World Health Assembly Wraps Up by Passing New IHR But No Pandemic Agreement - For Now

The World Health Assembly proceeded into overtime on Saturday, as delegates sought last-minute agreement on the International Health Regulations (IHR) amendments and pandemic agreement, items that had preoccupied the meeting for the past several days.

Late in the evening of June 1, the assembly did pass amendments to the IHRs by consensus (meaning no nation objected to their passage) but failed to agree on text for a pandemic accord — something that occupied much of the focus of the WHO for the past several years. However, the assembly did authorize the Intergovernmental Negotiating Body (INB) tasked with developing a pandemic agreement draft to continue working toward one before the 2025 World Health Assembly, with the possibility that one might be agreed to by the end of 2024. The first virtual meeting of this group will be in July 2024.

Of the final IHR amendments passed Saturday night, many of the provisions that have drawn concern in recent months were in the final adopted version. The IHRs themselves have been in existence since 1969 and were last modified in 2005 but have drawn more attention in the years since the COVID-19 crisis, as government handling of the pandemic has become more closely scrutinized.

So what was added to the final version of the IHR passed on June 1? Here are some of the key changes:

• Definitions section: Adds a definition of “relevant health products,” which includes vaccines, medical products, and “technologies”
• Definitions section: Adds definitions for “pandemic emergency” and “national health authority”
• Article 2: Increases the scope of the IHR to “prepare for” diseases — something that had not been in the scope previously
• Article 3: The guiding principles were amended to include “equity and solidarity” (italicized text is new): “The implementation of these Regulations shall be with full respect for the dignity, human rights and fundamental freedoms of persons, and shall promote equity and solidarity.”
• Article 4: Requires a “national IHR authority” to be established or designated (with a directive to change a member state’s laws to accomplish this if needed). This authority will handle implementation of the IHR within the member state.
• Articles 8 and 10: Consulting with WHO changed from “may” to “should” (more of a requirement)
• Articles 11 and 12: Adds “pandemic emergency” (defined as discussed above) to the areas of public health concern that the WHO can respond to. These provisions grant more authority to the director general to make certain decisions, and in general, bind member states to a greater level of scrutiny and control.
• Article 13: WHO “shall work to facilitate” and provide “equitable” access to health products (defined as referenced above).
• Article 44: Requires that member states maintain or increase domestic funding to support implementing the IHR. Requires that states report on these outcomes at the next WHA.
• Article 44: Establishes a “coordinating funding mechanism” that will conduct analysis of where funding is needed and report to the WHA
• Article 54: A committee is established to “facilitate” the effective implementation of the IHR.
• Annex 1: One of the “core capacity” requirements under the new IHR is that countries build the capacity to address “misinformation and disinformation” — something that was not in the previous IHR.

In addition to the above sections, the concepts of “prevention” and “preparedness” have also been inserted into the new IHR. These are areas that the pandemic agreement (not the IHR) is designed to address. With their inclusion, we see the WHO’s desire to “integrate” the IHRs with any pandemic agreement that is developed — something that was discussed at the World Health Assembly. The WHO is definitely thinking of these two agreements as part of one package.

In addition, the IHRs contain a number of references to “experts” sitting on and advising panels and committees. Some of this language was in the previous IHR, but it is indicative of the type of approach these new IHRs are even more inclined toward than the previous: looking to experts, committees, and advisory panels for advice and guidance.

In summary, the new IHRs create a set of greater and more interlocking requirements than before, integrate a focus on COVID (or pandemics more broadly), require greater sharing of resources and technologies between countries, try to integrate national governments on their pandemic responses, and push for more funding.

Moving on from this year’s World Health Assembly, the focus will now turn to the next meeting of the INB regarding the pandemic agreement. The focus will also be on member states to see how and whether they implement these new IHRs. Under Articles 59 and 61 of the IHR, member states can object to new amendments or issue reservations, in which case those provisions will not enter into force with respect to the member state.