The assembly hall of the Palace of Nations, Geneva, where the World Health Assembly usually meets. Photo: Tom Page/Wikimedia Commons, CC BY-SA 2.0.
The World Health Assembly (WHA) Resolution 73.1 on COVID-19 response, adopted on May 19, requests the director-general of the WHO to initiate a stepwise independent and comprehensive evaluation of WHO’s coordinated response to the novel coronavirus outbreak.
The purpose of the evaluation is to “to review the experience gained and lessons learned from the WHO-coordinated international health response to COVID-19”. The scope of the evaluation under paragraph 9.10. of the resolution includes (1) effectiveness of WHO’s mechanisms, (2) functioning of the International Health Regulations (IHR) and the implementation of recommendations by previous IHR Review Committees, (3) WHO’s contribution to UN-wide efforts and (4) the actions of WHO and their timelines pertaining to the pandemic. The review is also required to recommend ways to improve WHO’s emergency programme and strengthen its pandemic response.
The new resolution requires the director-general, currently Dr Tedros Adhanom Ghebreyesus, to consult the member-states and initiate a review, and decide how to carry it out.
Two mechanisms already exist to conduct reviews: the Review Committee under the IHR and the Independent Oversight and Advisory Committee of the WHO Health Emergencies Programme. However, the resolution now allows the director-general to establish a new mechanism altogether.
The question of evaluation is politically important due to the US’s and other countries’ accusations that the WHO didn’t announce the current outbreak to be a public health emergency of international concern (PHEIC) soon enough. And the scope of the review and the resolution’s text reflect this politics.
The proposed review under Resolution 73.1 ignores the evaluation of the member-states’ actions and is one-sided against the WHO. While the director-general has the power to review the actions of both the WHO and its member-states without a consultation, the new resolution requires him to act in consultation with member-states even to initiate a review.
Article 50 of the IHR 2005 allows the director-general to independently establish a review committee, which can then recommend amendments to the IHR, modification or termination of standing recommendations, and changes to the IHR’s functioning. Article 43(4) also empowers the WHO to assess member-states’ additional health measures, including those beyond what the WHO has recommended.
As such, both these provisions confer the director-general with independent capacity to refer the actions of the member-states to the IHR review committee. Thus, the new resolution effectively undermines the director-general’s powers.
There have been three IHR reviews thus far. Two of them related to response to health emergencies. In 2009, the director-general, by a proposal to the executive board of the WHO, initiated an IHR review of the H1N1 pandemic response – of both the WHO and its member-states. The 2015 review was primarily about the actions of the WHO and the effectiveness of the IHR. In this year, the WHA decision 68(10) established the terms of reference for the review committee; the WHA took this decision after the executive board asked the director-general to set up an IHR review committee.
Importantly, both the 2009 and the 2015 reviews did not require a member-state consultation to get going.
Though the proposed review under the new resolution, numbered 73.1, covers measures beyond the IHR, it cleverly excludes a review of the actions of member-states. It still includes the IHR’s functioning and the implementation of previous review committees’ recommendations, but with the focus squarely on the WHO secretariat’s actions. The review doesn’t seek to examine how well the member-states can implement their core capabilities either. So the member-states are using the resolution to collectively obscure their own accountability.
This is disturbing. There are many countries, both big and small, that have either allegedly ignored their obligations under the IHR or adopted measures beyond those recommended by the WHO. And so far, their actions have gone unchecked. China is at the top of this list : it allowing the mayor of Wuhan city and other residents to move out of the affected area before the national government declared a lockdown in late January. This move contravenes the WHO’s travel advisory dated January 9, 2020. The Chinese government has also been accused of suppressing the voices of healthcare workers who warned the people of the outbreak.
Following closely behind is the US, which didn’t impose physical-distancing norms soon enough; even in April, at least eight states hadn’t issued stay-at-home guidelines. Other countries have made less egregious mistakes but they have erred nonetheless. Italy allegedly downplayed the gravity of its epidemic in February and failed to create awareness. Places of mass gatherings, like cathedrals, were reportedly open until March. Spain also allowed mass gatherings and rallies until early March. All these actions ignored the PHEIC declaration, which the WHO had issued on January 30 itself.
India itself violated the 2016 WHO guidelines on Monitored Emergency Use of an Unregistered or Investigational Drug when it recommended hydroxychloroquine to frontline health workers without any caveats in late March.
There are many such actions on the part of member-states that need to be scrutinised for their compatibility with their obligations under the IHR.
In his opening remarks to the 73rd WHA on May 18, UN secretary-general António Guterres noted that different countries had followed different, and often contradictory, strategies to deal with the virus. He said many countries had ignored the WHO’s recommendations and, as a result, the virus had spread around the world. Many states have also interpreted the recommendations differently.
Dr Ghebreyesus, the WHO director-general, said in his opening and closing remarks at the WHA that the review should ideally examine the actions of the member-states as well. He was possibly reflecting on the exclusion of the member-states’ actions in the resolution. Indeed, the bigger question is whether Dr Ghebreyesus will exercise his independent powers under the IHR to review the member-states’ actions and make sure they remains accountable.
His remarks, on the other hand, also raise doubts of a possible political bargain between him and the member-states. It may be an open instance of the director-general indicating possible retaliation in case the member-states target his office. If this political scuffle between him and the member-states continues, it will only subvert the independent and unbiased evaluation of the world’s COVID-19 response, fail the purpose of Resolution 73.1, and leave science and evidence as the first casualties.
In the end, public health concerns may fail again, unless a new voice shakes up the consciousness of international organisations, their member-states and officials.
Nithin Ramakrishnan is an assistant professor of international law at the Chinmaya Vishwavidyapeeth (deemed to be university), Ernakulam. He is a scholar of traditional international law and closely follows the WHO and the IHR implementation.