Statement 148 of the Executive Board of the Chairman of the Committee on the Audit of the Functioning of International Health Regulations (2005) during response to COVID-19

Distinguished Chairman, Excellence, General Manager, Ladies and Gentlemen

Thank you once again for the opportunity to provide you with the latest information on the work of the Committee for the Review of the Functioning of International Health Regulations (2005) during COVID-19.

As you know, this committee was convened by the Director General on September 8, 2020, in accordance with World Health Assembly Resolution WHA73.1. The Board shall be composed of experts with a wide range of expertise and appropriate gender and geographical representation. I am honored to chair this committee, and I am supported by our Vice-President, Professor Lucille Blumberg of South Africa, and our rapporteur, Professor Preben Aavitsland, of Norway.

Our mandate is to review the functioning of the International Health Regulations (2005) during the response to COVID-19 and the status of implementation of the relevant recommendations of previous IHR audit committees and to provide technical recommendations to the Director General, including any potential amendments.

So far, we have convened 16 closed meetings and continue to work through three subgroups: alert, alert, and response. I take this opportunity to reiterate my gratitude to our three subgroups. We also convened 5 open meetings when we provided up-to-date information on our work and listened to submissions and questions raised by Member States, international agencies and NGOs in an official relationship with the WHO. These open meetings are still attended by a number of appointed representatives.

I reported on our progress to the 73rd World Health Assembly on November 9, 2020. And I continue to communicate regularly with the Co-Chairs of the Independent Pandemic Preparedness and Response Committee and the Chair of the Independent Advisory Committee.

Let me now turn to the essence of our work. I invite you to read our interim progress report, document EB148 / 19. It details our preliminary findings from December 2020, which came after numerous interviews, discussions and reviews of the wealth of documentation.

Let me highlight the most important:

1. Member States and experts overwhelmingly support the IHR as the foundation of international public health and health security law, but several areas need to be improved if we are to be better prepared for the next pandemic. Although we have not completed the evaluation by articles, there is a growing belief in the Committee that most of the necessary improvements can be achieved through more effective implementation of existing IHR provisions and does not currently require changes to the IHR design.

2. National IHR contact points need to be further strengthened, including, where necessary, national legislation. National contact points play a crucial role in the timely exchange of information, but their limited authority and status often lead to delays in notifications. The Committee noted that the effective implementation of the IHR requires many functions that are not within the narrow mandate of the national IHR contact persons, such as multisectoral coordination for preparedness and response and collaborative risk assessment. The absence of a dedicated national entity with sufficient authority and a clear mandate to take ownership and lead is considered a significant constraint on the effective implementation of the IHR at the national and subnational levels. At the state level, national IHR contact points should be integrated into the national emergency plan, as should the national health committee or similar body.

3. The possible need for a medium level of warning before declaring a public health emergency (PHEIC) is also being considered. A previous Ebola response review committee recommended such a mid-level, but this recommendation was not accepted. At the fifth open meeting of the Committee on 12 January 2021, issues related to the possible introduction of a grading system were discussed. The Committee will further examine the different views expressed by Member States and the advantages and potential disadvantages of the new system. It is clear that actions of global preparedness, alert and response must begin much earlier and more decisively than they began during COVID-19. But it is far from the case that the introduction of a medium level of warning would result in such earlier action. The Committee considers how regular global and regional risk assessments can be better used to guide earlier and more targeted responses at all levels. The Committee believes that the aim should be to react early and strongly enough to prevent the need to declare a PHEIC.

4. Compliance with IHR provisions remains a challenge in several areas, from the establishment of basic capacities to the implementation of travel measures during health emergencies. The Board notes the lack of teeth in the IHR. We are therefore looking for new ways to monitor and assess IHR compliance – both in readiness and in response – and to strengthen existing tools without overloading countries. Consideration of a review mechanism similar to the Universal Periodic Review used by the Human Rights Council could be useful to improve preparedness and response. For example, the Universal Periodic Review has been shown to encourage cross-sectoral coordination and government-wide approaches, encourage good practice and link the implementation of its recommendations to other government programs – all of which are vital for strengthening IHR implementation. In this context, the Director-General proposed the Universal Health and Preparedness Review initiative, which is currently under pilot testing.

5. Last but not least, political support and resources for IHR implementation remain insufficient and irregular at all levels. In this context, the Committee awaits further detailed information on funding mechanisms for the implementation of the IHR.

I would like to make clear my belief that we need more meaningful cooperation during and between health emergencies; more transparency, more regular detailed exchange of data and experiences in real time at all levels, greater reliability of interaction and higher speed of exchange of data and samples. Fortunately, digital technology supporting such developments is becoming increasingly available, from data mining for early detection of disease outbreaks, through next-generation sequences to track pathogens around the world, to virtual conferences that facilitate human interaction.

To conclude, the deadline for our final report is the 74th World Health Assembly in May 2021. However, as we all know, the COVID-19 pandemic will not be over in 4 months, and therefore our findings and recommendations will not necessarily be complete. Further considerations may be needed later.

Let me repeat what I said in November 2020 on the occasion of the 73rd Health Assembly: IHRs are your instrument, our instrument, of international public health law. Their work requires providing the WHO with the tools and resources needed to better prepare and protect humanity from public health risks, through an effective, coordinated, multisectoral and evidence-based public health response.

Thank you once again for the opportunity to speak with you today, and let me also thank the Director-General for the excellent support provided by the WHO Secretariat to this Audit Committee.