Every once awhile, everything seems to be happening in Geneva all at the same time. These weeks in the fall, are churning calendars like there is no tomorrow.
We witnessed a short session of the Executive Board of WHO, which revealed more than expected in some sense. Our analysis this week is on what we found significant at the meeting. We were struck by the nuance in countries’ positions. There are no absolutes in global health. And this is fascinating to capture - you can follow @pretpat or @filesgeneva if you are on twitter, for live feeds from such events.
Closer to Lac Léman, WTO has zeroed in on two final candidates to elect a new boss. Its historic, because it is going to be a woman! Apart from breaking the glass ceiling at WTO, members are also huddling together to see if bold proposals to effectively address the pandemic will pass muster entrenched interests. Two proposals will be taken up next week at the TRIPS Council. More on this next week. [This is in line with our stated mission of bringing you coverage of global health across disciplines.]
In addition, things are moving quickly in closed-door board meetings. We are trying to keep pace and bring the most urgent issues to you, but making sure we have got the facts right. Watch this space for more.
Finally, I am pleased to announce that Geneva Health Files has won a scholarship from Substack (the platform that brings you this newsletter). I will be a part of a journalism entrepreneurs group at the Entrepreneurial Journalism Creators Program at the Craig Newmark Graduate School of Journalism (the City University of New York) I will be learning from peers and practitioners worldwide over the coming months in this virtual program. We are excited about this endorsement. This will shape our potential and help make it sustainable. It also means we will be working harder than ever before.
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1. Story of the week
COUNTRIES WANT WHO TO CONSULT MORE: EXECUTIVE BOARD MEETING
Countries praise WHO efforts on addressing the pandemic, but want more consultation
A number of countries called on WHO for greater consultations on the decisions around the response to the pandemic at the Special Executive Board [EB] meeting earlier this week. From demands on consultations on the allocation framework that will determine access to COVID-19 health products, to the governance structure of the Gavi-led COVAX Facility, countries seemed to suggest that they have been left out of these consultation processes.
To be sure, in a repeat of the World Health Assembly in May 2020, countries came together to show their support for multilateralism, for the work of WHO and its dedication and commitment to fight the pandemic, but more questions were raised on governance processes, than witnessed in the recent past.
A range of countries from Austria to the UK, from Romania to Kenya asked for greater consultation and engagement.
In his response to member states’ concern, Director-General Tedros Adhanom Ghebreyesus promised to continue with weekly meetings with member states and acknowledged the importance of closer working relations with the governing bodies of WHO.
The two-day meeting saw member states consider the interim report by the DG on the implementation of resolution WHA73.1 (2020) on the COVID-19 response and an update from the Independent Panel for Pandemic Preparedness and Response. It also saw a technical briefing from WHO’s Emergencies program and an update from the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme. (Interim report on WHO’s response to COVID-19 January-April 2020)
Although the meeting was relatively brief given its hybrid format, it appeared that the session was significant in terms of reflecting the deep changes in the governance of global health, even as the world is very much in the midst of the COVID-19 pandemic.
In a short intervention, at the end of day one, DG Tedros seemed to suggest, that it was perhaps time to formalize the structures of the ACT Accelerator for future pandemics. This was striking, given that the structures around the ACT Accelerator are effectively located outside of WHO.
Citing the importance of the ACT Accelerator in responding to the current health emergency, he said:
“When the ACT Accelerator was proposed, I remember some people were sceptical, because we have inter-agency committees..and so on. Many were not sure if this could be successful… We are working to make sure the two objectives are met - meaning to accelerate the development of products, and also to discuss equitable distribution to have guidelines and frameworks… All the agencies including Gavi, CEPI, Unitaid, World Bank, the Wellcome Trust..and others...the level of commitment you cannot imagine. So, the idea now is, lets formalize this, and take it to the future. This is a good opportunity to create something like this..a machine..then move it. The research and development is accelerating, not just for this pandemic, but for other health problems that we are facing..”
UNDERSCORING THE IMPORTANCE OF GOVERNING BODIES
Austria made a strong statement on the importance of governing bodies such as the Executive Board, and did not mince words calling out the politicization of pandemic response.
Austria noted that the EB had not met on matters concerning the pandemic since February 2020, and although efforts were made to convene again, it had not been possible. A proposal has been suggested to convene a retreat for EB members only to deliberate on ways to strengthen core governance processes of WHO.
Dr Clemens Martin Auer said:
“..It is also the question of principle. Is the executive board an active governing board, or is it just a ceremonial one… that only expresses gratitude to the good work that you do. I want to see an active executive board, one which is guiding us through the pandemic and the crises…We are the governing body, we have to exercise leadership..”
Kenya pushed for greater transparency in the decision-making process and urged the DG to use provisions in WHO constitution.
United Kingdom also asked for greater consultation from WHO.
In its statement, Israel said,
“… fast developments demand more frequent opportunities for inclusive consultations and input from Member States. We ask that the Office will facilitate dedicated discussion on: The WHO Allocation Framework and Future directions for strengthening the WHO (reform).”
A number of detailed questions were raised by countries:
Speaking on behalf of Australia, Chile, Japan, New Zealand, the Republic of Korea, Switzerland, Singapore and the United Kingdom of Great Britain and Northern Ireland, Israel said:
We would highlight a number of important questions that remain around the Allocation Framework, including:
· Whether and which parts of the final working draft of the WHO Allocation Framework will be further iterated and how Member States will be involved.
· How the methodology proposed for the risk assessment in Phase 2 of the allocation mechanism will be developed and agreed, ensuring both transparency and relevance of indicators measuring “threat” and “vulnerability”.
Lastly, bearing in mind that the WHO plans to provide us with updates later this month, we wish to receive further information on the governance of the Allocation Framework and the governance structure of the Allocation Mechanism, which determine the allocation of vaccines to shareholders of the COVAX Facility and COVAX AMC Eligible Economies.
In particular, we wish to understand:
- What would be the composition and mandate of this governance structure?
- The steps that are being taken to avoid duplication in governance structures across the COVAX Facility initiative, and
- How COVAX Facility shareholders and COVAX AMC Eligible Economies would be involved in the design process of the Allocation Mechanism as it applies to COVAX?
We would welcome any further clarification on these points now, and also propose a dedicated interactive session or sessions on the WHO Allocation Framework with COVAX Facility Shareholders and COVAX AMC Eigible Economies. We would welcome discussions with the WHO on a suitable timeline for this, to ensure timely operationalisation of the COVAX Facility.
For experts watching these dynamics closely, this is not surprising. Sections of the civil society have repeatedly raised concerns on governance in the COVAX Facility. (Another top official, informed EB members during the meeting that Gavi’s board had already given in-principle approval for the Covax Facility)
Austria raised questions on governance issues at Gavi including “some managerial capacities of Gavi when it comes to the global access to vaccines," in addition to highlighting the role played by intellectual property on universal vaccine access.
To be sure, overwhelmingly countries expressed support for Gavi’s Covax Facility in their statements at the meeting.
On the question of allocation, DG Tedros reiterated at the meeting what he has said numerous times before:
“We have the allocation framework. ... Without political commitment, without political consensus, I don't think it can happen.”
But what was more significant, was a short but crucial update on the process around the framework from Mariângela Simão, Assistant Director-General, Access to Medicines and Health Products, WHO. Explaining the mechanisms of the allocation framework, she said:
“We have teams working on it, we have people from Gavi and CEPI working with WHO, it is a small team, a core group that is taking care of all this. Very much a dedicated group of people who are working on the allocation framework, so that it is agile and flexible that can work on practical solutions quickly. There is a proposal for a joint allocation task force in combination of both WHO and Gavi. This task force will work on proposals for allocation rounds. Then there is an independent advisory group on vaccines that will review these proposals.
The independent advisory group will also report to the Shareholders Council of the COVAX Facility.
While questions remain on phase II of the design of the allocation, it depends on the characteristics of vaccines. Countries will be consulted while discussing the indicators on threats and vulnerabilities that will feed into the allocation framework, she said. Although the allocation framework is product-agnostic, there will be consultation with member states on the therapeutics allocation framework in October, she added. The consultations will be similar to the ones conducted for vaccines, she said.
NO UPDATE ON TECHNICAL ASSISTANCE ON TRIPS FLEXIBILITIES
The report by the DG on the implementation of the resolution WHA73.1 (2020) on the COVID-19 response informed member states on actions taken by WHO and partners. However, there was no discussion on WHO technical assistance on TRIPS flexibilities in the report.
“The WHO report on the implementation of resolution WHA73.1 on the COVID-19 response focuses on requests made in paragraphs 9(1) to 9(10). Paragraph 9(8) mentions WHO technical assistance on TRIPS flexibilities. There is no reference to this in the interim report by the DG. It was a direct request from the resolution. The report should have addressed it even if briefly,” Thiru Balasubramaniam, Geneva Representative of Knowledge Ecology International pointed out.
This was not lost on countries.
In its statement, Kenya said, “With regards to paragraph 9.8 of the resolution, We request the Director General to provide an update on steps taken to develop the menu of options for scaling up manufacturing for COVID diagnostics, therapeutics, medicines, and vaccines for the consideration of the governing bodies.”
In a response to a query from Geneva Health Files, on this omission, a WHO spokesperson said that a more comprehensive report on the implementation of the Resolution will be made public certainly during next governing bodies meetings. It is a work in progress, she added. This interim report was meant to be brief.
WHO also pointed to relevant sections in the DG’s interim report:
“The document tries to summarize the vast amount of work done in this area, especially with ACT-A and COVAX initiatives. WHO’s Strategic Preparedness and Response Plan includes actions to coordinate international research and development efforts. This includes the use of the previously established Global Coordination Mechanism for Research and Development, and the Coordinated Global Research Roadmap, which unites the global community around research priorities and a common research agenda, to accelerate equitable access to affordable and effective medical countermeasures.
WHO continually maps and reports global progress against those priorities, in addition to coordinating and supporting the WHO Solidarity clinical trial on therapeutics and other studies that focus on the priorities set out in the Roadmap. The Roadmap, and an accompanying framework for coordinated investment, enables funders and researchers to prioritize investment and research options for COVID-19, and ensures that research adheres to three core principles: speed, scale and access.”
THE COMMITTEES - MULTI-LEVEL SCRUTINY
A number of committees (IOAC, IHR Review, IPPR) working at different levels to examine WHO and countries’ response to the pandemic, presented their work to the board.
The following slide shows how different committees will examine the various aspects of pandemic response.
IMAGE CREDIT: Update from the Co- Chairs of The Independent Panel for Pandemic Preparedness and Response for WHO EB October 2020
Of note, some countries including members of the African Union, and Russia called for a review of the Terms of Reference of The Independent Panel for Pandemic Preparedness and Response.
In a telling remark, Germany, speaking on behalf of the EU said during the meeting:
“In your evaluations, do not be afraid to tell uncomfortable truths. In your recommendations, do not be afraid to challenge…member states, to questions current modes of operation and to show boldness and vision. You can count on the full support of the EU and its member states.”
Germany at the EB
In a significant intervention, Soumya Swaminathan, WHO Chief Scientist, mentioned that efforts were being made to understand countries’ uptake on WHO guidance.
(This surely also puts responsibility also on member states to review their own motivations and actions during the pandemic.)
GOVERNANCE REFORMS – THEY ARE COMING
Countries continued to push for governance reforms at WHO in light of the pandemic.
In its statement, Germany alludes to its proposal for reforms that it indicated will be taken up in the coming months.
This found echoes in a statement made by the U.S.:
Germany and France jointly provided a paper also along this lines, and we understand Chile also has recommendations. We all share the same goals of reforming the WHO, fighting COVID-19, and defeating future outbreaks.
The U.S. at the EB
This is being seen as a re-conciliatory tone adopted by the U.S., and has prompted some commentators to declare that the U.S. is back in the WHO boardroom.
But governance is not only what countries aspire for WHO. Non-state actors in official relations with WHO, also shape governance by their presence and absence in these processes. There were no statements made by NSAs at the meeting, instead these statements were simply uploaded on the website. This prompted some civil society groups to lament on the “dire state of health governance”.
It is hard to understand the systematic reduction of civil society participation in global health institutions during the worst health emergency in a century.
Consider this, COVID-19 information sessions, crucial for dissemination and understanding the evolution of policy-making during the pandemic has now been put behind a secure login and have been described as “Planned Black-outs”.
See image below.
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2. What we found interesting this week:
I. SOUTH AFRICA-INDIA PROPOSAL AT WTO: TRIPS WAIVER DURING THE PANDEMIC
In one of the boldest proposals that captures the power of multilateralism, South Africa and India are urging WTO members to consider “a waiver from the implementation, application and enforcement of Sections 1, 4, 5, and 7 of Part II of the TRIPS Agreement in relation to prevention, containment or treatment of COVID-19.”
The proposal, Waiver From Certain Provisions Of The Trips Agreement For The Prevention, Containment And Treatment Of Covid-19 - will be taken up at the TRIPS Council meeting at WTO next week.
“This bold step is akin to efforts by governments nearly 20 years ago, which spearheaded the use of affordable generic HIV/AIDS medicines, and, if approved, could signal a major turning point in countries’ response to the pandemic.
Read our earlier story: The re-emergence of the WTO as a key forum for global health
II. While the Poor Get Sick, Bill Gates Just Gets Richer: THE NATION
This is an important story by Tim Schwab that raises urgent questions. Do not miss it.
Sample this from Schwab’s reporting:
Recent SEC filings and the foundation’s website and most recent tax filings show more than $250 million invested in dozens of companies working on Covid vaccines, therapeutics, diagnostics, and manufacturing. These investments put the foundation in a position to potentially financially gain from the pandemic.
“…Journalistic norms require disclosure of conflicts of interest. So do the prevailing rules in science, but even when Gates enters the scientific discourse—for example in the commentary he penned in the New England Journal of Medicine, prescribing what he thought government leaders should be doing to tackle Covid—he does not disclose the details of his financial ties. Gates filled out the journal’s required conflict-of-interest form, but simply listed his conflicts as “numerous”—giving readers no sense of the size, scope, or type of his financial stake in the pandemic.”
3. We are also watching:
A new proposal from Least Developed Countries at the TRIPS Council at WTO next week:
The first woman to lead WTO
“…the two candidates who secured the broadest and deepest support from the membership and who should subsequently advance to the final round are Ngozi Okonjo-Iweala of Nigeria and Yoo Myung-hee of the Republic of Korea. The result creates an historic precedent for the WTO in that it assures that the 7th Director-General will become the first woman to lead the organization…”
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