For the past two years, the COVID-19 pandemic dominated the World Health Assembly (WHA). In 2022, the war between Ukraine and Russia supplanted the pandemic as the most disruptive and urgent development in international politics. The theme of this year’s 75th World Health Assembly is: “Health for peace, peace for health”. The assembly’s theme highlights how this armed conflict looms over the global health agenda.
The COVID-19 pandemic and other health emergencies with international reach have highlighted the leadership and coordinating role of WHO in responding to such events. The President of the Republic of Botswana HE Mokgweetsi Eric Keabetswe Masisi became the first President of Botswana to address the World Health Assembly (WHA75). President Masisi also had an opportunity to meet the Director General of the WHO, Dr Tedro Adhanom Ghebreyesus. In his key note address this what President Masisi had to say:
“ Given our collective goal to recover equitably from the pandemic, and in recognition of the constraints to preparedness and response to a global pandemic, Botswana fully supports the elaboration of an international legal instrument under the auspices of the WHO. This new instrument should seek to build on the experiences and lessons learnt from the COVID-19 pandemic , with special attention to addressing the needs and priorities of developing, least developing countries and countries facing humanitarian crises”.
“ The instrument legal instrument should therefore, address the need to access vaccines and therapeutics in a timely and equitable manner, including scaling up……… “ There is also need for this instrument to have accountability, , mechanisms, including having regard to the who guidance in terms of travel and trade”.
What is WORLD HEALTH ASSEMBLY?
The World Health Assembly (WHA), the governing body of World Health Organization (WHO), is a leading player in Global Health Governance (GHG). For many years, it has also been a key site where geopolitical contradictions between the Global North and the Global South are played out. Recently the World Health Assembly (WHA), the decision making body of the World Health Organisation (WHO) met in person for the first time since 2019 from 22 May to 28th May 2022. For the last two years since the outbreak of COVID-19 pandemic, discussions at WHA has been dominated by the global response to the virus producing hundreds of proposals geared towards strengthening global health governance against future pandemics. The return of delegates to WHA75 is another sign that the world is fitfully moving past COVID-19. Instead, the assembly gathers under the shadow of a war that has shaken the international order, diverted attention from COVID-19, and made post-pandemic reforms and other global health challenges more difficult.
It has been noted by some scholars that since 2020 & 2021the WHA annual meetings in along with the WHA special session in November 2021, did little to clarify what WHO member states want in terms of such governance reform. Given this lack of action, the WHA75 confronted the question of how to change WHO’s approach to health emergencies. In this sobering context, many questions about the WHA meeting arise as WHO member states decide what they want from the organization. The WHA special session handed the Intergovernmental Negotiating Body (INB) an open-ended mandate on what type of instrument to negotiate and what issues the instrument should address. However, this clean slate does not mean that all WHO members have equivalent influence in the INB.
The COVID-19 catastrophe provides an unprecedented justification for the WHO to exercise its power to make treaties. Over its seventy years, the WHO has proved reluctant to create binding legal instruments, especially compared to other international organizations. The outcomes of the WHA meeting in May 2021 and special session in December 2021 reflect this historical pattern. This “treaty phobia” arises from different sources, different think tanks observed. The WHO’s commitment to scientific, public health, and medical strategies has, some believe, dampened its interest in international law. The WHA75 keeps the pandemic treaty glass only half full. However, WHO Director-General Tedros Adhanom Ghebreyesus has previously supported the pandemic treaty proposal. We can only hope that this will remain part of the agenda setting at the GHG.
The unprecedented outbreak of COVID-19 pushed political and health leaders globally to consider transforming global health governance on pandemics. This led to the development of the pandemic treaty as a mechanism for the provision of global health governance and stewardship. This initiative has been cross cutting and supported by various institutions inclusive of inter-alia heads of government, academia, NGOs as well as international institutions. Observers on this initiative thus provoked criticism and interest in developing a non-binding instrument and or revising the International Health Regulations (IHR), (2005).
At the World Health Assembly (WHA) meeting in May 2021, member states of the World Health Organization (WHO) could not reach a consensus on pursuing a pandemic treaty. Instead, they agreed to hold a WHA special session to discuss the development of “a convention, agreement or other international instrument on pandemic preparedness and response. The special session exhibited the same lack of consensus on December 1 2021 and established an intergovernmental negotiating body (INB) to negotiate a “convention, agreement or other international instrument on pandemic prevention, preparedness and response.
Multilateral diplomacy has often demonstrated that many Low & Middle Income countries (LMICs) lack the capacity to negotiate on equal terms with high-income states and multinational corporations. This “capacity conundrum” as reported by various scholars exacerbates the ability of LMICs to develop coherent, multisectoral strategies that are responsive to global problems but that protect gains made in other negotiations, such as access and benefit sharing regimes in the Nagoya Protocol and the Pandemic Influenza Preparedness Framework. The likelihood that WHO members will start negotiations on revising the International Health Regulations (IHR) contemporaneously with the INB’s proceedings compounds the capacity conundrum for LMICs.
It has been observed by various scholars that the WHO under the banner of the so-called “ WHO reform” has been under immense pressure to transform from an intergovernmental body where member states have sovereignty, to a multi-stakeholder public private partnership model where transnational corporations and philanthropic foundations are able to take up their rightful seat at the table. According to various literature sources, global health is of primary importance to human functioning and wellbeing, however, the literature furthermore points to the fact the state of global health by many measures is dire.
Despite the recent proliferation of actors and initiatives in the global health space, the current approach to governance is not solving the global health crisis. The unprecedented outbreak of the COVID-19 and the global response exposed flaws at the heart of the prevailing regime of GHG. The pandemic has produced many proposals focused on the need to strengthen the WHO by expanding its authority, improving its capabilities, and increasing the organization’s funding. As part of the governance reform effort, WHO member states agreed to negotiate a binding or nonbinding pandemic agreement through an Intergovernmental Negotiating Body (INB) and the revisions. What INB accomplished over the past year is not clear.
COVID-19 has prompted many global health experts to argue that the WHO should embrace the ambitious definition of health in its constitution and fulfil its mandate as the “directing and coordinating authority” on international health by adopting a pandemic treaty. The WHO has the constitutional power to create treaty law as well as non-binding instruments and recommendations. Criticism of the pandemic treaty idea includes scepticism that a treaty could effectively address the problems that COVID-19 has exposed.
This accordingly was acknowledged by President Masisi in his presentation at WHA75:
“ Regrettably, there was lack of global solidarity particularly during the early period of the pandemic. This was evident both at the decision-making on medical products such as vaccines and protective wear, as well as resource allocation to combat the pandemic”. ….. “ This resulted in preventable loss of lives , and disruption of quality healthy services”. “ To this end, post the peak of the Covid-19 pandemic, Botswana acknowledges the changing global trends that require strengthening our health systems to achieve universal health coverage as a means of attaining the Sustainable Development Goals”.
In his address HE Masisi made an outcry associated with the many problems associated with the pandemic treaty idea such as equitable access to health countermeasures, independent investigations of outbreaks, and enforcement of international legal obligations which are controversial in an international system composed of sovereignty obsessed states.
As the WHO lacks the capacity to enforce the fundamental purpose of the IHR protect public health with minimal interference with international traffic and trade the pandemic has potentially strengthened the desire of governments to preserve rather than restrict sovereign freedom of action on trade and travel during serious outbreaks. However, in a dramatic twist of events in the year 2022, the shift has been on the war between Ukraine and Russia leading to the 2022 WHA75 assembly’s theme – “Health for Peace, Peace for Health”, the agenda being as to how this armed conflict looms over the global health.
As to what’s Botswana’s position regarding the same remains a jig saw puzzle.
*Thabo Lucas Seleke is a Doctoral Candidate, Global Health & Development, London School of Hygiene and Tropical Medicine, UK
