Need for Accountability, Equity & Cooperation Dominate UNGA hearings on Pandemic Prevention, Preparedness, and Response
Newsletter Edition #185 [The Files In-Depth]
Hi,
Today we bring you a wrap on the public hearings on the governance of future health emergencies that were held in New York this week. These discussions were in the run up to the Political Declaration from the UN General Assembly High-Level Meeting on Pandemic Prevention, Preparedness and Response, later this year in September in New York.
My colleague Shoa Moosavi brings this story for the readers of Geneva Health Files.
These discussions at the UNGA are significant for the on-going global health negotiations in Geneva. Some diplomats engaged in Geneva negotiations view New York discussions with some amount of caution and concern. Many stakeholders, including the WHO, are of the view that health discussions should be anchored in Geneva processes.
Like our work? Consider supporting our journalism that ensures nuance, detail, and accuracy. Readers paying for our work helps us meet our costs. Thank you for reading.
Until later!
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
I. STORY OF THE WEEK
Accountability, equity and cooperation dominate UNGA hearings on Pandemic Prevention, Preparedness, and Response
By Shoa Moosavi
In preparation for the United Nations General Assembly High-Level Meetings taking place in September, the UN held multi-stakeholder hearings on key public health issues, including Pandemic Prevention, Preparedness, and Response (PPPR).
Speakers emphasized the connection between pandemic threats (such as COVID-19) and endemic threats (such as tuberculosis), both of which require countries to achieve universal health coverage.
The meeting came on the heels of WHO Director-General Tedros Adhanom Ghebreyesus’s termination of the COVID-19 pandemic as a Public Health Emergency of International Concern on May 5. This announcement emerged as a consistent theme for reflection by speakers who wanted to take the opportunity to enact reforms that would ultimately break the global community out of the cycle of panic and neglect.
The meetings took place on May 8th and 9th in New York City. On May 9th, the UN held a half-day, interactive hearing on PPPR strategies and financing. After opening remarks, Precious Matsoso, one of the co-chairs of the Intergovernmental Negotiating Body (INB) moderated the first panel. The second panel was moderated by Zeid Ra'ad Al Hussein of the International Peace Institute.
Panelists and other stakeholders, including representatives from civil society and UN member states, proposed various topics for inclusion into the political declaration that is scheduled to be adopted at the high-level meetings in September 2023.
PARTICIPATION FROM A RANGE OF STAKEHOLDERS
Civil society engagement is a critical part of the process, according to Cindy Kelemi, Executive Director of the Botswana Network on Ethics, Law and HIV/AIDS, who said that civil society and community leadership must be included in the political declaration to ensure “people-centered, resilient, and sustainable PPPR systems.”
The hearings also came at a time when stakeholders are engaging with the parallel processes of amendments to the IHR and the negotiation of the new pandemic instrument (WHO CA+).
Ricardo Bautista Leyte, representing the UNITE Parliamentarians’ Network for Global Health as a Portuguese parliamentarian himself, called for the INB process to include parliamentarians during negotiations as they will ultimately be responsible for ratifying the instrument in their home countries. Bautista said that in a recent meeting of over 300 parliamentarians, none had even heard of the WHO CA+.
Speakers connected PPPR capacities to broader health systems strengthening. A representative from the Worldwide Hospice Palliative Care Alliance suggested that the current draft of the WHO CA+ does not adequately refer to primary health care. Investing in universal health care through primary health services supports disease surveillance, treatment, and many other activities that are essential to PPPR.
Anamaria Bejar, a panelist from GAVI, argued that pandemic prevention relies on expanding access and service delivery in a way that protects individuals from catastrophic health expenditures. Primary health care is an essential component of PPPR “not just to prevent disease, but also to strengthen entire service delivery systems, including supply chains, data systems, and community engagement that enable early detection and effective responses to outbreaks before they become pandemics,” said Bejar.
United for Global Mental Health presented reasons why psychosocial preparedness and the availability of emergency mental health support are important to PPPR. Health systems strengthening also includes non-communicable disease prevention and disability justice, as several speakers asserted.
Stakeholders representing human resources for health expressed their concerns about needing better support for the health workforce. They called for Member States to make financial investments to address the current workforce shortages. For example, Pamela Cipriano from the International Council of Nurses spoke about the convergence of crises among the nursing workforce, including stress and burnout, the aging of the existing workforce, staff shortages, gender-based mistreatment, and increasing demand for nurses.
A GLOBAL THREATS COUNCIL
Following recommendations from the Independent Panel for Pandemic Preparedness and Response (IPPPR), countries are considering the creation of a Global Health Threats Council as an independent body that can monitor and coordinate between the UN, WHO, financial institutions, and other high-level stakeholders.
The IPPPR suggested creating the Council through a Resolution passed by the UN General Assembly.
Several stakeholders at the hearings expressed support for the idea of a multilateral accountability mechanism for pandemics.
Member states and civil society groups lamented the lack of accountability between countries that led to inequities in the COVID-19 response, including the hoarding of vaccines by high-income nations and the lack of mechanisms to expand vaccine manufacturing capacities in low-and-middle-income countries through technology transfer agreements.
Nina Schwalbe from the UN University International Institute of Global Health said:
“As has been evidenced by other sectors– including human rights, chemical weapons, climate, and atomic energy. Signing a treaty is not enough. Compliance requires independent monitoring, reporting to the highest level of government. A high-level political council made up of heads of States and their representatives can drive cross-national, multi-sectoral accountability and monitor Member States’ compliance with the Pandemic Accord.
Speakers emphasized the need for actionable change. The Africa Vaccine Alliance’s Ayoade Olatunbosun-Alakija said:
“Until there is a universal political acknowledgment of the need to address a confluence of multiple and reinforcing crises in a holistic and comprehensive manner, there will continue to be substantive health and climate threats which result in risks to everything, from our lives to our livelihoods, to our financial, political and economic systems.”
FINANCING ARRANGEMENTS
Several panelists criticized the absence of financial institutions from the discussion as a major oversight, especially during the second part of the hearing, which focused on financing for PPPR.
Shortcomings in financing and governance were ultimately what led to inequitable vaccine distribution and the failure of the COVAX facility, they said. The lack of transparent and equitable systems for financing medical countermeasures allowed for intellectual property policies to undermine public health needs in favor of the profits of private institutions in high-income countries, speakers said at the hearing.
INTELLECTUAL PROPERTY AND BENEFITS-SHARING
Experts from the Global South called on the global health community to assist countries in achieving technical capacities for domestic manufacturing.
According to Carlos María Correa, Executive Director of the South Centre, an intergovernmental organization representing 55 developing countries, improving these capacities will include better information transfer for research and technology; a benefit-sharing system for genetic information; a medical countermeasure distribution mechanism; and financial support.
Correa said:
“…First of all, there was, even on the part of the UNGA, solemn statements issued about cooperation and solidarity at the most serious ebb of the pandemic. However, none of that guaranteed equity.
Developing countries lost lives that could have been saved. Developing countries lost years in terms of the gains they have made to reduce poverty and in terms of achieving the SDGs.
The primary manifestation of inequality was the inequitable distribution of vaccines. The COVAX mechanism rather failed. It failed to achieve an equitable distribution of vaccines, not only due to financial reasons, but it failed also because the governance of the system was not multilateral in nature. For example, the recommendations issued by the WHO were not followed when it came to the equitable distribution of vaccines.
This lack of equity was also seen in the rigidity of the intellectual property system, in the refusal of businesses to share their technologies. The pandemic response seems to have been undermined more as a result of private greed, than [failing to meet] public health needs. Policies enacted by some countries also served to ensure the failure of that system, because they wanted to hoard vaccines above and beyond their needs. It seems that the life and health of a person in a rich country is valued more than that of a person in a poor country.
…We need to establish a new mechanism for the equitable distribution of vaccines. We can't simply touch up the COVAX mechanism. We need a mechanism that has a solid multilateral governance basis. We need a mechanism to share clinical information, the results of research and technologies, so that we can ensure the approval of new products and expand the supply of vaccines in an expeditious manner.
Certainly, we need to have a benefit sharing system, that is, for the sharing of benefits from genetic information and the sharing of information on pathogens, and that needs to be in line with international biodiversity systems and benefit sharing. We also need to ensure equity when it comes to financial capacities to ensure all countries can afford technological capacities. These capacities today are unequal as a result of unequal financial distribution, and the focus of any future work needs to be about achieving better balance in terms of financial capacities, technical capacities, so that we can address future pandemics.”
PRIVATE SECTOR
The need for better PPPR financing will require engagement with organizations in the finance and the private sector, some stakeholders suggested.
The Private Sector Roundtable on Global Health Security and several others called on Member States to create more formal pathways to connect with the private sector.
Ricardo Baptista Leite criticized the World Economic Forum’s report that placed health emergencies towards the bottom of their list of global risks.
The moderators encouraged other stakeholders to submit their statements online. In addition to the verbal testimonies at the hearing, these statements will also be read and incorporated into the political statement.
IPPPR EXPERTS SUGGEST TEXT FOR UN POLITICAL DECLARATION
Experts affiliated with the IPPPR have suggested text for the political declaration for the consideration of member states.
The text seen by Geneva Health Files, contains specific commitments for PPPR reform:
“1. Support for strengthened international rules to deal with pandemics (with reference to ongoing negotiations in Geneva toward a new Pandemic Agreement and revised International Health Regulations)
2. Support for a future platform/ecosystem for equitable access to medical countermeasures
3. A commitment to financing both preparedness and response to pandemic threats
4. An independent, well-functioning and authoritative WHO
5. Establishment of a Global Pandemic Threats Council to sustain political momentum
6. Requesting regular reporting from the Secretary General and the WHO Director General on the implementation of the declaration”
Co-facilitators of the hearings told attendees that their comments would be included in the draft of the political statement from the UNGA. Stakeholders suggested universal health coverage and concurrent crises to be reflected in the declaration.
Omar Hilale, Permanent Representative of Morocco and co-facilitator of the PPPR process, said: “We aim for the political declaration to be negotiated by Member States to achieve consensus, as stipulated in the Modalities Resolution. We strive for it to be concise and action-oriented with solid objectives to lend the highest level of political support to PPPR and also to the negotiations in Geneva for the INB.”
At the hearing, countries such as South Africa called for a solutions-based declaration including equity provisions & commitment to mobilizing international finance. Similarly, Tanzania called for Global South leadership to ensure equity in the declaration, and for the recognition of the key role of communities, and for strengthening community health systems.
GENEVA VS NEW YORK
The tension between how these discussions interplay between New York and Geneva was obvious in the statement made by WHO DG Tedros Adhanom Ghebreyesus, at the opening of these hearings:
Your Excellency Csaba Kőrösi, President of the General Assembly. Your Excellency Ambassador Omar Hilale, permanent representative of Morocco. Your Excellency Ambassador Gilad Erdan, permanent representative of Israel. Excellencies, dear colleagues and friends.
Good morning, and I apologize that I cannot be with you in person. I have the honor to make these remarks on behalf of Secretary General António Guterres and on my own behalf. I thank your Excellency, the President of the General Assembly. as well as Israel and Morocco for Hosting this important discussion, as we prepare for the high-level meeting on pandemic preparedness and response.
As you know, on Friday I declared an End to COVID-19 as a public health emergency of international concern. Over the past 3 years, COVID-19 has caused us all great suffering and taught us many painful lessons. We owe it to those we have lost to learn those lessons and to transform that suffering into meaningful and lasting change. COVID-19 may be over as a global health emergency, but the threat of another pathogen emerging with even deadlier potential remains.
And pandemics are far from the only threat we face. In a world of overlapping and converging crises, an effective architecture for health, emergency preparedness and response must address emergencies of all kinds.
Based on an analysis of the multiple reviews of the global response to COVID-19 and more than 300 recommendations, WHO has proposed to our Member States a framework for action for stronger governments, stronger financing, stronger systems and tools, and a stronger WHO at the center of the global health architecture.
Already WHO, our Member States and our partners are taking several of these actions forward. To enhance financing, a new Pandemic Fund has been established at the World Bank with technical leadership from WHO. The initial call for proposals has generated high interest from Member States
To enhance accountability, Member States are piloting the Universal Health and Preparedness Review, a new peer-review mechanism. To enhance monitoring, WHO and the World Bank established the Global Preparedness Monitoring Board.
To enhance systems and tools, we are working on various initiatives across 5 core areas: collaborative surveillance. community protection, safe and scalable clinical care, access to counter measures, and emergency coordination
To enhance governance, Member States are negotiating amendments to the International Health regulations to make them fit for purpose.
And to enhance international cooperation, Member States are negotiating a new Pandemic Accord, a generational commitment that we will not go back to the old cycle of panic and neglect that left our world vulnerable, but move forward with a shared commitment to meet shared threats with a shared response.
WHO also supports the proposal for a Health Threats Council as a forum for high-level political leadership. It's essential that such a council is grounded in the WHO’s constitutional mandate and complements and strengthens existing government structures, including the world, held Assembly and the Standing Committee on Health Emergency Prevention, Preparedness and Response, which WHO’s Executive Board established last year.
On one hand, we face the risk of failing to learn the lessons of the pandemic and perpetuating the cycle of panic and neglect. On the other, we face the risk of establishing multiple disconnected initiatives that drive further fragmentation.
As we recover from the collective trauma of COVID-19, we must work together to build a new future that's equitable, inclusive, and coherent. The year’s high-level meeting is a valuable opportunity for leaders to charge a clear path forward towards the future and a safer world.
I would like to take this opportunity to thank former President Ellen Sirleaf and former Prime Minister Helen Clark, the co-chairs of IPPPR, and all the panel members for their valuable contributions.
Thank you, and I look forward to seeing you all in New York in September.
CIVIL SOCIETY DISCONTENT:
Also see: Health Policy Watch - UN Multi-stakeholder Meetings Marred by Complaints About Lack of Consultation
Global health is everybody’s business. Help us probe the dynamics where science and politics interface with interests. Support investigative global health journalism.
Is this a battle of Oligarchs fighting over the spoils of Pandemic Plunder?
The only pandemic was that corporative/globalist interests, including Big Pharma and genocidal psychopaths whose names are known to us all, joining hands to create false pandemics for the purpose of 1, enriching their wallets, and 2, culling the “useless eaters“ from the world population. And that means more than 90% of those the WHO and WEF deem as excess baggage on this planet! They must feel that they can only handle a limited number of powerless serfs over which they can lord absolute control.