It’s likely to be a mad sprint to submit amendments to the International Health Regulations (IHR) by the World Health Assembly (WHA) next May, according to the working group overseeing this process, which is meeting for the fifth time this week.

Meanwhile, the Intergovernmental Negotiating Body (INB) is expected to release a new draft of the pandemic accord within the next few weeks following a flurry of meetings in September.  The new draft will be sent to member states ahead of the seventh meeting of the INB, which is set for 6-10 November, and resuming on 4-6 December 2023.

“When the 2005 International Health Regulations were negotiated and agreed, the final meeting finished on the weekend before the WHA started – at 4 am on a Saturday morning,” Dr Ashley Bloomfield, co-chair of the WGIHR, told the meeting on Monday.

While he hastened to add that the working group was “not intending to do that”, Bloomfield assured member states that they did not have to finish deliberations by January as they were not obliged to report to the World Health Organization’s (WHO) executive committee.

This followed an assurance by the WHO’s Principal Legal Officer, Steven Solomon, that there were no legal impediments to the WGIHR continuing negotiations up until the eve of the WHA, despite December being their last scheduled meeting.

The WGIHR could simply give the WHO DG a progress report by January, while a final text was still being negotiated, added Solomon.

Prioritise equity, Africa urges

The IHR are the only global rules that set down compulsory actions for countries once the WHO Director-General has declared that a disease outbreak is a “public health emergency of international concern (PHEIC)” – particularly in terms of reporting, surveillance and the domestic implementation of the IHR’s procedures.

However, the IHR failed to contain COVID-19, according to a damning report from the Independent Panel on Pandemic Preparedness and Response, which found that the IHR’s alert system “does not operate with sufficient speed when faced with a fast-moving respiratory pathogen” and the regulations are “a conservative instrument as currently constructed and serve to constrain rather than facilitate rapid action”.

As a result, the 2022 WHA resolved that the IHR should be amended. This resulted in a flood of over 300 proposed amendments from member states, which the WGIHR has been picking through, and has drawn up a compilation text.  Bloomfield, former Director General of Health in New Zealand, highlighted that equity, financing the response to health emergencies, and pathogen benefit-sharing are the most challenging areas.

Since the last WGIHR meeting in July, there have been briefings on the alert system for declaring a PHEIC, as well as pandemic financing together with INB members.

Kenya, on behalf of the 47 members of WHO’s Africa region, urged the working group to ensure “tangible progress on equity-related amendment proposals put forward by state parties to prevent escalation of PHEICs to pandemics by building the necessary capacities in countries”.

However, the Kenyan delegate noted that it appeared from the recent briefing on the system of declaring a PHEIC that “while the current alert system has been functioning well under the IHR, what was problematic during COVID-19 was the response, in particular actions related to equitable access to the health products and supplies.

“The PHEIC determination does not currently trigger a mechanism for the development, procurement and distribution of risk response measures such as diagnostics, medicines or vaccines.”

Meanwhile, South Africa called for equity clauses to be discussed first – while Saudi Arabia urged that clauses where there was agreement to be dealt with rapidly first.

Taking stock of progress

The meeting will take stock of progress on IHR articles previously considered. In the past week, the co-chairs have sent out new text proposals on Articles 4 (responsible authorities), 5 (surveillance), 9 (other reports), 10 (verification) and 48 and 49 (the Emergency Committee).

It will also consider Annex 2, which covers the “decision instrument for the assessment and notification of events”. Meanwhile,  informal consultations on Article 8 (consultation) and Article 11 (exchange of information) will also be considered in the WGIHR closed drafting session, which ends on Friday.

Meanwhile, the new draft of the pandemic accord comes following a series of informal meetings of the INB’s drafting group in September. These focused on some of the more contentious articles in the current Bureau text, namely  Articles 4 (pandemic prevention and public health surveillance),  5 (One Health), 9 (research and development), 11 (technology transfer) 12 (access and benefit-sharing) and 13 (supply chain and logistics).