“Equity” Stands A Chance In the International Health Regulations. Without Financing, Compliance At Stake [WG-IHR8]

Newsletter Edition #82 [Treaty Talks- IHR]

Hi,

When countries began sharing their visions to amend the International Health Regulations two years ago, there was strong resistance to broaden the scope of these technical regulations to fix what is missing - namely to reflect equity considerations, among others areas.

A persistent fight by developing countries to keep these issues on the table in these complex negotiations have paid off to a certain extent. This week countries are discussing proposals that could make this a reality. While we do not rule out realpolitik and tough bargaining to shape the final outcome, this is widely being seen as a significant development.

I am convinced individuals can make a difference even in the most polarized of times. The negotiations to amend the IHR illustrate what a clinical approach to conducting these discussions can accomplish while giving a nod to aspirations from countries. When the process is not jarring, discussions flow in a more predictable manner, albeit not fully insulated from the whirlwind of political considerations in rule-making.

Throwing journalistic staidness to the wind, I gushed to a senior official that the Bureau’s work explaining its rationale, read like music. (It is okay to do so once in a while!)

We hope you like this rather long edition. Thank you for reading.

We also drew up a quick schematic - a snapshot of IHR provisions under consideration for amendments. You are welcome!

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Until later.

Best,

Priti

Feel free to write to us: patnaik.reporting@gmail.com. Follow us on X: @filesgeneva

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. Analysis: WG-IHR8

“Equity” Stands A Chance In the International Health Regulations. Without Financing, Compliance At Stake

By Priti Patnaik & Tessa Jager

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The Working Group set up to amend the International Health Regulations (WG-IHR) has tried to bell the cat. For the first time in more than two years of these negotiations, the Bureau of the WG-IHR has formulated proposals to reflect language that attempts to capture equity-related provisions suggested by developing countries in order to frame obligations on equitable access in the IHR. It however, shies away from pushing for a dedicated financing mechanism to ensure implementation of IHR obligations.

While this is a significant start, whether this beast can be tamed will be clear in the coming days. There is expected to be push back on some of these elements from developed countries and even some developing ones, who have long resisted the articulation of equity-related provisions in the IHR. Many believe that expanding the scope, is akin to violating the technical nature of these rules and succumbing to political considerations. But ultimately countries will decide what they want.

Reaching near-consensus this week will be key not only for the IHR, but also in setting the tone for the Pandemic Agreement negotiations which resume next week.

In a span of five days, countries are attempting to finalize the amendments to the International Health Regulations (2005). More than 300 proposals submitted by scores of countries have been distilled into targeted, and potentially far-reaching amendments, provided the negotiations this week proceed along the direction set out by the Bureau of the IHR. Last week, the WGIHR Bureau published the full text encompassing its proposals based on what countries have suggested. This is a marked shift towards transparency in a bid to fight forces of disinformation.

In a well-explained rationale, that has won broad support and appreciation, the Bureau provided context and reasoning, reflecting a careful balance of the technical and the political, in its proposed text to finalize the amendments. This rationale has not been posted publicly. Geneva Health Files has reviewed both the Bureau’s text and the accompanying rationale.

This story has two parts: we look at some key proposals from the Bureau’s text, followed by the rationale presented by the Bureau. We also review what’s on the table for the meeting underway this week. Finally, we present statements made non-state actors.

In his opening remarks at the final scheduled meeting of the WG-IHR, DG Tedros Adhanom Ghebreyesus urged countries to take more time if needed. He said:

“The text of the proposed amendments, for most of the articles and annexes, reflects the patience, flexibility and commitment you have towards reaching a consensus over the past year and a half of deliberations. In particular, I would like to commend your progress regarding the possible new designation of a pandemic emergency within the PHEIC process.

This week, I urge you to capitalize on this progress and to focus on the provisions related to equity and closing the gaps in the global health architecture that were exposed during the pandemic. I trust in the constructive spirit that has driven your negotiations. And I hope you approach this final stretch of your negotiations, keeping in mind the importance of maintaining the universality of the IHR.”

Co-Chairs Abdullah Asiri and Ashley Bloomfield kicked off the meeting.

Bloomfield said:

“Our objective is to finish the task of finalising a package of targeted amendments, while considering the need highlighted by the pandemic to take equity fully into account in the updated IHR. The Bureau is grateful for your support, constructive engagement, and flexibility to date, and our request is that we all work towards Friday this week, as a firm deadline.

We are all aware that the INB process remains live with another two weeks of intense negotiations scheduled following this meeting. We continue to work closely with the INB Co-Chairs and the Bureau to ensure our work is aligned. One reason it is important for us to complete our work this week, is so that there can be a full focus on the INB negotiations in the following two weeks, to maximize the chance of success in that crucial process. The ideal outcome, and I'm sure we are all striving for this, is for both processes to conclude successfully, to agreed texts, that are being adopted at the 77th World Health Assembly.

The Bureau is aware there may be a need for subsequent editorial tidy-up of the text that we will agree this week, and potentially to make small adjustments to reflect the outcome of the INB negotiation. We will seek your agreement before the end of the week to do this if necessary. And we would do so transparently and keep you fully informed. However, this should not preclude us getting agreement on the IHR amendments in this room, this week. And we have shaped our relevant proposals with a view to achieving this.

We should also recall that we are not rewriting the IHR to develop an IHR 2024. We are amending the IHR 2005, and they will continue to be reviewed and updated in the future, just as they have been previously amended in 2014 and 2022.

And finally, we must keep in the front of our minds this week, as the DG mentioned, just how important and urgent our work is. You will all be aware of the growing concern about the threat of H5H1 bird flu highlighted by the WHO just last week. We have the opportunity to ensure that the world is better prepared, both individual countries and collectively, to address that threat through strengthening core capacities in all States Parties. As Co-Chairs, we, and the Bureau, are here to help ensure that you can seize this opportunity.”

Image Credit: Photo by Dom J, Pexels