 MC12 is the 12th Ministerial Conference of the Ministers at WTO that obviously is a space that's much more oriented towards realizing a free trade system and the right to health is not a priority issue for WTO. In contrast, the World Health Assembly is hosted by the World Health Organization and the right to health, meaning the right to the highest attainable standard of well-being is very much at the center of WTO's agenda. So the institutions are different also in terms of their procedures. WTO is more transparent than WTO, so for example at the WHA the agenda is published and the documentation relating to particular agenda items is made available usually in advance. In addition, civil society organizations that are in official relations with WTO can attend the meetings, they're partied to discussions, they can listen to discussions of agenda items and they can make statements from the floor. In contrast, the World Trade Organization is much more closed, so civil society organizations don't have access to meeting rooms, you don't know what's being discussed and also the proposed texts and so forth are not published as a matter of routine. And so in this way, WTO is slightly more open to civil society participation. They can work on similar issues, one example would be food but they see the very differently. So WTO for example would look at the health effects of food, food would be something that they're concerned about in relation to diabetes, heart disease and so forth. And so we've seen in this agenda that WTO is addressing interventions aimed at mitigating the extent of NCDs, so dealing with the effects, but that there's still a kind of constraint in dealing with the commercial determinants of NCDs. So the way in which corporate actors can shape the policy landscape for example, there's an acknowledgement that that's an issue, that that's a problem in WHO documentation, but there isn't necessarily an emphatic exclusion of corporate actors in big agri or big food from stakeholder consultations for example. So WTO also deals with issues around food but here the issue is seen as an extension of the trade agenda but still these agendas have an impact on social determinants of health. So for example one of the items being discussed is an item relating to fisheries and agricultural provisions and there is a concern that at this ministerial conference decisions will be taken that harm the livelihoods of small scale fishes and agricultural producers and that give big players in these industries even more power. So obviously that will affect livelihoods and also access to food and in this way down the road it affects also the right to health but as I said at the beginning WTO is mandated to prioritize the right to health. So similar issues with very different approaches although in both institutions there is an openness to consultation with for-profit actors in the under the guise of multi-stakeholderism. Many of the current discussions are aimed at creating an infrastructure that could make responses to health emergency more effective but also one of the mandates was to make sure that these responses are more equitable. So there is some concern that some of the framing around the language of pandemics versus health emergencies that that's likely to undermine equity. So what do I mean by that? A pandemic is something that comes along less frequently than health emergencies and many of the equity considerations being discussed for example the obligation of welfare countries to assist developing countries in under conditions of health emergencies. There's a concern that when the language shifts from health emergencies to pandemics that those kinds of equity considerations only then apply to these much more wide scale events because pandemics of course are broader in their scope than health emergencies right and so ideally we'd like to see equity considerations in responses to health emergencies not just pandemics. So there is there has been a kind of struggle around the language used to describe the the kinds of responses to specific these specific two types of interventions. There is a lot of discussion about institutional reforms and increasing efficacy and one way in which that discussion has moved is a set of proposed amendments by the US government to the international health regulations. So those propose centralizing decision-making power in the DG. It suggests shorter time frames for reporting outbreaks and so forth and it also limits the obligation to consult with national governments experiencing an outbreak and so this is something different something that to some extent limits I suppose it could be accepted the sovereignty or the degree of consultation with states in which outbreaks are happening so that's I think something that might be posed for concern for some countries. There's a lot of discussion about financing for pandemic preparedness surveillance and so forth or alternatively for health emergencies. So the financing discussion is obviously important but it does seem to be centered around a fairly specific issue which is this issue of health emergencies and so more extensive attention could be paid to investing in health systems as the foundation of any response to a health emergency. So in other words right now the attention seems to be on making health systems resilient during emergencies but I would argue that a more foundational response is to make sure that health systems are functional all the time and that could then make them more capable of spotting outbreaks and if needed responding to health emergencies or pandemics. I think another thing to think about in relation to this is that yes financing for emergencies is important but so there are other mechanisms that could increase the fiscal space that governments have one would be looking at debt especially odious debt that the countries are holding and that constrains what they have available to spend on public services like health and so debt and austerity policies also are problematic in terms of undermining investments in the public offices. Yes so Trips waiver was introduced in October 2020 by Indian and South Africa and it's been I think a steep road in terms of getting WTO members to accept the waiver in its original form. A leaked text was released a couple of months ago and it was framed as a text that had been created through consultations with India, South Africa, the EU and the US. So the leaked text seems to be closer to the EU's position throughout the debates on the Trips waiver. Of course the original waiver asked for suspension of many different forms of IP not on patents and it also asked for the suspension of the waiver to apply to vaccines, diagnostics and therapeutics. What we see is that the leaked text is much narrower so for example it only deals with vaccines and that doesn't seem to have shifted that it's been criticized for not really being a waiver at all but an extension of the EU position that the Trips flexibilities are sufficient and so the waiver expands on the ways in which for example licensing compulsory licensing can be done to increase access to vaccines in particular and so I think it's very much an issue that is important. I think if the waiver in its original form can be passed it would set a huge precedent for equity and access to essential medicines and I think the length of time that it's taken to pass the waiver shows that the IP system is dysfunctional so even in the midst of a huge crisis it's not doing what it supposedly could do with existing flexibilities. It's been two years more than two years and existing flexibilities have not delivered tech transfer increased access to vaccines and so forth and so I think it would be regrettable if the leaked text would become the baseline position in future for future suspensions of IPs during the emergency. So I think one of the things to look out for in terms of the assembly is to generally look at what happens with a conversation around funding for health emergencies and open debates. I think it would be really problematic if there was a vertical approach to that because you want the health system as a whole to be strengthened because that's the basis corresponding to any kind of health issue including a health emergency. I think on the point of verticalization there's generally a threat that runs through many of the agenda items that issues are somehow considered in silos and so again when we look at the health system as an integrated whole that's not necessarily something that will strengthen the health system as a whole particularly not if you're trying to build a comprehensive primary health care approach as the center of your health system. I think one of the things that's really important is the issue of commercial determinants of health somehow for proper corporations impact health. There is this framework for engagement with non-state actors that WHO adopted some years ago and there are many agenda items that speak to the need for consultation with corporate actors non-state actors including corporate actors and let's speak to significance of corporate or private sector sources as sources of funding for WHO's work and so I think that what happens on that front and how it impacts the power of commercial determinants and health is definitely something to keep an eye on because the issue of corporate power has not been front and center I would say in this agenda and it's been highlighted I think in the context of abandoning just really how much of a determinant of health transnational corporations currently. I think for MC12 definitely what happens in terms of negotiations on fisheries and agriculture that's important from the point of view of food security food sovereignty prospects for food sovereignty and livelihoods sources of income that people can use to access all of the other things they need to live their lives and then I think the other thing that would be important to keep track of is what happens to these so-called JSI's the joint statement initiatives particularly the ones focusing on e-commerce and trading and services both of which have an impact on the health arena and how healthcare is provided in the private sector so JSI is not officially part of the agenda but there does seem to be some some interest by the developers it's in particular to bring them to the meeting and so that definitely is something to keep an eye on.