Can a Pandemic Treaty located in an unreformed World Health Organisation be successful?

The World Health Organisation is currently conducting two ongoing processes, the Working Group on Amendments to the International Health Regulations (WG-IHR) and the Intergovernmental Negotiating Body (INB), which are aiming to address the organisation’s (in)ability to prevent a pandemic like COVID-19. The WG-IHR is a process that is aimed at considering the amendments proposed by member states to the existing International Health Regulations, which define the rights and obligations of member states in the event of a pandemic.

The Intergovernmental Negotiating Body, on the other hand, is negotiating a new “WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response”, which is referred to as the “Pandemic Treaty”.

Since the IHR in its present form were unable to prevent the spread of the coronavirus pandemic, which brought the WHO under global scrutiny, the WG-IHR aims to amend the existing regulations. The Intergovernmental Negotiating Body, on the other hand, is negotiating a new “WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response”, which is referred to as the “Pandemic Treaty”. While both these processes are separate, they maintain close coordination with each other as both aim to submit final negotiated documents before the World Health Assembly in 2024. Recently, the INB held its sixth meeting from 17-21 July, closely followed by WG-IHR’s fourth meeting from 24-28 July. While these processes continue as multilateral responses to the gaps in the global health architecture, they do not address the underlying issues burdening the organisational setup of the WHO. These issues require serious diplomatic attention since the negotiated IHR and the pandemic treaty are to operate within the existing setup of the WHO.

The organisational issues

 One of the most pressing issues faced by WHO is the penetration of geopolitics into the bureaucratic structure of the organisation. During the COVID-19 pandemic, the office of the Director General (DG) of the organisation came under direct political attacks, due to WHO’s failure to declare COVID-19 a Public Health Emergency of International Concern (PHEIC) on 22 January 2020. It was under the direction of the IHR Emergency Committee (EC) that the DG did not to declare a PHEIC, since the experts in the committee were divided on the decision. The committee arrived at a consensus on 30 January 2020, enabling the DG to declare COVID-19 a PHIEC. The DG’s decision on 22 January was adherent to the bureaucratic rules of the IHR, which required his office to concur with the advice provided by the Emergency Committee. Despite following clear-cut organisational rules, the DG’s office was helpless against political aspersions of being biased towards China, which ultimately led to the United States (US) withdrawing from the organisation. In order to avert such a multilateral breakdown in the future, the WG-IHR is considering giving the Director General the power to issue intermediate public health alerts to States Parties even before the Emergency Committee can make a clear decision. In the recent meeting of the Working Group from 24-28 July, the member states also discussed if a binary ‘yes-no’ declaration of PHEIC can be replaced with a graded declaration for situations that are not yet a full-blown global health crisis. While these efforts are progressive, they do not help in protecting the office of DG-WHO from accusations of compromised neutrality due to two reasons.

Despite following clear-cut organisational rules, the DG’s office was helpless against political aspersions of being biased towards China, which ultimately led to the United States (US) withdrawing from the organisation.

First, under Article 48 of the draft IHR, the experts who will sit in the EC are to be selected by the DG. Once these experts form the committee, the DG must adhere to their advice about a health event being a PHEIC or not. Since these experts are selected by the DG himself/herself, there is a close nexus between the committee members and the DG. The ongoing negotiations on IHR do not break this nexus. This close connection between the Director General and the experts of the Emergency Committee makes it easy for political accusations to malign both the Committee as well as the DG in events of crisis like COVID-19. Second, the idea of giving the  Director General the power to issue intermediate public health alerts without seeking approval from the Emergency Committee is a positive fix but has the potential to make the office of the DG more exposed to political pulls from powerful member states funding the organisation. In order to make the office of the DG immune from geopolitics, the Independent Panel for Pandemic Preparedness and Response (IPPPR) has already recommended barring the re-election of the DG to neuter the Director General’s need for political support to continue in office. Such a step will ensure that the DG’s actions are not based on any personal interest. Another step that can be considered is separating the selection process of the Emergency Committee from the office of the DG. This will end the nexus where the DG is apparently bound by the experts that he himself/she herself has installed in the first place. These steps will assist in making WHO an impartial organisational setup. Such impartiality in the organisation is fundamental towards isolating the instruments of the IHR and the Pandemic Treaty from geopolitical contests between the US and China. Initial signs of such power contests have already crept into the recently held fourth meeting of the WG-IHR. Russia and China have shown their disagreement towards the US’ proposal to amend the IHR, in which countries get a tight 48-hour window to notify the WHO of an emerging threat. As per the proposal, once the WHO has been notified of the emerging threat, the member state where the threat has been found gets another 48-hour window to allow a WHO-supported investigation. Otherwise, the WHO can unilaterally issue a notice to all member states for an emerging health threat. While states like US and India support this tight window of reporting, Russia and China view this as an infringement upon state sovereignty. It becomes imperative for WHO to fortify itself as a neutral location so it can restrain international power contests by having an impartial organisational structure. Reforming the Director General’s office is hence a crucial step towards providing the Pandemic Treaty and the revised IHR a politically neutral multilateral location in the WHO.

Such impartiality in the organisation is fundamental towards isolating the instruments of the IHR and the Pandemic Treaty from geopolitical contests between the US and China.

Need for a wider multilateral engagement

 As of today, WHO is seen as a location of ‘low politics’, the remit of health ministers rather than heads of state. As the negotiations around the IHR and the Pandemic Treaty require the WHO to enter into domains falling under the purview of the World Trade Organisation and the TRIPS agreement, a broader consensus needs to be built that demands commitment from the highest level of state functionaries. Since the Pandemic Treaty is being framed as a binding instrument, which the states will have to willingly ‘opt-in’, a heads-of-state approach can be beneficial. The United Nations General Assembly High-level Meeting on Pandemic Prevention, Preparedness and Response, which is due to be held in September 2023, offers a viable platform to directly involve the heads of state rather than health ministers in the process of pandemic prevention. The zero draft of the meeting also states that a review meeting is to be held in 2026 to evaluate the progress of multilateral response to pandemic prevention. This is an appropriate multilateral approach to assist the WHO in tackling challenges of geopolitics by directly bringing heads of state to the diplomatic high table.

The post-Covid WHO

 The ongoing multilateral efforts seen in July at the WHO, and the upcoming High-level meeting at the UN in September, are robust international responses to the pandemic. While health diplomats are engaged in negotiations around framing a revised IHR and a new binding health instrument, organisational reforms to the WHO have been on the backburner. The High-level meeting in September offers an opportunity for WHO member states to initiate discussions on reforming the organisation that is poised to be the home to the Pandemic Treaty.

While health diplomats are engaged in negotiations around framing a revised IHR and a new binding health instrument, organisational reforms to the WHO have been on the backburner.

Member states like India have already notified detailed intentions to seek reforms within the organisational setup of the WHO. A fundamental intention behind this approach to reform is to lend more power to WHO. The Indian government has supported a stronger involvement of the WHO in helping member states build technical capabilities so they can perform self-reporting of a health event under the IHR. There is also a proposal to increase the representation of developing countries and countries with high disease burden in WHO’s Technical Committees. These proposals show that the WHO still retains its credibility as the core of the international health architecture even at a time when its financial resources have dropped below those of other health initiatives like GAVI and UNAIDS. The task ahead is to capture the opportunity presented by the meeting in September to initiate serious diplomatic action towards reforming the organisational issues of the WHO.

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Angad Singh Brar is a researcher whose work focuses on issues of global governance, multilateralism, India’s engagement with international organisations and institutional reform.

• Healthcare
• India
• USA and Canada
• Covid-19
• geopolitics
• Global Health
• IHR REFORM
• INDIA'S PROPOSALS
• MULTILATERAL ENGAGEMENT
• ORGANISATIONAL REFORM
• UN
• WHO

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