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Text has been proposed by the Bureau of the Working Group on Amendments to the International Health Regulations 2005 (WGIHR) that seeks to make WHO prequalified vaccines as a compulsory requirement for the issuance of vaccine or prophylaxis certificates, raising concerns of vaccine supply concentration.

This took place at the recent 7^th meeting of the WGIHR held from 5 to 9 February 2024.

Vaccine certificates are used as evidence of vaccination to facilitate international travel. Article 36 of the IHR states that travellers in possession of a vaccine certificate should not be denied entry unless the competent authority has verifiable indications and/or evidence that the vaccination or other prophylaxis was not effective.

The working group negotiating amendments to the World Health Organization’s (WHO) International Health Regulations (WGIHR) has extended its seventh meeting, which was supposed to end last Friday, to include a special session on equity.

The resumed WGIHR 7 will be held within the first two weeks of March, finally acceding to member state’s requests – including from the Africa Group and the large alliance of countries known as the Equity Group – to give adequate attention to equity.

Unequal access to vaccines and other medical products during the COVID-19 pandemic was one of the triggers for the reform of the IHR, which are the rules setting out countries’ roles and responsibilities, and those of the WHO, during public health emergencies of international concern.

The resumed meeting will pay special attention to a new Article 13A, which addresses the availability and affordability of health products, technologies and know-how, according to a  year-old summary of the IHR negotiation text, which is the most recent public version of the negotiating text.

“Seek, and ye shall find” - I am not sure this sermon holds true in global health negotiations.

During this week’s discussions on amending the International Health Regulations, developing countries tried relentlessly to keep the equity agenda on the table of the working group. They may have succeeded for now.

The second part of this sermon: “knock, and it shall be opened unto you: For every one that asketh receiveth; and he that seeketh findeth; and to him that knocketh it shall be opened…” (As an agnostic, I am skeptical about this.)

We will be tracking the end-game of these negotiations, to keep our readers up to speed.

IHR revisions are likely to be staid and narrow, developed countries do not have a lot of appetite for what they argue as expanding the scope of these rules.

Also, it is striking how crucial a role interpretation plays in reading “old texts”!

The Bureau of the Working Group on the Amendment of International Health Regulations (WGIHR) rejected the WHO Secretariat’s proposal to delete equity-related amendment proposals (Article 13 A, Article 44 A and Annex 10).

The WGIHR Bureau did not circulate the Secretariat’s proposals as the Bureau’s text.

With only 10 official negotiating days left, the Working Group on Amendments to the International Health Regulations (WGIHR) is under pressure to reach agreement on changes to the rules that govern global health emergencies.

The seventh WGIHR meeting which began on Monday officially kicked off the 2024 pandemic ‘season’ negotiations at the World Health Organization (WHO) in Geneva.

It’s a short, intense season though, with the grand finale for both the IHR amendments and the pandemic accord set for the May World Health Assembly.

As Eswatini pointed out, the WGIHR only has 10 official negotiating days left until May, and by Friday, this time will be halved. 

Addressing the equity-related gaps in health emergencies should be prioritised, stressed Eswatini, speaking for the 47 African member states and Egypt (part of WHO’s Eastern Mediterranean region).

The 6th meeting of the Working Group on Amendments to the International Health Regulations 2005 (WGIHR6) has decided to focus on equity and allocate more time to the discussions on amendment proposals relating to equity in its upcoming 7^th meeting, to be held on 5 to 9 February 2024.  

Attempts to push for an early harvest approach on amendment proposals relating to surveillance, sanitary, and quarantine measures, and the structure and role of national authorities, were dropped due to resistance from developing countries.

But pending discussions and consensus on key proposals including those focused on introducing equity-related considerations to the IHR, more time has been sought to conclude the negotiations on amending these rules. In addition, critical issues such as definition of a pandemic; a tiered alert system for declaring health emergencies; and on financing mechanisms; are being addressed both in the forum to amend the IHR, and in parallel discussions towards a new Pandemic Agreement. Unless these key issues are addressed within the overall scope of governing health emergencies including also pandemics, changes to IHR cannot be approved in isolation, diplomatic sources explained to us this past week.

Proposals on various textual amendments to the international Health Regulations (IHR) from the Bureau of the working group mandated to undertake the amendments raise concerns on an early harvest approach at the cost of excluding proposals on equity, especially those on equitable access.

The job of global health negotiators working on a new Pandemic Agreement, and to amend the International Health Regulations, was already stacked against all odds. This has become even more difficult with Israel’s retaliation on Palestine following attacks by Hamas. The incessant attacks by Israel on health facilities in Palestinian Territories, directly speaks to the mandate of the WHO. It was no surprise that the crisis, bled into the discussions on the seventh inter-governmental meeting on the Pandemic Agreement this week in Geneva. Undoubtedly the stench of war pervaded the sterilized confines of the WHO headquarters where member states met this week.

It is on this fractured, splintered notion of international cooperation that diplomats have to now sew together new and complex rules on surveillance, information exchange and access to medical countermeasures. Commitments on accountability and transparency are also being sought. Tough that.

The initial assumptions on the apparently narrow and technical nature of the IHR are now being tested, with realpolitik inevitably now shaping these negotiations. As WHO member states get deeper into discussing and negotiating the proposed amendments to the IHR, it is becoming obvious that several difficult choices will need to be made in order to make this instrument better fit for purpose.

Various stakeholders including some developed countries, have shown propensity to focus on surveillance, broadly, prevention-related measures, that they feel would likely attract consensus more easily. But developing countries continue to push for fairer treatment of response related amendments to the IHR, including notably equity proposals such as access to countermeasures among others.