GENEVA – Despite pushback Monday from many WHO member states, including the 47-member ‘Africa Group’, Loyce Pace, US Assistant Secretary for Global Affairs at the Department of Health and Human Services remains “hopeful we may reach consensus” on reforming international health emergency rules at the World Health Assembly this week. 

The proposal backed by Australia, Colombia, the European Union, the United Kingdom, Japan and the United States, is perhaps the only concrete measure that the WHA can take in its current session to address the international rulebook for emergencies that largely failed the world in the COVID-19 pandemic – and was described by the widely-acclaimed Independent Panel review  as an “analogue” system in a digital age. 

While a much broader reform proposal backed only by the US also is technically on the table, it is the much narrower, process-based resolution,  A75/A/CONF./7, that has the only real chance of passage this year.  

Responding to a question from Health Policy Watch at a small media briefing Wednesday at the US Mission to the UN in Geneva, Pace spoke with diplomatic tact about the resistance that has been encountered to making any changes in the rules: 

“It’s obvious each country or government has a prerogative to express any concerns or reservations at any time, and it’s our job to listen, frankly.” 

But she added, “We are hopeful, I am hopeful we will reach consensus…. It is our hope…   to at least be able to move forward on this process point.” 

Process for changing a process 

Under the process proposed by A75/A/CONF./7, countries would submit and negotiate proposals for more substantive IHR amendments over the coming two years.  An amendment to Article 59 of the IHR, would also create an abridged one-year framework in which any future amendments would actually take force – as compared to the two-year time frame that now exists.  

“It’s really how we just get that ball rolling, and ensuring that we have some method whereby we can at least bring into force these various amendments at a faster pace,” said Pace of the issue at stake.

Time frame for IHR changes too tight? 

But ostensibly modest moves to expedite the timeline for future changes in the IHR ran into resistance in an initial debate on Tuesday, led by China and Iran, which complained that the time-frame for making amendments was too tight – although any process begun now would still take until 2025 to complete. 

While those objections may have been expected in light of the current state of geopolitical tensions, reservations by the WHA’s Africa bloc of 47 states took the resolution’s co-sponsors more by surprise.   

Led by Botswana, African countries expressed concerns about the nature of more substantive amendments lying in wait down the road – should they open the door to changes now.

“The amendments need to be considered as a holistic package,” Botswana’s Moses Keetile, a deputy permanent secretary in its health ministry, said on behalf of the African delegation to the Assembly. 

Admittedly the proposal tabled by the US early in 2022 sets out a more ambitious agenda for very substantive IHR revisions. Those include much clearer and tougher time frames for countries to report to WHO on suspected outbreaks as well language about responsibilities to rapidly share the “gene sequences” of pathogens, when available.  

Country comfort with pace of change 

But establishing tighter time frames for reporting on outbreaks could be difficult for low- and middle-income countries with few resources to muster for reporting at all, some African member states complained at Monday’s session. 

And there is a complex, brewing controversy over rules that would mandate sharing of the DNA sequences of new or emerging pathogens – which some low- and middle-income countries feel should be accompanied by guarantees that they would receive certain “benefits” from medicines or vaccines developed as a result.  

In the interest of transparency, the US has been forthright about the kinds of changes it would ultimately like to see in the IHR rules, Pace said.

However, she added that Washington is also keen to build a consensus with the African group and others uncertain about how next to proceed.   

“I think what we are keeping an ear out for is countries’ comfort with the pace at which things are happening and understanding of the scope of what is included in amendments,” she said.

“I think the President’s been clear about our commitment to international cooperation and dialogues…doing so with not only a sense of leadership but a sense of humility.  We’re still working to ensure that everyone is comfortable with where we are, and that we can move forward and that the very least on this process issue.”

Pace added that the US was “open to any sort of questions or conversations” and that “conversations have been ongoing, which I think is a good sign in terms of us reaching some consensus this week”.

“If it doesn’t happen this week, we’re not going to stop, we’re going to keep working to that end,” she added.

Need to keep up momentum even as pandemic urgency wanes

At the same time, there is still momentum for reforming emergency rules right now, and beyond that, discussing a broader pandemic convention or legal instrument, which could be lost if the discussion drags on, and the memory of the recent crisis fades.  

“You get to another phase of COVID or even get beyond COVID, hopefully, and it might be very hard to get this on the agenda or as high up on the agenda, as we put it off,” Pace said. 

“And so countries have really commented on the importance or the value of putting it on the agenda, keeping it on the agenda… not just in principle we should look at the IHRs, but practically, here’s some specific pragmatic changes we can make. In a way that can make a difference right now.

“Everyone acknowledges that this has been a nightmare that we’ve lived through, but if we don’t do anything about it, then what are we here for ultimately? 

“So that’s really our goal with this Article [IHR Article 59]. And I think that other countries … understand that as well and share that goal, which is you have to be taking steps, meaningful steps, tangible steps to demonstrate to our countries that … when we come together, we truly are taking action and we really are making progress.”

IHR not about sovereignty 

Pace also rebutted the claims being made in some US media channels as well as in some circles abroad – that a stronger set of global health emergency rules mean a loss of sovereignty for the US or any other nation.

Whether such claims originate in ”valid confusion or deliberate disinformation”, global inaction could put more lives at risk, she stressed.     

“The IHRs are not about sovereignty. They’re about public health. And they’re about ensuring that we all do – countries around the world, member states of WHO and WHO itself, do everything we can to protect the global community from anything like this ever again,” she said. .

“We’ve had over a million Americans who have lost their lives. Over 6 million people around the world lost their lives. WHO estimates even more than 15 million associated deaths with those are real numbers. And they’re real people,” Pace said.  

“And what we tried to do in a bureaucratic way, certainly, but in an important way, is to really show up with solutions to that problem – because we never should have been in a situation where we’ve lost so many to this.“

“ I think what happens when we see everything from… valid confusion to deliberate disinformation, is an undermining of those efforts to save lives in the future. And that’s never where we want to be. 

“What it is we are here to do is to protect all Americans and global citizens.”