WT/GC/W/867  
S/C/W/427  
 
24 February 2023  
(23-1321) Page: 1/4 
General Council  
Council for Trade in Services  Original: English  
 
BUILDING A POOL OF HEALTH PROFESSIONALS TO RESPOND EFFECTIVELY TO 
PANDEMICS/NATURAL DISASTERS  
COMMUNICATION FROM INDIA  
The following communication, dated 23 February 2023, is being circulated at the request of the 
delegation of India.  
 
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1  INTRODUCTION  
1.1.  The COVID -19 pandemic represented an unprecedented disruption to the global economy and 
world trade. In the  run-up to the Twelfth Session of the Ministerial Conference, WTO Members 
worked towards formulating a multilateral response to COVID -19 to guide the WTO's work to render 
the multilateral trading system more resilient for futures crises. This culminated in  the "Ministerial 
Declaration on the WTO Response to the C OVID -19 Pandemic and Preparedness for Future 
Pandemics " adopted by the membership on 17 June  2022 (WT/MIN(22)/31).  
1.2.  In the Declaration, the membership acknowledged the importance of facilitating trad e in 
services, including health services and ICT services, during COVID -19 and future pandemics. 
Further, the importance of understanding how WTO rules have supported the Members during the 
COVID -19 pandemic, and their role in future pandemics was undersco red. The need to review the 
lessons learned and the challenges experienced during the COVID -19 pandemic to build effective 
solutions in case of future pandemics including on services in an expeditious manner was affirmed. 
Moreover, the importance of the WT O working, along with the WHO and other international 
organizations, on an international pandemic response, including through mutual recognition norms 
related to services was noted. In this context, the relevant WTO bodies were asked to continue or 
initiat e work as soon as possible.  
1.3.  While natural disasters may differ from pandemics in terms of say the time period and localised 
geographical impact, the occurrence of such disasters and their severity are on the rise. Thus, both 
situations necessitate coordina ted action across geographies for their management, mitigation and 
eventual recovery. To the extent that these crises do not affect all geographies at the same time 
and with same severity, such coordinated action and burden sharing becomes easier. A critic al 
element of response to such crises is the availability and deployment of health professionals.  
1.4.  During the pandemic, the availability of health professionals became challenging not just on 
account of unexpected surge in demand but also depletion in supp ly on account of workers getting 
infected and prevalence of mobility restrictions. To ensure continued supply of quality health services 
in this crisis, maintaining and enhancing the capacity of the health professionals in a short time was 
of paramount imp ortance.  
1.5.  Globally, various countries took steps during the pandemic to enhance the surge capacity of 
their health professionals. These steps included expedited hiring of foreign health workers, 
facilitating renewal of work authorisation/visa, temporary an d/or restricted licensure and fast -track 
processing of recognition of foreign qualifications. Spain launched a coordinated action for the 
immediate hiring of foreign health workers. Italy adopted a decree that enabled temporary licensing WT/GC/W/867 • S/C/W/427  
 
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  of foreign trained  health professionals .1 Germany prioriti zed recognition of foreign health workers 
and some were granted temporary permission to practice including through relaxation of certain 
recognition norms/conditions .2 Other countries such as Belgium, Italy, Spain, the UK, and Ireland 
also took steps to bring foreign trained health professionals into their workforce either temporarily 
or by speeding up recognition procedures .3  
1.6.  Despite the significant potential which f oreign health professionals possess to respond to surge 
in demand for the services in another country, the offtake of their services remains limited owing to 
the way regulations attached to it are managed.  
1.7.  Lack of recognition of professional qualifications  acts as a critical barrier that impacts the 
services suppliers ' ability to provide services in another country. Mutual recognition of professionals 
by different regulatory regimes is central to facilitating cross border movement and provision of 
professio nal services via online platforms. Progress in terms of Mutual Recognition Agreements 
(MRAs) in professional services between countries has been unsatisfactory.  
1.8.  This submission aims to drive dialogue on the need for multilateral response for building a po ol 
of health professionals and to facilitate recognition of such professionals so as to smoothen the 
process of their deployment to ensure continuity of supply of services during crises like 
COVID -19/future pandemics/disasters.  
2  STRATEGIES AND APPROACHES  
2.1  Establishment of multilateral arrangement for building a pool of global health 
professionals and facilitating recognition thereof  
2.1.  A pandemic is a global challenge that is not confined within the borders of any specific entity. 
At the global level, C OVID -19 pandemic presented a unique situation where surpluses and shortages 
of health -related resources existed simultaneously as the pandemic came in waves, affecting 
different regions of the world at different times. The same trend was witnessed within large na tions 
too. In such a scenario, it has been seen that not all countries require health staff to deal with such 
pandemics simultaneously. Therefore, it would be useful to have Members sharing this burden 
collectively.  
2.2.  In this regard, we may explore the idea  of establishing a globally recogni zed pool of trained 
health professionals. This pool of resources could be drawn by a country in need of these resources 
during crisis. This collective burden -sharing arrangement would be in the spirit of international 
solidarity during situations of pandemics/natural disasters. Such large -scale adverse events cannot 
be effectively mitigated without joint action and a sharing of the related burdens.  
2.3.  Establishing such a pool of resources would, inter alia, require skill mapp ing, matchmaking, 
and augmenting supplies by temporarily relaxing regimes at both regional and global levels. A critical 
element to facilitate the deployment of such a global pool of health resources is development of a 
multilateral framework/norms for the  recognition of professional qualifications, in coordination with 
the relevant international organizations. This would be a crucial step in building preparedness for 
pandemics/natural disasters.  
2.4.  GATS has enabling provisions for such recognition. Article V II.5 states that "wherever 
appropriate, recognition should be based on multilaterally agreed criteria ". Members are also 
encouraged "in appropriate cases " to work "in cooperation with relevant intergovernmental and 
non-governmental organizations " towards the development of common international standards and 
criteria for recognition and common international standards for the practice of relevant services 
trades and professions .4  
 
1 "Contribution of migrant doctors and nurses to tackling C OVID -19 crisis in OECD countries ", OECD, 
May 2020.  
2 "Managing international migration under COVID -19", OECD, 2020 . 
3 "What strategies are countries using to expand health workforce surge capacity during the COVID -19 
pandemic ", Gemma A. Williams  and others, Eurohealth, 2020.  
4 Ibid. WT/GC/W/867 • S/C/W/427  
 
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  2.5.  These internationally recogni zed professionals may be granted special mobility rights or 
exemption from general movement restrictions so that they can be deployed promptly in 
coordination with the relevant international organisation, to enable continuity in supply of services 
in pandemic like situations.  
2.6.  Such multilateral solidarity in times of crises is essential for an effective response to 
pandemics/natural disasters. It is both ethically desirable and practically conceivable in this context.  
2.2  Implementation of notification/other requirements to facilitate recognition  
2.7.  GATS Article VII.2 requires a member who enters into an MRA to afford adequate opportunity 
to other interested Members to negotiate their accession to such an agreement or to negotiate 
comparable ones. To facilitate this, Article VII.4 require s that Members must notify existing 
recognition measures to the Council for Trade in Services (CTS) and promptly inform the CTS when 
they adopt new recognition measures or significantly modify existing ones. Article VII.4 goes beyond 
these standard transpa rency provisions to require that Members promptly inform the CTS of the 
opening of negotiations on an MRA in order to provide adequate opportunity for any other Member 
to indicate their interest in participating in the negotiations before they enter a subs tantive phase .5  
2.8.  The provisions of GATS Article VII remain largely unused. The year wise status of notifications 
under this article from 1995 to 202 2, as per an informal note prepared by the Secretariat6 is given 
in the figure below. Only 95 notification s have been received from 4 6 Members . 51% of these 
95 notifications are accounted for by 4 countries (Switzerland  19, Russian Federation 1 3, 
Australia  11, India 6). Given this trend, there is a need for prompt compliance by Members with 
Notification Requir ements laid down in Articles VII:4(a), (b) and (c).  
 
 
2.9.  It would be useful if the full text of existing MRAs is made available to the WTO Secretariat and 
circulated amongst all Members. Effective opportunities need to be provided to other Members. 
Article VII.4 is designed to enable other Members to be aware that negotiations are underway. More 
effective information flow by, e.g., including a standing item in the CTS on this subject under which 
Members could report, in a less formal way than via a notificat ion, the opening of negotiations on 
an MRA with another Member. This item would also provide an opportunity for other Members to 
signal their initial interest .7 Further, most of MRAs which have been concluded between countries do 
not seem to provide ready  avenues for accession. Few bilateral MRAs have created a body to handle 
 
5 "Service providers on the move: Mutual Recognition Agreements ", Working Party of the Trade 
Committee, OECD, 2002 (TD/TC/WP(2002)48/FINAL) . 
6 JOB(09)/10/Rev.1 3. 
7 S/CSS/W/12, 2000 . 
WT/GC/W/867 • S/C/W/427  
 
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  requests from foreigners for reciprocal treatment  / contain clear accession clauses .8 Proactive 
engagement in the CTS would allow better operationalisation of the relevant GATS disciplines and 
facilitate improvement in progress on MRAs between countries.  
2.10.   For better preparedness to deal with future pandemic like situations, there is a need to 
strengthen implementation of GATS disciplines.  
3  CONCLUSION  
3.1.  The COVID -19 crisis has highlighted the deeply embedded challenge of severe shortages in 
service supply, eit her in person or through remote consultations, in various countries along with the 
requirement of surge capacity often arising in different countries at different times. The pandemic 
has also brought into focus the role that foreign health professionals ca n play in ensuring continued 
supply of critical services. In pursuance of the Ministerial Declaration, and to better address the 
current or future pandemics/disasters, it would be imperative for the membership to formulate a 
multilateral and coordinated re sponse for building a pool of health professionals and facilitating 
recognition to ensure continued supply of critical services.  
3.2.  We propose that Members organi ze a dedicated discussion in the Council for Trade in Services 
along with a Workshop/Seminar to share information, experiences and views on this matter.  
4  QUESTIONS FOR DISCUSSION  
i. What have been Members ' experiences regarding planning surge capacity of health 
professionals during the pandemic? What are the major challenges in this regard? 
What measures  are being taken/were taken to ensure continuity of supply of these 
services?  
ii. What role can facilitating recognition of professional qualifications of health 
professionals play in ensuring a pool of resources to address the requirements of 
pandemic like si tuations?  
iii. In pursuance of WT/MIN(22)/31, what steps can the Members take to facilitate 
recognition and build a pool of health professionals to strengthen preparedness for 
future pandemic like situations?  
__________  
 
8 TD/TC/WP(2002)48/FINAL, 2002 .