In another one of a series of recent pandemic reform moves, the WHO Executive Board Monday approved the creation of a new Standing Committee on Health Emergencies, which could convene within 24 hours after the declaration of a global public health emergency – and liaise between the WHO Director-General and member states about modes of response. 

The creation of the EB committee was recommended by a number of review bodies last year as a key reform to better link the scientific work of the WHO with the political work of member states in real-time, as new health threats unroll.   

It took months for the EB to convene virtually following the March 2020 declaration of the COVID-19 pandemic by Dr Tedros Adhanom Ghebreyesus – a delay that member states and independent critics later said harmed collaboration and the smooth flow of information between the agency and member states in the darkest months of the unfolding crisis. 

The EB decision follows a World Health Assembly resolution and companion decision last week aimed at kick-starting a process of reforming the International Health Regulations, the binding rules that govern member states’ response to health emergencies.   

In a last-minute move on Monday, EB delegates, at the request of Botswana, amended the terms of reference of the new EB Standing Committee, to state that the new EB Committee also would consider the “information and needs expressed by member states in whose territory and event arises” – a clear nod to countries’ sovereignty concerns during outbreak alerts.

Board revisits painful WHA debates on HIV language, Ukraine and WHO internal justice flaws  

The day-long EB session, following on the heels of last week’s WHA, also saw a member states debrief on key moments of last week’s Assembly. In particular, EB members expressed deep concerns over the assembly’s failure to reach a consensus vote late Saturday on a new Global Health Strategy for HIV, Hepatitis B and Sexually Transmitted Infections. This was due to disputes over terms used in the strategy to refer to peoples’ sexual health and sexual orientation despite months of negotiations and numerous compromises.

Member states, led by Saudi Arabia, led a wave of objections to the strategy’s reference to “men who have sex with men” as an HIV prevention and treatment target group, “sexual orientation” and other references to sexual rights and sexuality. The dispute delayed the closure of the World Health Assembly closure until nearly midnight on Saturday evening.

In a compromise offered by Mexico, a glossary of terms was finally deleted from the strategy although the reference to men who have sex with men remained. Although the strategy was approved by a vote of 60, 120 member states either abstained or were absent, including Russia, China, India and Indonesia, all the WHO Eastern Mediterranean Region and most of the African Region of WHO.   

HIV vote – dismay over lack of consensus and lack of attention to evidence   

EB members expressed dismay over the “dangerous precedent” set by the long series of roll-call votes on an essentially technical document.  However, they diverged about whether the more fundamental problem was a lack of consensus or lack of agreement on evidence.  

Member states that had supported the strategy lamented the fact that the WHA could not agree on the terms used in an “evidence-based” technical document that aims to ensure that often-marginalized groups at risk are marginalised. 

Loyce Pace, US Assistant Secretary of State for Global Public Affairs, appealed for a balance between “science, respect for human rights and dignity, as well as national laws and context’

On Saturday night Pace had also made a spirited defense of the sexual health terms used, saying, “We should not need to hold a vote on the existence of entire communities of people.” 

Denmark’s Søren Brostrøm, Director-General of the Danish Health Authority, told the EB: “It’s very unfortunate that we had a discussion on Friday and Saturday that was very political, on established evidence and technical issues.  I think we need to reflect going forward, how we can balance the legitimate geopolitical differences that we have in our world, while at the same time protecting the technical authority of the WHO. I don’t have a solution. I think we need to reflect very carefully.” 

However, member states from countries that had opposed some of the language said that more efforts needed to be invested in consensus-building.   

“Botswana strongly believes that consensus should always be pursued in order to ensure our collective action and cooperation for a successful outcome,” said Dr Edwin Dikoloti, Minister of Health and Wellness, speaking on behalf of the 47 member state African group, which had largely abstained from voting on the strategy, with the exception of South Africa which supported the strategy. 

“It is important that the adoption does not set a precedent for consideration and adoption of technical documents by the Health Assembly.” 

Added Micronesia’s delegate, Marcus Samo, Secretary, Department of Health and Social Affairs. “I align myself with the sentiment raised earlier by honorable colleagues, particularly on the importance of compromise and consensus, rather than taking the floor for vote counts.”

WHO Staff Association Calls for Reshaping Internal Justice Board 

The Executive Board also saw a lengthy debate on WHO follow-up over the ongoing investigation of sexual exploitation and abuse charges against WHO staff and consultants during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo. 

In a related move, a written statement by the WHO Staff Associations, representing over 9,000 staff, called for a seven-point plan for staff reform, to ensure more diversity, equity and inclusion, as well as a remake of WHO’s internal justice system so that it operates more at arms length from the Director General’s Office. 

In particular, the Staff Associations proposed a remake of WHO’s Global Board of Appeals (GBA) body which renders judgment on cases of staff misconduct of any kind, brought by staff or managers.

Under the current system, the GBA is housed in the Office of the Director-General and its three board members are effectively appointed by a GBA Chair, a high-ranking career professional reporting directly or indirectly to the WHO Director-General, who also makes a final decision on GBA cases reviewed. This makes WHO’s key internal justice mechanism more of an administrative rubber stamp than an independent body. 

“The panel of the Global Board of Appeal (GBA) should have five-members,” stated the WHO Staff Association written statement. “A three-member panel – the current practice – is simply not reassuring staff that GBA deliberations are sufficiently robust. 

“Furthermore, the staff representatives on each of the GBA panels should be selected by the respective staff association rather than selected by the GBA Chair or Deputy-Chair.”

More ‘fairness’ needed in administrative leave processes  

In addition, the Staff Association statement called out the need for more “fairness” – regarding who is placed on administrative leave for abuses of power, misconduct, egregious behaviour etc. 

“We have noticed that whilst investigations take place, some staff are placed on administrative leave while other, often senior, staff members are allowed to continue to work.” 

The risk of being placed on administrative leave, or worse yet, terminated, is a deterrent to potential whistle-blowers against speaking out against misdeeds. It also inflicts permanent professional and financial damage on staff, who are wrongly charged as a result of political reprisals from more powerful managers or senior officials, WHO insiders have told Health Policy Watch. 

Speaking again on behalf of the US, Pace expressed discomfort that the head of investigations into sexual exploitation and abuse charges against staff and consultants during the DRC 2018-2020 Ebola outbreak reported directly to Tedros. This was the standard WHO internal justice process even though the exception had been sanctioned by the EB.

Pace acknowledged that “extraordinary factors” had led to the EB’s agreement to this chain of command. However, the “altered reporting lines” still “conflict with well-established communication and reporting lines of other UN system internal oversight offices”, said Pace.

In particular, “provisions allowing the head of an investigative unit to circumvent the leadership of the Oversight Office in which the unit sits, such as this decision has done, removes an ordinarily important level of oversight and quality control of the investigation function… 

“We believe that the current arrangement would benefit from further reflection and analysis as we consider what structures are required in the medium to long term,” she stated. 

WHA resolution on Russia’s invasion of Ukraine – about health not geopolitics  

Last Thursday’s WHA resolution co-sponsored by Ukraine, most of the EU, Turkey, Canada, and the USA condemning Russia’s invasion of Ukraine also briefly emerged again as an issue at Monday’s EB meeting. The resolution was adopted by a vote of 88-12, with 53 abstentions, mostly among African and Asian nations. 

“Resolution 75/6, this resolution was not unanimous,” said a Russian Federation delegate, speaking near the close of the day-long EB. “The Russian Federation thinks this is unacceptable, and it doesn’t take into account the true situation that has occurred, something that’s gone back to 2014. We hope that in the future, WHO will avoid polarization of issues.”

His remarks brought a strong response from Pace who stated that “the resolution … was not about politicization or global power struggles. 

“It really was about the health and welfare of millions, and the need to hold actors accountable for the devastation they’ve caused. And so this humanitarian crisis and aggression are in the minds of those who supported the resolution,” said Pace referring to the “indefensible destroyed infrastructure and disrupted chains of medical supplies. 

“And food now poses a grave threat to millions of people within, and well beyond, Ukraine. So over 80 million people are internally displaced and the number of people who have fled to neighbouring countries is now six million. 

“We thank the WHO and other humanitarian agencies and partners who are working tirelessly to provide protection and access to life saving supplies and services for affected communities and health workers.”