The holdouts on negotiating amendments to the IHR at WHA77

Countries are back at the negotiating table to hash out the details on the way forward for the pandemic treaty and to finalize amendments to the International Health Regulations, after failing to reach a consensus on either draft last week. The World Health Assembly, the ultimate decision-making body of the World Health Organization, agreed on Tuesday to create one drafting group to handle both sets of negotiations. It’s expected that the outcome will be presented before the WHA this Friday. But there’s a lot of uncertainty where that will lead. Countries are divided on how to proceed with treaty negotiations when they resume, and how long to extend them. Some countries, such as the United States, want to extend the timeline to at least one year, while African countries want to conclude the negotiations in a special session of the WHA before the end of 2024. There are hopes, particularly from some high-income countries, that WHA could conclude amendments to the IHR by the end of this week — the rationale being that just a few unresolved issues remain, and that finishing the job this week might help countries focus on the treaty negotiations in the coming months. “In our opinion, IHR could be finalized in this meeting this week,” German health minister Karl Lauterbach said before WHA. But the few remaining issues in the IHR amendments are also highly contentious. They include the creation of a new fund — which some low- and middle-income countries are pushing for but that others, including the U.S. and some European nations, don’t support. Some also believe the IHR amendments cannot be concluded ahead of the treaty. Realistically, “we're not going to negotiate a new fund in a week. Probably not even a month and maybe not even in a year,” Lawrence Gostin, founding O'Neill chair of global health law at Georgetown University, told Devex in Geneva. Gostin, who was part of the IHR review committee, said countries should agree on the amendments they’ve already reached consensus on, at least in principle, in the text — and then “make a rigorous, good faith effort to come to agreement on the 20% that [they] don't agree on now.” The advantages are enormous, he said. The IHR has the highest number of state parties of any treaty in the world and countries can choose to opt out of any amendments. “That would never happen with the pandemic agreement. It won't even come into force until enough countries ratify it, [whereas] IHR is immediately in force,” he said. But several countries appear adamant that nothing is agreed until everything is agreed. “We would not be in a position to support an approach which leads to a selective adoption of some provisions while provisions pertaining to equity remain an open-ended agenda,” said the delegate from Pakistan. Uganda said concluding the work on the IHR amendments should not come at the cost of inclusiveness and equity. Countries with smaller delegations would be constrained to participate in the negotiations alongside WHA. “It is our considered view that rushing it is not getting the job done,” said the Ugandan delegate. Gostin fears sticking to the principle of nothing is agreed until everything is agreed “might prevent us from getting anything,” and risks leaving the world less prepared for when the next pandemic hits. “Pandemics don't go on political lines, and a political calendar,” he said. It’s unclear what happens if amendments are not adopted by the end this week. At the moment, there’s no plan B. But Ashley Bloomfield, co-chair of the working group on IHR amendments, said Thursday during a side event hosted by the Pandemic Action Network and others, that they’re “focused on the task” — which he said would also help free up country negotiators as the work on the pandemic treaty proceeds. “We have until 23:59 on Saturday, but we’re not going to take all the time,” he said.