Pandemic Treaty & Other New COVID Initiatives Grab Center Stage At World Health Assembly


Conquering the COVID-19 pandemic will inevitably be the main topic for discussion at the impending 74th session of the World Health Assembly, which begins Monday, 24 May. Global health experts weighed in this week at a series of briefings on what to expect from at the upcoming event. Geneva Solution’s Pokuaa Oduro Bonsrah reports:

The annual World Health Assembly will open online on Monday, with ministers of health from the World Health Organization’s 194 member states tasked with wading through a heavy agenda dominated by how to fix the COVID-ridden global health system and step up global response to future crises. 

“It is time to elevate the threat of pandemics at the level of other existential threats such as nuclear accidents,” Dr Joanne Liu, former International president of Médecins Sans Frontières (MSF) and a member of the Independent Panel for Pandemic and Preparedness Response (IPPR), said in an interview with Geneva Solutions. 

“This is why we call it a “Chernobyl moment in the 21st century”. If we want to move fast and in a sustainable way this scale up is necessary.” The findings of the independent review panel, set up by the WHO to examine the international COVID-19 response and published last week, will be at centre of discussions next week. 

What is the WHA and Why is it Important?

WHO Director-General Dr Tedros Adhanom Ghebreyesus delivers the closing speech for the World Health Assembly, 2019

As the decision-making body of the World Health Organization (WHO), the annual WHA meet-up gives member states the opportunity to chime in on WHO’s policy direction, governance, budget spending and health priorities.

The eight-day assembly, while officially hosted in Geneva, will take place online for the second year in a row, with over 2,750 people already registered to the event including civil society organisations. While COVID-focused, the Assembly will also tackle a range of health issues from antimicrobial resistance to non-communicable diseases. Exhibiting the largest agenda ever, with over 72 items, global health experts shed light on areas that they expect will dominate this 74th session.

Pushing for Legally Binding Instruments to Fight Pandemics

Charles Michel, President of the European Council

Hot on the agenda are talks for a “pandemic treaty” or convention to better prevent, prepare and respond to infectious disease outbreaks. First floated by the European Council’s president Charles Michel in November, the idea has so far been backed by 25 countries, including the WHO. However some of the world’s major powers, including the US and China, have yet to commit. 

The organisation’s treaty-making powers have only been used once in its history to create the Framework Convention on Tobacco Control (FCTC); it is one of three decision-making tools the WHA has at its disposal, including its recommendation powers used the majority of the time, and its regulation tool that formed the basis of the International Health Regulations.

Speaking at a press briefing on Wednesday, Steven Solomon, principal legal officer at the WHO said: “What’s so interesting about this upcoming World Health Assembly is that all three tools will be considered for possible needs in response to the pandemic,” Solomon noted.

Antoine Flahault, director of the Institute of Global Health at the University of Geneva

Although the intricacies of the treaty are yet to be discussed, Dr Antoine Flahault, director of the University of Geneva’s Institute for global health, said a pandemic treaty should guarantee the power of investigation from an early stage.

“With COVID, it would have been useful to have a pandemic preparedness treaty to allow full, independent, rapid investigation into the inception of the pandemic. As we have seen in the China example and the investigation in Wuhan, we missed the chance to scrutinise the origins of the pandemic early on, which has potentially devastating effects” said Flahault, also speaking at the briefing.

Bearing this in mind, when convening a Public Health Emergency of International Concern (PHEIC), the formal declaration by WHO of “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease”, the pandemic should be treated in a similar way to the treaty on the non-proliferation of nuclear weapons or World Trade Organizations directives, “giving it the same level of power and impact, so that when violated sanctions are imposed,” he added.

In Liu’s opinion this should go beyond agreeing on rules, and would instead like to see more “action and accountability.”

Cementing the Power of the WHO to Fight Off Future Health Crises and Eradicate the Current Pandemic

The Independent Panel Team

At a more informal level, countries have been working amongst themselves to agree on how to strengthen WHO preparedness and response to health emergencies, and it is hoped recommendations emerging out of these discussions will be made at the WHA, according to Solomon.

In the recent report by The Independent Panel, co-chaired by the former prime minister of New Zealand, Helen Clark, and president of Liberia, Ellen Johnson Sirleaf,  weak links were found in both preparedness and response – including a broken global emergency alert system, a hesistant WHO and patchy country responses.  Lessons from previous pandemics were not incorporated either, the panel found, citing, for example, the 2009 H1N1 influenza response. 

Along with supporting a Pandemic Treaty, as a way to make pandemic response a higher political priority back by an stronger legal mandate, the Independent Panel also urged that WHA member states push for the creation of a Global Health Threats Council, with plans to put the idea forward at the United Nations General Assembly (UNGA) in September.

“By having this at the highest level it gives it the attention it deserves. We want it at the UNGA after discussion at the WHA, giving heads of states and governments the opportunity to take up ownership it needs,” said Liu.

WHO’s Political Independence

Current WHO Director General Dr Tedros Adhanom Ghebreyusus

In order for the WHO to flourish and have the appropriate means to address the current and future pandemics, the global health experts also believe the political independence of the WHO also needs to be frankly  discussed as  a top priority at the WHA.

This includes a recommendation by the Independent Panel that member states limit the WHO director general’s tenure to just one term of no more than seven years – as compared to the system today, whereby he can hold office for up to two, five year terms. 

The hope is this would shield the WHO chief from political pressures during his tenure – and from pressures to collude  with certain member states in order to secure re-election for a second term.

Instead of a seven-year non-renewable-term, Flahault, however, advocates for a five-year non-renewable term. Still, the main message of independence and autonomy  remains the same.

Governance and Funding Without Strings Attached

Bill Gates, chair of the Bill and Melinda Gates Foundation

When it comes to coughing up cash, member states have stalled on increasing their contributions. Philanthropic actors such as the Bill and Melinda Gates Foundation have filled the void by becoming major funders of global health and the WHO; but this has in turn been met with criticism from civil society as well as some member states for giving external actors too much influence over the organization.

Both Flahault and Liu say the blame should be shifted from philanthropies – to that of countries that are not playing their role. “The total WHO budget for example is hardly above the budget of most teaching hospitals in high income countries, such as University of Geneva Hospital,” explained Flahault.

Read also: Bill Gates is ready to spend more on global health – governments should too, says foundation official

The WHO should be robust and agile enough to anticipate, and respond to, health crises. As such the question of reform, including of its governance structures, also is a looming issue at WHA meetings.   

But for Flahault institutional reform can suck up a lot of energy and time – without yielding enough results. Instead, he says that the focus should be on giving the WHO the mandate to coordinate and lead on health matters.

The Question of Vaccine Equity

Civil society groups demonstrate outside embassies of the United States, United Kingdom, Australia, Canada, Brazil, and other countries which oppose a temporary WTO patent waiver on COVID-19 health products.

“One of the priorities of the WHA to be discussed with urgency is the production of vaccines, technology transfer and patent waivers”  Flahault also said.

While the final decisions around a proposed intellectual property waiver on Covid vaccines and other health products will be made in the World Trade Organization, WHA statements and discussions will also have an influence. 

The WHA debate will also come on the heels of a critical Global Health Summit of the Group of 20 (G-20). Outcomes of Friday’s G-20 meeting, hosted by the Italian government and the European Commission, will also set the texture of high-income country positions in the WHA proceedings.  

A draft G-20 “Rome Declaration” seen by Health Policy Watch,  makes no mention of the proposed IP waiver – referring only to the potential for “voluntary… technology transfer and licensing partnerships.”  And although the leaders of the G20 will also affirm their support for the WHO and Gavi co-sponsored ACT Accelerator initiative, which aims to hasten the distribution of Covid-19 vaccines, drugs and tests across the world, they fall short of clearly committing desperately needed new funding to it. 

A weak G-20 commitment would be a blow to the WHO-backed scheme, Flauhault said, adding that if there was sufficient political will, the US and its allies could potentially vaccinate the whole planet.

“It would cost about 27 billions of dollars to immunize the world population, which is affordable. A country like the US, which I am not saying should vaccinate the world, could however do so if it wanted to. If not high income countries should invest in doing so as soon as possible,” Flahault said.  

At the same time, this year’s WHA will see solid support from the United States, following the change in the administration – and Washington is expected to be a big player in the proceedings. 

Read also: Fauci signals new chapter in US relations with the WHO

“The US body-language is quite important because they have recently been a big defender for multilateralism,” said Liu.

“These are good signals for global health and particularly during the pandemic.  They are pushing back on the waivers of patents, and should also really consider funding the Covax equitable vaccine sharing scheme,”  Flahault added. 

COVID Will Become a Pandemic of the Poor if Neglected Now

The pandemic may become a disease of the poor if nothing is done; coronavirus lockdown in a Roma community in Romania. Makeshift barracks leaves it difficult to follow social distancing and basic hygiene rules.

In the absence of strong action by wealthy donor countries at the G-20 and the WHA, the trajectory of COVID risks the disease becoming a “pandemic of the poor”, Liu warns.

For Liu, if the opportunity is not seized at this year’s WHA to adequately address the WHA, by taking bold decisions and committing to actions then she believes COVID will become an endemic disease, mostly but will be limited to low and middle income countries, whilst high income countries leave the rest of the world behind.  

 “My biggest worry is that high income countries will pull themselves out of the grip of COVID-19 because they will vaccinate the population, and have herd immunity. Low and middle income countries will then be stuck, just like what happened with  HIV and Tuberculosis,” she said. 

The Question of Taiwan

Former Taiwan Vice President Chen Chien-jen in an interview in 2017 discussing the absence of an invitation for Taiwan to attend the World Health Assembly.

In 2008, Taiwan was invited every year to the WHA as an “observer” but since 2016, this invitation – issued at the discretion of the WHO Director General – ceased. This was after Taiwanese elections brought a new government into power with a more hard-line stance toward China – leading Beijing to oppose the seat for Taiwan in the Assembly – even as an observer.  

In the wake of the pandemic, which saw allegations of a Chinese cover-up of the SARS-CoV2 virus origins, as well as a refusal then and now to share critical data around the outbreak’s early days,  there have  been growing  calls to renew the invitation to Taipei – beginning already last year.  

For this year’s 74th WHA, some 13 WHO member states have called for Taiwan to be allowed to participate, with the issue set to be discussed on Monday.  This includes the G-7 (Group of Seven most industrialized countries), which have formally  endorsed Taiwan’s attendance. 

The participation of Taiwan is critical for scientific reasons,  says Flahault. “In global health and security terms, there is absolutely no doubt that Taiwan should be one of the full members of the WHA. The way the country has managed the pandemic offers great tools and lessons which will be important knowledge to share at the WHA and it is a pity if we do not get this,” he said. 

From Taiwan to vaccine equity, the challenge throughout all of the WHA debates will be for individual member states to rise above their own narrow set of national or geopolitical interests – recognising that the pandemic is a threat to all.  

“What I expect from the WHA is that member states show exemplary leadership. This year has to be a game changer in terms of response and preparedness to pandemic,” said Liu.

Republished from Geneva Solutions. Health Policy Watch Watch is collaborating with Geneva Solutions, a new non-profit Geneva platform for constructive journalism covering International Geneva

Image Credits: WHO / Antoine Tardy, Antoine Flahault, IPPR, UNGA, Tadeau Andre/MSF , Thomas Hackl/Flickr, Flickr – Taiwan Presidential Office.

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