The World May Agree on a Pandemic Accord, But How Will it be Implemented?
Social distancing squares marked out during the COVID-19 pandemic.

As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains.

Health Policy Watch:  You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like?

Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports.

HPW: Who would this “independent committee of experts” report to, and how would it be financed?

LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly.

Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained.

HPW: Isn’t this the job of the WHO?

LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee.

HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this?

LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on.

HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? 

LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics.

Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health.

Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector.

HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation?

LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council.

HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in?

 LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct.

Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. 

 * Kerry Cullinan asked the questions.


Image Credits: Shahin Khalaji/ Unsplash.

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