This year’s World Health Assembly (WHA) includes a number of proposals that will impact the governance of pandemic preparedness and response (PPR). Among these are interrelated reforms up for negotiation, including amendments to the International Health Regulations (IHR) and WHO governance and financing.
The United States has already proposed amendments to the IHR, which would grant WHO more authority to act, especially in cases of non-cooperation by countries affected by potential health emergencies.(1)
The WHA will also consider recommendations of two working groups: the Working Group on Pandemic Response on WHO reforms and the Working Group on Sustainable Financing on WHO financing - each with potential ramifications for the PPR ecosystem.
To help follow the WHA discussions about these developments, this document summarizes the key instruments and initiatives shaping the PPR landscape.
Key legal instruments:
The International Health Regulations (2005) are the key instrument governing preparedness and response to public health emergencies. Adopted in 1969 and revised in 2005 following the SARS outbreak, they legally bind 196 countries.(2) They empower WHO with responsibility for global surveillance of health threats and grant the Director-General (DG) the authority to declare a Public Health Emergency of International Concern (PHEIC), which mobilizes resources and mandates a response from countries. The WHA has established IHR Review Committees following the outbreaks of H1N1,(3) Ebola,(4) and COVID-19,(5) the recommendations of which have been reviewed as part of relevant working groups and the WHA.
Another legal international instrument of PPR is currently under development. In December 2021, the WHA established an Intergovernmental Negotiating Body (INB) to develop a new instrument that may be a convention, agreement, treaty, or other instrument.(6) Discussions are still at an early phase, currently limited to the substantive elements of the instrument. The INB aims to finalize a consensus text and report to the WHA by May 2024.
Time-limited reviews:
Several PPR reviews mandated by the WHA made recommendations to member states, including:
The Independent Panel for Pandemic Preparedness and Response (IPPPR) was established in 2020 by the WHA to review the WHO’s role within the PPR landscape after the COVID-19 pandemic.(7) It submitted its report to the WHA in 2021, offering a range of recommendations on the role of WHO, IHR, and the interaction of WHO with other intergovernmental bodies.
The WHA established a Working Group on Strengthening WHO Preparedness and Response (WGPR) in May 2021. The aim was to synthesize the findings of the IPPPR, IHR Review Committee (see above), IOAC, and GPMB (see below) and make recommendations to the WHA on WHO reforms.(8) The working group will submit its final report ahead of the WHA.
Continuous reviews:
Several longer-term initiatives have been established to monitor PPR.
The Independent Oversight and Advisory Committee (IOAC) was established by the WHO DG in 2016 following the Ebola outbreak.(9) It oversees the WHO Emergencies Programme and guides its activities, advising the DG and reporting to the WHA.
The Global Pandemic Monitoring Board (GPMB) was convened by the WHO and World Bank in 2018 in response to the Ebola outbreak. (10) The GPMB assesses the global preparedness of governments, intergovernmental organizations, the private sector, and civil society broadly and publishes its recommendations annually.
The Universal Health and Preparedness Review (UHPR) was established by WHO as a standing mechanism to assess countries’ preparedness for health threats.(11) Currently as a pilot, UHPR takes a holistic view, incorporating multisectoral assessments, reporting on health system resilience, and aligning gaps with the required support.
Financing initiatives:
Several reviews recommended the establishment of financing mechanisms for PPR.
A Financial Intermediary Fund (FIF) for health security has been proposed to be hosted at the World Bank. The World Bank, WHO, and the G20 have lent their support,(12) and the Governments of the US, Germany, and the EU, and the Wellcome Trust have committed $960 million of funding.(13)
The G20 established the Joint Finance and Health Task Force in 2021 to improve the alignment of health and finance ministries on PPR. It brings together health and finance officials to discuss efforts to expand PPR capacities, especially public and private financing and legal frameworks.(14)
The WHO Executive Board has established a Working Group on Sustainable Financing to recommend financing of WHO.(15) It is informed by the IPPPR, IOAC, and GPMB and expected to report to the WHA in 2022. It has reached a consensus on increasing member states’ Assessed Contributions to 50% of the WHO Programme budget, with steps of increase linked to WHO reforms.
What’s next:
These are the foundations of PPR governance that will be under discussion at the WHA as part of reform proposals. The next steps for the pandemic treaty will be an outline document of substantive elements in June and a working draft for the second INB meeting in mid-July. Other discussions, including on IHR amendments, WHO reform, and financing, will take place in parallel and depend on the decisions reached at the WHA.
References:
1. WHO. Strengthening WHO preparedness for and response to health emergencies - Proposal for amendments to the International Health Regulations (2005). Published April 12, 2022. Accessed April 22, 2022. https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_18-en.pdf
2. WHO. International Health Regulations. Published 2022. https://www.who.int/health-topics/international-health-regulations#tab=tab_1
3. WHO. Role of the IHR in the H1N1 Outbreak and Response. Published 2011. Accessed April 16, 2022. https://www.who.int/teams/ihr/ihr-review-committees/h1n1
4. WHO. Role of the IHR in the Ebola Outbreak and Response. Published 2016. Accessed April 16, 2022. https://www.who.int/teams/ihr/ihr-review-committees/role-ihr-ebola-outbreak
5. WHO. Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 Response. Published 2020. Accessed April 16, 2022. https://www.who.int/teams/ihr/ihr-review-committees/covid-19
6. WHO. Intergovernmental Negotiating Body. Accessed April 16, 2022. https://inb.who.int
7. Independent Panel for Pandemic Preparedness and Response. COVID-19: Make It the Last Pandemic. Independent Panel for Pandemic Preparedness and Response; 2021. https://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf
8. WHO. Working group on strengthening WHO preparedness and response to health emergencies. Published 2022. Accessed April 16, 2022. https://apps.who.int/gb/wgpr/index.html
9. Independent Oversight and Advisory Committee, for the WHO Health Emergencies Programme. Interim Report on WHO’s Response to COVID-19. January-April 2020. The IOAC; 2020.
10. Global Preparedness Monitoring Board. A World at Risk: GPMB 2019 Annual Report. GPMB; 2019. https://www.gpmb.org/annual-reports/overview/item/2019-a-world-at-risk
11. WHO. Universal Health and Preparedness Review (UHPR). Published 2021. Accessed April 16, 2022. https://apps.who.int/gb/COVID-19/pdf_files/2021/25_11/Item2.pdf
12. Bank of Indonesia. Ministers of Finance and Governors of Central Banks of G20 Countries Work Together on Solutions on the Current Global Economic Challenges. Published April 21, 2022. Accessed April 21, 2022. https://www.bi.go.id/en/publikasi/ruang-media/news-release/Pages/sp_2411022.aspx
13. The White House. 2nd Global Covid-19 summit commitments. Published May 12, 2022. https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/12/2nd-global-covid-19-summit-commitments/
14. MEF Italian Government. The G20 established a joint Finance-Health Task Force to strengthen pandemic prevention, preparedness and response. Published October 29, 2021. https://www.mef.gov.it/en/inevidenza/The-G20-established-a-joint-Finance-Health-Task-Force-to-strengthen-pandemic-prevention-preparedness-and-response/
15. WHO. Working Group on Sustainable Financing. Published 2022. Accessed April 16, 2022. https://apps.who.int/gb/wgsf/