Senior WHO officials sounded a cautiously optimistic note Tuesday about the prospects for WHO member states to somehow wrap up down-to-the-wire negotiations on a landmark Pandemic Accord in time to submit a final agreement to the World Health Assembly, which begins next Monday, 27 May.

Meanwhile, they heralded the milestone agreement “in principle” to amend the circa 2005 International Health Regulations, which set out in detail the processes by which countries prepare for, detect and respond to any global disease outbreak or epidemic – designated as a “Public Health Emergencies of International Concern.”

“Along with strengthened International Health Regulations, the pandemic agreement remains our best shot, and indeed our generational opportunity, at making sure next time a virus hits, we have a plan to get critical health tools to people quickly, effectively and fairly,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in a pres briefing on Tuesday.

“It will save lives and I’m asking country leaders to give it one last big push to get it over the line next week.”

Extra sessions convened this week 

The Intergovernmental Negotiating Body, which includes all WHA member states negotiating the accord, convened in overtime sessions again this week, after failing to reach a final agreement by the original 10 May target date that had been set.

When talks resumed on Monday, negotiators were pessimistic about reaching a final agreement by the WHA deadline, saying talks would likely have to continue for weeks or months beyond that.

Text in key sessions remained a mass of yellow and white – indicating a lack of full agreement on wording.

However, in the past 48 hours, more and more text has been “greened” signaling final agreement among member states, said Mike Ryan, WHO’s Executive Director of Emergencies, sounding more upbeat Tuesday.

“We’re very pleased to see a lot of greening of text yesterday in key areas like around the global health emergency workforce,” Ryan said. “So we’re seeing a very high level of willingness to move forward.

“But there are clearly some key areas in which the member states still have some distance between them – and they really boil down to areas around access and benefit sharing;  the value of set- asides of vaccines; some issues related to prevention and One Health and other issues related to financing,” he admitted.

“Many, many times in these situations when there’s much at stake, it is very often it is the at last minute agreement. But what I would say is that the atmosphere in the room the determination of the participants is very high.

“There is a huge commitment on behalf of our member states to take this forward. But the devil is in the detail.”

Options before the INB

If the members states don’t reach full agreement, the INB could still opt to present “a text that’s not completely agreed with a few issues to be resolved, which could be resolved during the Assembly itself, when ministers are here,” Ryan added. He noted that the 2021 WHA resolution mandating the negotiations requires the member states to present the “outcome” of the negotiations this May – no matter what that is.

“And there are other options at the disposal of the World Health Assembly, such as to suspend the Assembly and to have a special assembly [to decide on any outstanding issues],” Ryan noted.

Even so, he added that “it is my personal believe that the member states will make this.  I sense they’re getting closer and closer.  They’re inching towards agreement,” he said.

He echoed remarks by others involved in the talks, underlining that the outstanding gaps are now more about technical wording than about principles.

“It’s more about having a common understanding of the language, rather than a massive difference,” Ryan said.

“Everyone is committed to vaccine sharing and sharing of [medicine products].  Everyone’s committed to the sharing of data and the sharing of [pathogen] samples. Everyone’s committed to a One Health approach for the prevention of the next pandemic.

“Everyone is committed to building a stronger and global health emergency workforce. Everyone is committed to strengthening supply chains are brought down during the pandemic. Everyone’s committed to investment in research – and then having mutually agreed technology transfer to broaden the base of of pandemic product production in the future. There is agreement on the outcome or what we want.  But this is a negotiation between member states and these negotiations have legal implications. The language is important when it comes to arrangements that could bind the country later. So countries are being exceptionally careful around the language has been chosen.”

Rebuffing critics who say accord impinges on countries’ sovereignty

Ryan and othe WHO officials also issued a strong rebuff to critics of the accord, who have claimed it would impinge on member states’ sovereignty.  See related story here:

Disinformation: Anti-WHO Convoy Heads to Geneva for World Health Assembly

He described the potential accord as “a collective security arrangement” that could only be reached, in fact, between sovereign states.

“This [a pandemic agreement] will allow us to better prevent, better prepare, and better respond to any future pandemics, but it is only possible through international cooperation. And for those out there who who speak about this being in some way a breach of national sovereignty, in fact, this kind of work that we do together is in fact, I think… an absolute expression and definition of your sovereignty.

“To be truly sovereign means to engage with others confidently. When you are truly independent and fully confident in your own nation, that is when you reach out and work with others on issues of common concern,” Ryan said, adding. “Confident nations working together to find solutions for the betterment of their peoples.”

In the COVID era, he added, WHO and countries built new processes almost “from scratch” to confront a pandemic the likes of which had not been seen for at least a century.

“We do not want to be standing that far behind the starting line the next time around. So we’ve learned a lot of lessons,” he said. “I think the member states now have it at their responsibility to be able to give us a set of rules and a set of processes that we all agree in the future will help us prepare better.”

New WHO strategy, WHO finance and draft climate resolution among other hot-ticket WHA items

While the prospective pandemic accord has been stealing the media thunder in the lead-up to the WHA, the annual meeting of the global health body is awash in other critical issues that will leave a mark on global health for years to come.

On the eve of the WHA, WHO will formally launch a first-ever “investment round” designed to channel the oft-chaotic patterns of voluntary contributions from member states and philanthropies more systematically to priority needs and organizational areas of work.

“The Investment Round is designed to ensure that voluntary contributions, which are currently the majority of our funding, will be more predictable, flexible, and sustainable,” Tedros said at Tuesday’s briefing.

Paired with that is a detailed “Investment Case” which makes the argument for WHO’s financial priorities, and expected outcomes, to be presented on Tuesday, 28 May, at the WHA.

A draft climate and health resolution, led by the Netherlands and Peru is curently being negotiated by member states. It would be the first health and climate resolution to come before the WHA since 2008, when climate ranked as a much lower global health concern.

The key focus of that resolution was on health sector adaptation to climate change – with little regard for the role the health sector might be able to play in slowing the pace of global warming.  Proposed language in the new resolution, in contrast, would also aim to mobilize the health sector to play a more proactive role in climate action – as urged by an expanding array of civil society organizations. This includes fostering more green, low-carbon health facilities that are more climate resilient, as well as offering a healthier setting for both patients and staff.

Pending ‘silence procedure’ for draft climate and health resolution

While full and final agreement on the text, first shared at the January 2024 Executive Board, has not yet been reached, the hope is that it will be finalized this week, in time for the WHA, WHO officials said at the briefing.

“There was broad consensus on all major elements of the climate change resolution,” said senior WHO advisor Bruce Aylward. “There’s a couple of outstanding issues … but I think … our member states are in a strong position to be able to successfully conclude that one by the time we get to the assembly itself. It’s our understanding that that resolution will go into what we call a silent procedure in the very near future and if it’s not broken, then there will be considered by the Assembly next week.”

And critical debate and decisions also are expected on a range of other WHA draft decisions, reports and resolutions related to WHO’s work in health emergencies; in conflict zones, including Ukraine and Gaza; communicable diseases, antimicrobial resistance, noncommunicable diseases, mental health, women’s health and the reform of WHO itself.

Finally, member states also are set to approve a new WHO global strategy, its “Fourteenth Global Plan of Work”, to guide “the agency’s operations from 2025-2028. The new strategy “sets a course for getting the world back on track to hit the health related-Sustainable Development Goals (SDGs),” said Tedros.

WHO insiders say the strategy also echoes the health-related SDGs – and that will ease the mission of monitoring progress against goals. The last WHO Global Plan of Work (GPW)  and it’s ambitious “Triple Billion” goals for improving the health of three billion people worldwide by 2023 was knocked far off course by the COVID pandemic. But critics said that the so-called Triple Billion goals also demanded enormous energy and resources to track and monitor – diverting attention from the SDG health goals, targets and indicators, agreed to by the UN General Assembly in 2015.

Image Credits: WHO , Unsplash.