Latest version (May 8th) of the resolution on Covid-19 response for WHA73

Countries continue to negotiate today (May 11, 2020) on the language of the COVID-19 resolution that will be considered at the World Health Assembly next week.

Geneva Health Files has reviewed recent progress on the on-going consultations. The analysis presented here is based on a draft of the negotiated text as it stood on May 8th. This analysis builds on the previous version of the discussions (May 6th) that I had previously blogged about.

NEW CHANGES IN TEXT – There have been suggestions for more explicit references to the WTO TRIPS Agreement (and flexibilities), the Doha Declaration. Suggestions for stronger language for patent pooling mechanisms. It continues to be unclear whether “global public good” will continue to feature in the text. Extensive discussion on how and when an independent evaluation into the international response to the pandemic will be conducted; suggestions for deeper investigations to examine origins of the virus. Also suggestions to include references to international humanitarian law. Also some changes on freedom of expression, “in accordance with national laws” in the context of misinformation.

As before, the text itself is not being shared, to protect country positions on issues.

The text in blue is the Chair’s proposal from May 4th, based on which negotiations have progressed over the last few days.  My analyses, as before,  is indicated in red. (If you wish to read and compare the previous iteration, read here.)

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

(CO-SPONSORS: EU and its Member States, Monaco, North Macedonia, San Marino, Zambia)

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;

Suggestions to include “negative” impacts in this para.

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;

Suggestion to add 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 suggested references to human rights and the right to health.

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;

Suggestions to have explicit references to the United Nations General Assembly resolutions A/RES/74/270 on “Global solidarity to fight the coronavirus disease – COVID-19” and A/RES/74/274 on  “International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19”, “the International Conference of the Red Cross and the Red Crescent resolution 33IC/19/R3 entitled “Time to act: tackling epidemics and pandemics together”, as well as the  WHO’s Strategic Preparedness and Response Plan (SPRP) and the Global Humanitarian Response Plan for COVID-19. In addition to references to WHO’s Strategic Preparedness and Response Plan (SPRP) and the Global Humanitarian Response Plan for COVID-19.

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;

Stronger language suggested on referring to WHO’s leadership and role. Suggestions to refer to “the constitutional mandate of WHO to act, inter alia, as the directing and coordinating authority on international health work, and recognizing its crucial leadership within the broader UN response…”

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 number of suggestions including recognising how the pandemic affects the poor and vulnerable “disproportionately”. More importantly suggested language on necessary development assistance.

Additional suggested para on “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”

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;

This seems to have generated a lot of discussion. Suggestions range from referencing international law and international humanitarian law to contain and mitigate outbreaks of COVID-19 in armed conflicts. Calls to include, the strengthening of the coordination of emergency humanitarian assistance of the United Nations. To include earlier ICRC resolutions, and even a proposal to take into account increasing attacks on medical personnel and facilities and by the lack of access to medical services that is a consequence of these attacks.

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;

Suggestions to include references to International Humanitarian Law (IHL), the United Nations General Assembly resolution 46/182 on the Strengthening of the coordination of emergency humanitarian assistance of the united nations.

To mention assistance to affected civilian populations including migrants, refugees and internally displaced persons, in accordance with the UN guiding principles of humanitarian assistance.

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;

A suggested reference to fundamental rights.

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;

Suggestions to include negative socio-economic impacts specifically hunger, malnutrition, unemployment. And to include impact on persons with disabilities. 

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;

A new addition recognizing that women represent the majority of the health force.

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;

Some countries want addition of “the importance of investing in health systems strengthening and preparing for future epidemics”.

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;

One new suggestion to include environment and climate change.

Another suggestion, to replace “response” with “the unintended consequences of public health measures” (Which I find extremely interesting.)

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;

To include civil society here (in addition to the private sector)

A curious suggestion for a new para:

On expressing optimism that COVID-19 pandemic can be successfully mitigated, controlled and overcome through  leadership and sustained global cooperation, unity, and solidarity.

Importantly:

One African nation has suggested the inclusion of the following:

PP Reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), as amended, and also reaffirming the 2001 Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products;

Or, alternatively: Consider, as necessary, adoption of national legal mechanisms for the use of the flexibilities contained in the Agreement on Trade Related Aspects of Intellectual Property Rights in order to promote access to pharmaceutical products, vaccines, personal protective equipment, diagnostics, medical devices and other health technologies required for the prevention, diagnosis or treatment of COVID-19.

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;

It is unclear how this para will evolve. Previous discussions on this showed suggestions to include improve “equitable” and “unconditional” access to necessary commodities and their distribution. Some countries continue to support referencing ACT Accelerator and EU’s pledging campaign.

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;

While many countries want to call WHO’s leadership as “crucial”, there continues to be reservations on the word, by a member state. There is also a suggestion to recognize the central role of member states in the response to the pandemic.

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.

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;

It is suggested that access here is qualified to include “unconditional”, “timely”.

Instead of “using fully the provisions of international treaties…”, it has evolved to … “consistent with the provisions and flexibilities of relevant international treaties.”

In addition, suggestion for “products including their precursors required in the response to the Covid 19 pandemic as a global priority, and the urgent removal of arbitrary and unjustified obstacles thereto, and unilateral coercive measures and sanctions”

There is a suggestion for a new para, from one of the “early” countries, most affected by the pandemic:

Urges all States to cease adopting or implementing any unilateral measures not in accordance with international law, international humanitarian law, the Charter of the United Nations and the norms and principles governing peaceful relations among States, which impede the full and timely access to essential health products and technologies in the global fight against COVID-19,

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;

There continues to be reservation against the inclusion of “global public good” in this para. Another suggestion, as before, to footnote references to the use of global public good in the context of COVID19.

Countries feel that a population-wide vaccine could be “instrumental” in fighting the pandemic. A request has been made by one country, to include reference to WHO validated scientific evidence.

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;

No major changes.

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;

No major changes, since previous iteration.

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.

No major changes since previous iteration.

OP6.4 Ensure access to clean water, hygiene and sanitation, and appropriate nutrition, in particular for children and infants

No major changes since previous iteration.

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;

 No major changes since previous iteration.

One suggestion includes “recognizing the importance of increased domestic financing and development assistance where needed.”

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;

New suggestions include references to respecting freedom of expression and “in accordance with national laws” and international legal obligations. (These changes reflect a variety of cultures on how countries deal with information and freedom of expression, which is interesting to note!)

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;

No major changes, see previous iteration

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;

No major changes, see previous iteration

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;

One suggestions reads like this – “Leverage digital technologies for the response to COVID-19, including for addressing its socioeconomic impact, , paying particular attention to digital inclusion, patient empowerment,  data privacy, and  security, legal and ethical issues, and the protection of personal data;”

OP6.10 Provide WHO in a timely manner with information related to the COVID-19 pandemic as required by the IHR;

As before, specific reference to be made to requirements under Article 6.2 of the IHR, according to one suggestion.

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.. (Eloquent diplomatic language!)

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;

One suggestion is for this to read as follows: “Collaborate to promote both private sector and government-funded research and development, including open innovation, across all relevant domains on measures necessary to contain and end the COVID-19 pandemic, in particular on vaccines, diagnostics, and therapeutics and share relevant information with WHO”

In response to a query on “open innovation” – WHO secretariat has clarified that there is “no agreed definition of open innovation, but for example open licensing (including voluntary licensing) for new and existing products and sharing information on R&D and genetic material..”

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;

No major change.

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;

See previous iteration. “Women’s participation” suggested.

On OP6.14bis

Additional para as mentioned in the previous iteration: 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”.

Language suggested as “Provide sustainable and flexible funding to the WHO  to ensure that can fully respond to public health needs in the global fight against COVID-19, leaving no one behind;” 

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;

A few significant suggested changes to the language including addition of “affordable” diagnostics, medicines and vaccines….including “but not limited to optimal use of existing mechanism for (dropped “voluntarily”) pooling of patents and licensing of medicines, “therapeutics”, to facilitate fair distribution of timely, equitable and affordable access to them. Also suggested to add “consistent with the provisions of international treaties, including flexibilities under those treaties.”

At least six different countries were favour of continuing with the earlier text suggested by the chair.

Some countries also requested the use of consistent language on ‘health products and technologies, including diagnostics, therapeutics and vaccines’ throughout the resolution.

In addition, two countries suggested an additional para, “Voluntarily share data and know-how for diagnostics through universal, nonexclusive and open licensing of medicines, vaccines and other health technologies related to COVID-19”

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;

Greater collaboration suggested while working on member states on addressing issues of disinformation and misinformation. Also suggested references to language on “respecting freedom of expression”.. “in accordance with national laws”, and “international legal obligations” among other changes.

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”

Additional suggested para OP8.1bis 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;

A few changes suggested to add “safe” functioning of systems, discussion on essential public health “services” or “functions”.

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;

Suggestions include ….updating “regulatory” and normative products. References to respecting freedom of expression in the context of countering misinformation and disinformation.

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

Stronger language suggested in order to work with OIE. “Initiate, as a matter of priority and in collaboration..”  with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and suggestions include  working with the UN Environment Programme”.

Also suggested “as a matter of priority, an investigation to identify the zoonotic source of the virus”.

Suggestions to add “understand and manage the risks at the human-animal interface”

Sugegstion to include “in a scientific and collaborative manner”

Also suggested that efforts to address this includes “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” and “on how to prevent SARS-COV2 infection in animals and humans and establishment of new zoonotic reservoirs….to reduce the risks of transmission of zoonotic diseases”

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 States, 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;

Suggested to add “rights” in addition to obligations in the text above. … “resulting from relevant international treaties and with inputs from relevant international organizations and the private sector”

Countries differ in their opinion on whether the Access to COVID-19 Tools (ACT) accelerator should be referenced here.

Suggestions to include not only voluntary pooling of patents, but also other forms,  including but not limited to existing mechanisms in this area.

Some countries prefer earlier text suggested by the Chair.

An alternative formulation of the above is suggested as

Chair’s proposal OP8.7: Rapidly, and in consultation with Member States1, identify and provide options that respect the provisions and flexibilities of relevant international treaties, and with inputs from relevant international organizations and the private sector as appropriate, 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, medicines, and vaccines for the COVID-19 response taking into account 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;

OP8.8 Ensuring that the Secretariat itself is adequately resourced to support the Member States granting of regulatory approvals for COVID-19 countermeasures;

One country suggested granting of regulatory approvals “to enable timely and adequate 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, 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; Including an IHR Review Committee, the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme and the Global Preparedness Monitoring Board.

It appears there has been a lot of discussion on the approach, timing and outcome with respect to the independent evaluation of the response to the pandemic.

Suggestion to include “at the appropriate moment”, and in close consultation with member states”. Countries also asked to refer to the status of implementation of the recommendations of the previous IHR Review Committees.

There is also a suggestion “to achieve a global initiative on pandemic prevention, preparedness and multidimensional response”

OP8.10 Report to the 74th World Health Assembly, through the Executive Board, on the implementation of this resolution.

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