World Health Assembly Finds Way Forward On Pandemic Flu

Responsibility to take forward a still in-progress framework to cope with global influenza pandemics is now in the hands of the World Health Organization Director General Margaret Chan, member states agreed in a meeting Thursday. This was approved by the full World Health Assembly on Friday.

Chan will “facilitate a transparent process to finalise the remaining elements” of the agreement and report the work to the next meeting of the WHO Executive Board in January.

The framework is intended to set forth guidelines for the sharing of viruses, vaccines, and other benefits related to pandemic strains of influenza. This includes mechanisms for tracing and reporting outbreaks, as well as for capacity building, technology transfer, and stockpiles of vaccines. It also includes a model binding contract for entities sharing viruses with pandemic potential.

After working for the last two years to bridge differences over what guidelines are needed to ensure the readiness of the world, and especially its poorest places, to cope with a potential global pandemic, member states proved unable to find consensus on several key parts of the framework, in particular a standard material transfer agreement (SMTA), a legally-binding document to be used in the case of virus sharing.

The Intergovernmental Meeting (IGM) on Pandemic Influenza Preparedness concluded its final meeting on Saturday (IPW, WHO, 18 May 2009).

Member states came to the 18-22 May World Health Assembly (WHA) with the incomplete body of work and the conviction that “the half-finished work of IGM can’t be left as it is,” as India said during the WHA.

“Development of a fair and equitable system is vital to continuing pandemic influenza preparedness efforts, [and] trust in the previous system has broken down,” said the Australian delegation, during the Thursday meeting. It is “most important to finish the SMTA,” they added.

Process Concerns

The biggest concern was over what kind of process the way forward would entail.

Some wanted more formalised negotiations, believing the legitimacy of a multilateral, process including all member states was necessary to lend appropriate weight to the remaining text, which many consider to contain the most critical elements of the framework. Without a formal process, they were concerned that unfinished parts of the text would never be fully addressed.

“Collective good from international regimes gain strength and legitimacy when they come from member-driven negotiation,” said Brazil during the meeting.

Others were concerned that formal consultations would be a repeat of the IGM process, which over the last two years had failed to produce an agreement. Formal talks, they said, are expensive, have not proven effective, and would keep health ministers away from their countries precisely when they are needed most: while the threat of a pandemic outbreak looms.

The “more we think of it, the less we see a reason to create another IGM that would be redundant at this time,” Israel said during the Thursday meeting.

One nation, Thailand, was frustrated enough with the process that they even suggested terminating the discussion. If there is good public spirit, the delegation said during the meeting, much can be achieved without resolution. Further, they did not want a resolution that would be “just another pile of papers to help lawyers make their livings.” But, they said they would accept a resolution on a way forward to please other delegations.

Israel agreed, saying that the process for dealing with pandemic influenza needed to “be result and not resolution oriented,” but also said that they could accept a way forward.

In the end, careful language was found to bridge the gap. It reads that member states:

“Request the director general to facilitate a transparent process to finalise the remaining elements, including the standard material transfer agreement and its annex, and report the outcome to the Executive Board at its 126th session in January 2010.”

The use of the word ‘finalise,’ said Chan in the meeting, is important because it emphasises that member states want results. Notably excluded from the text is the word “negotiations,” which Chan said is a term of art meaning another intergovernmental meeting.

Also excised from the text was “all member states,” which caused concern from developing and least developed country members who were worried their voices would not be heard. But Chan said it was for pragmatic purposes, and promised in her meetings she would choose a geographically and gender balanced group.

The resolution also asks the director general to take forward elements of the framework on which there is already consensus. These include key agreements on benefit-sharing and aspects of virus-sharing.

Reactions As Governments Look Forward

“Now it’s anchored,” said Abdulsalami Nasidi of Nigeria, who had drafted part of an original proposal on a way forward and who had chaired one of the working groups during the IGM process (IPW, WHO, 19 May 2009). “Now I can be proud to be part of the IGM; it’s a beautiful end.”

Part of the reason for the successful way forward, he told Intellectual Property Watch, was the willingness of the United States and Mexico to share viruses and science during the H1N1 swine flu outbreak, “to the surprise of many.”

Now it is just necessary to facilitate a process of sharing outside of an emergency situation, “because emergencies happen without warning.”

However, states “have to be careful” during the process, said Silvio Albuquerque from the Brazilian delegation. Brazil was a leading voice in calling for a more formal way forward.

“We trust the director general,” added Albuquerque, but we “will be following the process” closely and with caution.

“We do not accept just the framework” if the rest of the agreement – including the SMTA – is not finalised, he explained, reiterating that nothing is agreed until everything is agreed.

We insist, he added, the process be member driven, and that industry is only allowed to participate if civil society is included as well.

As a part of the wider picture, both the United Kingdom and Switzerland suggested that Chan be given wider flexibility to decide on “phases” indicating the seriousness of a pandemic. Currently, WHO phases are based on geographical spread; but they should also look at severity, the countries said. Also, the UK said, WHO should look into broad-spectrum vaccines that are able to combat many strains of influenza and last a while. Then, the country said “we can talk about prevention rather than containment and mitigation.”