The COVID-19 resolution, adopted at the 73rd World Health Assembly (WHA), calls for global cooperation, unity and solidarity and confirms commitment to meaningful change. Participating countries welcome the announcement of WHO on 9 July 2020 to launch an impartial, independent and comprehensive evaluation by the “independent panel for pandemic preparedness and response” (IPPR) of the global COVID-19 response. We support this approach and suggested an independent review early on in the COVID-19 outbreak. We welcome the aim of the panel to provide timely and concrete recommendations for strengthening future responses and urge all countries to work constructively with the review, whilst not distracting from the immediate response. We commit to work with every country and partner for a safer world where our shared systems and institutions work transparently and collaboratively as intended to improve the global capacity to prevent, respond to and defeat pandemics.
With that in mind, this roadmap sets out areas where we believe there is an opportunity to strengthen the WHO by increasing accountability and its ability to be impartial and objective, improve transparency and its overall effectiveness, by providing it with a more comprehensive set of tools that are fit-for-purpose to address new and emerging threats.
A. Areas for short term progress under existing mandates
Public Health Emergency of International Concern (PHEIC) Declarations
We encourage the WHO to consider a new designation -- the Intermediate Public Health Alert (IPHA) or “amber light” -- as recommended by the Independent Oversight and Advisory Committee (IOAC). We believe WHO can do this through Member State consultations. WHO can use this opportunity to increase collaboration with UN and other partners and to establish a clear and systematic set of rules for activating the broader UN system and global health architecture. The amber light aims at timely communication about evolving threats to Member States and the public, thus encouraging improved reporting, earlier preparation, and better resource allocation.
Clarifying responsibilities around outbreaks
Drawing on IHR Articles 6 (Notification), 7 (Information-sharing during unexpected or unusual public health events), 8 (Consultation), 9 (Other reports) and 10 (Verification), we invite WHO to issue updated guidance for itself, Member States and non-state actors of the expectations, after the initial notification of an event, as part of the new IPHA or under the existing process leading to a PHEIC declaration, including specific timeframes for action. The WHO should continue to promote safe and rapid sample sharing of pathogens of pandemic potential or high risk, including during the assessment phase.
IHR Emergency Committees (EC)
Increased objectivity and impartiality of WHO, including the membership and scope of an EC, tailoring each to a given outbreak and adapting as needed, over the course of each event as new evidence emerges provide a pathway to an improved EC. Additionally, more transparent public accounting of proceedings is important to understand decision making around PHEICs. The ECs should hold additional meetings, including if requested by an appropriate number of Member States, and be responsive to Member States’ inquiries. Providing written summaries of the discussion in all EC meetings would help build confidence.
Effective and transparent oversight
For both the IOAC and Global Preparedness Monitoring Board (GPMB), established jointly by WHO and the World Bank, it is essential that WHO and the World Bank, working with Member States, review and secure their permanent mandates, terms of reference, defined scope of activities and sufficient resourcing.
Quality and speed of WHO guidance development and issuance
We appreciate the establishment of a Chief Scientist’s Office at WHO to raise the quality of, and confidence in, guidance documents and normative materials. It should be empowered, in compliance with Framework of Engagement with Non-State Actors (FENSA), with sufficient budget and staffing, and make global expertise available to all levels of WHO.
Access to Medical Products
We will work together to expedite the development, approval, manufacture, and distribution of safe, effective and affordable COVID-19 vaccines, diagnostics and therapeutics. Providing access to products for high-risk populations, such as health care workers and vulnerable groups is key. Once COVID-19 countermeasures are developed, all countries must benefit from equitable access. Based on the experiences with access to medical products for COVID-19, strategies for medical countermeasures for future pandemics could be developed.
B. Areas for medium and longer-term action
IHR compliance, preparedness, detection and response
A tool allowing a better understanding of Member State IHR compliance and preparedness may provide needed clarity on areas for additional work. Therefore, we propose consideration of a universal review mechanism for IHR compliance, to encourage countries to view preparedness as fundamental to national and health security as well as incentivize fulfillment of IHR obligations. We encourage the independent review panel, the WHO, and Member States to initiate a discussion on a review process at the earliest opportunity.
Support on capacity building and resource sustainability
Any universal periodic review mechanism should promote cooperation and support across countries and partners, especially for low- and middle-income countries seeking to fill core capacity gaps. The review could also look at how international organizations and international financial institutions can better support capacity building through providing and catalyzing funding for national plans and technical expertise, and how countries can support each other, including self-financing.
Enhanced Transparency, Accountability and Oversight
New measures coupled with targeted resources are necessary to respond immediately and transparently to emerging threats. Especially for public health risks with the potential to spread globally, we need to consider how best to strengthen Member State reporting to WHO, and empower WHO leadership to articulate Member States’ responsibilities in an impartial and objective manner when they are not meeting obligations. It is essential to strengthen oversight mechanisms and clarify mandates to ensure full transparency and participation by Member States, other global health partners and the public.
WHO Access to Outbreak Areas
We encourage the independent review panel to consider mechanisms to facilitate more rapid access to outbreak areas for WHO-led response teams to the extent required for a robust public health response, including in the assessment phase. Such access is crucial to the early containment of outbreaks, so recommendations should also look at ways to empower the DG to report and incentivize Member State compliance as a part of this process.
Handling Travel and Trade Restrictions
COVID-19 lessons show potential benefits of de-linking travel from trade restrictions under emergency conditions, with the goal of maximizing public health measures while minimizing economic impacts. Ensuring open and safe global transportation routes and securing supply chains to allow delivery of essential products, guaranteeing humanitarian aid access to people in need and continued travel for responders are necessary. We encourage WHO to lead an evidence-based process to develop recommendations on the appropriate role of domestic and international travel restrictions within a suite of preparedness and response interventions, in close consultation with other relevant organizations and tailored to the circumstances of relevant industries, such as cruise ships, air travel and shipping.
Strengthen effectiveness and sustainability of World Health Emergencies (WHE) Program
WHE performance has improved since 2016 but needs further strengthening. In particular, we commit to serious consideration of potential budget reforms that would ensure adequate and sustainable financing for WHE and accelerate continued performance gains. The WHO Solidarity Fund and the WHO Foundation are helpful in broadening the donor base, but any new funding sources need Member State oversight.
III. Health Cooperation
One Health cooperation
We recommend a look at how to improve collaboration on zoonotic diseases among WHO, the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE), as well as the United Nations Environment Programme (UNEP). The existing tripartite agreement for antimicrobial resistance (AMR) serves as a model and starting point for broader efforts to track and respond to zoonotic diseases, but further action is needed.
WHO and the United Nations System
The review provides an opportunity to improve coordination between WHO and relevant organizations in support of the greater preparedness and response collaboration called for in IHR Article 44. Recommendations should focus on improving capacity, accountability, transparency, and coordination, including avoiding competing calls for funding. All partners must work toward shared goals, including UN development system improvement.