Intervention to the 74th World Health Assembly

Tuesday 25 May 2021, 14:00 Geneva time

Honorable Chair, Director-General, your excellencies, ladies and gentlemen, colleagues,

Thank you for the opportunity to speak to you today about the work of the Review Committee on the functioning of the International Health Regulations during the COVID-19 response.

[Mandate]

The Review Committee was convened by the Director-General of WHO in September 2020, at the request of WHO Member States.

Our mandate was focused on reviewing the functioning of the IHR during the COVID-19 response. The key function of the IHR is to prevent the international spread of disease.

[Process]

The Committee met virtually from September 2020 for 28 plenary meetings and 7 open meetings with Member States and representatives of international organizations and NGOs. Work was conducted through four sub-groups – preparedness, alert, response, and governance. Working in a personal capacity and not as representatives of countries or employers, the 20 Committee members examined each article of the IHR in the light of countries’ and WHO’s response to the spread of COVID-19.

We interviewed more than 100 experts, including National IHR Focal Points, Chairs of former Emergency and IHR Review Committees, representatives of international organizations and academic experts. We also reviewed a large number of background documents commissioned by the IHR Review Committee Secretariat, as well as written submissions from more than 35 Member States and some international organizations. We interacted with the other two review panels through regular discussions among the chairs.

[Main conclusion]

The questions that lay behind our deliberations were: Why was the world unable to prevent or at least delay the pandemic? And: Why is the world still struggling to contain SARS-CoV-2? With our focus on the IHR we concluded that there are mainly three reasons:

• Overall, national capacity to prevent, detect and respond to public health risks is weak.
• International alert, risk assessment and warning take too long.
• In many cases, the countries’ initial public health response was insufficient.

However, we concluded that the design of the IHR is not the reason for these failures. Rather, the interpretation and implementation of the IHR by both WHO and States Parties have been suboptimal.

Despite the challenges in implementation, the International Health Regulations continue to provide the framework for global health protection. They constitute the foundation of the global architecture for monitoring and responding to public health risks and emergencies, involving countries, institutions and networks under the leadership and coordination of the WHO.

[Preparedness]

An important limiting factor during this pandemic response was, that too many countries still do not have well-functioning public health capacities to protect their own populations, and to give timely warnings to WHO, as required by the IHR. In addition, the current self-reporting mechanism on the implementation of core capacities does not provide enough incentive for and confidence in compliance with the IHR obligations.

This is why we propose a universal periodic review mechanism to engage all States Parties regularly in an open assessment of IHR implementation, to ensure accountability and regular improvements. Such a mechanism, in our view, provides advantages for IHR accountability and compliance as it will foster intersectoral collaboration, a whole-of-government, whole-of-society approach and civil society engagement, which will help to improve emergency preparedness and response. A universal periodic will improve preparedness and response.

To be clear here: Sufficient levels of preparedness will not be reached without sufficient levels of sustained political attention at national and international level, including the required financial commitments.

[Alert]

Notification and response to verification of unofficial information were applied within the timeframes provided by the IHR. However, a lot room for improvement remains to be strengthened in relation to the information that is required for WHO to conduct a well-informed risk assessment.

We recommend that WHO develops a more standardized format to collect the information required to conduct a realistic risk assessment. We also consider it critically important that information directly be shared with WHO as it becomes available, not only when all information required in such a form has been collected.

WHO’s alerts and risk assessments for COVID-19, available for countries through the Event information system (EIS) or a Disease Outbreak News (DON), as well as by partners through the Global Outbreak Alert and Response Network (GOARN), were useful to decide on appropriate response measures. The Committee noted however that WHO does not share its full risk assessment publicly.

The Committee recommends that WHO develop a mechanism for States´ Parties to automatically share real-time emergency information, including genomic sequencing data, needed by WHO for risk assessment, to build on and strengthen already existing relevant regional and global digitized systems. WHO should also proactively and assertively make use of the provisions of Article 11 of the IHR to share information about public health risks with States Parties, including unofficial information without waiting for agreement from the States Parties concerned.

In particular, we consider that sharing of genomic sequencing data early on during the outbreak was crucial to allow for rapid development of diagnostic tests, for vaccine development and later for the identification of variants of concern. We strongly recommend that WHO should develop options to strengthen, and where appropriate, build global genomic sequencing infrastructure to maxime use of this critical technology as a component of future preparedness and response.

Most importantly in relation to alert functions, the Committee extensively considered the workings of the Emergency Committee and the question of a level of alert below the declaration of a Public Health Emergency of International Concern. We agreed that the introduction of a formal intermediate level of alert would not solve the existing challenges of delayed readiness and response. We recommend instead a new approach for early alert and response through what we call “World Alert and Response Notice” (WARN). Such notices would be developed and published by the WHO Secretariat and provide countries with information about the level of risk posed by specific health emergencies and the necessary actions required to respond to those risks. This is the mandate of WHO and we consider that this mandate should be further strengthened by allowing WHO to support early investigation of public health threats and independent publication of risk assessments and required readiness and response actions.

[Response]

Early response and coordination was another area that the Committee reviewed at length, including through a survey we commissioned to the Global Outbreak Alert and Response Network. We recommend that States Parties give WHO a clear mandate to proactively support individual States Parties when information about high-risk events become known. Currently this can only be provided upon a State Party’s request.

WHO should further strengthen its work with relevant networks like the International Association of National Public Health Institutes (IANPHI), to coordinate and offer immediate technical support in outbreak investigations and risk assessments. Such offers should be accepted by States Parties; where such offers are not accepted by States Parties, they should promptly provide a written explanation of their position.

The inherent tension between the purpose of the IHR to protect health and the need to protect economies by avoiding unnecessary travel and trade restrictions has been noted by the Committee as a central factor limiting compliance with the IHR.

We recommended that WHO should examine the term “unnecessary interference with international traffic”, to arrive at a more practical and consensual interpretation of this term in the context of travel measures during a public health emergency of international concern or a pandemic. We also recommended that WHO should support research efforts to strengthen the evidence base and its recommendations on the impact and advisability of travel restrictions in relation to a public health emergency.

[NFPs and legal preparedness]

Strengthening the capacities of the National IHR Focal Points has been consistently raised by previous Review Committees and much has been done to achieve this, but more efforts are still needed. This is why we propose that WHO should assess the performance and functioning of NFPs using appropriate criteria and in full transparency, and report its findings accordingly in WHO’s annual report to the World Health Assembly.

WHO should also work with States Parties to identify additional stakeholders, such as professional organizations and academic institutions, capable of supporting IHR advocacy, implementation and monitoring. The Committee considered that networks such as the International Association of National Public Health Institutes (IANPHI) could raise awareness of the IHR at the global, regional and national level and across government sectors.

Many States Parties passed new legislation during COVID-19. Much of this was used to enable swift and necessary public health interventions, such as imposing quarantine and isolation and requiring physical distancing and the wearing of masks. As the pandemic is not over yet, legislative work in relation to COVID-19 continues and extensive experience is being accumulated worldwide. Many of the legal provisions introduced in response to COVID-19, however, remain emergency laws, which need to be examined in terms of respect for fundamental human rights.

We recommend that States Parties should periodically review existing legislation and ensure that appropriate legal frameworks are in place to manage health risks and health emergencies. WHO should engage with partners and continue to support States Parties in their use of national legislation for IHR implementation by providing tools, and technical guidance, consistent with its normative function under the WHO Constitution.

[Treaty]

During our deliberations, we came across many aspects of international health crisis response that lay outside the Committee’s mandate, that need a strong legal basis for international cooperation. We recommend the consideration of developing a legal instrument - a convention for health preparedness and response - that might include for example provisions for the rapid sharing of pathogens, specimens and genome sequence data; for equitable access to diagnostics, medical prevention and countermeasures such as vaccines, and medical devices such as personal protective equipment; for rapid deployment of WHO teams for early investigation and response; for maintaining the global supply chain. In addition, this legal instruments should include provisions for prevention and management of zoonotic risks as part of a One Health approach.

[Financing WHO]

The Committee also looked into resource issues. We requested an analysis of the WHO’s capacities and funding for implementation of its obligations under the IHR. We were informed that less than 200 full-time equivalents are employed by WHO at headquarters and Regional offices to implement all WHO obligations under the IHR, for an annual cost of a little more than 40 million USD. This is clearly insufficient, and we recommended WHO conduct a more in-depth analysis of its IHR-related resources. Furthermore, States Parties should ensure adequate financing of WHO to enable it to exert its functions. Without adequate financing, how can WHO carry out its so much needed functions?

[Other]

There are numerous other recommendations in our report, not least relating to the increasingly important work around risk communication and infodemic management, or the utilization of digitized tools, but I will stop here.

[Conclusion]

The report I have presented echoes some of the recommendations made by the Review Committees after the H1N1 pandemic and the Ebola Virus Disease outbreak in West Africa. We realize that the uptake of past recommendations by the global community has been limited.

What will it take for all of us to finally appreciate and understand that if we fail to prepare, we are in fact preparing to fail. Let us finally learn the lessons, and let us support each other as countries, experts, international institutions and organizations, and civil society, to implement these recommendations in a structured and timely manner, under the leadership of WHO.

However appropriate the IHR may be, they can never fully play their part in keeping people safe unless all countries – their governments, communities, civil society, businesses and public health leaders – work together in solidarity and good faith. Fruitful collaboration can only thrive if trust and transparency are the founding principles: without these two pillars it is hard to envision a safer future.

Lastly, a word of thanks to the superb support provided by the IHR Review Committee Secretariat throughout this journey, to all the experts who provided their time and expertise, and mostly to my esteemed Vice-Chair and Rapporteur, and the subgroup leads for their outstanding leadership, all my Committee Members for their commitment and expertise in bringing this report to you today, and all representatives of States Parties that critically and enlightening discussed various topics during our open meetings. My Committee Members and I trust that our recommendations will not gather dust on a shelf, but help all of us to be better prepared and to better respond during the remainder of the ongoing pandemic and when the next health crisis will strike.

Madame Chair, thank you for the opportunity to address the Committee A of the World Health Assembly today. It has been an honor and privilege for me and my esteemed committee members to serve the WHO member states.

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