Independent Assessment & Governance Committees: Addressing Accountability and Governance in a Pandemic Accord [Guest Essay]

Newsletter Edition #31 [Treaty Talks]

Jun 28, 2023

Hi,

As global health negotiations on addressing health emergencies in Geneva swiftly move into a decisive phase this summer, questions on accountability and governance will be crucial parts of the puzzle that countries must put together. These issues underpin not only a new Pandemic Accord but also amendments to the International Health Regulations.

In today’s edition, we bring you a guest essay from the Panel for a Global Public Health Convention, that is suggesting an Independent Assessment Body and governance committees as defining features to improve accountability in the remaking of the governance of health emergencies.

Also see the Bureau’s Text for a Pandemic Accord with suggestions on governance.

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We will not have a reported edition, as I am happily immersed in a global health law course this week.

Until later!

Best,

Priti

Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva

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I. GUEST ESSAY

Independent Assessment & Governance Committees: Addressing Accountability and Governance in a Pandemic Accord

By the Panel for a Global Public Health Convention

Barbara Stocking, Lawrence Gostin, Jane Halton, Jorge Saavedra, Patricia Garcia, Angel Gurria, Ricardo Baptiste Leite, Jemilah Mahmood, Laura Chinchilla Miranda, Winnie Mpanju & Elil Renganathan.

Even after the World Health Organization ended the COVID-19 public health emergency of international concern on 10 May 2023, the world is still far from ready to prevent and respond to future global health threats. Cracks identified in our international system back in 2020 continue to undermine preparedness today. The Intergovernmental Negotiating Body, tasked with filling these cracks at the global level by crafting a pandemic accord or treaty, has released the Draft Bureau’s text of the WHO CA+. While the text covers a lot of ground – from surveillance and report to equity and “One Health” – that will improve pandemic preparedness and response, there are critical aspects conspicuously absent. Nowhere in the draft are strong mechanisms for good governance and accountability. Yet there are clear options to ensure improved governance and accountability.

The Panel for a Global Public Health Convention is an independent coalition of ex-leaders and senior experts who are committed to strengthening the global public health architecture to prevent future pandemics.

Image Credit: Photo by Lola Russian, Pexels

What should countries be accountable for?

Preventing outbreaks from spinning out of control to become global health threats requires rapid detection, reporting, and response—transparency in reporting and information sharing, and response based on scientific evidence. Countries must also be accountable for delivering all the binding obligations in the Treaty, not only preparedness and response.

Inevitably, countries at various income levels will find themselves at different stages of preparedness. Like the Paris Climate Change Accords, countries should be incentivized to set their own realistic, yet ambitious targets based on their starting point and the finance made available to them.

Who should countries be accountable to?

Governments have primary responsibility to their residents, especially those on the frontlines of disease outbreaks and the most disadvantaged. Parliamentarians, civil society organizations and others must be able to hold their governments to account through a new pandemic treaty.

Countries must also be accountable to each other to ensure a global health security that benefits everyone. National and regional stakeholders should be able to swiftly respond by executing a multi-country response. This is the kind of mutual assurance between countries that should be codified in the treaty.

Governance

There must be a governance structure that ensures all countries are accountable to the larger international system. Since the COVID-19 pandemic there have been many analyses of what went wrong, and the lessons learnt. Yet there has been relatively little discussion of the governance failures, especially the need for action across the whole of a government, and leadership by heads of state/government. Domestically, heads of state must coordinate an all-of-government and all-of-society strategy for pandemic prevention and response. They must also engage globally to ensure improved coordination and collective action. Pandemics are not just matters of health. They require high level and timely decision-making and action across areas including health, finance, trade, education and public well-being.

How could global governance of health emergencies work?

As a potential framework convention, the WHO CA+ would establish a Conference of the Parties (CoP) to oversee the treaty’s implementation and its development over time—much like the CoP in the WHO Framework Convention on Tobacco Control. The CoP would be comprised of heads of government with its own secretariat which will be hosted by WHO but functioning independently. Article 19 of the WHO constitution empowers the World Health Assembly to adopt a convention. States become party to the treaty only if they ratify according to their constitutional processes.

WHO Member States are also currently negotiating amendments to the International Health Regulations (IHR) under Article 21 of the WHO Constitution. Currently, the IHR is one of the world’s most widely embraced international instrument with 196 states parties. It is likely that all current states parties will agree to the revisions, making it a more inclusive agreement.

The CoP for the Pandemic Accord could include only states parties, so finding solutions to ensure inclusive governance are under way in Geneva and beyond. Discussions are under way about a wider all Member States body for consultation and implementation as well as oversight of IHR. The proposal from our Panel calls for two separate committees. One committee would include only the CoP with other countries acting as observers. The second committee would include representatives of all Member States with a common secretariat for both committees and a common chair, and therefore also cover issues related to IHR. See Figure below. The governance arrangements are now being considered but an essential requirement is to ensure coherence and complementarity between the new convention and the revised IHR with compliance measures which cover both.

Image credit: Global Public Health Convention

Committee 1 (Conference of parties, CoP)

This committee represents the CoP of Member States who have ratified the WHO CA+. The CoP members oversee the convention and its protocols. Other Member States could join as observers without decision-making powers. As with the FCTC, we also see a major role for civil society in partnering with the CoP.

Committee 2 (Compliance and Complementarity Committee)

This committee would comprise all Member States of WHO, and other relevant stakeholders. This committee will be kept abreast of developments in Committee 1 and would be the entity that ensures coherence and complementarity between the new convention and the revised IHR; and other WHO committees/entities covering health emergencies.

It is proposed that the there is a common Chair for both Committee 1 and 2. The two committees will also be supported by the same secretariat at WHO.

Independent Assessment Body (IAB)

Though WHO, as the world’s leading health organization, must continue to set international standards and support countries to achieve targets, an independent body at arm’s length to the organization is needed to assess country performance. A proposed Independent Assessment Body would be overseen by Committee 1 when assessments concern issues specific to the new treaty. It would be overseen by all Member States through Committee 2 for matters specified by the International Health Regulations.

The independent body would need to be shielded from political pressures, have its own source of reliable independent funding and be able to enter countries for assessment and make its findings public.

Creating a global system with real authority and accountability to protect people is not a radical idea. In 1945, hundreds of thousands of people died from nuclear attacks in WWII, and shortly after the International Atomic Energy Authority (IAEA) was founded with powers to go into countries and investigate potential infringements on global nuclear proliferation treaties. Since 2020, over 6.5 million people have died from COVID-19, yet global stakeholders are shying away from a global treaty strong enough to prevent the next disease X, or known pathogen, from going global. Good governance and accountability are vital.

Wider governance across all sectors

Solutions have been proposed for achieving wider global governance beyond health and health systems. The Independent Panel on Pandemic Preparedness and Response (IPPPR) proposed a Global Health Threats Councilin 2021. The IPPPR envisaged the Council being established by the United Nations General Assembly and to be an ongoing UN standing body including heads of state and other global leaders.

Concerns have been raised that heads of government already dealing with enormously complex responsibilities are not likely to fully engage outside times of emergency. The Council might also overlap with the work of a Heads of Government CoP of the new treaty. The reporting lines of the Council are also unclear – it is proposed that ‘The council would report to the UNGA, and could also report to the World Health Assembly and the World Bank and IMF Boards; and should coordinate closely with the UN Secretary-General, the WHO Director-General and other relevant UN agency heads, and with the heads of the IMF and World Bank’.

However, in order to bring the world together to act when a global co-ordinated response to a pandemic is needed the most, the UN could play a critical role. The United Nations Secretary General already has the authority to bring together government leaders and others to respond to an emerging or ongoing global health crisis. A recent proposal has been put forward by the UN. A Policy Brief ‘Strengthening International Response to Complex Global Shocks – an Emergency Platform’, offers proposals for high-level engagement during complex emergencies. The Policy Brief is one of several policy papers being prepared for the UNGA special session in 2024 to develop a ‘Pact for the Future’. The Policy Brief describes an ‘Emergency Platform’ which would not be a standing body, but a set of protocols triggered automatically by a ‘Crisis of Sufficient Scale and Magnitude’, for example a pandemic. The UNSG would convene leaders from Member States, the UN system, International Financial Institutions, and subject experts including civil society, industry, and research bodies. Although this body would not deal directly with pandemic prevention and preparedness it must of course work in co-ordination with the health governance system.

The COVID-19 crisis may be over, but we are at considerable risk of becoming complacent once again. We know that the chances of another major global health event are extraordinarily high, especially from zoonotic spill overs, or perhaps by a laboratory leak. We need to be ready, not just in country but in terms of accountability and organized governance required for global collective action.

Get in touch Elil Renganathan at the Panel for a Global Public Health Convention - elil@sunway.edu.my

II. WHAT WE ARE READING

III. WHAT WE ARE TRACKING

WGIHR Facilitated informal consultation and briefing: June 29

WGIHR Facilitated informal consultation to discuss the combined AFR/Bangladesh text. Related article: 13 A: June 30

INB intersessional informal meeting: July 3

WGIHR Informational briefing: July 3

INB intersessional informal meeting: July 4

INB intersessional informal meeting: July 5

INB intersessional informal meeting: July 6

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