Friday 14 June 2024

 

Complete article-by-article analysis of the adopted IHR and how it differs from what was proposed by WHO in February 2023

Below, I will be comparing the WHO's initiallyproposed International Health Regulations (IHR) amendments of 6 February 2023 with what actually got passed (adopted) on June 1, 2024--because there has been an extraordinary amount of confusion about this in the media.  Please remember that I am a doctor, not a lawyer and these are my impressions.  I will only comment on things I think are of particular relevance.

Here is something else there is confusion about:  the adopted changes will not go into effect for 12 months for most countries and 24 months for others.  So the version of the IHR that is in force currently is the (2005) version, which went into force in 2007.  The bolding and crossed out words are the changes to this 2005 version.

Above I screenshot both document titles so you can see which 2 documents I am comparing.

Below is the key for understanding the meaning of the bold language and struck through language in the 6 February 2023 proposed amendments.

Article 1   Definitions

Article 1 as proposed crossed out "non-binding" for both temporary and standing recommendations.  This meant that all "recommendations" were to become binding "advice."  In other words, they would no longer fit the meaning of recommendations or advice, and instead they would become orders. This was tricky language some lawyer for the WHO came up with, but it was almost immediately exposed.  People did not like it.

In the adopted version, "non-binding" is no longer crossed out.  This means that all recommendations and advice have returned to their clear meaning (recommendations only) and there is no requirement that nations comply with the "advice."  This is extremely important because it removed the teeth from nearly every article in the rest of the document.

Article 2   Purpose and Scope

Article 2 as adopted got rid of the claim that the purpose of the IHR included "health systems readiness and resilience"--which is good, because the proposed terminology was very loose, and a lot of requirements for health systems could be snuck in later as being necessary for readiness or resilience.

The current (2005) version of the IHR noted that public health responses should be a) "commensurate with and restricted to public health risk" and b) "avoid unnecessary interference with international traffic and trade." 

The proposed version expanded possible responses to a) "all risks with a potential to impact public health"-- in other words, anything that might affect health, such as climate change, firearms, sugary drinks, or many other things.

The proposed version of b) was interesting.  The meaning of the sentence was changed in the proposed version to avoid unnecessaryinterference with (language added:) livelihoods, human rights, and equitable access to health products and information.  In other words, while such language did not fit well in a section on Scope and Purpose, it was placed there in order to sneak in the word "unnecessary."  What the sentence then indicated is that it would be okay, when necessary, to interfere with livelihoods, human rights, and equitable access to health products and information.  This was consistent with the crossing out of human rights in proposed Article 3, and therefore I believe it was intentional.

All the worrying changes in the proposed IHR Article 2 that I just described were not included in the amendments that were adopted.

Article 3   Principles

The proposed Article 3, paragraph 1 attempted to fool readers by removing the existing IHR language, which guaranteed that implementation of the IHR must respect "dignity, human rights and fundamental freedoms of persons."  These are rights that are specifically laid out in UN treaties and other documents.  The proposal replaced this with language that did not have legal meaning and was ambiguous besides, while intended to convey an aura of "equity."  The replacement language was: "based on the principles of equity, inclusivity, coherence."

The adopted Article 3 paragraph 1 amendment retained all the original language that guaranteed rights, while adding the words equity and solidarity:  "The implementation of these Regulations shall be with full respect for the dignity, human rights and fundamental freedoms of persons, and shall promote equity and solidarity."  No rights were lost, and equity and solidarity were added.  Of interest, neither equity nor solidarity are defined in the extensive list of definitions in Article 1.

Paragraph 2 simply states an old fact:  the IHR implementation should conform with the UN Charter and WHO Constitution.  Just like US law must conform with the Constitution.  I am not sure why people took issue with this.

Article 4 Responsible Authorities

There already exists a "National IHR Focal Point" in every nation whose role is to notify the WHO of possible outbreaks, etc.  This is an old requirement.

Article 4 creates a second entity, the "National IHR Authority" in each nation, but allows nations to have one entity serving both roles.  The role of the IHR Authority is to implement the IHR regulations.  Note that in the proposed version, this entity would be "held accountable" for delivering IHR "obligations"--in other words, nations would be forced to comply with their "obligations."   All this accountability language was been removed from the adopted version.

Paragraph 2 is about getting information to the WHO in a speedy fashion, through the Focal Points and Contact Points.  Since one of the main reasons to amend the IHR, according to the US, was to be sure that pandemics will not be hidden by national governments, it makes sense that the state parties demand details about how the information about possible outbreaks will be passed on and who will be responsible for doing so.  

In paragraph 3 of the proposed IHR, nations were to be asked or required to pass legislation to give power and funding to the Focal Points.  This language, reproduced below, is gone in the adopted IHR.

NEW (1bis) States Parties shall / ALT may enact or adapt legislation to provide National IHR Focal Points with the authority and resources to perform their functions, clearly defining the tasks and function of then entity with a role of National IHR Focal Point in implementing the obligations under these Regulations.

Article 5 Surveillance

This adopted article newly establishes the norm that nations will be expected to meet core capacities in their public health response within 5 years, or longer if an extension is granted.  WHO is to assist developing nations meet this requirement, but it is not stated what WHO must do.  Open-ended, more extensive requirements in the proposed version were not in the adopted version.  One African nation (Uganda?) noted in its discussion after the new IHR was adopted that it has little outbreaks all the time and it would be onerous and unrealistic to require early reporting of all of them.  This statement portends that African nations may issue reservations or rejection of the surveillance and notification provisions of the adopted IHR.  They have 10 months (or for a few nations, 18 months) to do so.

Article 6  Notification

The proposed Article 6 wanted very specific genetic sequencing data, specimens, and detailed epidemiological information from nations with an outbreak.  The WHO would then share this information with all Parties.  This was not adopted.

The proposed version then stated (disingenuously): 

" WHO shall not transfer the public health information received...[to entities] engaging directly or indirectly with conflict and violence elements."  

I found this proposal horrifying:  WHO planned to share pandemic pathogens with anyone who wanted them, with the exception of those "engaging... with conflict or violence elements"?  

Why did WHO plan to proliferate microorganisms that could cause pandemics?  The WHO's use of this language seemed to me to be an attempt to obtain tacit agreement from nation states to the idea of proliferation.

The adopted Article 6 fails to say anything about the WHO transferring materials.  It omits the terms "genetic sequence data" and while it requires information, it is much less specific about what information nations must provide.

Article 7   Information-sharing during unexpected or unusual public health events

The proposed language demanded that nations supply microbial samples and genetic sequence data to WHO.  The adopted language simply says nations will supply all relevant public health information.  I was struck by how aggressively the WHO demanded genetic sequence data in many versions of the documents and was pleased that such language was removed everywhere.

Article 8   Consultation

Not much of significance changed

Article 9   Other Reports

The proposed article removed the requirement that the WHO would have to consult with the nation in whose territory an outbreak was occurring before taking action.  This was not removed in the adopted version.

This wording was proposed: 

(New wording) "In the recommendations made to the States Parties regarding the collection, processing and dissemination of health information, WHO could advise the following: (a) To follow the WHO guidelines on criteria and analogous modes of processing and treating health information."

Remember that in the proposed version, 'advise' could mean "order' (if the term 'non-binding' had been eliminated as proposed, which did not make it to the adoptedversion).  This would have given WHO wide berth regarding for demanding information and what WHO could do with the information.

Article 10. Notification

Insignificant

Article 11.  Provision of information by WHO

Insignificant

Article 12   Determination of a public health emergency of international concern, including a pandemic emergency

The proposed amendment included more than a page of language about emergencies that were not severe enough to meet a PHEIC, or were regional emergencies or potentialemergencies.  This language was removed from the adopted version.  There is no option for declaring "potential" emergencies as was desired.

Article 13  Public health response, including equitable access to relevant health products

The WHO is to assist nations to obtain or produce health products, but there are no real specifics or guarantees of what assistance will be provided.  Product dossiers will be shared if manufacturers agree.  This is what developing nations wanted but they got nothing concrete.

Article 14   Cooperation of WHO with intergovernmental organizations and international bodies

No change

Article 15 Temporary recommendations

The proposed article included "The recommendations based on these assessments shall include:

(a) support by way of epidemic intelligence surveillance, laboratory support, rapid deployment of expert teams, medical countermeasures, finance as well as other requisite health measures to be implemented by the State Party experiencing the Public Health Emergency of International Concern"

You may remember a video of bill Gates discussing the deployment of expert teams flying to an outbreak to gather information and maybe perform other tasks.  The 2023 NDAA also talks about the US sending "teams" [military] to foreign nations when the USG is not being given sufficient information about an outbreak.  The CDC has long sent epidemic intelligence service staff to outbreaks on request, but the language used here could have opened the door to CDC and its quasi-military Public Health Service members entering uninvited.

I don't think most nations want the US or anyone else barging in to "assist" without being invited.  The word "shall" in a treaty means "must," and that, along with the original plan to make these articles binding, would have made every nation susceptible to being invaded by foreign teams in response to suspected outbreaks.  The adopted version did not include any of this.

Article 16   Standing recommendations

Insignificant

Article 17   Criteria for recommendations

Insignificant

Article 18   Recommendations with respect to persons, baggage, cargo, containers, conveyances, goods and postal parcels

The proposed article included this:

"ensure mechanisms to develop and apply a traveller's health declaration in international about travel itinerary, possible symptoms that could be manifested or any prevention measures that have been complied with such as facilitation of contact tracing, if necessary..."

This was not included in what was adopted.  Other changes are insignificant.

Article 19   General obligations

Insignificant

Articles 20-22 were essentially unchanged

Article 23  Health measures on arrival and departure

This is where health documents and "passenger locator forms" which could be used for contact tracing were to be enforced in the proposedIHR.  But the old IHR was retained (adopted) without changes.

Article 24  Conveyance operators

The proposed article added the ability for conveyance operators to " implement quarantine promptly on board as necessary."  This was dropped in the adopted IHR.

Articles 25 and 26 are unchanged

Article 27   Affected conveyances

The ability for a "competent authority" to quarantine a conveyance was adopted.

Articles 28-34

No changes

Article 35  General rule

Authentic paper or digital health documents are required, but the proposed need for a QR code and detailed language on authenticity is gone

Articles 36-42 are essentially unchanged

Article 43  Additional health measures

The proposed article 43 paragraphs New 3 bis. and 4 used tricky language to give the WHO Director-General the right to withhold medications if he found them to be "disproportionate or excessive."  This was the unbelievably bad clause to be used to stop people obtaining hydroxychloroquine, ivermectin, vitamins or other substances during declared emergencies.  The adopted article 43 did not include this.

Article 44 Collaboration and assistance and Article 44 bis.

The proposed article established a funding mechanism for the IHR to provide assistance to developing countries to meet the obligations they would take on for pandemic preparedness activities, including core capacities.  A funding mechanism for pandemic preparedness has already been established in 2022 jointly through the WHO and World Bank but is funded with under $2 Billion.  Estimates are that the pandemic program envisioned by the WHO would cost $30-42 Billion/year.

The obligations for which funding might be provided, or loaned, would have included:

"1.  (c) (New) building capacity to identify emerging public health threats, including through laboratory methods and genome sequencing; (c) (new) strengthening capacity to identify health threats including through surveillance, research and development cooperation, technological and information sharing. (e) (new) collaborating with each other, with WHO, the medical and scientific community, laboratory and surveillance networks, to facilitate timely, safe, transparent and rapid exchange of specimens and generic sequence data for pathogens with the potential to cause pandemics and epidemics or other high-risk situations... digital technologies to improve and modernize communication for preparedness and response to health emergencies, including to better meet the obligations of these Rules (h) (new)in countering the dissemination of false and unreliable information about public health events, preventive and anti-epidemic measures and activities in the media, social networks and other ways of disseminating such information"

This language above, listing expectations c) -- h) is missing from the adopted version.

I anticipate that nations will be given small grants while being encouraged to take on large debt obligations to meet their "core capacities" and potentially build out other parts of the pandemic preparedness agenda.

Articles 45-47 are unchanged

Article 48-53 had only minor changes

Article 54 and 54 bis.

The adopted version does establish an implementation committee though it omits the proposed compliance committee.  The proposed IHR suggested it wanted to be able to enforce the IHR.  In the adopted version, the implementation committee is specifically stated to be advisory only:

1. The States Parties Committee for the Implementation of the International Health

Regulations (2005) is hereby established to facilitate the effective implementation of these Regulations, in particular of Article 44 and 44bis. The Committee shall be facilitative and consultative in nature only, and function in a non-adversarial, non-punitive, assistive and transparent manner, guided by the principles set out in Article 3.

Articles 55-66 are unchanged

ANNEX 1. A Core Capacities

Countries will be obliged to take on new obligations in this ANNEX, and surveillance and censorhip are among them, both at the national and local levels. This is where we lost, but I was expecting to lose this because, as other items were jettisoned in successive drafts, this obligation always remained. And all Western nations and probably others as well are already surveilling and censoring their citizens:

ANNEX 6.  VACCINATION, PROPHYLAXIS AND RELATED CERTIFICATES

This is the section where the language is loose enough for people to obtain "fake" vaccine certificates.  There is no requirement for "true" authentication.  No need for a QR code.  The authorities are essentially requiring the same level of authentication required when I went to Africa in 1972, rather than detailed authentication that was proposed.

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