This blog post tries to analyse some of the latest consultations (May 6th version) on EU’s proposal on Covid-19 Response that will be taken up at the World Health Assembly this month. Many thanks to my credible sources who provided information and perspective on some of these on-going negotiations.
What the latest negotiations dwell on: Discussion on global public goods, open innovation, the push for a population-wide vaccine, a reference to the EU pledging campaign among others.
Yesterday, Reuters brought attention to EU’s intentions on calling for a review on the international response to the pandemic including on the role of WHO – as a part of the draft resolution now being discussed by member-states. Geneva Health Files had discussed the April 26th version of the draft resolution text in detail here (See OP5.18)
Soon after, Health Policy Watch published the 4th May version of the Chair’s proposal on the same. The text of this May 4th version cited is here follows in blue. And the information received on the basis of a new version dated May 6th, follows in red.
The document is titled “Chair proposal for a CONSOLIDATED zero draft on a WHA73: “Covid-19 Response” WHA73, 18 May 2020, Agenda item XX Draft Resolution Text of 4 May at 12.00″ And co-sponsors include Argentina, EU and its Member States, Monaco, North Macedonia, San Marino, Zambia. The analyses here is based on a version dated May 6, 2020 and in addition, it also reflects conversations with sources.
In order to preserve the sanctity of the negotiations and not impede the multilateral process, by revealing positions of all countries, the document is not being shared here. I am also unable to quote and cite verbatim directly from the document, in order to respect the on-going consultations between member-states.
There has been no change in preambular paras between the May 4th and May 6th version – published here in full as is:
The Seventy-third World Health Assembly,
Having considered the address of the Director General on the current COVID-19 pandemic (Doc WHA73/X),
PP1 Deeply concerned by the morbidity and mortality caused by COVID-19 pandemic, the impacts on physical and mental health and wellbeing, the impacts on economy and society, and the consequent exacerbation of inequalities within and between countries;
PP2 Expressing solidarity to all countries affected by the pandemic, as well as its condolences and sympathy to all the families of the victims of COVID-19;
PP3 Recalling the declaration of a Public Health Emergency of International Concern on novel Coronavirus (2019-nCoV0) issued on 30 January 2020 by the Director General; and the further recommendations of the International Health Regulations (2005, IHR) Emergency Committee;
PP4 Recognizing the leadership of the World Health Organization within the broader UN response and the importance of strengthened multilateral cooperation in addressing the COVID-19 pandemic and its extensive impacts;
PP5 Recognizing that COVID-19 pandemic affects the poor and most vulnerable people and that its impact will have repercussions on health and development gains, hampering progress towards Universal Coverage and on the achievement of the Sustainable Development Goals.
PP6 Noting the needs of low- and middle-income countries as well as those in conflict, post-conflict, or humanitarian situations for development assistance and humanitarian support;
PP7 Noting the need for safe, rapid, and unimpeded movement of humanitarian personal, in particular health workers, including their equipment and medicines necessary to fulfil their duties;
PP8 Reaffirming that the enjoyment of the highest attainable standard of physical and mental health and social wellbeing is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition and the need to respect all human rights and fundamental freedoms in the COVID-19 response;
PP9 Recognising the negative impacts of the COVID-19 pandemic on social wellbeing, including poverty and homelessness; increased violence against women, children, andfrontline health workers, and disruptions in care of older persons;
PP10 Underlining the primary responsibility of governments to adopt and implement responses to the COVID-19 pandemic that are specific to their national context as well as for mobilizing the necessary resources to so.
PP11; Emphasising the need to protect populations, in particular people with pre-existing health conditions, older persons, other people at risk of COVID-19, health professionals and other frontline workers, as well as vulnerable groups and people in vulnerable situations, and stressing the importance of gender-responsive measures;
PP12 Noting resolution EB146.R.10 entitled “Strengthening Preparedness for Health Emergencies; Implementation of International Health Regulations (IHR, 2005)” and reiterating the obligation for all Parties to fully implement and comply with the IHR;
PP13 Recognizing the importance of planning and preparing for the recovery phase, including to mitigate the impact of the pandemic and of the response on society, public health, human rights and the economy;
PP14 Recognising further the many unforeseen public health impacts, challenges and resource needs generated by the ongoing COVID-19 pandemic and the potential re-emergences, as well as the multitude and complexity of necessary immediate and long-term actions, coordination and collaboration required at all levels of governance across organisations and sectors, including the private sector, required to have an efficient and coordinated public health response to the pandemic, leaving no-one behind;
Changes to the operative paras:
OP1 Calls for intensified international cooperation and solidarity to collectively contain, mitigate and defeat the COVID-19 pandemic, including coordinated mobilisation and use of financial resources and joint efforts to improve access to necessary commodities and their distribution, such as the Access to COVID-19 Tools (ACT) accelerator; [Version May 4, 2020]
[The following is based on a version dated May 6,2020]
In the newer version, suggested changes include “international support and local cooperation, collaboration at all levels”..to contain and mitigate the pandemic, including equitable and timely coordination, relating to all resources including relevant medical and health products, services and technologies.
Some countries have called for efforts to improve “equitable” and “unconditional” access to necessary commodities and their distribution. A few countries did not want a mention of the Access to COVID-19 Tools (ACT) accelerator in this paragraph.
Some what unsurprisingly, the COVID-19 pledging campaign has been “welcomed”. Another suggestion includes reference to both the Access to COVID-19 Tools (ACT) accelerator and The Coronavirus Global Response pledging campaign, “to collectively contain, mitigate and defeat the COVID-19 pandemic, including coordinated mobilisation, distribution and use of financial resources”
OP2 Acknowledges the leadership by the World Health Organization and the fundamental role of the United Nations system in the comprehensive global response to the COVID-19 pandemic, and the efforts of countries in protecting their populations; [Version May 4, 2020]
[The following is based on a version dated May 6,2020]
The changes here suggest describing UN’s role as both catalysing and coordinating the global response to the pandemic. And also referring to the role of countries in protecting their populations. One country referred to WHO’s role as “crucial”.
OP3 Expresses its highest appreciation of the dedication, efforts, above and beyond the call of duty, of health professionals, other frontline and public workers, including WHO staff, in responding to COVID-19 pandemic; [Version May 4, 2020]
New suggested changes include appreciation and support for scientists, researchers, WHO leadership and staff.
In addition, a suggestion to register the major impediments in implementing national plans to fight the pandemic as a result of “unilateral coercive measures and sanctions”
OP4 Calls for equitable access to and fair distribution to all countries including through using fully the provisions of international treaties, of personal protective equipment and the quality, safe, efficacious and affordable medical technologies, commodities and materials required in the response to the COVID-19 pandemic, in particular quality, safe, efficacious and affordable medicines and vaccines, and the urgent removal of obstacles thereto;
OP4Alt Calls for equitable access to and fair distribution to all countries, including through using fully the provisions of international treaties of personal protective equipment and the quality, safe, efficacious and affordable medical supplies, devices and other technologies, commodities and materials, including diagnostics and other laboratory materials, required in the response to the COVID-19 pandemic, and in particular of quality, safe, efficacious and affordable medicines and vaccines, and the urgent removal of obstacles thereto; [Version May 4, 2020]
Countries have suggested unconditional, fair, transparent, efficient and timely access to fair distribution as a global priority, in addition to a reference to LMICs.
There is also reference to using fully/ the urgent removal of obstacles thereto consistent with] [the provisions of [relevant] international treaties, [including flexibilities under those treaties] of personal protective equipment and the quality, safe, efficacious and affordable health products and technologies. There are a number of suggestions on what kinds of categories should reflect here – medical technologies, commodities , materials, services – required in the response to the COVID-19 pandemic, in particular quality, safe, efficacious and affordable [medicines and vaccines,] / [diagnostics, therapeutics and vaccines].
Additional suggestions include references to prevent stockpiling and speculation; and the urgent lifting of Unilateral Coercive Measures (UCM)
This is an addition in the latest version: OP4bis. [Acknowledges the urgent needs of low- and middle-income countries and those in conflict, post-conflict, or humanitarian situations for development assistance as well as humanitarian and other support in order to fill the gaps to fight the epidemic, including ensuring fair distribution and equitable access to health products and health technologies and address the negative consequences of the C19 pandemic;]
OP5 Recognises population-wide vaccination against COVID-19 as a global public good for health, which is necessary to prevent, contain, and stop transmission in order to bring the pandemic to an end, once safe, quality, efficacious and affordable vaccines are available; [Version May 4, 2020]
It seems that there is some discussion and disagreement on whether “global public goods for health” should be referenced in the text. Some countries argue that global public goods have not been defined in a way that shows a shared understanding of the term. As a result countries with differing positions on IP rights have found themselves on the same side as it were. (When this story went to print, this “anomaly” was being looked into, sources said)
There is also a definitive push for the role of vaccines and immunization to contain the pandemic. It is understood that having a population-wide vaccine would amount to a Global Public Good, that will also drive home the message on the importance of a vaccine – this was pointed out during the discussions on this paragraph. Countries wanted to include the word “benefit” to underscore the importance of a vaccine.
In addition, the UNSG had referred to a global public good in the context of the pandemic, it was pointed out.
One country was of the view that vaccination is a process, not a good. Another, felt strongly that not referring to Global Public Good, will fundamentally weaken the resolution.
OP6 CALLS ON MEMBER STATES1, IN THE CONTEXT OF THE COVID-19 PANDEMIC, TO: [Version May 4, 2020]
OP6. [bis][Reiterates the call by the United Nations Secretary-General and the High Commissioner of the United Nations Human Rights Office for Human Rights for an end to unilateral sanctions which are impeding international collaborative efforts to curb the viral spread and to treat the patients in the targeted countries];
OP6.1 Protect their populations through a whole-of-government and whole-of-society response, including through implementing a national cross-sectoral action plan that outlines both immediate and long-term actions with a view to permanently strengthening health systems, capacities and resilience, taking into account WHO guidance, engaging with communities and collaborating with civil society and private sector; [Version May 4, 2020]
Some countries fighting shy on making stronger commitments on strengthening health systems, or explicitly engaging with communities, civil society and the private sector, instead naming them as “relevant stakeholders”. One country pushed for surveillance on account of greater preparedness and response capacities.
OP6.2 Put in place comprehensive, proportionate, gender-responsive and context-specific measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization; [Version May 4, 2020]
Suggestions to other measures include considerations of timebound, age and disability sensitive measures.
OP6.3 Ensure that restrictions on the movement of persons and of medical equipment and medicines in the context of Covid-19 includes exceptions for the movement of humanitarian and health workers to fulfil their duties and for the transfer of equipment and medicines required by humanitarian organizations for their operations. [Version May 4, 2020]
Suggestions to refer to “compliance with national legislation” to regulate movement. and to make “exemptions” for the same.
OP6.3 alt Facilitates the movements of humanitarian and health workers and the transfer of equipment and medicines required by humanitarian organizations for their operations in the context of the COVID-19 pandemic
OP6.4 Ensure access to clean water, hygiene and sanitation, and appropriate nutrition, in particular for children and infants [Version May 4, 2020]
New specific reference to the the promotion of hand washing with soap and WASH in health care facilities
OP6.5 Ensure uninterrupted delivery of essential public health functions, in particular immunisation against vaccine-preventable diseases, and continue meeting the other health needs of the population, including for non-communicable disease prevention and control, mental health, child health and sexual and reproductive health; [Version May 4, 2020]
Changes include public health “services” with a push for immunization, with some countries wishing to not include sexual and reproductive health here. Also a reference to UHC, “recognizing the importance of increased domestic financing and development assistance where needed”; and a request to include nutrition and child services.
OP6.6 Provide the population with reliable and comprehensive information on COVID-19 and the measures taken by authorities in response, and take measures to counter misinformation and disinformation, and as well as cyber-attacks; [Version May 4, 2020]
OP6.6 Provide the population with reliable and comprehensive information on COVID-19 and the measures taken by authorities in response, and take measures to counter misinformation and disinformation, and as well as cyber-attacks; no comments from the floor [Version May 6, 2020]
OP6.7 Strengthen surveillance of and provide testing and treatment for COVID-19, paying particular attention to those with pre-existing health conditions, older persons and other people at risk, in particular health professionals and other frontline workers; [Version May 4, 2020]
Changes to note inclusion of persons with disabilities, migrants irrespective of migratory status
OP6.8 Provide health professionals and other frontline workers exposed to COVID-19 access to necessary commodities and training, ensure their adequate protection at work and outside, remove obstacles in their access to work, safeguard their adequate remuneration, and consider introducing task-sharing to optimize the use of resources; [Version May 4, 2020]
No major changes. (An addition about access to PPE and other necessary commodities)
OP6.9 Develop and deploy digital technologies for the response to COVID-19 and share information on them, paying particular attention to the protection and ethical use of personal data; [Version May 4, 2020]
New inclusions including on purposes for addressing socioeconomic impact of the disease … “paying particular attention to digital inclusion, patient empowerment, data security”. A proposed deletion of “ethical use”.
OP6.10 Provide WHO in a timely manner with information related to the COVID-19 pandemic as required by the IHR; [Version May 4, 2020]
New suggestion ” …and report, when necessary, the difficulties faced and support needed in responding to the potential public health emergency of international concern as required by the [in accordance with Article 6.2 of the IHR”
OP6.11 Share COVID-19 related knowledge, lessons learned, data and materials, as well as commodities needed in the response with WHO and other countries; [Version May 4, 2020]
Suggestion on “voluntary” sharing on information.
OP6.12 Promote both private sector and government-funded research and development across all relevant domains on measures necessary to contain and end the COVID-19 pandemic, in particular on vaccines and therapeutics, and inform WHO on these activities; [Version May 4, 2020]
Discussion around “open innovation” [Secretariat requested to provide information on open innovation.]
OP6.13 Optimize prudent and rational use of antimicrobials in the treatment of COVID-19 and secondary infections in order to prevent the development of antimicrobial resistance; [Version May 4, 2020]
Suggestion to drop “rational”
OP6.14 Strengthen actions to include, engage and involve women in all stages of decision-making processes, and mainstream a gender perspective in the COVID-19 response and recovery; [Version May 4, 2020]
Changes suggested include “women’s participation” (Sounds like a weakening of the language)
ADDITIONAL PARA: Calls for ensuring sustainable, flexible unearmarked funding for WHO. “retain reflection of two ideas of WHO being adequately financed and Member State assessed contribution obligations ..” Discussions around “flexible” funding vs “non-earmarked funding”.
The following section in the May 6th continues to be consistent with the May 4th version when this story went to print.
OP7 CALLS ON INTERNATIONAL ORGANISATIONS AND OTHER RELEVANT STAKEHOLDERS INCLUDING CIVIL SOCIETY AND THE PRIVATE SECTOR TO:
OP7.1 Support all countries, upon request, in the implementation of their multisectoral national action plans and in strengthening their health systems to aid and respond to COVID-19, and in maintaining the provision of all other essential public health functions;
OP7.2 Work collaboratively at all levels to develop, test, and scale-up production of safe, effective, quality diagnostics, medicines and vaccines for the COVID-19 response, including through existing mechanisms for voluntarily pooling of patents and licensing of medicines and vaccines, to facilitate equitable and affordable access to them;
OP7.3 Address the proliferation of disinformation and misinformation, as well as malicious cyber-activities, that undermine the public health response, especially in the digital sphere, and support the provision of clear, objective and science-based data and information to the public;
OP8 REQUESTS the DG to:
OP8.1 Continue to work with the United Nations Secretary-General and other major multilateral organizations including the signatory agencies of the Global Action Plan for Healthy Lives and Well-Being on a comprehensive and coordinated response across the UN system supporting Member States in their responses to the COVID-19 pandemic, demonstrating leadership on health in the UN system for the overall health response, and act as the health cluster lead in the UN humanitarian response;
OP 8.2 Assist and call upon all Member States to take the actions according to the provisions of the IHR, including by providing all necessary support to countries for building, strengthening and maintaining their capacities to fully comply with the IHR;
OP8.3 Provide assistance to countries on request to support the continued effective functioning of their health systems in the response to the COVID-19 pandemic and in the undisrupted provision of essential public health functions in particular for immunisation against communicable diseases, and continued meeting of the other health needs of the population, including for communicable and non-communicable diseases, mental health, child health, and sexual and reproductive health;
OP8.4 Assist countries in developing, implementing and adapting relevant national response plans to COVID-19, by developing, disseminating and updating normative products and technical guidance, learning tools, data and scientific evidence for COVID-19 responses, including to counter misinformation and disinformation, and to work against substandard and falsified medicines and medical products;
OP8.5 Work with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and countries to identify the source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts, collect evidence and provide guidance to reduce the risks of transmission of zoonotic diseases, following a One Health approach;
OP8.6 Regularly inform Member States, including through Governing Bodies, on the results of fundraising efforts, the global implementation of and allocation of financial resources through the WHO Strategic Preparedness and Response Plan (SPRP), including funding gaps and results achieved, in a transparent, accountable and swift manner, in particular on the support given to countries;
OP8.7 Rapidly identify and provide options, in consultation with Member States1, in line with their respective obligations resulting from international treaties and with inputs from relevant international organizations and the private sector, to be used in scaling up development, manufacturing and distribution capacities needed for equitable and timely access to quality, safe, affordable and efficacious diagnostics, therapeutics, and vaccines for the COVID-19 response taking into account the Access to COVID-19 Tools (ACT) accelerator as well as the voluntary pooling of patents;
OP8.8 Ensuring that the Secretariat itself is adequately resourced to support the Member States granting of regulatory approvals for COVID-19 countermeasures;
OP8.9 Initiate, as soon as possible and in consultation with Member States, a process of independent evaluation, including using existing mechanisms[1], to review lessons learnt from the WHO-coordinated international health response to COVID-19, the effectiveness of the mechanisms at WHO’s disposal, the functioning of the IHR, WHO’s contribution to United Nations-wide efforts, and the actions of WHO and their timelines, and make recommendations to improve global pandemic preparedness; including through strengthening WHO’s Health Emergencies Programme;
OP8.10 Report to the 74th World Health Assembly, through the Executive Board, on the implementation of this resolution. [Version May 6, 2020]
[1] Including an IHR Review Committee, the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme and the Global Preparedness Monitoring Board
Please note that OP5 was updated with more information a few hours after this blog was first published.
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