclude, there are moves underfoot to try to quickly wrap up negotiations and get final member state sign-off on amendments to the 2005-era WHO International Health Regulations  (IHR) at the this week’s World Health Assembly (WHA), said the co-chair of the working group on amendments to the IHR, Ashley Bloomfield, of New Zealand.

He was speaking at the Geneva Graduate Institute‘s Global Health Center, on the eve of the opening of the WHA, which will grapple with an agenda that is perhaps one of the most complex, divisive and also potentially impactful, in the Organization’s 75 year history.

The week-long Assembly will be taking up resolutions and decisions dealing with a new four-year strategy to WHO; it’s new funding appeal to raise some $7 billion more over that period in voluntary funds from donors; the humanitarian crises related to wars in Ukraine and Gaza; as well as a host of other vital health themes – from a new resolution on climate and health to the status of efforts to eliminate malaria, tackle chronic disease as well as head off a wave of drug resistant pathogens and disease, to name just a few.

Amidst all of that, while two-years of negotiations on a proposed new pandemic agreement ended Friday without final agreement on a draft, the committee negotiating parallel amendments to the IHR, the pre-existing set of WHO emergency rules approved in 2005, have moved closer to the end goal with an agreement in principle over its contents.

And out of 34 articles in the IHR amendments, 17 are fully approved, while another 17 remain to be finalised, Bloomfield said.  As a result, he said the group would be sharing the document-in-progress with the assembly, but asking for the go-ahead to continue negotiations during the WHA.

“We will put forward a draft resolution asking the Assembly to continue the work this week, and hoping that it will be adopted by the Assembly before the week is over,” he said.

“I think there is a really strong intent by us to seize the moment,” he added, noting that language advancing more “equity” between countries during health emergencies are among the “significant inclusions” to the draft  IHR amendments – although he did not elaborate.

More predictable financing for disease threats

The IHR equity achievements include stronger commitments by high-income states, such as the European Union, to support more predictable and sustainable financing for all countries in outbreak prevention, preparedness, other sources told Health Policy Watch.

That, in turn, should help support more robust surveillance of pathogens which pose outbreak, emergency and ultimately pandemic risks, particularly in low- and middle-income countries that lack the tools and resources to track and identify them quickly.

Other elements of the amendments on which the working group is close to an agreement, include an official definition for a “pandemic.” This would be a trigger for WHO to declare a higher level of emergency beyond the current designation of a “Public Health Emergency of International Concern” (PHEIC).

That would activate the more far-reaching provisions of a future- pandemic accord, should that new legal instrument be finally approved and ratified by countries. During the COVID pandemic, no actual “pandemic” designation existed and so when WHO declared that the world was facing a pandemic, on 11 March 2020, moving beyond language for the PHEIC that had been declared in late January, it was more of a symbolic step, rather than one with any legal implications.

Another element of the IHR amendments, also close to conclusion, would involve creation of a mechanism for indpendent monitoring of how countries implement the IHR’s key provisions – to strengthen what one negotiator called “the collective oversight” of the readiness process.

WHO’s new global health strategy and the $14 Billion ‘Ask’

Another key feature of this year’s WHA will be the launch of a first-ever WHO “Investment Round,” which seeks to raise an additional $7.1 billion in voluntary contributions from member states for the four-year, 2025-2028 period, on top of regular asssessed contributions, which are expected to amount to $4 billion.

“The 7.1 billion seeks to expand the envelope to cover what is not covered by the assesssed contributions of WHO,” said senior WHO advisory Bruce Aylward.

While WHO has always sought and received voluntary contributions from member states and philanthropies, the idea is to systemize the giving, allowing the organization to more flexibly allocate funds to agreed-upon priorities and enjoy more “predictability” in its funding cycles.

“The idea is to really lobby at the highest levels, presidents and prime ministers for funding for WHO,” said Bjorn Kummel, a senior official in Germany’s Ministry of Health, who led moves last year to increase assessed member state funding to WHO.  “Most of the funding [now] comes in highly earmarked,” he noted.  Additionally, significant organizational resources from various departments, are expended courting to donors individually and reporting to them. 

“The other challenge is predicability,” Kummel added.  “You may notice that there are many in WHO on short-term contracts, and this is due to the way that we are funding WHO through unpredicatable finances.”

Additionally, he noted, the aim is to broaden the base of voluntary giving to include more countries that have moved up the ladder of economic development and could now shoulder a share of the burden.

“It’s been the same 18 key donors  [for voluntary contributions] over the past 50 years,” Kummer said.  “That can’t continue.”

Geopolitical and cultural divides deeper than ever

Against all of the complexity, the WHA convenes in a period where geopolitical and cultural divides are deeper than ever.

Two more resolutions on the humanitarian situation in Ukraine following Russia’s 2022 invasion may come before the assembly, said Gian Luca Burci, WHO’s former chief legal counsel and now a senior faculty member at the Geneva Graduate Institute.  That follows divisive debates in 2022 and 2023 over previous WHA resolutions, initiated by the European Union and its allies, on the Ukraine situation.

And the health and humanitarian emergency in Gaza, triggered by Israel’s war against Hamas, following the bloody 7 October 2023 Hamas incursion into Israel, will be the focus of a dedicated resolution that member states will debate alongside a perennial resolution and debate on the health conditions in the Occupied Palestinian Territories, including the West Bank.

That latter resolution, however, has taken on added significance since the war began, insofar as West Bank Palestinians also have faced tough Israeli military lockdowns and curtailment on routine movements, including to obtain health care.

In addition, there may be moves afoot to enhance Palestine’s status at the WHA, where it is now merely an observer, like the Vatican:  “There may be an initiative to adopt a resolution giving Palestine … rights of member states,” Burci said, referring to a similar move recently taken by the UN General Assembly.

The UN GA resolution greatly expanded Palestine’s rights before the body, although it stopped short of giving it the right to vote, or allowing it to posit its candidacy for the UN Security Council, rights that only the UN Security Council may bestow.   Finally, he said that there could be moves afoot to curtail Israel’s eligibility to serve on WHO’s governing body, the 34-member Executive Board, although that would have little immediate meaning as Israel recently completed a three-year EB term.

Gender inclusion and sexual and reproductive health rights

Another flashpoint that has been the focus of gathering stormclouds is the issue of gender inclusion and sexual and reproductive health rights.

Standard language about those issues was traditionally a part of most resolutions and decisions on topics ranging from HIV/AIDs to maternal and child health, as well as environmental health. But increasingly an alliance of conservative countries have sought to have such references watered down or removed, not only from WHA-approved resolutions but even from WHO Secretariat reports.

“There’s really a much more fundamental question that is happening within the lines of gender equality as a shared value,” said Pascale Allotey, a Ghanaian public health researcher who is now director of WHO’s progamme on Sexual and Reproductive Health (SRH) and its joint programme on Human Reproductive Health (HRP).

“We hear a lot now of the use of the term ‘gender ideology’  – this idea that it’s just about imposed concepts,” she said. “But this agenda isn’t about imposed concepts or about concepts at all. It’s really just a …framework for understanding the realities of people’s lives – the ways in which your lack of power and agency restricts people’s capacities and opportunities in unjust ways.” 

Image Credits: The National Guard/Flickr, Matteo Minasi/ UNOCHA.