With only 10 official negotiating days left, the Working Group on Amendments to the International Health Regulations (WGIHR) is under pressure to reach agreement on changes to the rules that govern global health emergencies.

The seventh WGIHR meeting which began on Monday officially kicked off the 2024 pandemic ‘season’ negotiations at the World Health Organization (WHO) in Geneva.

It’s a short, intense season though, with the grand finale for both the IHR amendments and the pandemic accord set for the May World Health Assembly.

As Eswatini pointed out, the WGIHR only has 10 official negotiating days left until May, and by Friday, this time will be halved. 

Addressing the equity-related gaps in health emergencies should be prioritised, stressed Eswatini, speaking for the 47 African member states and Egypt (part of WHO’s Eastern Mediterranean region).

Malaysia, representing the Equity Group (a cross section of over 30 countries), stressed that articles to “operationalise equity” – particularly Articles 13, 13A, 44 and 44A, alongside annexures 1 and 10  – need to be prioritised.

“It is important for the IHR amendments to enable us to better prepare for future pandemics and other health emergencies, and this can only be achieved through concrete provisions that effectively operationalise equity,” said Malaysia.

“Hence, we look forward to more concrete engagements and conclusive discussions on equity related provisions before we can agree on the full package of proposed amendments,” it added, appealing to the WGIHR Bureau co-ordinating the negotiations to “make every effort to facilitate the informal consultations as much as possible in order to make headway”.

Sincerity of developed countries?

Bangladesh, which had made a similar appeal at the last WGIHR meeting, was more forthright: “It is a fact that, in many cases, equity-related proposals have fallen apart despite the strong demand of a large number of countries.”

“Developing countries have sincerely engaged in all proposals submitted by the developed countries. Reciprocity to that is not a demand rather a cause that once motivated us to conceive the idea of amending IHR 2005,” said Bangladesh. 

“We are confident that the developed countries have the capacity to deliver on them and towards that we all need to demonstrate our real intent and commitment.”

Avoid ‘complexity’

Dr Mike Ryan, WHO head of health emergencies, appealed to negotiators to ensure that any amendments were clear and simple to enable efficient implementation.

Ryan summed up the IHR thus: “We protect each other and our communities by committing to provisions to make our borders safe, to make sure that we have good surveillance systems in place, that we manage information in a way that allows others to be alerted when there’s a problem, and  commit to helping others when they have a problem.”

“I would only ask you in what is already a very complicated instrument, and it is very difficult for the Secretariat to meet those provisions and carry out those provisions in an efficient way, not to bring complexity that results in inefficiency, despite the intent. 

“Sometimes in life, especially in an emergency situation, the more complex the action, the more likely it is to fail at a time of critical pressure.”

‘Optimism is high’

Despite the daunting week ahead, Dr Abdullah Assiri, the working group’s co-chair, said that “the optimism is high”. 

“We have had ample time to deliberate with our capitals and therefore we can take swift positions on the proposed text. We have several articles and annexes of which consensus could be reached in this meeting,” said Assiri.

Thanks to meetings with the Intergovernmental Negotiating Body (INB), which is developing the pandemic accord, there was also “more clarity on common issues”.

 “For example, you correctly believe that surveillance and the definitions of health alerts all the way to the pandemic definition are mainly IHR related issues. At the same time, you made it clear that equity and finance need to be addressed in both instruments,” said Assiri.

Collaboration, capacity building and financing

The WGIHR Bureau suggests that the meeting begins with text proposals relating to “collaboration, capacity building and financing”. 

These are the articles proposed by Malaysia (13,13 A ,44, 44A) as well as Annex one and a new Annex 10. 

The outbreak continuum – from issuing a public health alert up until the WHO Director General declares a Public Health Emergency of International Concern pandemic – (Articles 6, 7, 10, 11,12, 48 and 49), will be next. 

Then the meeting will address articles related to “governance, monitoring and oversight”, said Assiri. 

“Here we suggest that the proponents – African Group, European Union and the United States of America – work with the Bureau to develop updated text proposals which can be reviewed during the week.”

However, in response to concerns about time, Russia suggested that it might be necessary to implement the amendments in stages.

Misinformation

Dr Ashley Bloomfield, the other co-chair, raised the “well coordinated campaign to try and undermine this process and the INB process and indeed, to try to undermine the work of the WHO”. 

“It’s very important in our work that we provide confidence, both on the importance of the work, and the fact that it is a member state driven process and that the sovereignty of countries is not threatened by this process,” stressed Bloomfield.

“Rather, the sovereignty of each country can be enhanced by us all working collectively,” he added.

“We will be working hard to make sure there is a public profile for this work and that it does address the myths and disinformation that has been targeted at our process. I’m sure you’re aware of it. You’re probably facing your own battles back in your countries with those WHO wish to undermine the process and we must of course not let that happen. There is too much at stake.”

Raising its own concerns about misinformation, Japan proposed that the WGIHR releases an updated draft of the proposed amendments so the public could see that the process is member state driven.

The WGIHR will hold a public update on this week’s negotiations on Friday afternoon.