Countries plot changes to World Health Organization once pandemic recedes

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While many world leaders disagree with Trump’s attempts to make the WHO a scapegoat for the early spread of the coronavirus in 2020, they acknowledge the multilateral organization needs changing.

Now, Germany, France and Chile are signaling they agree on many of the changes the U.S. is seeking at the WHO, even as the Americans head for the exit.

POLITICO reviewed reform proposals from the U.S, France and Germany and Chile, which concur on several points: The world health body should be able to access areas where an outbreak has occured early on; have a more nuanced system to define health emergencies than the current one; and be able to assess whether countries are respecting international rules on health emergencies and are prepared to respond to and report them.

While no one — not even the U.S. — is naming names, it’s clear that the WHO’s lack of access to China early in the coronavirus outbreak, as well as its powerlessness to hold China and others to account for not reporting emergencies fast, were the impetus for these changes.

“There is significant common ground about how to address those problems and reform the organization so we can avoid a repeat of the COVID-19 disaster in the future,” said a spokesperson for the U.S. Department of Health and Human Services.

The WHO reform — or as one-Geneva based diplomat POLITICO spoke to called the proposals, “improving preparedness” — is not formally on the agenda of the Executive Board meeting next week, but the fight to influence the discussion is on. The Executive Board is a WHO governing body made of 34 national representatives elected for a three-year mandate which works to implement the decisions and policies of WHO general assembly.

Germany, which holds the rotating presidency of the EU Council of Ministers, organized a meeting Friday with the rest of European Union health ministers to discuss the bloc’s position on global health. The richest EU country has long eyed a bigger role on the issue and at the WHO, and the U.S.’s withdrawal in the middle of a pandemic is providing it with an opening.

“While the EU has not been perceived as a key player in global health for a long time, the situation has now changed radically as the COVID-19 pandemic, including the difficult geopolitical situation, has brought global health to the centre of attention also in the EU,” Germany said in a document drafted ahead of the meeting that was seen by POLITICO Europe.

It is not yet clear if China is preparing its own vision for WHO changes. The country’s mission at the U.N. in Geneva did not respond to repeated requests for comment.

Its deputy ambassador in Geneva Li Song in late September tweeted what he called a “reality check” in response to U.S. allegations against it and the WHO. One of the 24 allegations the tweet responds to is that a Chinese cover-up is to blame for the virus spreading across the world.

“What has happened is an unexpected attack by an unknown virus against human beings,” the rebuttal said. It maintained that China has been transparent with the information provided. “Statistics show that very few cases were exported from China,” it said.

For his side, Russian President Vladimir Putin said during his speech at the United Nations General Assembly that the work of the WHO needed qualitative strengthening. Daria Rudakova, a spokesperson for the country’s mission in Geneva, provided some additional details about what that means: more money, more transparency and more accountability to member countries.

“Further strengthening the WHO Health Emergency Program (WHE) should be considered a priority,” Rudakova said.

But the discussion for change should not just be pushed through without “solid evidence and reliable expertise,” she said.

How to do better next time

Everyone agrees that there will be more pandemics in the future. A renowned Belgian virologist even said humanity may be entering an age of pandemics.

A split between the U.S. and France and Germany this summer over how to reform the WHO appears to have been more about optics than substance. The two European countries didn’t want the U.S. to lead the process, given it’s leaving the organization.

But the three countries and Chile use similar language in their proposals when it comes to, for example, granting the world health body speedy access to a place experiencing an outbreak, for example.

The WHO’s network should be enabled to “immediately perform outbreak investigation” in member countries, France and Germany said in their paper. “This would allow the WHO to alert the world about a potential global emergency sooner,” they add.

An Emergency Verification Committee should be set up to “proportionally evaluate situations or events that could be underestimated, thus hampering decision-making,” Chile said in its proposal, seen by POLITICO.

When a public health event is considered to endanger international public health and potentially requires an international response, the WHO can declare it a public health emergency of international concern. The WHO did that for coronavirus at the end of January. It is the highest form of alert, obliging countries to share information about it with the WHO. The global health body began calling it a pandemic on March 11 — meaning that it was affecting virtually all countries in the world.

But such health emergencies would be better categorized under a sort of traffic light system, with different levels of alert requiring different actions to be taken, all four countries suggest.

The current alert system was established in the International Health Regulations, a set of international laws that require countries to report outbreaks of diseases that may pose a wide scale threat. But there is no real punishment for countries that don’t abide by those rules.

Trying to amend the regulations is a difficult undertaking that may end up weakening them further, said Lawrence Gostin, a professor of global health law at Georgetown University. Having a sort of inspector to really enforce those rules and investigate outbreaks may make the world safer and more secure, but “the geopolitical challenges are overwhelming,” he said.

Nonetheless, the U.S. suggests giving the WHO a way to assess how well a country is complying with the alert system and reporting rules. France and Germany ask for a similar “review mechanism,” while Chile wants a periodic review of countries’ capacity to detect, assess and notify health events of concern.

Managing expectations

While there are plenty of ideas for how to change the WHO, one thing is certain, France and Germany argue: the organization faces unlimited expectations despite very limited funding. Countries provide roughly one fifth of the body’s biennial budget through mandatory contributions, less than $1 billion total. The rest comes from countries’ voluntary contributions, as well as from foundations, private companies and other entities. France and Germany argue that funding model is not sustainable if the WHO is to meet the world’s multitude of demands.

The U.S. acknowledges the issue too, even as it withholds part of its 2020 dues as it prepares to withdraw its membership in the organization. “We commit to serious consideration of potential budget reforms that would ensure adequate and sustainable financing for WHO and accelerate continued performance gains,” it said in its paper.

It’s hard to predict how many of the changes that countries are pushing for will actually happen, Georgetown University’s Gostin said.

“Certainly, I’m hoping that there’s going to be greater and more stable funding for the World Health Organization,” he said. He’s also hoping that there will be more political support for it and more flexibility to declare a public health emergency in stages.

“It would be a huge missed opportunity if we didn’t use this crisis to create positive reform at the World Health Organization.”

Jillian Deutsch and Sarah Wheaton contributed to this report.

VACCINE RACE LATEST

WHO gets promises for more money: The WHO didn’t leave the United Nations General Assembly empty handed. The health body implored member countries to donate more money for coronavirus vaccines, medicines and tests. In the end, it managed to secure about $1 billion in additional commitments. The money came from the British, Canadian, Swedish and German governments, and is mostly meant to help purchase future vaccines for low- and middle-income countries. That means the WHO now has about $4 billion of the minimum $38 billion it estimates it needs to help countries fight Covid-19 across the world.

The World Bank is also expected to provide $12 billion in funding to help developing countries purchase Covid-19 vaccines as soon as they are available. The Bank’s shareholders still have to approve that plan.

Vaccine nationalism: A new report from the ONE campaign — which works to advance development globally — argues that 15 of the G20 countries and many drugmakers are “impeding equity” when it comes to vaccine access, and that no country or company meets the group’s criteria for “advancing equity.”

Bad and good news for AstraZeneca: The U.S. Food and Drug Administration is digging deeper into the report of illness that forced a temporary halt to trials of the vaccine candidate developed by AstraZeneca and Oxford University. The trials have resumed in the U.K., Brazil, India and South Africa, but not in the U.S., where the drug regulator wants to determine if similar side effects appeared in trials of other vaccines designed by Oxford University.

Meanwhile, the European Medicines Agency has started reviewing data necessary to approve the vaccine as it comes in. “This does not mean that a conclusion can be reached yet on the vaccine’s safety and effectiveness, as much of the evidence is still to be submitted to the committee,” it said.

Second vaccine coming in Russia: A second vaccine developed in Russia is expected to be approved for use in the country by Oct.15, even if it has not gone through large-scale studies to see if it’s safe and effective. The first one, Sputnik V, was approved in August, even though late-stage testing is ongoing.

Putin, Russia’s president, has not yet taken the Sputnik vaccine, even though he claimed his daughter had gotten it. His way of keeping the coronavirus away, for now? Strict isolation from most people and two-week quarantine for anyone who needs to meet him in person.

GLOBAL HEALTH SNAPSHOTS

Trump has coronavirus: The U.S. president is now the highest profile person in the world to have a confirmed infection of the coronavirus. His wife Melania also tested positive Covid-19. Aged 74 and overweight, the U.S. president is at risk of serious complications from the virus. His doctor said that both Trump and the first lady were doing well and that the president will continue to carry on with his duties. Vice-president Mike Pence and his wife tested negative in a routine test.

Global Health Spotlight is ending: This is the last edition of the Spotlight. If you missed any editions over the last three months, you can read them all here. And if you’re hooked, we’ve got great news: Global Pulse, a new weekly newsletter that pulls back the curtain on the politics and policy driving global public health, is coming Oct. 22. You can sign up here.

Who’s done well: As the world hit another Covid-19 milestone this week — one million deaths — WHO boss Tedros Adhanom Ghebreyesus tried to stir hope in countries that may now feel overwhelmed by the pandemic. Just look at Italy, the WHO said, where, “National unity and solidarity, combined with the dedication and sacrifice of health workers, and the engagement of the Italian people helped bring the outbreak under control.”

Other countries getting good grades: Thailand, Uruguay, Pakistan, Cambodia, Mongolia, Japan, New Zealand, South Korea, Rwanda, Senegal, Spain and Vietnam.

Ebola workers accused of sexual abuse: WHO staff in the Democratic Republic of Congo, along with workers from other international organizations and charities, allegedly gave women jobs in exchange for sex, according to a journalistic investigation published this week. Some of the women reported being abused. The WHO has promised to investigate and take action, “including immediate dismissal.” How about criminal prosecution?

How the pandemic is ruining children’s lives: Children may have largely been spared from serious infection and death, but the virus’ consequences on communities is hitting them hard. Some children in India and other developing countries are taking illegal and often dangerous jobs. And Save the Children warned that 2.5 million more girls are at risk of early marriage by 2025, which would reverse more than two decades of progress toward ending the practice.





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