 It's year four of the pandemic and if there's one thing that has changed during this period, it's the fact that a lot more people are trying to be aware of, trying to find out more about various aspects of health care from medicines to even issues related to policy. We've seen of course health workers coming out onto the streets in larger numbers to defend their rights and there's been a lot of discussion on issues such as vaccines, diagnostics, the right to access to health care. All these have come to the fore and that's maybe one of the few positive things that has come out of this pandemic. But there's still a lot of aspects which are really behind the veil, so to speak, which are discussed in board rooms which don't really make it to the news so much but which have a huge impact on our lives, on our health. Today we'll be talking about some of these aspects. We are joined by Jyotsna Singh or the People's Health Movement. Jyotsna has just been to the World Health Organization's Executive Board Meeting which took place in Geneva. Thank you so much Jyotsna for talking to us. Always a pleasure. So Jyotsna, just to sort of set the stage, could you maybe take us through why the Executive Board of the World Health Organization, why is it important? It sounds very bureaucratic, it sounds like a committee, but why is it so important for you and me and for all of us? Absolutely. So the thing is, WHO holds two meetings a year which are very important because they're open to everyone to witness. It is live-streamed civil society and health activists and other stakeholders in health can actually go and be there. So it's like a gala ceremony, so to speak, where the governments are there, the health ministers and if not the ministers, the health secretaries are definitely there. And then you have that space where you can directly talk to them, talk to the WHO officials who end up guiding a lot of policies what we witness in our countries and have a chit-chat and see where, in which direction is the global health governance moving. So these two meetings are, one is the Executive Board which just happened in Geneva in the WHO headquarters. The other is World Health Assembly which is a much bigger version of this meeting which happens in the month of May. So in an Executive Board meeting, it is a limited number of countries who are part of the Executive Board of WHO and only they have the right to vote and things like that whereas in WHO it is all the countries who have equal participation. So these are the two and, I mean in between there are a lot of meetings that happen but everybody is not a party to it, it is fewer number of people. So that's where they become important. So just now in the EBE meetings that took place and you were there, you talked to people over there, what do you think are some of the main things that you know, off the top of your head, what are some of the main things that sort of struck you as themes that were significant at this point of time? Right. So Executive Board meeting, it discussed around 23 or 24 agenda items this year starting from social determinants of health to universal health coverage to budgets and the WHO is looking for more and more money and funds. So all of these issues were discussed there, behavioral science was another one. Some of these issues are going to be reflected in World Health Assembly also. So this was more, this is like a preparatory meeting. So that definitely was there and but if you, I mean there are many interesting things that happen when you are there. You can see how the international politics plays a role in itself because the Russia-Ukraine war was a theme that determined a lot of discussions throughout. So the Director General had made a report on health emergencies in which there was a mention, I mean it was a detailed mention, not just a mention of the war in Ukraine and Russia completely disagreed with it. It said that we won't let this report pass because it is so one-sided and you could see the EU and other NATO countries coming together and saying no, we agree with the report. So that is one thing that you really see. The other part would be I think the way national politics in the countries also get reflected in these discussions. For example, I mean it was in one sense amazing to see the Brazil declared, Brazil is back, science is back. Obviously taking a satirical jab on Bolsonaro's government who was very unscientific, so to speak, in dealing with COVID-19, calling for hydroxychloroquine as the treatment for COVID and etc. So all of that you see U.S. for example, the kind of a stances it takes now compared to how it was doing during the Trump administration is different. U.S. clearly said that we stand for the rise of LGBTIQ plus communities. Trump administration was very much against it. The new government also said Biden's government, the language is much softer in favor of sexual and reproductive rights, which was the opposite during Trump administration again. So these are the kind of things that you really witness. I believe you said Columbia also, Columbia also had an interesting intervention. It did. So one of the civil society constantly has been saying and we have been raising our voice, saying that civil society is getting excluded more and more by the WHO. And the amount of time that is given to us, where we are made to sit within these discussions, all of that has come under attack by the civil society to WHO. Columbia and obviously there has been a change in the government recently. It's so openly and a beautiful statement by Columbia saying that we need more of civil society in the room and they should be included more. So all of these things, when you witness it tells you what is happening in the nations also and how it governs these global governance issues as well. So just of course now the meeting taking place, like I said, this is the fourth year of the pandemic. Various countries have taken various stances on how they view what the state of the pandemic is so to speak. But generally I think it's, there's a general feeling that the pandemic is now maybe a bit on, there's a bit of a downturn so to speak. It's not over of course, but it's not as pressing an issue as it was maybe in 2021 or even early 2022. But the pandemic definitely must be casting a shadow on the world health organizations, deliberations, on the deliberations of people who work in the health sector. So how did the EB actually, you know, how did the pandemic sort of figure in the discussions of the executive board? Throughout. I think when the countries make their interventions, if you read all the reports that are presented by the director general Dr. Tedros, there is a constant reminder about COVID-19 pandemic and what we have learnt. The entire question of equity comes up again and again in all the deliberations that happen. So one can see that. But I think the question is that, has WHO and have the developed countries actually learnt from the pandemic or not? That is a big question mark and I think the simple answer is no. So WHO is also discussing the pandemic treaty. It is called the Global Architecture for Health Emergencies Preparedness, Response and Resilience. In short, pandemic treaty that is being called. There's a parallel process going on which is amendment to IHR which is the International Health Regulation 2005. So when the agenda of health emergencies come, you can see people are responding and the countries and civil society is responding to it. But it is important to mention that these two processes are happening simultaneously throughout the year in WHO. There is an intergovernmental negotiating body that has been formed to discuss the pandemic treaty. And maybe if we can spend some time on these two things. So IHR 2005 has been in place since 2005 as the name suggests. But the developing countries actually started to ask for amendments in the light of the pandemic because one realised that health emergencies is not only about pandemic. It would also be about the recent earthquake in Turkey and Syria or floods that we witnessed in Pakistan. But pandemic of course was at such a global scale. And there was such lack of equity in the response and how the developed countries and their big pharmaceutical companies and everybody dealt with it that there was a need to make some amendments. So these proposals have come and if you see India, Bangladesh, the Africa region, 47 countries are represented by that. They have made a detailed plea that how IHR should be amended so that if we are in a similar situation later, people do not die of something for which the vaccines and medicines exist in some other part of the world. The point is, and then we talk about pandemic treaties or how it came about in the middle of the pandemic. European Union and many other developed countries, they proposed that we need to be ready for future pandemics. So we were still struggling. The developing countries were still struggling with the current pandemic. And the developed countries had, they had, of course, they had vaccinated majority of their population and they had the audacity to go ahead and start discussing future pandemics. So there was at that point of time also a lot of opposition that how are you discussing the future pandemics can we deal with this one. So it was a problem, but well we have it now. So we have to discuss it. And there also if you see there is a zero draft of the pandemic treaty that came about a few days ago earlier this month. And if you look at the preamble of the zero draft, it has all the correct language in it. Equity is there. They talk about health workforce and how they were overburdened and they should not be. It recognizes very clearly that the internationally we failed to respond to COVID-19 the way we should have. It says that 70% of the health workforce is women and we should be taking care of that. It talks about community and community participation, everything. And then when you start to see the actual language which will determine the policy, none of these things appear there. It looks like there is no learning from COVID-19 at all. You are talking in the preamble about intellectual property barriers, but you are not giving a solution to it in that. So it is a huge problem the way zero draft is. The proponents of it, the people who have written it have clearly not really taken into consideration what the poor countries have gone through during the pandemic. So the point is that we need to see the IHR amendment process and the new proposal of pandemic treaty as parallel processes and look at both and fight for equality in both. Because the IHR is going to be the founding principles and the pandemic treaty is going to be a part of it because it is one part of the entire health emergencies domain. So we need to look at both. Both are not in a good shape at the moment and we can see developing countries fighting for it. It is just that the kind of experience we have had through trips waiver where in the World Trade Organization despite so much of push, the gain was much less. It wasn't just nothing but it was much less. Learning from that the developing countries I think will have to put forth, I mean they have to set red lines at a very different level. But because if you see the developing countries are asking for in IHR amendments, health system strengthening. If you see what the developed countries are asking for, it is asking for securitization. So this is also a classical debate in public health where the developed countries say surveillance. They focus more and more on surveillance which means we will know when the pandemic is about to emerge. Developed countries are saying and have been saying that we need to focus on response also. If in a poor country it has happened and you know there is a possibility of an outbreak, what do you do about that? Developed countries can immediately go on producing vaccines and hold the vaccines. What will happen to the rest of the world? So surveillance and response have to go hand in hand together. We do not see that. We see 80% surveillance, 20% response. Huge problem. The other problem in these drafts that we are facing is there is no, you do not find access and benefit sharing. Now what is it in very short that if a pharmaceutical company is able to make a vaccine or any medical product using a pathogen that has emerged in some other country and the country has shared it and that is why this company is able to produce it, right? Then the sharing of the benefit should go to that community as well. For example, Ebola. If you have got the strain from West African nations and you are sitting in a developed country, you cannot say I will not share the vaccine or the know-how with the Western African nations and I will use it only when Ebola comes to my rich country. So that access and benefit sharing should happen. It is not happening. That discussion has been going on for a decade in WHO. It should also get reflected in this. So the health system is strengthening, access and benefit sharing, equity. These are the three things that the developing countries are fighting for in these two mechanisms and there is a lot of opposition obviously to that. Long road to go for many of these countries. It is interesting that you mentioned, when you started, you mentioned something about the behavioral sciences, which when you hear behavioral sciences, you always go, okay, the alarm needs to sort of sound at this point. So could you maybe just take us through how that came up and who is behind that as well? Absolutely. So this was one of the agenda items and many eyebrows were raised. What is this about? And one did not know where this agenda item came from. But well, it is not as simple. So the thing is behavioral science, so WHO, SPHM, we have a position that the vertical way of dealing with diseases is problematic. You have to look at social determinants and the structural problems. You cannot go disease by disease. If you strengthen public health systems overall, you fight all the diseases together. So that has to be the approach. Now this behavioral science is even a further attack. It is actually putting the entire onus on the individual to do or not to do to make healthy choices and not make unhealthy choices. So and this push seems to have come from the World Bank and etc. Because the World Bank and OECD countries for the past one decade almost they have been working in the field of behavioral economics, which says that you work on people's behavior. And then so in a supermarket, put healthy items at a more prominent space and put the junk item at some other place. The point is there should be no junk material or unhealthy material in the supermarkets and that regulation has to come from the governments. So it actually takes away your entire focus from regulating the market and the TNCs, the transnational corporations and ensuring healthy food. So no regulation, but you leave it to the individual. And then if you don't make the correct choice, boss, we try. So that is coming and this kind of an approach is going to be a problem. And we know that the World Bank policies and the way World Bank deals with health is a huge problem the way OECD countries look at it. And if WHO starts to get influenced by that so much that it has an agenda item and they're spending time on it, then we really need to sound caution there. Absolutely, definitely not a very positive or quite an alarming trend in fact, actually, if you think about it. Thank you so much, Jyotsana, for speaking to us, for giving us, I think, a very concise and clear idea of what actually happens in these meetings, breaking down some of these technical aspects. So thank you so much for talking to us. Thank you. That's all we have time for today. But keep watching NewsClick and People's Dispatch for more such videos on issues such as health, on issues such as policies in various aspects of life, but in a language in a way that all of us are able to understand and act upon it.