WHA approves new IHR amendments, resets timeline for pandemic agreement negotiations

Cuban health workers PPE

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On the final day of the World Health Assembly (WHA) on June 1, delegates from 194 member countries agreed to a set of amendments to the International Health Regulations (IHR), aimed at bolstering the world's capacity to quickly identify and respond to pandemic threats.

In a statement, the World Health Organization (WHO) said the IHR amendments are part of a two-step process to ensure that the world is better prepared to handle the next infectious disease threat, building on sobering lessons learned during the COVID-19 pandemic.

WHA members also committed to complete their negotiations on a global pandemic agreement, also known as the pandemic accord, within a year at the latest.

In a statement, Tedros Adhanom Ghebreyesus, PhD, WHO director-general, called the two decisions historic and said the IHR amendments will help strengthen national capacities and improve coordination among countries on disease surveillance, information sharing, and response. "This is built on commitment to equity, an understanding that health threats do not recognize national borders, and that preparedness is a collective endeavor."

Equity issues at heart of new IHR amendments

Of the four new amendments, one introduces a definition of a pandemic emergency, which is designed to spark a more effective international collaboration in response to events that are at risk of becoming or have become a pandemic. The pandemic emergency classification represents a higher level of alarm that builds on existing IHR mechanisms and is defined as a communicable disease that poses a high risk of global spread, threatens to exceed healthcare system capacity, poses a high risk of economic disruption, and requires rapid and equitable international action.

Another amendment addresses equity issues laid bare by the COVID pandemic. It establishes a Coordinating Financial Mechanism to identify and access financing to fairly address the needs and priorities of developing countries. 

The other two amendments establish a state parties committee to facilitate the implementation of the amended IHRs and create national IHR authorities to improve implementation and coordination of the amendments within and among countries.

Abdullah Asiri, MD, assistant deputy minister for preventive health with Saudi Arabia's health ministry and cochair of the IHR amendment working group, said, "Today's powerful show of global support for stronger Regulations also provide a great boost for the process to negotiate a much-needed international Pandemic Agreement."

The Independent Panel for Pandemic Preparedness and Response (IPPR) was among the groups applauding WHO member states for adopting the IHR amendments. In a 2021 review of the international health response to and lessons learned from the COVID pandemic, which was commissioned by the WHO, the group found that IHRs constrained the response instead of facilitating quick action. 

The world must now urgently make the investments needed to implement the revised IHRs.

The IPPR also observed that, in the early pandemic months, the public health emergency of international concern was the loudest alarm bell that the WHO was allowed to ring, and many countries didn't heed warnings until months later, when the WHO used the term "pandemic" to describe the impact and spread of the virus.

Helen Clark, former cochair of the IPPR and New Zealand's former prime minister, said in a statement from the group, "The world must now urgently make the investments needed to implement the revised IHRs, including in low- and middle-income countries, with the objective of stopping pandemic threats in their tracks."

Fresh momentum for pandemic agreement negotiations

In a related action, WHA delegates agreed to continue negotiations on a pandemic agreement to improve international collaboration and equity when preventing, preparing for, and responding to future pandemics. 

The WHA established an Intergovernmental Negotiating Body (INB) in December 2021 to work out an agreement to present to the WHA at its meeting in May 2024. However, it extended the INB's mandate to finish within a year with the option to call a special session in 2024 if they wrap up their work earlier.

It's been a roller coaster ride.

Larry Gostin, JD, director of the WHO Collaborating Center on National and Global Health Law, has been working with the WHO and the INB on a draft of the treaty and said on X, "It's been a roller coaster ride" with the IHR amendments passing in the final hours of the WHA. Gostin is also faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.

He said the new amendments will make the INB's negotiations less complex and that pathogen access and benefit-sharing, as well as equity, are the keystones.

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