Questions About New Amendments to the 2024 IHRs

News Analysis

On June 1, 2024, the World Health Assembly (WHA) adopted a series of new amendments to the International Health Regulations (IHRs). In doing so, the World Health Organization proclaimed that these amendments will “build on lessons learned from several global health emergencies, including the COVID-19 pandemic” by strengthening “global preparedness, surveillance and responses to public health emergencies, including pandemics.”

Although the IHR amendments were adopted, the decision on the Pandemic Agreement (previously called the Pandemic Treaty) was set back up to 12 months, requiring further negotiations before going to a WHA vote. In response, many advocates of the process quickly sought to highlight that the WHA “had really progressed a lot” while emphasizing that the world still faces significant risk without further agreement on pandemic preparedness. Against this backdrop, the IHRs were quickly seized upon politically as an act of saving face by its champions even though there remained many unresolved questions.

As has become emblematic of the pandemic preparedness and response agenda in general, the passage of the IHR amendments, and continued negotiations on the Pandemic Agreement, remain contentious. The debate surrounding these instruments is often polemic, operating in a political environment that has largely stifled democratic deliberation, wider scientific and political consultation, and ultimately, legitimacy.

This undermining of legitimacy was only reinforced during the WHA, when a series of last-minute additions to the IHR amendments was pushed through. This raises important questions about whether these eleventh-hour additions are based on sound evidentiary rationales and wider public health benefits, or whether they merely allow for a further concentration and potential misuse of power.

Under the Wire

Agreement on the IHR amendments was reached in the final hour and after considerable political arm-twisting. Although the current IHR (2005) stipulates that proposed changes must be finalized four months in advance of a vote (Art 55, Para 2), the text was not available to the delegates of the World Health Assembly until the afternoon of the decision. Furthermore, by pushing through the IHR, and by tabling the Pandemic Agreement for a later vote, the scope and legal status of the IHR have seemingly become less clear, since the last-minute additions to the IHR are notably underspecified and will likely only be concretized with a decision on the Pandemic Agreement.

For example, the IHR establishes a new financial mechanism without offering any details on its workings, while using similar words as found in Article 20 of the draft Pandemic Agreement. As a result, the putative agreement on the IHR reform has not brought clarity but has only muddied the waters further, and it is not exactly clear how an adopted Pandemic Agreement will impact on the funding requirements within the IHR, or their implementation, monitoring, and evaluation.

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Again, this ambiguity has created an ongoing condition ripe for politicization, weaponization, and the abandonment of meaningful and open scientific discourse and policy reflection. Despite these uncertainties, the IHR amendments have been agreed upon and are currently awaiting adoption.

So, What Is Known About the New International Health Regulations?

The IHRs are a set of rules for combating infectious diseases and acute health emergencies that are binding under international law. They were last majorly revised in 2005, extending their scope beyond a previous catalogue of defined diseases such as cholera and yellow fever. Instead, a mechanism for declaring a “public health emergency of international concern” was introduced, which has since been declared seven times, most recently in 2023 for monkeypox.

An initial compilation of reform proposals from December 2022 envisaged that the recommendations issued by the WHO Director-General during such an emergency would effectively become orders that states would have to follow. There was considerable resistance to these plans, especially from critics of the COVID-19 lockdowns recommended by the WHO. In the end, the idea of far-reaching restrictions on national sovereignty did not have majority support among states. In response to this growing resistance, the new IHR reforms appear to be significantly weakened compared to the much-criticized early drafts.

Nevertheless, they still contain some worrying points. For example, there is the introduction of a “pandemic emergency” whose definition is highly unspecific and whose consequences remain unclear, as well as new sections on increasing core competencies for public information control, capacity financing, and equitable access to vaccines. We examine these areas in turn below.

The New Introduction of a ‘Pandemic Emergency’

Even though the WHO declared SARS-CoV-2 a pandemic on March 11, 2020, the term “pandemic” had not previously been defined in the IHR or definitively in other official WHO documents or international agreements. The new IHR now officially introduces the category of a “pandemic emergency” for the first time.

The WHO suggests that this new definition is “to trigger more effective international collaboration in response to events that are at risk of becoming, or have become, a pandemic. The pandemic emergency definition represents a higher level of alarm that builds on the existing mechanisms of the IHR, including the determination of public health emergency of international concern.”

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The criteria for making this declaration include an infectious pathogenic threat with a wide geographical spread or risk of spread, the overload or threat of overloading health systems of affected states, and the onset of significant socio-economic impacts or threats of impact (e.g., on passenger and freight transport).

However, it is important to note that none of these conditions must exist or be demonstrable at the time of declaration. Rather, it is sufficient that there is a perceived risk of their occurrence.

The WHO Director-General has significant room for interpretation under the new criteria for declaring a pandemic emergency. This highlights how extensive restrictions on human rights were justified during the COVID-19 response based on potential health system overload rather than actual transmission rates.

The fourth criterion for a pandemic emergency allows for even more interpretation, emphasizing the need for rapid international action with comprehensive approaches. The response design itself determines the triggering event.

The definition of a pandemic emergency in the new IHR lacks specified consequences, leaving room for future discussions and agreements among WHA signatories. It may serve as a placeholder within the IHR rather than a clear trigger for mandatory actions.

The inclusion of the term “pandemic emergency” raises concerns about its practical implications and potential misuse by states. It remains to be seen how this term will be implemented and whether it will lead to measures similar to those seen during the COVID-19 response.

The new IHR also introduces core competencies related to managing misinformation, marking a shift towards international standards for public information control. It is important to monitor how states handle misinformation and how these expectations may impact freedom of expression.

Overall, concerns arise regarding the potential misuse of emergency powers in the context of managing “infodemics,” highlighting the need for vigilance in safeguarding freedom of speech during health emergencies. In essence, questions remain about the appropriate use of information management and whether it encourages a balanced approach. Additionally, defining what constitutes “information” versus “misinformation” is crucial, as it could impact decision-making and public discourse. Determining what is misinformation may involve political processes, raising concerns about democratic principles and human rights norms.

The new financial mechanism under the revised International Health Regulations (IHR) aims to boost investment in pandemic prevention and response. However, ambiguity surrounds its operation and how it aligns with the proposed Coordinating Financial Mechanism for pandemic preparedness. The financing needs for pandemic preparedness are substantial, leading to concerns about diverting resources away from other health priorities.

Concerns also arise regarding the IHR Coordinating Financing Mechanism covering both the IHRs and the Pandemic Agreement. This raises questions about governance and financing, especially in light of reduced donor support for development assistance. Lower-resource countries may struggle to meet the financial requirements, potentially facing penalties for non-compliance.

Promoting vaccine equity is a key aspect of the new IHR, particularly in light of disparities in access to COVID-19 vaccines. The WHO aims to address equity by ensuring access to health products, including vaccines and other essential items. However, equating health equity with commodity equity requires careful consideration, as they are not always interchangeable. Prioritizing health equity should involve targeting interventions that can have the greatest impact on improving health outcomes, especially in resource-constrained settings. The issue of vaccine equity is crucial, especially in the context of COVID-19 vaccines. It raises questions about the necessity and appropriateness of mass vaccination in Africa, considering the minimal-risk demographics, limited and waning vaccine protection, and high levels of natural immunity in Sub-Saharan Africa.

The high cost of mass vaccination policies, coupled with their limited potential impact on African public health, highlights the significant opportunity cost involved. This expenditure may divert resources from addressing other endemic disease burdens, contributing to health inequity.

The focus on “vaccine nationalism” versus “vaccine equity” reflects broader global health disparities, including limited access to affordable medicines and TRIPS restrictions. These disparities hinder health outcomes and perpetuate poverty, which is a crucial determinant of health.

The pharmaceutical industry’s profit-driven motives in promoting vaccine equity raise skepticism about genuine commitments to equal access to health products. Access to health products is restricted in many places, leading to lower standards of medical care and perpetuating poverty.

The ongoing debate surrounding pandemic preparedness instruments, such as the International Health Regulations (IHR) amendments, underscores the need for specificity and deliberation. The ambiguity surrounding the new category of “pandemic emergency” and the financing and equity architecture requires thorough evaluation to make evidence-based decisions.

In response to these challenges, organizations like REPPARE continue their work to assess pandemic risk, disease burden, and the financial aspects of pandemic preparedness. Research efforts aim to understand the political drivers and suitability of the global health agenda for pandemic prevention, preparedness, and response.

The viewpoints expressed in this article are the author’s opinions and may not necessarily reflect those of The Epoch Times. Please rephrase.

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