- When this blogpost went to print, it is understood that member states had arrived at a “final text”. However, over the next few hours, it will become evident whether the text will have reached consensus. By 9 p.m. today, May 13th, the silence procedure comes to close.
- Disagreements on the references to the Doha Declaration and TRIPS flexibilities continued between countries, among other issues of divergences.
- Geneva Health Files reviewed and analysed the draft of the COVID-19 Response resolution dated May 12. What follows here is based on this version (May 12, 2020). Although a final text is ready, this analysis has been posted here to see the evolution of the text of the draft resolution.
- Co-sponsors of resolution are Albania, Australia, EU and its Member States, Monaco, Montenegro, New Zealand, North Macedonia, San Marino, UK, Zambia
- On behalf of the Africa Group, a letter dated 12th May was sent by the Republic of Cameroon, to the United nations office, the WTO, and other international organizations in Geneva. The letter states that the resolution must consider the following thematic areas – reaffirming their confidence in WHO and its leadership; underscoring the need for the full utilization of the flexibilities within the TRIPS agreement and Doha Declaration; consideration of debt relief in the context of COVID-19; supporting the calls for evaluation of pandemic response; the continuation of essential health services. Geneva Health Files has seen this letter.
As before, text in blue is based on Chair proposal from May 4th, and in red, my analyses based on the May 12th version of the document reviewed. (There was consensus on some of the paragraphs, indicated here as “agreed text.”) As before, have not quoted text verbatim)
KEY CHANGES: A systematic pushback against language around voluntary pooling of patents; against references to flexibilities in the TRIPS Agreement and the Doha Declaration.
Chair proposal for a CONSOLIDATED draft on a WHA73: “Covid-19 Response”
WHA73, 18 May 2020, Agenda item XX
Based on draft Resolution Text of 4 May at 12.00 as amended
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;
Following previous suggestion, the word negative has been included here. Consensus had been reached on this paragraph (hereafter referred as “agreed text”).
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;
The following previous suggestion does not seem to feature here – “provision of equitable and affordable access to health services and health products to all, in order to ensure the effectiveness and legitimacy of the response to the pandemic”. Also no suggested references to “human rights and the right to health”. (Agreed text)
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;
ICRC resolution, previously suggested does not seem to feature here – “the International Conference of the Red Cross and the Red Crescent resolution 33IC/19/R3 entitled “Time to act: tackling epidemics and pandemics together”
A new para PP3bis is included: “Recalling the United Nations General Assembly resolutions A/RES/74/270 on “Global solidarity to fight the coronavirus disease 2019 (COVID-19)” and A/RES/74/274 on “International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19” (Agreed text)
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;
Dropped “crucial” role/leadership wrt WHO. (Agreed text)
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.
A previous suggestion to this para, remains to be agreed upon– “Recognizing the need for all countries to have unhindered timely access to quality, safe, efficacious and affordable diagnostics, therapeutics, medicines and vaccines, and essential health technologies, for the COVID-19 response”
The suggestion to characterize the “disproportionate impact ” on the poor has been accepted.
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;
New suggestion to refer to protection of hospitals and medical facilities.
Continues to be suggested: [Underscoring that respect for international law, including international humanitarian law, is essential to contain and mitigate outbreaks of COVID-19 in armed conflicts]
Suggestion to refer to resolution 46/182 of 19 December 1991 on the strengthening of the coordination of emergency humanitarian assistance of the United Nations and all subsequent General Assembly resolutions on the subject, including resolution 74/118 of 16 Dec 2019]
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;
Reference to the constitution of WHO, unlike before. (Agreed text)
PP9 Recognising the negative impacts of the COVID-19 pandemic on social wellbeing, including poverty and homelessness; increased violence against women, children, and frontline health workers, and disruptions in care of older persons;
Dropped previous suggestion to include “unemployment” here. (Agreed text)
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;
Most of the suggestions on ”women representing the majority of the health workforce” and gender-responsive and disability-sensitive measures – have been accepted.
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;
Not accepted – suggestion to include environment and climate change.
Accepted previous suggestion- to replace “response” with “the unintended consequences of public health measures”
Not accepted – An additional suggested para on “Recognizing the need for continued and concerted efforts to implement the SDGs, in particular SDG 3.8, underlining the need to strengthen PHC in the most inclusive, effective and efficient way.
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;
Coordination with “civil society” added here. (Agreed text)
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;
Previous discussions on this showed suggestions to include improve “equitable” and “unconditional” access to necessary commodities and their distribution. These suggestions do not reflect in the agreed text. No references to ACT Accelerator and EU’s pledging campaign here.
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;
Agreed text does not describe WHO’s leadership as “crucial”, as suggested earlier. Suggestion to recognize the central role of member states in the response to the pandemic, has been accepted. (Agreed text)
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;
No Major changes. (Agreed text)
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;
The suggestion for the word “unconditional” access has been dropped.
“Using fully the provisions of international treaties” has transformed to be articulated as “…. consistent with the provisions of relevant international treaties including the provisions and flexibilities of the TRIPS agreement and the Doha Declaration on TRIPS Agreement and Public Health.”
New additions: OP4.addition [Urges all parties to remove any unilateral measure that impedes the global solidarity in response to the C19 pandemic]
OP4.bis Reiterates the importance of urgently meeting the needs of low- and middle-income countries in order to fill the gaps to overcome the pandemic through timely and adequate development and humanitarian assistance;
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;
New articulation: “Recognizes the role of extensive immunization against Covid-19 as a global public good” (not the vaccine itself!)
Third World Network has deciphered this politics of language to unravel deeper commercial considerations. Read their story here. I quote relevant section below.
WHO: Chair’s COVID-19 text builds on “Business as Usual” approaches, sidelining Member States – TWN
Global Public Goods for Health
The original EU resolution included an operational paragraph which recognized “immunization” as a “global public good for health”. It “Recognizes population-wide immunization against COVID-19 as a global public good for health and the crucial role of quality, safe, and efficacious vaccines therein”. The Chair’s text of 4 May also recognized “population-wide vaccination” 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”.
However, the notion of “global public good” has been opposed by several countries, especially the United States and Switzerland. An argument put forward was that it is an “academic” term and the implications of the use are uncertain, sources say.
Many other countries supported its inclusion, for instance Algeria has argued that without its inclusion, the fundamental goal of the entire resolution would be deleted, sources say.
According to diplomatic sources, the Chair clarified that it recognized that “population-wide vaccination” was a global public good for health but the vaccine itself was not.
In the latest Chair’s proposal, reference to “global public good” is proposed to be replaced with text that recognizes the benefit of population-wide vaccination/immunization.
This shift is in line with the explanation of the Chair that the vaccine itself was not a global public good for health, meaning the production and distribution of future COVID-19 vaccines would be governed by the rules of intellectual property and commercial interest.
OP6 CALLS ON MEMBER STATES1, IN THE CONTEXT OF THE COVID-19 PANDEMIC, TO:
1 And regional economic integration organisations as appropriate
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;
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;
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.
OP6.4 Ensure access to clean water, hygiene and sanitation, and appropriate nutrition, in particular for children and infants
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;
New additional text: “Recognizing in this regard, increased domestic financing and development assistance where needed in the context of achieving UHC;
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;
Prior suggestions do not feature in this version: references to respecting freedom of expression and “in accordance with national laws” and international legal obligations.
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;
“Strengthen surveillance” – changed to “provide access to safe testing, treatment and palliative care for COVID-19…” (Agreed text)
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;
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;
OP6.10 Provide WHO in a timely manner with information related to the COVID-19 pandemic as required by 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;
Previously “voluntary” sharing of information, has evolved to “Share, in a spirit of solidarity and a united response…” as per one suggestion.. No agreement yet on this
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;
It appears for the moment, the Chair’s proposal continues to prevail. But since this was not agreed text, subject to change. See discussion in previous iteration.
TWN had said in its editorial, cited above- “While the text asks Member States to collaborate to promote private and government funded R&D including open innovation, similar corresponding language on “open innovation” is absent from the part concerning commitments of the non-state actors including the private sector.“
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;
(Agreed text) Dropped “rational” use
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;
(Agreed text). “Women’s participation” plugged in.
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;
New version reads like this:
OP7.2: Work collaboratively at all levels to develop, test, and scale-up production of safe, effective, quality, affordable diagnostics, therapeutics, medicines and vaccines for the COVID-19 response, including, existing mechanisms for voluntary pooling of patents and for licensing to facilitate timely, equitable and affordable access to them, consistent with the provisions of relevant international treaties including the provisions and flexibilities of the TRIPS agreement and the Doha Declaration on TRIPS Agreement and Public Health;
Discussions reveal stronger push for voluntary use by rights holders of existing mechanisms for licensing intellectual property. Suggestions against including references to voluntary pooling of patents and against references to flexibilities of the TRIPS agreement and the Doha Declaration on TRIPS Agreement and Public Health
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;
No change since previous iteration
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;
Suggested to change “working with other international partners” instead of “other multilateral organizations”. Stronger language asking the DG to work in “in full cooperation and coordination with concerned governments” – not yet incorporated.
Additional suggested para OP8.1bis has become agreed text. Continue to build and strengthen the capacities of WHO at all levels to fully and effectively perform the functions entrusted to it under the IHR ;
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;
No change from previous iteration.
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;
New version reflects previously made suggestions including”:
…to identify the zoonotic source of the virus … including through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events as well as to provide guidance on how to prevent SARS-COV2 infection in animals and humans and prevent the establishment of new zoonotic reservoirs….”,
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;
“Voluntary pooling of patents” dropped in the new version
“For the consideration of the Governing Bodies” added in the new version
I quote TWN analyses, (cited above) on this para:
In this text, in identifying options for scaling up development, manufacturing and distribution capacities, the WHO Secretariat is only required to undertake “consultation” with Member States. This means active engagement or negotiation among Member States is not required and neither do the views of Member States need to be adequately reflected in the plan that is to be developed by the Secretariat.
Often “consultations” result in outcomes that favor the interest of powerful developed nations for they are more able to influence the formulation of the plan through the Secretariat, while developing countries will have a more limited role. Worryingly, beyond consultation, according to the Chair’s proposal, the Secretariat does not even need to submit the plan for approval by WHO’s governing bodies. Hence, WHO Member States will not have any effective oversight over the Secretariat’s plans for scaling up production and timely access.
The proposed text also only requires the Secretariat to obtain inputs from relevant international organizations and the private sector. In doing so, it ignores the role of civil society and other non-state actors such as Médecins Sans Frontières (MSF), the Drugs for Neglected Diseases initiative (DNDI) and many other civil society organizations.
In addition, the Chair’s text requires that the WHO Secretariat to take into account the “existing mechanisms, tools, and initiatives such as the Access to COVID-19 Tools (ACT) accelerator and relevant pledging appeals, such as “The Coronavirus Global Response” pledging campaign” when identifying and providing options for scaling up of production and timely access.
Hence, the Chair’s text is attempting to legitimize the ACT-Accelerator, which was neither established by WHO Member states, nor is it accountable to the Member States.
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 mechanisms2, 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;
2 Including an IHR Review Committee, the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme and the Global Preparedness Monitoring Board
“As soon as possible” modified to “at the earliest appropriate moment”
OP8.10 Report to the 74th World Health Assembly, through the Executive Board, on the implementation of this resolution.
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