“Equity and Financing are Really Key to Probably Doing the Deal Ultimately”: WG-IHR Co-Chairs Asiri & Bloomfield on the Amendments to IHR
Newsletter Edition #83 [Treaty Talks-IHR - The Files Interview]
Hi,
The work around the amendments to the International Health Regulations have cruised along a steady speed and are now nearing conclusion.
In today’s edition we bring you an exclusive interview with Abdullah Asiri of Saudi Arabia, and Ashley Bloomfield of New Zealand, Co-Chairs of the Working Group for the amendments to the IHR. They have led this careful process and are scheduled to steer these negotiations towards conclusion with significant and targeted amendments - mostly led by member states.
We hope you find this interview insightful and useful. It gives us a glimpse of the multi-faceted considerations that have guided these intergovernmental discussions on strengthening existing rules to govern health emergencies.
If you find our work valuable, become a paying subscriber. Tracking global health policy-making in Geneva is tough and expensive. Help us in raising important questions, and in keeping an ear to the ground. Readers paying for our work helps us meet our costs.
Watch out for more from us, as the final IHR meeting comes to a close later today. In the coming days we will bring you the state of play and behind-the-scenes dynamics in this process. (Here is our earlier story from this week in case you missed it: “Equity” Stands A Chance In the International Health Regulations. Without Financing, Compliance At Stake [WG-IHR8])
Thank you for reading.
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
I. THE GENEVA HEALTH FILES INTERVIEW
“Equity and Financing are Really Key to Probably Doing the Deal Ultimately”: WG-IHR Co-Chairs Asiri & Bloomfield on the Amendments to the International Health Regulations
By Priti Patnaik & Nishant Sirohi
On the side-lines of the final meeting of the Working Group to amend the IHR, Geneva Health Files sought an exclusive interview with Abdullah Asiri of Saudi Arabia and Ashley Bloomfield of New Zealand, Co-Chairs of the working group. This interview was conducted on April 25th at WHO.
The co-chairs tell us that this package of amendments will be by far the most significant update of the IHR 2005 regulations and are calling it “a real step change”. Read on.
Q1. Geneva Health Files [GHF]: How has the meeting been going? What is the current mood after the first few days? You had suggested that you might be able to conclude most of it by Friday (April 26th) and if needed, maybe an additional session after the INB resumed session in May 2024. Is that getting clearer now?
Abdullah Asiri [AA]:
Thank you very much. No, we plan to finish by Friday. So, keeping this message to Member States. We are progressing really well. I believe we'll be able to accomplish most of the core issues that have been arising through the process. However, there are, of course, other situations that might necessitate continuous discussion, but we don't want to really bring this upfront unless we have to. So, we still believe that by the end of the WG-IHR 8 we will be able to deliver on our mandate.
GHF: Would you already know… I guess on which specific issues that you're suggesting might need more time. Are they also linked to the INB?
Ashley Bloomfield [AB]:
Two things. To your original question… the mood in the room is very positive and extremely constructive, and it has been throughout the process. But even this week, we notice real flexibility, engagement, and strong aspiration and our sense is that everybody would like to finish this process, to actually help build momentum and create good momentum going into the INB process. And on some of those key crossover issues, like financing, for example, actually, there is no reason why we can't thrash them out and get some resolution on them in our process. And as we've said, and gift them to the INB. We can make their job hopefully easier.
The other point here is, we talked about it this morning, any task expands to fill the time available, and if we say there is more time available, then that reduces the pressure because the challenge in all these negotiations as things go, the most challenging issues go to the wire. Now we are just clear where that wire is. And it is at the end of tomorrow.
If there are any outstanding matters, and we raised this at the start that, it may need some small adjustments pending the outcome of the INB discussions. But not major changes, we will seek out a mandate and outline a process for how we might make any minor adjustments after the end of this week, if that's required.
GHF: So does that mean you're actually ruling out an additional day at this point or you're open to having some additional time after the INB?
[AB]:
We're ruling it out. Well, in the sense that we're not planning for it, and our very strong preference is that we don't need to do that.
This is the time for us to drive towards consensus. And judging by the momentum we've got, we had another good morning. This afternoon, we're returning to our two critical issues of Article 44 and Article 13, with some updated text.
We're going to really focus on those because we are clear that those are the ones that are really key to probably doing the deal ultimately.
GHF: I just had few clarifications on some of the more substantive questions.The Bureau proposed an early action alert, but we heard this week there is a preference for a pandemic alert. Can you explain a little bit about the direction that's going in? And what I wanted to understand is basically the continuum of the early action alert, a pandemic emergency and a pandemic. At what point does the potential new legal instrument kick in, and also if you can clarify whether at all points IHR will retain the supremacy in this hierarchy of instruments.
[AB]:
Quick comment from me, but it is a bit like a case still being in front of the courts. It is still an act of discussion. So, it is limited to what we can say, but we've already had a very good, discussion on this, and we've got some more work to do.
[AA]
So, the idea of the continuum was evident from the beginning of the discussion on both processes. There is already the essence of a continuum in the IHR, but up until a Public Health Emergency of International Concern (PHEIC) and then stops there.
So, what both groups are trying to do is to define this continuum in a way that is leading to or helping the discussion in the Pandemic Treaty. And this task of defining this continuum was given to the WG-IHR, and that was managed through a subgroup in consultation with Member States. There are no suggestions on how to address or how to define the continuum. There's still ongoing discussion. We did not finalise on the definition, for example of a “pandemic emergency” and how to address the early action alert. There are different views around that.
So, we believe that the discussion is progressing well in that, and it is one of the issues that is still open for negotiation. But we are very close to reaching a midway agreement between Member States on how to address the continuum. Then the success in defining this will reflect positively, we believe, on the discussion with the Pandemic Treaty.
Then, there will be, of course, a need to discuss the implication of this continuum on triggering the Pandemic Treaty and the logistics around that.
So, I believe we are, compared to the pre-pandemic (COVID-19) phase, we are in a much better position. There is no more clarity on how to define a period between a PHEIC and a pandemic. There is some discussion, very fruitful discussions on how to define a “pandemic emergency” moving away from the epidemiological definition of a pandemic, which has been a problem repeatedly. So, we are hopeful that this discussion will [conclude] by the end of WG-IHR8, and then we can confidently say that we have delivered in our mandate to define the continuum.
GHF: So, if I understood right, you will have a term such as the “pandemic emergency” to basically be a bridge between the two stages, as it were.
[AB]
It's between the two stages of a PHEIC and a pandemic. And there are two aspects to this. One is it will be stand alone within the IHR. The interest of the INB processes that a pandemic emergency is likely to be the trigger for provisions there. So hence, the crossover for the two.
But the second is, this is having had lunch with the Director General, a couple of days ago, this is a very important thing from the perspective of the Director General because, at the moment, there's no provision in the IHR other than the PHEIC, and so in terms of a tool in the Director General's toolbox to be able to say actually, this is more than a PHEIC. It has got a very strong potential for turning into a pandemic, and we need to act collectively now. That is the idea of the pandemic emergency and the associated definition, which you would have seen in the text we circulated. Because, as Dr Mike Ryan has pointed out, by the time you say this is a pandemic, you are sort of…it is almost too late. And so you need something that is increasing the sense of urgency and triggering a much stronger international response, including, perhaps, subsequently, through the pandemic agreement as well.
GHF: Just the other question I had on financing. I think the question of financing is more straightforward for IHR. From what I understand because the option on the table, meaning that we use pandemic fund as an existing mechanism. I understand that IHR is already in the agenda or the way the Pandemic Fund disburses funds, but the kind of issues covered under the Pandemic Treaty is wider than what the Pandemic Fund currently deals with. So, I think it's more straightforward for IHR financing. So, I'm not sure what it means for a financing solution that actually transcends both these instruments.
[AA]:
So, to start with IHR itself as a tool, [since] is not, was not designed to be a financing mechanism or the IHR core capacities.
So, there have to be other ways to help Member States maintain and build their core capacities for IHR. That's why there are mechanisms internally inside WHO, other intergovernmental organisations, and bilateral collaborations between countries to try to address the issue of core capacity financing. However, without financing core capacity, the world will continue to be at risk of epidemics and pandemics, and that's where the discussion on pandemic financing comes in.
So, in the beginning, there was, I mean, trying to address the financing as one package for both processes. But it was clear that this is not going to fly. We need to have some intellectual separation between financing an actual pandemic that is already happening and you need a different set of interventions that are out of scale of any financing mechanism.
But in the same time, in order to not reach to the stage [of a pandemic], you need to have continuous mechanism of maintaining the core capacity in that member state. And that's what the equity part is becoming into play into the IHR discussion. So, there is a good progress in introducing for the first time the concept of equity in IHR. Trying to find legal terms within the IHR to help Member States build and maintain their core capacities, stronger surveillance systems and other core capacities that are required to provide pandemics.
Financing is a tricky discussion whenever the international collaboration comes in into play.
But for the IHR I think the focus now is more towards how do we make equity operational inside that IHR, of course, if we succeed to progress with that we'll definitely reflect on less propensity for having pandemics or triggering any pandemic treaty.
[AB]
Interestingly, there's an agreement on including provisions around financing and the IHR. When we have had this discussion…it was quite a historical step.
But there's still a meeting of minds that needs to happen around some of the more challenging aspects of that and the one that's most obvious is the establishment of a bespoke dedicated fund, which there are still divergent views.
GHF: It was part of your proposal actually….
[AB]:
It was part of our original proposal, yes. Because we were… it is one that we still need to find a solution on because there is not a meeting of minds about how to progress, but that there's also strong engagement in trying to find a way through. So there's no one who has walked away from it, which is great.
GHF: At the moment, there's a lot of uncertainty on a potential new mechanism for Pathogen Access and Benefits Sharing. But is there at all a possibility of having a placeholder for a future multilateral mechanism that will also be applicable to IHR State Parties?
[AB]
It is not something that was put forward as one of the proposals originally in the IHR, and it's not part of our discussions. I think of all the areas that is where there is sort of some overlap, potential overlap. That one conversation is very much in the INB process. And so, it's not a part of, as you would have seen, it's not a part of our proposals in our text, and it hasn't been raised at all this week. So, that's an area that's been left to the INB because it has much more to do with the pandemic - the end of the continuum…
GHF: But I think initially, there were some discussions about sharing genetic sequence data and then countries said that if you are going to have obligations around sharing in the IHR, then you will also need to have sort of corollary mechanism for sharing benefits.
[AB]:
Those were part of the original proposals, but as our conversations have evolved over the last seven meetings. I'd say, States Parties seem to be comfortable leaving that discussion to in the INB. It's not one that we've pursued in the IHR…that would be my assumption.
[AA]
There is a general support for information sharing as a general concept and timely sharing and some tendency to increase the obligation to share information but it does not go down to sharing specific genetic material or viruses or other pathogens. So we I think the discussion has to be at least somewhat on these details, and this is happening not only in the INB but also there are other fora that are discussing this, and I think they are important. Because the economic interest into this is the main driver.
GHF: So, one final question. It sort of occurred to me when you clarified at the beginning of the week that this is not IHR (2024) but a revision of IHR (2005). So, in that sense, then, so does it mean that the amendments are not far-reaching enough for it to be sort of called IHR 2024? That's one on the nomenclature of it. And the second thing is, when this discussion started two years ago, there was obviously a lot of strong resistance that you cannot have dimensions of equity reflected in the IHR and it could be too expansive and political and so on. So how would you sort of go back to those questions like…in the sense that if member states want… you know…this potentially could be possible [to have equity in the IHR]? So how do we understand the change in positions as they have progressed over the last few years on this?
[AB]
Well, our mandate was to update, [with] targeted amendments to the current regulations, not to renegotiate a new set of regulations and to make sure equity was accounted for. I think there's been [at] no point in our discussion, has there been any disagreement that we need to reflect equity in the document and we've made enormous strides. When we finalise this package of Amendments, it will be by far the most significant update of the 2005 regulations, a real step change. The point I was making there, let us not let the perfect be the enemy of the good. We've already agreed to, and we will agree to, some substantive changes, even if it's not the perfect set of IHR. And we can come back and have another look in the future if we find there are still things that need improvement and that would be appropriate and normal. We should sort of bake that into our thinking.
GHF: One last thing on the question of governance. A few experts have pointed out that the amendments on governance in these negotiations in the context of the IHR is quite significant and substantial. Maybe can you explain to us why this is so, I mean, you will have a new potentially a new implementation committee?
[AA]
This is a member-state-driven process, and there has always been a concern about the implementation aspects of the IHR more than anything else. That's why at least three proposed amendments talk about establishing a body to monitor the implementation and enhance it. This is one of the major additions to the IHR however, the discussion is not yet finalised.
So, we are answering to the Member States’ request, which rightly requests that we need to improve the way that this was presented. We are here to improve the accountability of everyone, not individual states or singling anybody, but it is a collective accountability, and we believe that this is one of the major amendments that we are going to produce from this process.
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II. PODCAST CORNER
Dialogues: a conversation with Kinari Webb
In this episode of Dialogues, host Garry Aslanyan speaks with Kinari Webb, a medical doctor, public health innovator and thought leader on how human and planetary health are linked. Kinari's journey started at the age of 21 when she worked as a research student in the rainforests of West Kalimantan in Indonesia. Years later, she established a non-profit organization called Health in Harmony. In her book "Guardians of the trees,” Kinari outlines how she and her team developed a novel model that provides health care as an incentive to protect the environment.
Garry Aslanyan is the host and executive producer of the Global Health Matters podcast. You can contact him at: aslanyang@who.int
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