Jerry Buttimer (Fine Gael)
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I am glad Senator Keogan is here. It is good to see her. I welcome the Minister of State, Deputy Butler, to the House.

Sharon Keogan (Independent)
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Earlier this year, I called for a debate on Ireland opting out of the amendments to five articles in the international health regulations that were adopted on 27 May 2022 by the World Health Assembly. On that day, 194 unelected, unaccountable and largely unknown delegates to the assembly from WHO member states agreed on amendments to five separate articles of the international health regulations, namely, articles 55, 59, and 61 to 63, inclusive. These amendments are legally binding on WHO member states and do not require ratification by national legislatures or presidential signatures, both of which are required for national legislation under Irish law. While four of these amendments give no cause for concern, the amendment of Article 59 slashes the period after which future amendments would come into force from 24 months to 12 months. Furthermore, the time during which a member state can exercise its right to reject was shortened by 18 months to ten months.

Amendments to the international health regulations often have sweeping effects on WHO member states. The periods after their passing are an essential time to allow individual states to appraise such amendments and choose whether to opt out, as allowed for by Article 61. The World Health Assembly, WHA, is now examining a whopping 307 amendments to the international health regulations, which are expected to be decided at the 77th assembly in May 2024. If Ireland does not opt out of the May 2022 amendments, we will have only one year to prepare for the implementation of these 307 amendments in our country and even less than one year to decide which ones will be of benefit to Ireland and which we could do without. No one in this House or outside of it is under any illusion as to the current health of our healthcare system. We need all the time we can get if huge, sweeping changes are to be made and imposed on us by the WHO. If we do not opt out of the amendment to Article 59, the HSE and the Department of Health simply will not have that time when it comes to May 2024 and the international health regulations are amended more than 300 times. As such, I think Ireland should reject the 2022 amendments to Article 59 of the international health regulations and President Higgins and An Taoiseach should write to the WHO to signal this.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Keogan for raising this important matter. As the recent Covid-19 pandemic has demonstrated, international co-operation is vital in the response to cross-border health threats. As such, Ireland strongly supports a multilateral approach to global health issues, with the World Health Organization in a central leadership role.

The purpose and scope of the World Health Organization regulations is to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.These regulations act as an important mechanism for international co-ordination and provide the basis within international law for the setting up of reporting structures for the monitoring and reporting of issues relating to infectious diseases, particularly where they may pose an international threat. Following the Covid-19 pandemic, several World Health Organization member states expressed the need to strengthen these regulations under agenda item 16.2 of the 75th World Health Assembly in May 2022. Accordingly, the establishment of a working group on the international health regulations was approved on 27 May 2022.

Noting Senator Keogan’s concerns regarding Ireland's decision on opting out of the amendment made to Article 59 of the international health regulations, IHR, I would like to clarify that the decision made by the World Health Assembly on 27 May 2022 did not amend the regulations. Rather, it commenced the negotiation process to amend the regulations which is currently ongoing and is due to conclude by May 2024. The working group has been tasked with discussing targeted amendments to the IHR to address specific identified issues, challenges and gaps, which are critical to supporting effective implementation and compliance with the IHR going forward. More than 300 proposed amendments have been submitted by WHO states parties, with common themes including equity, transparency, collaboration and assistance, in addition to the overarching principle of strengthening accountability to protect global public health. While Ireland did not submit any proposals, it plays an active role in the discussions.

As provided for in the Irish Constitution, the conclusion of an international agreement such as the IHR is an exercise of the executive power of the State in connection with its external relations and is therefore concluded by or on the authority of the Irish Government. In practice this means that Government approval must be sought for the signature, ratification, or approval of the amended international health regulations. However, this can only take place once the agreement has been finalised.

As such, I would like to assure the Senator that no amendments to the IHR will take effect in December 2023. Article 59 of the IHR will only be applicable once a final text has been agreed by the working group and submitted for the consideration of the 77th World Health Assembly in May 2024, at which Ireland will be represented.

Sharon Keogan (Independent)
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I appreciate the attempt at reassurance on where our health service is going to be going forward. However, it does not give me any comfort. The media has been entirely silent on this. If it were not for a few good people with their ears to the ground, all of Ireland would be ignorant of what is happening over on the Continent, where laws are being made which will drastically impact the lives of Irish people. We do not know who is making them, nor do we appear to have any say in the matter. It simply does not sit right with me nor with many other Irish people who expect to be ruled by an Irish Government. I have said in the past that the Government is engaged in a piecemeal parcelling out of Ireland's sovereignty and I stand by that. Will the Minister of State please allow the HSE and the Department the necessary time to react to the WHO changes and opt out of this amendment to Article 59?

Mary Butler (Waterford, Fianna Fail)
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The Department of Health is leading the co-ordination of Ireland’s position in respect of the proposals to amend the IHR. This work involves working with the relevant policy units in the Department, Government Departments, Ireland's permanent representation to the UN in Geneva, EU member states and EU partners on this matter. I would again like to reassure the Senator that Article 59 of the IHR will only be applicable once a final text has been agreed and adopted by the World Health Assembly, at which Ireland will be represented. As negotiations are still ongoing in relation to these amendments, it is not possible at this time to determine the precise legal ramifications of these amendments, if agreed, nor has it been determined what form if any these amendments will take. As such I would like to re-state that no amendments to the IHR will take effect in December 2023.

The requirements of the Irish Constitution will, of course, be fully reflected in Ireland’s position towards these negotiations, and my Department will engage with the Office of the Attorney General on any concerns that may arise in this regard. Ireland will continue to fully engage with the work of both the working group of international health regulations and the IHR review committee to ensure that ambitious, fair and implementable amendments are submitted for adoption to the World Health Assembly in 2024.