Statement from the Advisory Group on Health on COVID-19

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STATEMENT OF THE INTER-PARLIAMENTARY UNION’S
ADVISORY GROUP ON HEALTH REGARDING THE CURRENT
OUTBREAK OF CORONAVIRUS (COVID -19)
INTRODUCTION
The World Health Organization (WHO) declared COVID-19 as a global pandemic on
March 11, 2020. The COVID-19 has spread over 212 countries and territories around
the world. As of 27 July 2020, the number of confirmed cases is 16,114,449 and 646,641
deaths were recorded.
On May 19, 2020, the Seventy-third World Health Assembly called on all Member States
to address the COVID-19 pandemic on the following terms:
• Enact a “whole-of-government” and “whole-of-society” response to the
pandemic through an action plan that includes immediate and long-term actions.
• Implement national action plans that contain context-specific measures which are
comprehensive, proportionate, time bound, gender responsive, and sensitive to
vulnerable groups.
• Ensure that any restrictions on movement of people, medical equipment and
medicines are limited and temporary, with provision of exceptions for
humanitarian and health workers.
• Guarantee access to safe water, sanitation, hygiene, and infection prevention and
control.
• Afford the necessary domestic financing and development assistance to maintain
the functioning of health systems, which is indispensable for an effective public
health response to the COVID-19 pandemic.
• Inform the population in a reliable and comprehensive manner on the ongoing
COVID-19 pandemic, including authorities’ response, in addition to tackling
misinformation and disinformation.
• Make sure that access to safe testing, treatment and care for COVID-19 is
provided, with particular attention to those groups who are prone to higher risk.
• Provision of personal protective equipment, psychosocial support, training, and
other necessary commodities to all relevant frontline health workers.
• Use of digital technologies to address the pandemic comprehensively, with
attention to privacy, personal data, and security concerns.
• Present timely, accurate, detailed public health information on the pandemic to
WHO, per the International Health Regulations (2005).
• Share knowledge, lessons learned, experiences, best practices, data, materials,
and commodities with both WHO and other countries.
Dansk Interparlamentarisk Gruppes bestyrelse 2019-20
IPU Alm.del - Bilag 18
Offentligt
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• Promote both public and private funding of research and development,
particularly for vaccines, diagnostics, and therapeutics, as well as sharing relevant
information on this matter with WHO.
• Optimize use of antimicrobials in the treatment of COVID-19 and secondary
infections, preventing development of antimicrobial resistance.
• Promote actions that include women at all stages of decision-making processes.
• Contribute funding to WHO, so that the Organization can respond to public
health needs across the world during this pandemic.
The International Health Partnership for UHC 2030 (UHC2030)1
has also released a
political statement reminding governments of their commitments towards UHC made in
the Political Declaration on universal health coverage (UHC), which cannot be forgotten
in their COVID-19 response. Further, guidance for various health and non-health actors,
including parliamentarians, was developed in May 2020 on what to prioritize in terms of
service delivery, health financing, and governance for UHC in times of COVID-19 in the
Discussion Paper ‘Living with COVID-19: Time to get our act together on health
emergencies and UHC’ as well as a specific letter to all presidents of parliaments in June.
PUBLIC HEALTH AND SOCIOECONOMIC IMPLICATIONS
In addition to the Ministry of Health and other government sources for respective
countries, WHO and UHC2030 are trustworthy sources of information for
parliamentarians to stay informed on new developments related to the COVID-19
pandemic.
PUBLIC HEALTH IMPLICATIONS
The immediate health risks for individuals range from mild symptoms to life-threatening
situations. Certain groups of people are particularly vulnerable to contracting and/or
developing serious health complications from COVID-19, including:
• Older adults (particularly over age 60);
• Individuals with underlying medical conditions (e.g., heart disease, diabetes, and
chronic respiratory diseases); and
1
UHC2030 is a movement to accelerate progress toward UHC by providing a multi-stakeholder
platform that promotes collaboration on health systems strengthening at the global level and in
countries around the world. We promote enhanced commitments for UHC, more coherent
health systems strengthening by all relevant health partners, inclusive approaches, and
accountability for results. IPU joined UHC2030 in 2019 and the President of IPU is a member of
the UHC Movement Political Advisory Panel of UHC2030.
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• Individuals with compromised immune systems (e.g., people living with HIV or
undergoing chemotherapy).
The health workforce has a high risk of exposure to COVID-19 and many have become
ill or died. There are important gender considerations. For example, women make up half
the doctors and 80% of the nurses, and they also perform the majority of unpaid care
work. Other indirect health and social effects include mental health and psychosocial
effects, such as those related to isolation and stress as well as social stigma as a result of
health misinformation. Moreover, COVID-19 has the potential to overburden health care
systems, which in turn affects the provision of essential health services.
Overwhelmed health systems and COVID-19 response measures are also seriously
disrupting access to health services, including disruptions to supply chains for
medications and medical products, suspension of large-scale public health programmes,
closure of health services, and lack of access to health care facilities. UN agencies are
warning of significant impacts on vaccination programmes, HIV services, maternal health
care and sexual and reproductive health programmes in particular, with projections of
serious short and long-term health and mortality ramifications now and into the future.
SOCIOECONOMIC IMPLICATIONS
The COVID-19 pandemic has disturbed the existing political, economic, and social
structures. The situation has had a significant impact on the global, national, and local
economies. Furthermore, existing socioeconomic factors also make certain groups of
people more vulnerable during this pandemic. Overcrowded living conditions and
settings with poor water and sanitation—commonly seen with refugee and internally
displaced populations, urban slums, and prison populations, for example—amplify the
risk of outbreaks. Such conditions expedite person-to-person transmission and limit the
ability to practice preventive behaviours, such as hand washing and physical distancing.
Poverty, disability, and low literacy also affect access to health care and information, the
ability and/or resources to act on recommended prevention measures, and the resources
to access basic needs for preparedness (e.g., water, food, housing, medicines). The
pandemic also has the potential to trigger widespread economic consequences.
This economic downturn is likely to disproportionately harm vulnerable and marginalized
groups and further exacerbate income and gender inequality. As such, it is crucial that
under-privileged, women and marginalized groups, including daily wage earners, be
included in the development of immediate and long-term responses using an all-hazard,
all-of-government and all-of-society approach.
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PARLIAMENT’S ROLE DURING THE HEALTH CRISIS- COVID 19
The current outbreak of coronavirus disease (COVID-19) sets a challenge to all countries
globally, as it places new and increasingly complicated demands on decision makers,
including parliamentarians, to take action. Members of Parliaments around the world
need to collaborate with all stakeholders from a variety of sectors to enhance capacities
to manage the risks and impacts of emergencies, including emergency prevention,
preparedness, response, and recovery, as well as to promote the rapid deployment and
efficient coordination of emergency medical teams with a bearing on human health.
The WHO recognizes the authority that parliamentarians have in tackling emergencies,
both nationally and globally, through the key enabling roles of legislation, oversight,
budgeting, and representation. It is clear that the communication of health risks must be
reinforced, with the population at its center, so that the effects on health and other parts
of society are minimized. In playing their role to strengthen capacities to effectively and
efficiently implement preparedness and response to this emergency, Parliaments will
need to work to achieve the following specific objectives:
OBJECTIVES:
• Guarantee the allocation of a specialized fund for the acquisition of essential
supplies such as hand sanitizer with alcohol-based gel, antibacterial spray, hand
gloves, high efficiency face mask and Personal Protection Equipment (PPE) for
health workforces and all other essential workers.
• Communicate evidence-based information to protect human life: Official
information on COVID19 should be guided by the science and evidence following
the global and national standard and procedure. All information disseminated to
the population must be factual, evidence based and culturally appropriate, and
originated from a reliable source. This will be instrumental in stopping the
infodemic (rumors and spreading of unvalidated information).
• Facilitate Governments’ accountability to collect, analyze and report reliable
statistics with equity disaggregation, in salutation with civil society and those who
are directly affected by COVID-19, regarding the number of infection cases and
its impact on human lives, in particular for those commonly left behind in health.
• Support Governments to carry necessary preparedness and response measures to
manage COVID-19 related issues including rapid case identification, rapid testing
and isolation of cases, comprehensive contact tracing and quarantine of contacts,
readiness of hospitals with dedicated number of beds, COVID-19 specific
personal protective measures & equipment’s for health workforces, laboratories,
intensive care facilities with protection and isolation wards with the scope of
surge in order to anticipate changes in the implementation of hospital
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containment policies, as well as recognizing the costs of minimal standards and
be able to allocate budgets accordingly.
• Engage the whole of society to the COVID-19 preparedness and response,
mobilizing all available resources in the public and the private health sectors to
strengthening health system capacity, ensuring optimal functioning through an
integrate and coordinated response.2
Parliaments must also make sure that they comply with the following general objectives
with regards to the rapid responses of crisis:
• Facilitate for strengthening and sustaining the capacity of the health system to
prevent, prepare for and respond to COVID-19 pandemic including continuation
of essential services;
• Oversee the capacity to establish protocols, guidelines, rapid case detection and
contact tracing for confirming the outbreaks;
• Provide leadership for establishing a functioning public health emergency
management system, strengthen and sustain the capacity to promptly respond
to and recover from the negative effects of outbreaks and other concurrent health
emergencies.
• Promote multisectoral collaboration and coordination and encourage
Government to engage health experts in the overall decision making for issues
related to COVID-19 as well as to monitoring the progress of emergency
responses, accountability for measuring the success, and reporting to
constituencies.
• Advocate with central government to address the local challenges, needs and
gaps with required resource allocation.
• Clearly communicate to their constituents the importance of prioritizing and
supporting increasing investments in public health ‘common goods for health’,
such as comprehensive surveillance, laboratories, information systems,
information, education and communication starting at the community – to
strengthen health systems for both emergency preparedness and UHC. This can
mobilize the people to value and align behind these critical priorities.3
2
See the WHO’s Action Plan to engage the private health service delivery sector in the response
to COVID-19.
3
See page 4 of UHC2030’s discussion paper “Living with COVID-19: Time to get our act
together on health emergencies and UHC”.
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To achieve the above listed objectives, parliamentarians should play the following roles:
a) Enactment of laws and policies that handle emergencies
Legislating is a unique function of Parliaments which plays a critical role in preparing for
emergencies based on local evidence while also upholding international human rights
obligations. Parliaments need to enact legislation that enables countries to respond
effectively to emergencies including facilitating the implementation of measures
necessary for ensuring the continuation of essential health services. These laws and
policies should provide for emergency funds or easy variation of funds to be channeled
to areas in a crisis. Parliamentarians should repeal laws and policies that are prejudiced
and ineffective in dealing with the epidemics and may be hampering the management
of emergencies or the provision of essential health services. The laws and policies should
also provide for the various aspects of emergencies like prevention, prepared health
systems, the international health regulations as well as maintaining essential health
services as part of efforts towards Universal Health Coverage, in keeping with the 2019
IPU resolution Achieving universal health coverage by 2030: The role of parliaments in
ensuring the right to health and the Political declaration of the high-level meeting on
universal health coverage in 2019. Parliaments also have a key role to play in ensuring
that States comply with their international human rights obligations and that where
restrictions are imposed on certain rights to protect public health, these restrictions
are necessary, proportionate, non-discriminatory, and limited in duration.4
b) Representation of Constituents affected by epidemics
Parliamentarians play a crucial role in representing their constituency, which includes
people affected by emergencies. Representation is one role that enables
parliamentarians to use their position to advocate for assistance for the people at risk or
affected by a disaster and ensure their participation in task forces, planning and
implementation. COVID-19 reinforces the importance of governments seeing local
communities, women, and affected populations as part of the solution to the epidemic
and working closely with them. An effective response necessitates that governments are
trusted from these constituencies though parliamentarians so that governments’
strategies are supported.5
Further, parliamentarians can contribute to the prevention and recovery from a health
emergency by promoting awareness on the vulnerability of some of their constituents,
as well as educating the constituents, especially the vulnerable groupings, on the
prevention, management and recovery mechanisms and system of an epidemic. Clear
4
See “UN Policy Brief: COVID-19 and Human Rights: We are all in this together”.
5
See pages 5-6 of UHC2030’s discussion paper “Living with COVID-19: Time to get our act
together on health emergencies and UHC”.
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and consistent messaging from parliamentarians to these constituents also helps build
trust. COVID-19 is a source of fear and confusion for many people, often struggling to
cope with the ‘infodemic’ at the same time as the epidemic. Clear messaging from
parliamentarians needs to be transparent and based on evidence.6
c) Oversight over the Executive’s response to an emergency
The oversight function of a Parliament allows it to hold the government to account for
appropriate and timely funding of health programmes. In doing so, Parliaments can
assess how government interventions prepare for health emergencies and how they are
responsive to an emergency. Parliamentarians are positioned to advocate and lobby for
the Executive to act on a scourge that is exhibiting tendencies of becoming endemic.
Further, parliamentarians have an obligation to monitor government’s holistic
preparedness and response facilities to health threats as well as mechanisms established
to respond to possible outbreaks. Infrastructure such as facilities to quarantine and
isolate suspected cases as well as confirmed cases. Parliaments can also hold their
governments accountable for the non-domestication of ratified and assented treaties or
other international agreements.
Parliamentarians should also be alert to the risk of the diversion of resources from the
response and should hold governments to account for the creation and maintenance of
appropriate risk-based probity controls designed to ensure a rapid public health
response while also ensuring that resources are not diverted, depriving people of health
care and resources from the public health response.
d) Budget Approval / Allocation of sufficient resources for health emergencies
Parliaments use their budget approval function to ensure that sufficient funds and other
resources are allocated for health emergencies. This entails appropriation of public funds;
monitoring budgetary processes; commitments and fulfilment of financial assurances on
health aspects related to emergencies that are aimed at addressing the epidemics like
the coronavirus.
It is also the duty of parliamentarians to look at the resources allocated to the prevention
of outbreaks and match it with the risk or likelihood of their country being attacked by
the outbreak. As parliamentarians we should reinforce our position as key stakeholders
in managing emergencies at the various stages, from preparation and prevention to
when recovering from an emergency. We set the legal framework, which sets the tone
for the control programmes. We also have a unique and advantageous position, as
elected leaders representing the people, to be among the front liners in preparedness,
6
See page 5 of UHC2030’s discussion paper “Living with COVID-19: Time to get our act
together on health emergencies and UHC”.
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prevention and advocating for funds to manage the emergencies through the discharge
of their constitutional functions.
e) Promoting multi-sectoral collaboration and monitoring, Evaluation & Reporting
of emergency response to COVID 19 for its accountability
Recognizing the importance of a multi-sectoral and all-of-society approach to the
COVID-19 response, parliament and parliamentarians can help government to
strengthen multisectoral collaboration on COVID-19 preparedness, response, and
management. The Member of Parliament (MP) also needs to participate, engage, and
oversee the monitoring and evaluation of emergency responses for COVID-19. It can be
done through designated technical and oversight committees for tracking the progress
and generate support to emergency responses. This monitoring, evaluation and
reporting will further strengthen national data base and overall reporting on COVID-19
responses. It is also important that parliamentarians ensure governments to embark on
a ‘whole of society’ approach with strong accountability, gender equity and the
empowerment of women in shaping health emergency preparedness and response.
COVID-19 has exposed weaknesses in links between health and social care systems and
renewed attention on both the balance of responsibilities between local and central
government and the role of the private sector. An effective response requires managing
across multiple organizations, together with agreed responsibilities, fit-for-purpose
regulation, and clear accountability. Parliamentarians may play a key role in balancing
and coordinating different priorities and incentives from their constituencies.7
CONCLUSIONS
The COVID-19 pandemic has put significant pressure on Governments around the world
to respond to a rapidly evolving situation with many unknown variables and
emergencies. In addition, such crises exacerbate pre-existing social and economic
inequalities. Thus, Parliamentarians have a crucial function to oversee this response, as
well as evaluate and swiftly pass emergency legislation to approve national funds to meet
the needs of the populations they serve. They can also promote transparency around
global and national developments surrounding COVID-19, which is key to maintaining
the public’s trust in the government’s response to the pandemic. In this sense, they can
also complement communication efforts, where possible, to ensure that their
constituencies receive the information they need and also appreciate citizen’s health.
7
See pages 5-6 of UHC2030’s discussion paper “Living with COVID-19: Time to get our act
together on health emergencies and UHC”.