World Health Assembly Debate On Improving Emergency Response – Warmup For Bigger Reforms? World Health Assembly 73 10/11/2020 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Virtual World Health Assembly nerve center at WHO’s Geneva headquarters, with only a skeletal staff around the table, due to the pandemic. The World Health Assembly on Tuesday approved a resolution calling to strengthen WHO and global preparedness for health emergencies – with few new teeth but lots of symbolism attached. The resolution makes a sweeping, but still largely ceremonial, call to countries and the WHO to reinvigorate systems of emergency preparedness, vulnerability assessment, alert, response, compliance and investments, in line with the 2005 International Health Regulations (IHR), which are a binding legal framework. The new resolution’s major novelty is a mandate to WHO to come up with proposals by next year’s WHA for “possible complementary mechanisms to be used by the Director General to alert the global community about the severity and/or magnitude of a public health emergency, in order to mobilize necessary support and facilitate international coordination.” In plain language, member states have discussed adding a possible “amber alert” – like an orange traffic signal – to the current IHR system by which WHO could signal that a public health emergency is developing – even before it becomes a full blown “public health emergency of international concern”. Geopolitical Divide Between Reformists & Backers of the Status Quo Tuesday’s debate between member states over the measure seemed largely to be a warm-up for the more far-reaching reform proposals that may be in the offing next year, following the completion of multiple reviews over pandemic response now underway. Those reviews are looking at countries’ and WHO’s pandemic performance; WHO’s health emergencies programme, and the IHR system itself. And overall, member state remarks were framed by the same geopolitical divides that plague multilateral efforts more generally – leaving questions about what kind of truly far-reaching reforms could really be achieved that might help head off a future pandemic. Speeches by the United States, Japan, European and other western allies, on the one hand pressded for more speed in data sharing, transparency and measures to compel member state compliance with early alert rules. Russia, Pakistan and China, on the other hand, suggested no such changes in the IHR system are needed; and such reforms could even encroach on countries’ sovereignty. “We need a more independent and authoritative World Health Organization with strengthened IHR implementation, including robust monitoring and evaluation,” said Australia, speaking on behalf of the reformers. “We look forward to an assessment of whether the WHO powers are sufficient to properly investigate and prevent future outbreaks.” A representative from Japan speaks at the resumed 73rd WHA, November 2020. Said Japan: “IHR reform calls for clearly defined responsibilities and requirements for countries to improve their communications capacities and processes.” The United States, meanwhile, said there was “overwhelming agreement” between the G7 (Group of 7 most industrialized nations), “that WHO and IHR state parties must improve preparedness and response, including a ‘traffic light approach’ for declaring a public health emergency of international concern, universal review mechanisms for IHR compliance, and revising travel and trade restrictions in systematic and evidence-based way. “The US along with its G7 partners initiated discussions on WHO strengthening and reform in early 2020,” said Garrett Grigsby, Director of Global Affairs for the US Department of Health and Human Services. “Several member states have since put forward proposals “that reflect our shared values,” he said, noting that the US had put forward a “roadmap” for reform, also being supported by Brazil. On the other side of the divide, Russia stated grand revisions legal mandates should be avoided: “We need to use the experience accumulated in combating the pandemic to strengthen existing multilateral instruments of cooperation in combating epidemics including the International Health Regulations, but not to revise them.” China, stepping gingerly, added, “We firmly support WHO’s leadership role and the framework of the IHR, adding only that “all parties should “effectively implement the requirements of the IHR &…work together to maintain global health security.” China’s reprsentative speaks at the WHA73 Pakistan, which also has said that too much IHR reform could impinge on countries’ sovereignty, stressed the need for stepping up technical assistance to low-income countries and addressing fundamental drivers of pandemics, like population growth and climate change. “The pandemic has highlighted the need for developing IHR core capacities,” said Pakistan’s WHA representative. “The discourse on the IHR must embed a focus on technical assistance, financing and capacity building, & trends outside the health sector, like climate change, need particular attention,” the representative said. “That there will be another pandemic is not a question of IF, but of When, in light of climate change, population growth and other global trends.” Low- and Middle Income Countries: Investments & Technical Assistance Most Important Other low and middle-income countries also tended to stress the importance of gaining greater access to investments, equipment and other know-how – as compared to reforming the legal rules of the emergencies system. Reforms in the IHR and other emergency response systems should “build on existing mechanisms to avoid running up costs,” said Kenya’s WHA representative. Bangladesh talked about the importance of “more predictable and stable core funding” for WHO as key to improving the Organization’s emergency capacity – and thus its support to countries. Ghana called for a “more meaningful engagement between the International Health Regulations review and member states – particularly low- and middle income countries and small island states – to reflect all experiences.” Investigating the Sources of the Virus Left-right: Bjorn Inge Larsen, Norway; Helen Johnson Sirleaf; and Helen Clark at the virtual WHA The member state debate followed presentations of two reviews of the pandemic response. These included reviews of WHO’s Health Emergencies programme by an Independent Oversight and Advisory Committee (IOAC), and a report by the Independent Panel for Pandemic Preparedness and Response (IPPR), just getting underway. The IPPR review is intended to take a more step-back approach, evaluating pandemic response by countries as well as by WHO. “It’ll be important to establish a “chronology” about what happened in the emergence and spread of the SARSCoV-2,” said Helen Clark, former New prime minister of New Zealand, in a diplomatic remark heavy with meaning. She is serving as the co-chair of the IPPR committee along with Helen Johnson Sirleaf, former prime minister of Liberia. Member states would also like to see yet another, new WHO committee dig more deeply in the murky history surrounding the original source of the SARS-CoV2 virus, and its origins. There is wide agreement among experts that those sources is a natural, animal reservoir, like bats, which are known to harbor coronaviruses in the wild. But the route by which this novel coronavirus first reached humans remains entirely unclear. Bats found to be harboring a virus nearly identical to SARS-CoV2 have been reported by Chinese researchers in one or two published studies, but at sites hundreds of miles away from Wuhan, China, where the first major infection cluster was reported. Whether the virus reached the city of 10 million people via people traveling to the city from rural China, or via another wild animal source, such as pangolins, sold in the city’s open markets there, or yet by other means [more conspiratorial theories have it escaping from a laboratory], remains a mystery. And in light of the strict limits imposed more generally by the Chinese government on research and information exchange, the landscape for investigating such a question is forbidding. A new WHO terms of reference for the virus investigation, drafted in July but only published recently states: “As the information is scarce, there are limited hypotheses about how the outbreak might have started in Wuhan. It may have started from an infected individual contaminated elsewhere, from contact with an infected animal, or less likely through contact with contaminated products. The early cases in Wuhan are thought to have occurred in early December, and preliminary information from surveillance data of severe pneumonia suggest no unusual cluster or departure from trends in the weeks and months preceding the first reported case in Wuhan. “The search for the virus’s origins is a study in the compromises the WHO has made,” observed the New York Times in a damming 3 November report of how the Organization may have hindered such work, more than it has helped. Seafood and fresh food market in Wuhan, Hubei, China. Some early cases of SARS-CoV-2 were traced back to Wuhan’s Wholesale Seafood Market, but not all – adding to the mystery of where it first emerged. Countries Also Say Investigation of Virus Origins Should Move Faster Only recently has WHO formulated the committee of international experts to probe the issue more systematically, which was mandated by the WHA in May – and only after the names were approved by Beijing. Moreover, the first, critical, elements of inquiry, to probe who were in fact the first people to become infected in China and the role of the Wuhan wild animal market, will be led by Chinese scientists. At Tuesday’s WHA session, a number of countries expressed impatience that the quest for the virus origins needs to move ahead more aggressively. “The investigation into the sources of the virus should be prioritized,” said the United Kingdom at the debate, striking a chord that the United States and other European allies also echoed. Underlying the comments are palpable fears that the committee’s mission could be watered down and lost at sea in the same geopolitical gulf that divides China’s controlled information regime from European and western allies. “The terms of reference for investigating the SARS-CoV-2 virus origins was not negotiated in a transparent way with member states,” charged the US, at Tuesday’s WHA session. “Member states only received TOR terms a few days ago. And it seems to be inconsistent with the mandate provided by the WHA’s member states,” it added, referring to the WHA resolution mandating the virus quest, which was approved by member states already in May. At the close of Tuesday’s WHA session, WHO Director General Dr Tedros Adhanom Ghebreyesus attempted to reassure jittery member states that the experts appointed would be serious and impartial, saying: “The review team on SARS-CoV2 origins will be coming from the United States, Russia, Australia, Sudan, Denmark, The Netherlands, Germany, Japan, Vietnam and the United Kingdom. “And the TOR is now online,” he added, saying that WHO would make updates on the investigation “transparent so you can see how study of the virus origins progresses.” Even so, sentiment that more light needs to shine on such processes also appears to be widely shared in Europe hard-hit by the pandemic – including the most progressive and pro-WHO member states. After lauding WHO for its “significant improvement” in handling the COVID-19 pandemic, as compared to the 2014-16 Ebola outbreak that paralyzed West Africa, Norway’s representative added, diplomatically, the following caveat: Norway “would have liked to have seen more WHO leadership in the early phases, including earlier WHO access to the source of the outbreak.” Image Credits: @ThiruGeneva, Arend Kuester/Flickr. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. 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