Postpone vote on the WHO’s amendments to health regulations and pandemic agreement

The power to decide on how pandemics are managed should not reside in one individual at the World Health Organisation

During the 77th World Health Assembly in Geneva, Switzerland, later this month, health ministers the world over will consider amendments to the International Health Regulations and to establish a new Pandemic Agreement. These drafts are intended to set up legally binding commitments under which the World Health Organisation’s (WHO’s) 194 member states undertake to follow its recommendations regarding the management of health emergencies. 

Strengthened with centralised power, the WHO’s director general would have enhanced authority to unilaterally declare public health emergencies of international concern, and during such emergencies, exercise increased powers over member nations. This would radically change how pandemics or threats thereof are managed, further shifting public health policy away from sovereign nations to a global, untempered body. 

This important role ought not to be vested in a single individual. Instead, it should be entrusted to a body free from conflicts of interests and adequately representing a cross section of regions, disciplines and cultures to determine response mechanisms appropriate for specific settings and diverse cultures in a bid to promote the highest possible holistic health outcomes (such as physical, social, psychological and economic). 

What is of greatest concern is that much of the global population and its leaders remain largely unaware of these proposed radical changes.

According to the WHO, the two documents are being drafted with intentions of learning from failures in the management of the Covid-19 crisis and building upon its successes. But these two instruments, if adopted in their current form, would accomplish the opposite. The WHO’s failures during the pandemic and its now discredited exaggeration of disease outbreaks and risk, both of which have trended downward in recent years, have now been well documented. Going by the content of the two documents, WHO clearly intends to pursue the same trajectory.

Furthermore, given that the two documents are still being negotiated just days before the 77th World Health Assembly means the WHO is contravening its own legal requirements for voting by disregarding article 55(2) of the current International Health Regulations that reads: “The text of any proposed amendment shall be communicated to all states parties by the director general at least four months before the assembly at which it is proposed for consideration.” In like manner, the Pandemic Agreement, also still under negotiation, was intended to be delivered by 29 March, for a similar intent of providing time for reflection prior to commitment to vote, but is also still under negotiation.

Consequently, we scholars and practitioners with varying expertise, unique perspectives and from different countries in the Global North and South, are unified in our conviction that the Pandemic Agreement and amendments to the International Health Regulations should not be adopted at the 77^th WHA because this can no longer be achieved in a lawful manner or with any measure of integrity. Further, these instruments lack the twin guardrails of evidence and transparency, which together engender trust and help legitimise global public health instruments and practices. Most tragically, they are being negotiated in opaque haste without genuine public participation.

In sum, we passionately appeal to the WHO to postpone its planned votes on the Pandemic Agreement and amendments to the International Health Regulations, affording countries more time to review and contribute to them. This would provide an opportunity to address the gaps and concerns raised above. In particular, the final agreement and amendments to the regulations should address the need for all of the following:

1.  Negotiations that facilitate effective public participation;
2.  Respect for statutory deadlines to enable countries to interrogate the documents;
3.  Recognition of the unique health needs of different regions in theory and practice;
4.  Commitment to the recognition and protection of human rights, including freedom of thought and expression that were grossly violated at the height of the Covid-19 crisis;
5.  Respect for the principles of medical ethics, including beneficence, non-maleficence, voluntary informed consent, patient confidentiality, and adherence to research ethics;
6. Adherence to the principles of public health ethics, including balancing individual liberty and well-being with the public good, fairness in the distribution of burdens, and public participation in the formulation of mitigating measures;
7.  Protection of humanity from poorly tested vaccines, therapeutics and devices by discouraging emergency use authorisation of those, and refraining from providing legal protections for pharmaceutical corporations from liability in events of injuries arising from such products;
8.  Commitment to respect and uphold the multi-dimensional sovereignty of state parties, health sovereignty and financial sovereignty included;
9.  Promotion of the scientific impartiality of WHO by eliminating the influence of corporates and individuals on its governance and funding framework.

Elizabeth Hankins is an international peace worker, author and human rights advocate serving in war and conflict-affected regions of East and Central Africa. She leads a nonprofit organisation to that end. Dr David Bell is a public health physician and former medical officer and scientist at the WHO, programme head for malaria and febrile diseases at the Foundation for Innovative New Diagnostics in Geneva, Switzerland, and director of Global Health Technologies at Intellectual Ventures Global Good Fund in Washington.  Dr Henry Kyobe Bosa is a physician epidemiologist serving as incident commander of the Uganda Incident Management Team, ministry of health, and a senior research scientist at Makerere University’s Lung Institute in Uganda. Dr Janci Lindsay is a toxicologist and molecular biologist with 30 years experience, including expertise in pulmonary and reproductive system immunology and toxicology, as well as vaccine development. Dr Misaki Wayengera is a physician scientist and assistant professor of human and pathogen genetics and genomics at Makerere University, Uganda, and on national service as chair of the Uganda Ministry of Health Scientific Advisory Committee on epidemics and dangerous pathogens. Professor Reginald MJ Oduor is associate professor of philosophy at the University of Nairobi, member of the Pan-Africa Epidemic and Pandemic Working Group and chairperson of the Nairobi-based Society of Professionals with Visual Disabilities.