The working group negotiating amendments to the World Health Organization’s (WHO) International Health Regulations (WGIHR) has extended its seventh meeting, which was supposed to end last Friday, to include a special session on equity.

The resumed WGIHR 7 will be held within the first two weeks of March, finally acceding to member state’s requests – including from the Africa Group and the large alliance of countries known as the Equity Group – to give adequate attention to equity.

Unequal access to vaccines and other medical products during the COVID-19 pandemic was one of the triggers for the reform of the IHR, which are the rules setting out countries’ roles and responsibilities, and those of the WHO, during public health emergencies of international concern.

The resumed meeting will pay special attention to a new Article 13A, which addresses the availability and affordability of health products, technologies and know-how, according to a  year-old summary of the IHR negotiation text, which is the most recent public version of the negotiating text.

Article 44, dealing with collaboration and assistance, is another equity-related section that deals with building capacity to identify emerging public health threats, including through surveillance, research and development cooperation, and technological and information sharing.

The final key equity-related section is Annex 1, which relates to the core capacities needed by countries to improve their disease detection, surveillance and emergency response, including the assistance that developed countries can offer to developing countries to improve their capacity.

Ethiopia on behalf of the Africa group expressed its support for the equity-focused dedicated sessions to Articles 13 A and 44 A, describing it as “critical and important”.

“You all recall that this has been tabled prior for several months and we believe that these [articles] are at the heart of dealing with equity-related issues, which are part of the mandate of the IHR discussion,” said Ethiopia. 

Joint session planned with INB

During the reportback, WGIHR Co-chair Dr Ashley Bloomfield said that there would be a joint session between his group and the Intergovernmental Negotiating Body (INB), which is drawing up the pandemic accord, on 23 February.

That date is also the deadline for member states to provide written comment on the new text provided by the bureau during the meeting.

Bloomfield also pointed out that the resumed seventh meeting would take place after a two-week negotiating INB session, which begins on 19 February, and was likely to benefit from equity-related discussions during the INB.

“Our relationship with the INB process is strong and essential,” stressed Bloomfield.

The European Union’s representative stressed that the work of the WGIHR and the INB needed to be aligned.

“It is not that we are going to do this to do the same discussion or to address the same issues,one here and one there. This is not going to be possible nor efficient. There should be an understanding that there are a number of issues – sharing countermeasures, access to countermeasures, the financial issues writ large, some governance issues – that are entirely connected, and they cannot be addressed in isolation, otherwise, we will never solve them,” he stressed.

There was across-the-board appreciation for the role of the Bureau in facilitating the negotiations, particularly providing text in real time during the meeting for member states to consider.

Reality-check for negotiators

Dr Mike Ryan, the WHO’s executive director of health emergencies, gave negotiators a reality check at the end of the meeting.

“While you’ve been doing this, this week in the interest of the future health and workability of amended IHR, the elves have been in the basement processing 37,000 signals of potential epidemics, triaging 80 of those signals for follow-up member states, confirming 14 events around the world -circulating vaccine-derived polio, measles, Avian flu, Nipah, Chikungunya, [extensively drug-resistant] TB, diphtheria, swine flu, Orbivirus, Rift Valley Fever, Western Equine Encephalitis, yellow fever, SARS COV2 and the Lassa fever outbreak all happening in real time,” said Ryan.

The WHO has also carried out systematic rapid risk assessments under IHR, and published various alerts and disease outbreak news. 

“That’s the core of IHR. That’s what IHR is about, is working with our member states to increase that capability for the world to work together to detect, confirm, to share real time information about emerging events and ensure those events get collective response,” stressed Ryan.

“It’s a very precious process that has taken decades to develop,” he added. “What you’re discussing here may sometimes seem like word-smithing or not having necessarily an immediate impact on the world. It will because it will define the next 10 years of global surveillance and of collective security when it comes to health emergencies and particularly high impact epidemics. 

“This is a collective process. It provides a safety net, it provides protection for all our communities. You’ve treated this process with tremendous care and professionalism. I just would urge you again as the Director General has: get this done by May and give us back the IHR in better shape than it’s ever been and we will be forever grateful.”