Seventy-first Regional Committee for Europe: virtual session, 13–15 September 2021: report of the Twenty-eighth Standing Committee of the Regional Committee for Europe

WO R L D H EAL T H O RG AN I Z AT IO N R EG I ON AL O F F I C E FO R EU R O PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC71/3 71st session Virtual session, 13–15 September 2021 2 September 2021 210878 Provisional agenda item 1(d) ORIGINAL: ENGLISH Report of the Twenty-eighth Standing Committee of the Regional Committee for Europe This document is a consolidated report on the work done by the Twenty-eighth Standing Committee of the Regional Committee for Europe (SCRC) at the four regular sessions and one special session held to date during its 2020–2021 work year. The report of the Twenty-eighth SCRC’s fifth and final session (to be held virtually on Wednesday, 8 September 2021, before the opening of the 71st session of the WHO Regional Committee for Europe), will be submitted to the Regional Committee as an addendum to this document. The full report of each SCRC session is available on the WHO Regional Office for Europe’s website (https://www.euro.who.int/en/about-us/governance/standing-committee/twenty-eighth- standing-committee-of-the-regional-committee-for-europe-20202021). EUR/RC71/3 page 2 Contents Introduction ................................................................................................................................ 3 Reflections on the 70th session of the Regional Committee for Europe ................................... 4 SCRC subgroups ........................................................................................................................ 4 SCRC subgroup on WHO/Europe’s work at country level .............................................. 5 SCRC subgroup on WHO/Europe’s governance .............................................................. 5 SCRC subgroup on WHO/Europe’s financing ................................................................. 6 Updates on the COVID-19 pandemic and response in the WHO European Region ................. 7 Pan-European Commission on Health and Sustainable Development ....................................... 8 Implementation of the European Programme of Work .............................................................. 9 Preparation for the 71st session of the Regional Committee ................................................... 10 Draft provisional agenda and programme ...................................................................... 10 Proposed schedule for RC71 ........................................................................................... 11 Overview of resolutions and decisions ........................................................................... 15 Budgetary and financial issues ................................................................................................. 15 WHO/Europe financial situation .................................................................................... 15 Proposed programme budget 2022–2023 ....................................................................... 15 Progress reports ........................................................................................................................ 16 Membership of WHO bodies and committees ......................................................................... 17 Vacancies for nomination for membership of the Executive Board and the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction and election for membership of the SCRC at RC71 ................................................................................. 17 Elective posts at the Seventy-fourth World Health Assembly in May 2021 .................. 18 Officers of the 71st session of the WHO Regional Committee for Europe .................... 18 Address by a representative of the WHO Regional Office for Europe Staff Association ....... 19 Annex. Statement by the Standing Committee of the Regional Committee for Europe, 12 March 2021 COVID-19: a continued call for international solidarity and equity ........................................................................................................................ 21 EUR/RC71/3 page 3 Introduction 1. The Twenty-eighth Standing Committee of the Regional Committee for Europe (SCRC) has held four regular sessions to date: • 15 September 2020; • 18 November 2020; • 10–11 March 2021; and • 18 May 2021, with an additional private session held virtually on 11 June 2021. 2. By virtue of Rule 5.3 of the Rules of Procedure of the Standing Committee of the Regional Committee for Europe, the Twenty-eighth SCRC also held one special session on 8 January 2021. 3. All sessions were held in a virtual format because of the ongoing COVID-19 pandemic. Both the third regular session and the special session were open to all 53 Member States of the WHO European Region in accordance with Rule 3. 4. The SCRC agreed to hold its virtual fifth session on 8 September 2021, also in a virtual format. 5. In accordance with Rule 9 of the SCRC’s Rules of Procedure, Dr Iva Pejnović Franelić (Croatia), as Deputy Executive President of the 70th session of the WHO Regional Committee for Europe (RC70), is ex officio Chairperson of the Twenty-eighth SCRC. At its first session, the Twenty-eighth SCRC elected as its Vice-Chairperson Ms Nora Kronig Romero (Switzerland). 6. The member of the WHO Executive Board from Germany agreed to act as the link between the Twenty-eighth SCRC and the WHO Executive Board in 2020–2021. Also at its first session, the SCRC welcomed new members from Czechia, Kazakhstan, Norway and the United Kingdom of Great Britain and Northern Ireland, who would each serve a three-year term of office from September 2020 to September 2023. 7. Also at the SCRC’s first session, the members of the new Executive Council of the WHO Regional Office for Europe (WHO/Europe)1 (Mr Robb Butler, Executive Director, Office of the Regional Director; Mr David Allen, Director, Business Operations; Dr Dorit Nitzan, Regional Emergency Director; Dr Natasha Azzopardi Muscat, Director, Division of Country Health Policies and Systems; Dr Nino Berdzuli, Director, Division of Country Health Programmes; and Ms Gabrielle Jacob, Special Adviser, Transformation and Organizational Development) committed themselves to working closely with the Twenty-eighth SCRC on the issues raised at RC70 in their respective areas of responsibility, with the overall aim of helping Member States to engage more closely with the Secretariat of WHO/Europe. 1 The WHO Regional Office for Europe (WHO/Europe) consists of the Head Office in Copenhagen, Denmark; 40 country, field, liaison, representation and sub-offices including three sub-regional WHO Health Emergencies Programme (WHE) hubs; five geographically dispersed offices (GDOs); one WHO-hosted Partnership; and one office for Health Systems Financing. It is through these offices that Programme Budget 2022-2023 will be delivered, with the support of a broad partnership community, including over 270 WHO collaborating centres. EUR/RC71/3 page 4 8. At its third session, the SCRC, noting that Dr Franelić was unable to complete her term of office, confirmed Ms Romero as Acting Chairperson of the SCRC in accordance with Rule 12 of the SCRC’s Rules of Procedure. Reflections on the 70th session of the Regional Committee for Europe 9. At the first session, members of the Twenty-eighth SCRC congratulated the WHO Regional Director for Europe on the success of the RC70, his first session in the post. It had been a productive meeting, and the technical challenges of the virtual format had been overcome. Many innovations had been introduced with regard to the format of the session and the management of the agenda, presentations and interventions. Discussions had been organized around certain agenda items. 10. Highlights of the session had included the adoption of the European Programme of Work, 2020–2025 (EPW) and the discussion of WHO transformation. On the other hand, it had been disappointing that the Regional Committee had not been presented with a full first draft of the Organization’s Proposed programme budget 2022–2023. 11. The special rules and procedures, put together with guidance from the SCRC subgroup on WHO/Europe’s governance, had ensured smooth proceedings. The provision in the special rules and procedures for the organization of a secret postal ballot after the closure of RC70 (in which all 53 European Member States had taken part) had helped to ensure continuity in governance. During a virtual session that was held on 28 October 2020 and chaired by the Deputy Executive President of RC70, Dr Iva Pejnović Franelić, the votes cast had been counted by two appointed tellers under the supervision of the WHO Legal Counsel. 12. Nonetheless, in some areas there was room for further improvement. The lengthy period of consultation on working documents had led to delays in their dissemination, while the virtual platform of the session had sometimes rendered decision-making more difficult. Some members had suggested that the handling of candidatures for membership of the WHO Executive Board and the SCRC should be reviewed and that further efforts should be made to involve non-State actors more fully in a virtual format. SCRC subgroups 13. At its first session, the Twenty-eighth SCRC decided that the two subgroups currently in existence, on country work and governance, would continue for a further year and that consideration of their terms of reference and composition should be deferred to the subsequent session. At the second session, in view of the interventions that had been made at the Seventy-third World Health Assembly (WHA73), it was proposed that a new SCRC subgroup on financing should be established. To ensure active participation of all members, the Regional Director suggested that the composition and the chairpersonship of all subgroups should be renewed and invited members to express their interest in participating in any of the subgroups and to nominate possible chairpersons. EUR/RC71/3 page 5 SCRC subgroup on WHO/Europe’s work at country level 14. The Twenty-eighth SCRC confirmed that its subgroup on WHO/Europe’s work at country level should continue. Its main objective in the year ahead would be to support the development of an agile operating model for WHO/Europe in order to achieve maximum impact at country level. That should include systematic assessment of countries’ expectations of WHO/Europe and an exploration of existing and new modalities of WHO’s support to countries, as well as an assessment of the organizational and financial sustainability of WHO/Europe’s country engagement. 15. The members from Armenia, Bulgaria, Croatia, Czechia, Kazakhstan, Poland and the Republic of Moldova indicated that they wished to participate in the subgroup, which the member from Belgium agreed to chair. The subgroup met on five occasions: 11 December 2020; and 15 February, 2 March, 10 May, 21 June and 18 August 2021. 16. The SCRC subgroup members also held a virtual “inception retreat” on 29 March 2021 with representatives of other Member States and key stakeholders (development partners, academia, civil society and WHO collaborating centres). A core team of “doers”, composed of the Secretariat and some Member States, produced a discussion paper to drive implementation of the country work review. The discussion paper would be further developed into an information document to be submitted to the Regional Committee at its 71st session, possibly supplemented by a shorter paper summarizing the country-level discussions. 17. The SCRC subgroup recommended that the review process should continue after RC71 under the subgroup’s guidance, resulting in the development of a strategic regional position paper on country presence that would be submitted for adoption at RC72. 18. The SCRC approved the approach adopted by its subgroup on WHO/Europe’s work at country level. SCRC subgroup on WHO/Europe’s governance 19. A subgroup on governance has been established for each session of the SCRC since 2010. Based on the proposed terms of reference, members of the Twenty-eighth SCRC suggested that in 2020–2021 the subgroup should focus on the review of the procedures used at regional level for elections and nominations for membership of WHO bodies, including country groupings, the scoring system, and the practice of semi-permanent membership for countries that were members of the United Nations Security Council. 20. The members from Croatia, Poland, Norway, the Republic of Moldova, the Russian Federation and Switzerland indicated that they wished to participate in the subgroup, which the member from the United Kingdom agreed to chair. The subgroup met on three occasions in 2021: 28 January, 23 February and 5 May 2021. 21. Several Member States had voiced concerns regarding the current system for nominations and elections to WHO bodies and committees. They had called for a fairer, more inclusive, transparent and predictable nomination process, expressed discomfort with the way in which the scoring exercise worked in practice, and suggested that the current system conveyed a false sense of objectivity. EUR/RC71/3 page 6 22. The subgroup identified several options for changing the current system in response to those concerns. Medium- and longer-term options requiring wider engagement and, in some cases, changes to the Rules of Procedure included formalization of fluidity between geographical groups when some groups had no candidates; recalibration of periodicity; revision or reweighting of the scoring system; and improved transparency in the scoring process and outcomes. 23. The subgroup also identified a number of possible improvements to the current process that could be implemented immediately on a trial basis, without the need for formal changes to the Rules of Procedure of the Regional Committee. • On inclusivity, the subgroup was proposing to replace the scoring of individuals with a ranking process that was more open and gave more prominence to the profile of the candidate Member State and, in particular, the year it had last served on the governing body. The subgroup had elaborated a revised assessment procedure by the SCRC based on a four-step “manual” for ranking the nominations received. This procedure, which would not require any rule change, and was based on the same selection criteria as before, would be tested in the private session scheduled on 11 June 2021. • On transparency, the result of that assessment by the SCRC would be communicated to all candidate Member States, including explicit reference to the constitutive elements and criteria underpinning the ranking outcome. • In the interests of predictability, the subgroup was also proposing to introduce a new pre-consultative phase between the end of the RC71 and the launch of a new call for nominations (January 2022), inviting all European Member States to share their interests and aspirations for future membership of governing bodies until 2025. 24. The subgroup accordingly proposed that the SCRC Chairperson’s report to the Regional Committee at its 71st session should include the following points, to be taken up by the Twenty-ninth SCRC’s working group: • evaluate the ranking trial and further review the assessment by the SCRC of nominations received; • introduce a new pre-consultative process for 2022 nominations on a trial basis and evaluate its use; • continue the discussion on more fundamental changes to the rules of representation after the session; and • conduct a comprehensive review of governance in the Region by the 72nd session. 25. The SCRC approved the approach proposed by its subgroup on how to organize the assessment of nominations received, and its proposal to continue work on governance under the Twenty-ninth SCRC. SCRC subgroup on WHO/Europe’s financing 26. Since only approximately 30% of the base programme budget of the WHO European Region comes from corporate flexible funds, WHO/Europe is highly dependent on specified EUR/RC71/3 page 7 and earmarked voluntary contributions. More recently, the introduction of thematic funding has helped in addressing the need for more flexible funding for WHO, but the level of such funding is still not high enough to completely resolve all of WHO’s funding challenges. 27. The subgroup on WHO/Europe’s financing aims to identify possible measures to remediate and overcome the challenges identified; review and act as a sounding board for WHO/Europe resource mobilization products; and provide input to the Regional Committee at its 71st session on the planning and approval process for the Programme budget 2022–2023 from a regional perspective. Members of the SCRC suggested that the subgroup should also look at the financing of WHO’s activities at country level and consider how best to link its work with that done at the global level of the Organization. 28. The members from Bulgaria, Croatia, Kazakhstan and Norway indicated that they wished to participate in the subgroup, which the member from Switzerland agreed to chair. The subgroup met on four occasions in 2021: 2 February, 4 March, 4 May and 7 September 2021. It also hosted a briefing with all Member States on 28 June 2021 to report on its work and consult on a draft resolution on sustainable financing in the European Region that had been developed by the subgroup and would be submitted to the Regional Committee at its 71st session for adoption. 29. At the SCRC’s third session, the chairperson of the SCRC subgroup reported that the group had conducted a funding analysis of WHO/Europe as a basis for identifying possible steps towards a more sustainable financing model; had linked up with the global Open-ended Intergovernmental Working Group on Sustainable Financing to ensure that the work done at the regional level could feed into global processes; and had had an initial exchange of views on a WHO/Europe resource mobilization strategy and the WHO/Europe investment case. 30. The draft resolution, sponsored by all members of the subgroup and shared with all Member States of the Region, recognized the role of WHO/Europe, its financing challenges and the efforts made by WHO/Europe to address them. It approached sustainable financing as an issue at all three levels of the Organization, requiring coordinated actions across levels. It listed initial potential options to address WHO/Europe’s financing challenges. Lastly, it requested WHO/Europe to continue its resource mobilization, communications, transparency and financial management efforts. The objective was to have the resolution adopted by all Member States at the 71st session. 31. The SCRC approved the approach proposed by its subgroup on WHO/Europe’s financing. Updates on the COVID-19 pandemic and response in the WHO European Region 32. At each of its sessions, the Twenty-eighth SCRC discussed the prevailing COVID-19 pandemic situation and WHO/Europe’s response to it. At its second session, it took note of the WHO European regional strategy to respond to COVID-19 and the need for risk communication and community engagement to counter pandemic fatigue. 33. At its third session, when transmission and mortality rates continued to be high in Europe, the Regional Emergency Director said that vaccines, which were effective in all EUR/RC71/3 page 8 population groups, had brought hope but also risked creating a false sense of security, at a time when new variants of interest and concern continued to emerge and challenge responses. Under the COVID-19 Strategic Preparedness and Response Plan, the strategy for 2021 was to suppress transmission, reduce exposure, protect the vulnerable and reduce mortality and morbidity from all causes, and save lives. The impact of the response measures that had been taken was being assessed through intra-action reviews; results would be presented to the Standing Committee at its next session. 34. By the time of the fourth session, COVID-19 vaccines had been rolled out in all 53 Member States in the European Region. In the 156 days since the first country in the Region had started vaccinating, more than 308 million doses had been administered, 23% of the total population had received at least one dose, and 11% of the total population had received a complete course. It was noted that, although Member States had prioritized health workers and elderly populations, the benefits of vaccines had reached population groups inequitably (only 1.5% of the population in low- and lower-middle-income countries had received one dose of vaccine, compared with 32% in high-income countries). As vaccination uptake increased, incidence and mortality were declining among high-risk older populations (people over 80 were on track to become the age group with the lowest per capita incidence in Europe), but a significant proportion of the population above 60 years old remained unvaccinated as at May 2021. 35. At the third session, members of the Standing Committee agreed to issue a joint statement on the occasion of the first anniversary of the statement on the COVID-19 situation in Europe, which had been made by the Twenty-seventh Standing Committee at its third session on 12 March 2020. Several members proposed that the joint statement should begin by underlining the need for solidarity between Member States in managing supplies of COVID-19 vaccines. The joint statement (see Annex) was subsequently approved electronically by members of the Twenty-eighth Standing Committee and published on WHO/Europe’s website. Pan-European Commission on Health and Sustainable Development 36. At its third session, the SCRC considered the work of the independent Pan-European Commission on Health and Sustainable Development, which was chaired by Professor Mario Monti and consisted of 18 high-profile members employing a multidisciplinary approach to making recommendations on measures to improve the resilience of health and social care systems in the European Region. It was assisted by a Scientific Advisory Board and various working groups had been set up. 37. The Standing Committee welcomed the timely decision to establish the Commission and also supported the proposal of the Commission’s chair for an interim statement to be issued. In that call for action that was issued mid-March 2021, the Commission called on governments, economic and social stakeholders, and international organizations to rethink their broad policy priorities, to step up investments and reforms in health and social care systems, and to upgrade global governance of public goods, such as health and the environment. 38. At the fourth session, the Chairperson of the Pan-European Commission on Health and Sustainable Development said that the keyword underpinning the Commission’s whole EUR/RC71/3 page 9 approach was “integration”, at three different and complementary levels: within health; between health policy and other policies in countries; and internationally. Members of the SCRC commended the impressive work done by the Pan-European Commission on Health and Sustainable Development and emphasized the importance that they attached to the One Health approach. 39. While some supported the suggestion by the Chairperson of the Commission to create a pan-European health security council, it was considered that the Regional Committee would need to seek a way to consider the Commission’s report and recommendations after its official launch and presentation to Member States at RC71. In that respect, the Standing Committee recommended the establishment of a subgroup to look into the Commission’s recommendations. Action by the Regional Committee Consider the establishment of a subgroup to consider the recommendations in the Report of the Pan- European Commission on Health and Sustainable Development – rethinking policy priorities in the light of pandemics. Implementation of the European Programme of Work 40. As the Regional Director had said at the first session that the Secretariat intended to carry out further work on monitoring and evaluating the implementation of the EPW, beginning with the elaboration of key performance indicators, he welcomed the SCRC’s ongoing guidance in that area, with the aim of alleviating the reporting burden on Member States. At each of the following sessions, the SCRC was briefed on the implementation of the EPW in the report by the Regional Director. 41. At the fourth session, the SCRC was informed about the progress made with the development of the EPW measurement framework. Based on consultations with European Member States, as well as with the European Health Information Initiative and the Central Asian Republics Information Network, the Secretariat was proposing an initial list of 26 indicators across 16 targets of the Sustainable Development Goals; 18 indicators came from the Thirteenth General Programme of Work (GPW 13) Impact Framework, seven were modified from existing frameworks, and one was a new indicator. In addition, the Secretariat had drawn up a development list of 19 indicator areas that were important for the Region but that currently had data availability issues. To reduce the reporting burden for Member States, all indicators could be sourced through existing international, Region-wide data collection efforts. Particular attention would be paid to appropriate representation and standardization of small countries’ data. 42. Also at the fourth session, the Secretariat proposed that the rigorous review of all regional action plans and resolutions in light of the EPW and revised priorities should be postponed until RC72, in view of the fact that the first biennium of EPW planning had not yet been completed, that the first flagship initiatives would not be launched until after RC71 and that only three existing action plans extended beyond 2022. EUR/RC71/3 page 10 Action by the Regional Committee Review Development of the measurement framework for the European Programme of Work, 2020–2025, and Measurement framework for the European Programme of Work, 2020–2025 - approach, targets, indicators and milestones. Consider the related draft resolution and its financial implications. Preparation for the 71st session of the Regional Committee Draft provisional agenda and programme 43. At its second session, the SCRC considered a first draft of the provisional programme of the 71st session of the Regional Committee. Members welcomed the proposed three-day duration and endorsed the approach of structuring the session around the EPW. Responses to the COVID-19 pandemic and health emergencies should occupy a prominent place in the political dimension, scheduled for the first day of the session. Pillar 2 of the EPW (Protecting against health emergencies) could be taken up next, followed by the other pillars. Preference was expressed for technical briefings on access to affordable medicines and on climate change and health (in view of the 26th Conference of the Parties to the United Nations Framework Convention on Climate Change, to be held in November 2021). It was also proposed to present the work of WHO’s geographically dispersed offices (GDOs), such as those in Kazakhstan, the Russian Federation and Turkey. 44. The provisional programme for the session was adjusted in the light of comments made by the SCRC and resubmitted at the third session. In particular, a staggered launch of the four EPW flagship initiatives was proposed: the European Immunization Agenda 2030 and the Mental Health Coalition would be introduced at the 71st session, and Empowerment through Digital Health and Healthier behaviours: incorporating behavioural and cultural insights at the 72nd session. The SCRC agreed to include the EPW flagship initiative on Empowerment through Digital Health under the item on lessons learned from COVID-19. As requested by the SCRC subgroup on WHO/Europe’s governance, more time would be devoted to discussion of the Proposed programme budget 2022–2023 and WHO transformation, and progress reports would, as far as possible, be linked with related technical items on the agenda. 45. Commenting on the provisional programme of RC71 as a whole, one member of the SCRC said that the structure of the session was logical and took account of the interests of Member States. 46. At its fourth session, the SCRC approved the proposal to hold RC71 as a virtual three- day session. It also approved the proposal that the parallel sessions (ministerial briefing, technical briefings and side events) should be removed from the plenary programme and scheduled on the two days following the session, to lighten the workload and give more time and space for organizing them under the best possible conditions. 47. A draft decision was distributed containing special rules and procedures required to regulate the conduct of a virtual RC71. Non-State actors should be fully involved in the meeting and allowed to make joint three-minute statements. Interventions on the agenda items EUR/RC71/3 page 11 on matters arising from resolutions and decisions of the World Health Assembly and the Executive Board, and on progress reports, would be limited to written statements only. Member States would have a total of 15 working days within which to exercise their right of reply to written statements. If necessary, voting would be by roll-call conducted through the virtual system, while elections and nominations could be conducted by secret postal ballot (as had been done at RC70). Substantive amendments to proposed resolutions and decisions should be introduced in writing at least 24 hours before the start of the session. If adoption of a revised draft resolution or decision was not feasible before the end of the session, the Regional Committee might decide to establish an open-ended working group that would meet virtually after the adjournment of its session. The SCRC endorsed this draft decision and agreed that it should be circulated for further consultation with Member States. Action by the Regional Committee Review and adopt the provisional agenda, provisional programme and provisional annotated programme of the 71st session. Review and adopt the draft decision on special rules and procedures for a virtual 71st session of the WHO Regional Committee for Europe. Review and adopt the draft resolution on dates and places of regular sessions of the Regional Committee for Europe in 2022–2023. Proposed schedule for RC71 48. At its fourth session, the SCRC was informed of the following proposed schedule for RC71. Day 1: political dimension 49. The SCRC was informed about the items scheduled for the first day of the session, including an address by the Regional Director. 50. The item on lessons learned from COVID-19, to be taken up in the afternoon of the first day, would include a review of the progress made in the implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023 (resolution EUR/RC68/R7). Lessons would be drawn from material produced by the Independent Panel for Pandemic Preparedness and Response, the Global Preparedness Monitoring Board and the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 Response, as well as from the experience of Member States as captured in intra-action reviews. The Regional Committee would be asked to consider the development of a new five-year action plan that would be submitted to RC72 for adoption. A virtual consultation with European Member States, expert networks and operational partners was held in June 2021. Dr Anthony Fauci, Chief Medical Adviser to the President of the United States of America, was confirmed as the inspirational speaker to introduce this item. 51. A discussion of the report of the Pan-European Commission on Health and Sustainable Development was likewise scheduled for the afternoon of the first day. The report would be a slim, actionable report for use by high-level policy-makers at both national and supranational EUR/RC71/3 page 12 levels. It would contain an introductory section on the legacy and lessons from the COVID-19 pandemic, followed by seven main chapters: operationalizing the concept of One Health; taking action to fix the fractures that left so many people vulnerable to the pandemic; investing in healthy societies; supporting innovation in health systems; promoting global public goods; making changes to the global financial system; and enhancing international governance. A moderated panel discussion with invited members of the Commission would be held to inform Member States of the rationale underlying the recommendations in the Commission’s final report and to advocate for steps that could be taken to operationalize those recommendations. Action by the Regional Committee Review Report of the Regional Director and consider the corresponding draft resolution. Review European Health Report 2021. Review Response to the COVID-19 pandemic: lessons learned to date from the WHO European Region. Review A timeline of WHO's COVID-19 Response in the WHO European Region. Review Health system transformation in the digital age during the COVID-19 pandemic. Day 2: political and technical dimension 52. Since the COVID-19 pandemic had created a new context for primary care, it was opportune to spotlight the issue once again. Under the RC71 agenda item on “Realizing the potential of primary health care in the post-COVID-19 era” it was expected that Member States would renew their commitment to primary health care by adopting a resolution incorporating the lessons learned from COVID-19 that would replace the earlier resolution EUR/RC69/R8. This item on primary health care would also be an occasion to further discuss the implementation of the Operational Framework for Primary Health Care adopted by the World Health Assembly. 53. Under the item “European Immunization Agenda 2030: building better health for tomorrow” the Secretariat would present the European Immunization Agenda (EIA) 2030, which would be aligned with the global Immunization Agenda 2030 and would draw on the achievements of the European Vaccine Action Plan 2015–2020. Consultations with Member States on finalizing the priority actions and the monitoring and evaluation framework had been held in June 2021. A draft resolution would be proposed by three Member States. 54. To place mental health at the heart of the recovery process, the Secretariat had drawn up the WHO European Framework for Action on Mental Health 2021–2025 and brought together a new Mental Health Coalition to oversee and facilitate implementation of the objectives of the Framework. It had also tabled a “zero draft” of a resolution for consideration at RC71, on which Member States had been consulted in early June. EUR/RC71/3 page 13 Action by the Regional Committee Review Realizing the potential of primary health care: lessons learned from the COVID-19 pandemic and implications for future directions in the WHO European Region. Consider the related draft resolution and its financial implications. Review European Immunization Agenda 2030. Consider the related draft resolution and its financial implications. Review The WHO European Framework for Action on Mental Health 2021–2025 and the new Mental Health Coalition. Consider the related draft resolution and its financial implications. Day 3: governance dimension 55. At RC71, the Regional Committee would be informed about the current financial situation of WHO/Europe and be briefed on the proposed programme budget for the forthcoming biennium in advance of its endorsement by the World Health Assembly. The proposed programme budget for the forthcoming biennium would be presented in the context of the longer-term planning process that was being introduced in WHO/Europe. 56. An agenda item on “Delivering a fit-for-purpose WHO/Europe for country impact” would cover the activities of WHO/Europe on the integrated change agenda for WHO/Europe since RC70 and the progress made on the country presence review in the period up to the third quarter of 2021. There would not be a specific report to RC71 related to particular GDOs, since their work had been considered during the structural realignment of the head office in Copenhagen, Denmark, and in the context of an integrated, WHO/Europe-wide approach to noncommunicable diseases. 57. At its third session, the SCRC was informed that the Secretariat had received applications from six non-State actors (NSAs) not in official relations with WHO for accreditation to attend sessions of the Regional Committee: the European Association for Palliative Care; the European Disability Forum; the European Heart Network; the European Network for Smoking and Tobacco Prevention; the European Society of Cardiology; and Mental Health Europe. In addition, 19 NSAs that had been accredited at RC68 were due for a triennial review of their accreditation status. The Secretariat recommended that these six NSAs should be accredited to attend meetings of the Regional Committee, and that the accreditation of the 19 non-State actors currently registered should be renewed for a further three years. The Secretariat was also exploring other methods of engagement, including a large-scale meeting with NSAs scheduled to take place prior to RC71; the involvement of NSAs in all items at RC71; and the creation of a virtual exhibition space where delegates and stakeholders could engage with NSAs to gain a better understanding of their contributions. 58. On matters arising from resolutions and decisions of the World Health Assembly and the Executive Board, the related document would be finalized after the closure of the Seventy- fourth World Health Assembly and the 149th session of the Executive Board. 59. Under the last subitem, the Regional Committee would be invited to note the remaining progress reports that had not been covered under previous agenda items. EUR/RC71/3 page 14 Action by the Regional Committee Review WHO sustainable financing in the European Region and consider the related draft resolution. Review Delivering a fit-for-purpose WHO/Europe for country impact. Review WHO/Europe’s presence and work in countries. Review Engagement with non-State actors: accreditation and triennial review of regional non- State actors not in official relations with WHO to attend meetings of the WHO Regional Committee for Europe, and consider the related draft decision. Review Matters arising from resolutions and decisions of the World Health Assembly and the WHO Executive Board. Ministerial briefing, technical briefings and side events 60. At its fourth session, the SCRC noted that the ministerial briefing on building a resilient health and social care workforce would give visibility to health and social care workers and the role they had played in responding to the COVID-19 pandemic while also maintaining access to essential health services. Health workforce case studies would be presented from selected countries in the Region. 61. The technical briefing on elevating climate change in the health debate was intended to raise awareness of the health significance of climate change and to emphasize the synergies and health benefits of tackling air pollution and mitigating climate change. The technical briefing on the Oslo Medicines Initiative would provide an update of the status of the Initiative, with perspectives from two Member States, NSAs and the European Commission. The technical briefing on work by the GDOs and technical centres in the WHO European Region would look at how WHO/Europe’s GDOs and technical centres had been repurposed to deliver “dual-track” support during the COVID-19 pandemic. 62. The side event on health literacy in the context of behavioural and cultural insights would introduce the new EPW flagship initiative; raise awareness of how health literacy could be measured; and advocate a broader approach to behavioural and cultural insights. The side event on alcohol policies would emphasize the gap between evidence of alcohol consumption and the implementation of alcohol policies in the Region. It would also underscore the relationship between alcohol consumption and cancer and call for increased political commitment and engagement of civil society organizations and professional associations. The side event on health in prisons would aim to raise awareness of the relevance of prison health as an integral part of public health and to encourage Member States to meet their commitments under the United Nations Standard Minimum Rules for the Treatment of Prisoners, especially since the COVID-19 pandemic had revealed deficiencies in prison health systems that had resulted in outbreaks in various countries. EUR/RC71/3 page 15 Overview of resolutions and decisions 63. At its fourth session, the SCRC was presented with an overview of draft resolutions and draft decisions that would be submitted to RC71. They included resolutions to adopt the two EPW flagship initiatives on immunization and mental health, as well as an important resolution on strengthening investment in primary health care. Member States were playing an active role in proposing and drafting resolutions, such as the one that would be presented on sustainable financing. Budgetary and financial issues WHO/Europe financial situation 64. At its fourth session, the SCRC was informed of the US$ 150 million increase in the budget for outbreaks and crisis response (OCR) that had been allotted to the Region to manage the response to the COVID-19 pandemic, as well as the US$ 20 million increase in the base segment of the 2020–2021 regional budget directed towards the EPW priorities and the flagship initiatives. Donors had responded positively to the increased funding needs. Most of the funding continued to stem from voluntary contributions and thematic funds. Funding distribution remained somewhat uneven, with pockets of poverty in some categories. Pockets of underfunding were being covered by the flexible funding provided by donors such as Belgium, Germany, the Netherlands and, most recently, Finland. Although non-emergency activities suffered major disruption in 2020, with the new WHO/Europe divisions in place and delivering on the EPW by the end of 2020 utilization of activity funds had quickly increased, and the programme and budget were expected to be fully implemented by the end of 2021. Proposed programme budget 2022–2023 65. At its fourth session, the SCRC was informed that, in a change from previous practice, the proposed programme budget for the forthcoming biennium would be presented to RC71, in the context of the longer-term planning process that was being introduced in WHO/Europe. A three-stage approach was proposed for planning WHO/Europe’s programmatic activities in the coming biennium, consisting of a medium-term strategic outlook for each country, with a time frame mirroring that of the EPW; country support plans or concrete programmes of work for the coming two years in a given country; and operational workplans, budgets and human resource plans, which would be entered in WHO’s global management system. All three stages of the planning process would inform the elaboration of biennial collaborative agreements for 2022–2023, which were expected to be ready for joint signature by the end of the year. 66. At the special session convened virtually on 8 January 2021, the SCRC was provided with an overview of the global Proposed programme budget 2022–2023, scheduled to be presented to the World Health Assembly in May 2021 and subsequently updated to take account of the results of the evaluation by the Independent Panel for Pandemic Preparedness and Response. Key drivers of the proposed budget increase were: lessons learned from the COVID-19 pandemic; transformation, in particular the need to strengthen the Organization’s science and research functions; the polio transition; and efficiency savings made during the COVID-19 pandemic. The overall increase would be 5%; the budget for base programmes EUR/RC71/3 page 16 would be increased by 19% and the budget for the polio eradication programme would decrease by 48%. 67. From the perspective of the European Region, a study of the prioritization submitted by country offices showed that priorities had evolved in the light of the COVID-19 pandemic; while access to quality health services had previously been the priority for most countries in the Region, focus was shifting to preparedness for health emergencies and building country capacity in relation to data and innovation. Regarding the European Region’s share of the global proposed programme budget, while US$ 10 million had been allotted to lessons learned from the COVID-19 pandemic, WHO/Europe had requested a further US$ 6 million to optimize investment in building the Region’s capacity for emergency and pandemic preparedness and response. The sum of US$ 11.7 million had been requested for transformation, in particular to increase investment in strengthening health leadership, behavioural insights and boosting the Regional Office’s capacity to coordinate the work of the country offices. The Region would thus have a total of a 21% increase in budget space for the biennium 2022–2023. 68. The SCRC welcomed the detailed presentations and the ambitious proposed programme budget, which illustrated the critical role of WHO during a global pandemic. Efforts to bolster pandemic preparedness and response were welcomed, in particular the emphasis on health systems strengthening. The COVID-19 pandemic had shone a light on the inadequacies of a siloed approach. Sustainable, predictable, flexible financing was considered crucial and constituted a political issue; WHO/Europe still relied heavily on voluntary contributions, which severely restricted the predictability and flexibility of its funding. Concerns were therefore raised that a budget increase would in fact further restrict WHO’s flexibility. It was felt that it would be useful if WHO programming could be aligned with that of the United Nations. To do so, the GPW 13 should be extended to 2025. 69. The chairperson of the SCRC subgroup on WHO/Europe’s financing took the initiative to prepare a joint statement on behalf of the Region for presentation to the upcoming Executive Board, which following the in-principle endorsement by members of the Standing Committee would then be circulated to all Member States in the Region for finalization. This statement would underline that while Member States in the European Region acknowledged the need to increase the budget and the financing of activities, the COVID-19 pandemic had shown the importance of qualitative financing for the Organization; the context of the provision of that financial support required re-evaluation. Action by the Regional Committee Review Overview of the implementation of Programme budget 2020–2021 in the WHO European Region. Review WHO Programme budget 2022–2023 in the context of the European Programme of Work. Progress reports 70. At its third session, the SCRC had before it the following progress reports: • Final report on implementation of the European Mental Health Action Plan 2013–2020, and the WHO European Declaration and Action Plan on the Health of Children and Young People with Intellectual Disabilities and their Families EUR/RC71/3 page 17 • Progress report on the European Food and Nutrition Action Plan 2015–2020; • Final progress report on the implementation of Priorities for health systems strengthening in the WHO European Region 2015–2020: walking the talk on people centredness; • Progress report on the European Vaccine Action Plan 2015–2020; • Progress report on the implementation of the European Environment and Health Process; • Progress report on the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well- being. 71. At its fourth session, the SCRC had before it, in addition to the above, the following progress reports: • Progress report on the implementation of Towards a sustainable health workforce in the WHO European Region: framework for action; • Progress report on the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well- being; • Midterm progress report on the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, 2018–2023. 72. Members were invited to submit comments and suggestions in writing on the progress reports. During RC71, progress reports would, as far as possible, be linked with related technical items on the agenda, but specific interventions on the agenda item of progress reports would be limited to written statements only. Action by the Regional Committee Review the progress reports. Membership of WHO bodies and committees Vacancies for nomination for membership of the Executive Board and the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction and election for membership of the SCRC at RC71 73. At its second and third sessions the SCRC met in private to consider the procedure for the nominations for membership of the Executive Board (two seats), the SCRC (four seats) and the Policy and Coordination Committee of the Special Programme on Human Reproduction (one seat). 74. Since insufficient nominations were received by the indicated deadline of 10 March, the SCRC agreed at its third session to extend the deadline for nominations until 31 March 2021. As after this extended deadline, still insufficient nominations had been received for the SCRC, the SCRC agreed by written procedure to a second extension until 3 May 2021 for this governing body. EUR/RC71/3 page 18 75. At the fourth session, the SCRC agreed that the assessment of the various nominations received from Member States to serve on WHO governing bodies and committees would be scheduled at a special private session to be held virtually on 11 June 2021. This would allow the time of the open meeting to be better managed and the private deliberations among SCRC members to be held in the best conditions, following the second extended deadline for submission of candidatures. 76. At this additional meeting held virtually on 11 June 2021, the SCRC met in private. It was recalled that the SCRC had decided to apply, on a trial basis, a more simplified and open evaluation process, based on the detailed guidance note produced by the Secretariat. To avoid any conflict of interests, SCRC members who had presented candidacies for membership of one of the bodies or committees were requested to temporarily leave the meeting. Elective posts at the Seventy-fourth World Health Assembly in May 2021 77. At its third session, the SCRC approved the nominations suggested by the Regional Director for the nominations of the elective posts of Vice-President of the Seventy-fourth World Health Assembly, Rapporteur of its Committee A and Vice-Chair of its Committee B, and for membership of the General Committee (four seats) and the Credentials Committee (three seats). It also approved the nominations proposed by the Regional Director for the post of Vice-Chairperson of the Executive Board and membership of its Programme, Budget and Administration Committee (one seat) to replace outgoing European Executive Board members following the Seventy-fourth World Health Assembly. Officers of the 71st session of the WHO Regional Committee for Europe 78. At its additional meeting held virtually on 11 June 2021, the SCRC agreed to propose the following nominations for officers of RC71 in accordance with Rule 10.2 of the Rules of Procedure of the Regional Committee for Europe: • President: Ms Ogerta Manastirliu, Albania • Executive President: Dr Päivi Sillanaukee, Finland • Deputy Executive President: Ms Nora Kronig Romero, Switzerland • Rapporteur: Dr Marat Shoranov, Kazakhstan Action by the Regional Committee Review Membership of WHO bodies and committees, the related addendum, and the guidance note on the assessment process and criteria for nominations and elections. Review Process and criteria for nominations and elections: guidance note EUR/RC71/3 page 19 Address by a representative of the WHO Regional Office for Europe Staff Association 79. At its third session, the SCRC was briefed by the President of the Staff Association of the European Region of the World Health Organization, who commended the efforts made by the Regional Director and senior management to nurture a healthy staff–management relationship. The consultative approach to staff issues through regular meetings, two-way communication and the “Ask Hans” mailbox, as well as the leadership’s readiness to participate in staff-led events, were greatly appreciated. 80. In the previous year, staff had done their utmost to maintain a high level of work ethics and commitment throughout the restructuring process and the functional review undertaken in the midst of the COVID-19 pandemic. The process had generated a high level of anxiety and individual dissatisfaction. Concerted efforts were required to repair and regain trust, and the Staff Association was pleased that the Regional Director had agreed to its proposal for an independent evaluation of the restructuring process to date and looked forward to its outcome. It also welcomed the establishment of the Core Team mechanism to review WHO’s country presence and looked forward to engaging with management in that regard. 81. The restructuring of the Organization and the forthcoming roll-out of the global mobility scheme highlighted the need for equal access to justice for staff in all duty stations. The inability of staff to appeal administrative decisions because of often unaffordable legal fees placed them in an unfavourable position vis-à-vis the Organization. The Staff Association urged Member States to support effective access to justice for all staff, including through the establishment of an Organization-wide legal insurance fund. 82. Staff were grateful for European Member States’ support of their request to the WHO Executive Board and its Programme, Budget and Administration Committee to review, revise and promulgate the WHO policy on preventing and addressing harassment, sexual harassment, discrimination and abuse of authority. 83. The challenges posed by transition and restructuring had added to the already significant mental pressure on staff caused by the pandemic. Action taken by the Regional Office to enable easy access to psychologists and mental health support was greatly appreciated. Despite the support provided, however, staff stress and fatigue would continue to accumulate as the current marathon continued at sprint pace in the absence of contingency planning. 84. Staff recognized and valued the trust placed in them by the governing bodies and were deeply committed to working to accomplish the Organization’s goals. The Staff Association greatly appreciated the support, encouragement and continued guidance of the SCRC. 85. The SCRC expressed its deep appreciation of the work and dedication of staff in difficult times. Their commitment and professional support were crucial to identifying appropriate solutions. 86. The Regional Director said that over the previous 14 months, since WHO had declared COVID-19 a public health emergency of international concern, WHO’s staff had shown the utmost commitment and dedication to the people they served. The restructuring of the head office in Copenhagen had generated change, uncertainty and anxiety for staff. Still, Member States’ expectations of innovation under the new leadership had created an urgent need to EUR/RC71/3 page 20 move towards full structural alignment of the activities of WHO/Europe with the strategic priorities of the EPW and GPW 13, with the emphasis on enhancing country focus. 87. One year into the current public health crisis, staff well-being, and especially their mental well-being, was a priority. The first “Open House” event had therefore been dedicated to staff mental well-being and stress management. The Regional Director was a great believer in staff mobility, which had also characterized his own professional and personal life. The main office in Copenhagen could only be a temporary duty station; the greatest privilege for staff was to work at the country level. EUR/RC71/3 page 21 Annex. Statement by the Standing Committee of the Regional Committee for Europe, 12 March 2021 COVID-19: a continued call for international solidarity and equity Exactly one year after COVID-19 was characterized as a pandemic, the Twenty-eighth Standing Committee of the Regional Committee for Europe (SCRC), on the occasion of its third regular meeting on 10–11 March: • wishes to express its heartfelt sympathy and solidarity with all people, families and communities who have been directly or indirectly affected by this pandemic, which has to date reached the level of nearly 41 million confirmed cases and 900 000 registered deaths in the WHO European Region; • appreciates the dedication and sacrifice of frontline workers throughout this pandemic in protecting and saving lives wherever possible and at a high personal cost; • is mindful of the negative collateral impacts that the COVID-19 pandemic is having on the prevention, diagnosis, treatment and care of other health conditions, including mental health and noncommunicable diseases; • acknowledges the devastating impact of the pandemic on all sectors, including people’s livelihoods and countries’ economies, as well as the social consequences and the setbacks for the achievement of the Sustainable Development Goals; • is aware that the COVID-19 pandemic and its consequences have exacerbated social and economic inequities and have hit severely the most vulnerable; • reminds that personal protection measures (frequent hand hygiene, physical and social distancing, respiratory etiquette, use of masks if ill or attending to someone who is ill, and environmental cleaning and disinfection at home) are a cornerstone for COVID-19 control and prevention; • welcomes the development and production of vaccines in record time, effectively protecting people from the serious health effects of COVID-19 and preventing health systems from collapsing; • while acknowledging the importance of vaccines as an effective measure of fighting the virus, also notes the wide gap in access to vaccines between countries in the European Region as a stark reminder of persisting inequities; • recalls that no single country is safe until all countries are safe and that economic and social recovery is only possible if disparities in vaccination coverage, both regional and global, are addressed; and • commends individual countries and subregional organizations that have demonstrated international solidarity and have effectively contributed to and supported other countries in procuring and deploying vaccines, including through the COVAX Facility. EUR/RC71/3 page 22 In this context the SCRC, acting on behalf of the WHO Regional Committee for Europe, calls upon Member States to: • adhere to the general principles of international solidarity, multilateral cooperation and cross-country coordination at all levels to successfully contain and control the COVID-19 pandemic and mitigate its impact; • help wherever possible to ensure that health care workers and other frontline workers as well as vulnerable groups across the Region can be prioritized in national vaccination strategies and that national health systems are stabilized; • apply whole-of-government and whole-of-society approaches to contain further spread of the virus within communities and across borders; • within a national context, commit to early, fair and equitable access to quality and safe testing, treatment and vaccination for COVID-19, which are free at point of use, while at the same time maintaining access to essential health services, including mental health and non-COVID-19 related services; and • further step up their preparedness capacities, including the International Health Regulations (2005) core capacities, plan for the recovery phase and prepare for any future health emergencies. Expressing its highest appreciation to the WHO Regional Director for Europe for the leading role that WHO/Europe has taken in supporting Member States throughout the pandemic and coordinating actions among them, the SCRC calls upon the WHO Regional Office for Europe to: • continue to use its convening power to advocate for timely and universal access to vaccines and facilitate international cooperation and solidarity in the pandemic response; • further coordinate action at regional and country levels to contain and control COVID 19 and mitigate its impact; • maintain a dual-track approach so that support is provided to countries in addressing post-COVID-19 conditions, the collateral effects of the pandemic and maintaining access to essential health services, with the aim of leaving no one behind; • assist Member States in improving their understanding of the virus, adopting evidence-based public health measures and providing the population with reliable and comprehensive information on COVID-19 treatment and immunization; • take proper account of the lessons learned in the European Region from the response to this pandemic to help end its acute phase and build resilience and better preparedness for future emergencies, using the all-hazard and hazard- specific approaches; and • contribute to building back better our health and social care systems in the light of current and future pandemics. = = =