PHM-Exch> [PHM NEWS] PHM Comment on the WHO draft resolution on Covid19

[Claudio Schuftan]

As most of you have heard, the World Health Assembly is being held in an
abridged form and on virtual platform on May 18 and 19. The agenda has been
truncated to just one discussion  on COVID 19 Response.

This resolution has seen immense, highly contested discussions and has gone
through many versions. But finally a draft resolution is out and this has
been put up for discussion. The first drafts of this resolution were
essentially a taking forward of corporate interests- but t in much more
sophisticated and flexible way than the US. Despite its outside hostility
to the WHO, the US has been one of the hard bargainers in shaping this
resolution. The final version is better and has responded on some concerns
of member nations,  but not by much.

The WHO watch has this year had a two day workshop organized by Susana and
Gargeya and discussed this draft resolution ( an earlier version) and some
of the PHM concerns on this . The team would be attending the virtual
sessions. Their inputs were useful to develop the WHO tracker page and its
contents.

The WHO Tracker has put up a copy of the WHO draft resolution on COVID 19 ,
other important resolutions and background papers  on this resolution and
on the pandemic from civil society organizations and most important the PHM
COMMENT drafted by David Legge. You can access these in the the WHO Tracker
<https://docs.google.com/document/d/1ihGsUJx1HCgDpDMelopcXMQHIO-o0pmIjNX0U4BE-ic/edit>.
This tracker page is quite a comprehensive introduction to this resolution
and its politics- and we hope you find it useful.

Here is the PHM Comment

PHM Comment

PHM calls upon member states participating in WHA73 to focus on:

   -

   strengthening international arrangements for responding to this and
   future pandemics more generally; and
   -

   strengthening the accountability of nation states in relation to
   preparing for and responding to the pandemic in accordance with public
   health best practice and human rights principles.

Beyond these pandemic priorities there are broader global health
objectives; action on the social determinants of health, action on equity
in health and action towards strengthening health care systems in every
nation to the level required for the progressive realization of the right
to health and healthcare. The pursuit of these objectives is necessary for
global preparedness but global preparedness planning and response must also
work towards these goals.

It is against these expectations that PHM’s comment on this item is
prepared.

There are four strategic objectives to be served by the proposed resolution.

 I.            Request and/or empower the DG to take particular actions in
responding to the pandemic;

 II.            Give direction for further action by the Assembly (in
future deliberations);

 III.            Endorse and give weight to policy directions to be
operationalized in future (by different players, at different levels, and
different institutional settings) and

 IV.            Set out clear principles to guide Member States’ (MS)
responses to COVID (and against which MS ought be held accountable).

PHM structures its comment on the ‘EU resolution’ under these four headings.
I. Request and/or empower the DG

PHM appreciates the several provisions in the draft resolution which
endorse the Secretariat’s role in the COVID response. We appreciate the
acknowledgement of “the key leadership role of the WHO” in OP2.

PHM endorses OP9.6 which calls for WHO to work with other organisations to
“to identify the zoonotic source of the virus and the route of introduction
to the human population, including the possible role of intermediate hosts,
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, as well as to reduce further
risks of emergence and transmission of zoonotic diseases”.

The rise of pandemics from zoonosis is recurring with increasing frequency
and there is also a need to assess not only the immediate outbreak, but
also to explore the role of changing ecological relationships and how these
need to be addressed to reduce the potential for future pandemics. Such a
provision ought be included in the draft resolution.

PHM endorses OP9.10 which calls for the DG to “initiate, at the earliest
appropriate moment, and in consultation with Member States, a stepwise
process of impartial, independent and comprehensive evaluation, including
using existing mechanisms, as appropriate, to review experience gained and
lessons learnt from the WHO-coordinated international health response to
COVID-19”.

The lack of any explicit reference to evaluating MS policies, practices and
experiences in this paragraph is striking. PHM urges an amendment to this
paragraph to make it clear that “experience gained and lessons learnt”
includes country actions and experience and lessons learnt.

PHM suggests including in this paragraph an explicit reference to
strengthening the DG’s emergency advisory powers, short of declaring a
Public Health Emergency of International Concern (PHEIC), and considering
the possibility that the IHR decision instrument
<https://apps.who.int/iris/bitstream/handle/10665/246107/9789241580496-eng.pdf#page=51>
is overly dependent on international transmission. The rules regarding
mechanisms of verification also need to be reviewed so that the DG is able
to be able to exercise due diligence in reporting about the outbreaks in
any one country.

OP9.3 calls upon the DG to ‘assist and call upon’ MS to comply with the
IHRs but no clear authority is given to review MS actions in complying with
WHO temporary recommendations. Likewise there are no provisions in the
draft for mechanisms to review MS actions in complying with information
sharing obligations or complying with human rights principles including
with respect to lockdowns, and the conditions of quarantine and isolation.

MSs need to be accountable for the efforts they make to address the impacts
(of both the virus and the measures put in place) on vulnerable
populations.  However, the draft is silent on the needs of migrants,
refugees and stateless people, and the conditions of work of health workers
and other frontline workers. PHM calls for empowering the DG with the
authority and the finances so that the WHO can, in cooperation with other
concerned UN agencies, launch and sustain interventions of both medical and
humanitarian nature where there are large concentrations of refugees or
stateless, failing to receive the standards of care or protection that is
required, or in low and middle income nations who are unable to cope with
the surge of cases or the humanitarian crisis consequent to the pandemic
and state response.
II. Committing to further action by the Assembly

OP9.9 asks the DG to ensure that the Secretariat is adequately resourced to
support the Member States granting of regulatory approvals for diagnostics,
medicines, and vaccines. It is not clear whether this implies the need for
a redistribution within the Secretariat budget or fund raising specifically
for this purpose. PHM urges that the member states recognise the degree to
which WHO’s funding shortfall and donor dependence limits what WHO can do.
Once again, PHM urges member states to lift the freeze on assessed
contributions and untie donor funding.

PHM appreciates the recognition (in PP13) of 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, and their components as well as equipment for the COVID-19
response”.

PHM also appreciates the request in OP9.8  for the DG “to identify and
provide options … for the consideration of governing bodies” …for  ”
scaling up development, manufacturing and distribution capacities needed
for transparent equitable and timely access to quality, safe, affordable
and efficacious diagnostics, therapeutics, medicines, and vaccines for the
COVID-19 response”. This however is a very timid and cautious commission
(“to identify and prepare options”). PHM calls on member states to request
the DG to redouble his efforts to assist states in securing their
entitlements and rights to safeguard their public health by developing the
capacity they need to use the TRIPS flexibilities, the GSPOA, CBD, The
Nagoya Protocol and other such international agreements so as to attain
adequate access to these products and ensure health security.

PHM urges WHO to establish an open innovation platform for the rapid public
sharing of all research outcomes, problem solving, and closing knowledge
gaps and towards that end secure binding commitments from entities and
individuals engaged in this R&D.

PHM notes the references to the Access to COVID-19 Tools (ACT) accelerator
and pledging appeals, such as “The Coronavirus Global Response”. Ad hoc
‘appeals’ are no substitute for ensuring adequate and flexible funding for
WHO based on mandatory contributions.

PHM urges member states to recognise that both the ACT and the Covid Global
Response Appeal have the effect of marginalising WHO as just one player in
yet another ‘multistakeholder partnership’ rather than affirming and
respecting its preeminent role as, as the directing and coordinating
authority on international health work. There are serious conflicts of
interest in the composition of ACT, which could come in the way of
implementing compulsory licenses or other uses of TRIPs flexibilities and
the development of national self-reliance in essential anti-COVID
technologies.

PHM notes the call in OP8.2 for international organisations and other
relevant stakeholders to “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 technology transfer, voluntary
pooling and licensing of patents to facilitate timely, equitable and
affordable access to them, consistent with the provisions of relevant
international treaties including the provisions of the TRIPS agreement and
the flexibilities as confirmed by the Doha Declaration on the TRIPS
Agreement and Public Health”.

Voluntary pooling and licensing is not enough. As well as ensuring
countries can use to the full the flexibilities available under TRIPS PHM
urges WHO to continue to explore various approaches to delinking the price
of medicines and vaccines from patent derived profits, building on the work
of the Consultative Expert Working Group on Research and Development under
WHO (CEWG) and the High Level Panel on Access to Medicines.
III. Endorse and give weight to policy directions and principles which need
to be operationalized at a later stage (by different players, working at
different levels and in different settings)

PHM appreciates the several expressions of concern in the draft resolution
regarding the impact of the pandemic and the expressions of solidarity. PHM
appreciates the recognition of the disproportionate impact of the pandemic
(including government responses) on vulnerable people, health workers and
other frontline workers (PP12). However, we regret that there are no
references to prisons or refugee camps or to migrant workers left stranded
by the lock-down and the economic crisis.

We appreciate the recognition of the need to protect personnel, facilities
and supply lines in conflict and humanitarian settings (PP14) and the
emphasis on respect for international law as a condition for managing COVID
in conflict settings (PP16). We appreciate also the acknowledgement of the
commitment and sacrifice of health workers, other frontline worker and
staff of the Secretariat (OP3) and the call (in OP5) for timely and
adequate development and humanitarian assistance.

OP8.1 calls on “international organisations and other relevant
stakeholders” to support countries in health system strengthening but makes
no reference to their assisting in establishing IHR core capacities. IHR
core capacities are intrinsically tied to health system strengthening and
should be explicitly recognized as global public health goods with an
accompanying obligation for international funding.

PHM appreciates the recognition of immunization as a global public health
good (in OP6) but condemns the exclusion of vaccines from this status
(effectively affirming market-based production and distribution with the
prohibitive pricing and failure to invest in meeting public health needs
which is part of this approach).

PHM calls for a review of lock-down strategies across countries and
contexts, to understand how effective, proportionate or humane these
restrictions were. It is critical to assess how the benefits achieved
compare with the loss of lives and suffering due to other health
conditions, and due to hunger, starvation, loss of livelihoods, loss of
freedoms and exposure to violence in such lock-downs. The commitment to
reach and maintain a level of health systems preparedness that makes such
future restrictions less essential and more selective must become a global
commitment.
IV. Principles to guide MS responses to COVID (and against which MS ought
to be held accountable)

PHM notes and appreciates the various references to international
cooperation unity and solidarity (eg in PP19). OP1 “calls for, in the
spirit of unity and solidarity, intensification of cooperation and
collaboration at all levels to contain, control and mitigate the COVID-19
pandemic”.

Cooperation implies mutual accountability but there are no references in
this draft to member states’ accountability for acting in a spirit of unity
and solidarity.

PHM is not arguing for member state accountability to the Secretariat but
governments’ accountability to their own people. To strengthen such
accountability in the case of COVID would require impartial, independent
and comparative evaluation of country performance so that we can be assured
that the necessary lessons are learned. This is an important role for WHO.

In OPs7.1-7.15 the draft calls on countries to put in place a comprehensive
COVID action plan. The elements of the plan which are listed are broadly
comprehensive but we note the lack of any references to nutrition, prisons,
refugees, the stateless and large numbers of migrant workers. We also are
concerned with the complete absence of mention of the economic and
humanitarian consequences of the lock-down and the way lock-downs have in
many nations led to abrogation of many human rights as well as labour laws
and been used in strengthening state surveillance and action against
political enemies. Equally troubling is that there is no consideration of
MS accountability for the implementation of such a plan.

PHM appreciates the reference in PP8 (and OP9.2 and OP9.3) to the
obligations on states parties to implement and comply with the IHRs.
However, there are no matching references to any accountability mechanisms
for the full implementation of the range of obligations on states parties
to the IHRs.

The exception is the ongoing pressure on low and middle income countries
over the core capacities (see for example OP9.2). However, there is no
recognition that the core capacities of MSs are intrinsically tied to
health system strengthening and does not acknowledge that IHR core
capacities are essentially global public health goods. A global recognition
of this would strengthen the case for mobilizing international funds for
core capacity development (and therefore for health system strengthening)
in low and middle income countries.

OP7.10 calls upon member states to provide WHO with “timely, accurate and
sufficiently detailed public health information related to the COVID-19
pandemic as required by the IHR”. There is no suggestion of any
accountability for not doing so, nor of the need to set data standards, and
establish procedures for independent verification and comment

PHM appreciates the call (in OP7.15) for sustainable funding for WHO but
this call is weakened by the lack of any reference to the freeze on
assessed contributions; or to the need for flexible funding rather than the
continuing donor chokehold over WHO’s effective budget.
Over-riding principlesThese implementation issues need to be couched within
a set of broad human rights derived principles such as those set out by David
McCoy in his BMJ Blog (April 29)
<https://blogs.bmj.com/bmj/2020/04/29/covid-19-affects-everything-more-than-a-disease-control-plan-we-need-a-manifesto>
‘We need a manifesto’.
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