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Special Content


Issue no 16, 20 - 26 July 2024

Uniting Against Future Threats

Progress in Pandemic Treaty Negotiations

Advitya Bahl

Amid the peak of the COVID-19 pandemic in March 2021, twenty-five heads of state and leaders of international organisations issued an unprecedented joint appeal for a "new international treaty for pandemic preparedness and response". This visionary call aimed to fortify global defenses against future pandemic threats. The treaty was slated for adoption at the World Health Assembly, the governing body of the World Health Organization (WHO) earlier this year. However, negotiations stalled due to sharp political disagreements among member countries.

Nevertheless, a beacon of hope emerged. On June 1, 2024 the assembly's concluding day, it enacted historic reforms to the International Health Regulations, which govern matters related to the international transmission of infectious diseases. Additionally, they agreed to extend negotiations on the pandemic treaty to May 2025 or sooner. These decisions reinforced the importance of multilateral institutions and international cooperation. Political will seemed to coalesce around a common desire for a healthier and more secure world.

The rationale for a pandemic treaty resonates universally, benefiting both the Global North and South. Envision this treaty as a grand societal pact designed to shield future generations from the catastrophic and inequitable impacts of pandemics. This global social contract pursues two primary objectives: the real-time, transparent exchange of scientific information, and the fair distribution of medical counter measures. These objectives are fundamentally intertwined, each enhancing global security and equity.

What Transpired During the 77th WHA?

The final negotiations on the International Health Regulations (IHR) during the 77th World Health Assembly (WHA) lasted for a week and were described as a "desperate race" to achieve consensus. Even before the onset of the WHA, there was significant contention among WHO member states to agree on the Pandemic Agreement. This disagreement persisted until the formal beginning of the WHA.

Meanwhile, during the WHA, reports indicated that the Africa Group insisted on not finalising the amendments to the IHR without assurance of completing the Pandemic Agreement by the end of 2024. On the other hand, the United States and its allies advocated for immediate adoption of the amended IHR while seeking to buy time of one to two years for completing the Pandemic Agreement negotiations, citing "fundamental differences" on crucial aspects of the agreement.

Also, final controversy remained over equity and financing, with low and middle-income countries pushing for a new fund to cover IHR responsibilities and implementation, and the United States and some of its developed partners resisting. 

What are the International Health Regulations?

A legal agreement adopted by all 194 member states of the WHO, the IHR–which establish definitions and rules for countries to respond to and communicate on Public Health Emergencies of International Concern (PHEIC)–were last revised in 2005 after the outbreak of SARS.  

Although the IHR set obligations for member states to report international health threats to the WHO and collaborate to ensure that countries have the surveillance capacity to detect and respond to PHEICs, they were criticised during COVID-19 to be inadequate for internationally coordinating a pandemic response. Concerns over the IHR included the lack of their implementation by member states and the WHO's delayed evaluation of the COVID-19 outbreak as a health threat. 

In 2022, WHO member states established the Working Group on the International Health Regulations (WGIHR) to negotiate new amendments to the IHR. After considering more than 300 proposals for amendments over eight negotiating sessions, WGIHR representatives reached a tentative agreement on a text on May 18, 2024 for consideration by the WHA to adopt at its meeting.

Key Amendments to the IHR

Definition of Pandemic Emergency: The amendments introduce a clear definition of a "pandemic emergency", aimed at enhancing international collaboration in response to events that pose a risk of, or have already escalated into, a pandemic. This definition represents an elevated level of alert within the existing framework of the IHR, encompassing criteria such as widespread geographical spread across multiple states, overwhelming of health systems, significant socio-economic disruption, and the need for swift, equitable, and coordinated international action.

Solidarity and Equity in Access to Medical Products and Financing: A commitment to solidarity and equity is emphasised, particularly in improving access to medical products and financial resources. This includes the establishment of a Coordinating Financial Mechanism to ensure equitable access to financing for developing countries, addressing their needs in terms of capacity-building, pandemic preparedness, and response.

Creation of Committees and Authorities: The amendments also entail the establishment of the States Parties Committee to facilitate effective implementation of the amended regulations. This committee will foster cooperation among states for the successful execution of the IHR. Additionally, the creation of National IHR Authorities aims to enhance coordination within and among countries in implementing the regulations.

The importance of these amendments lies in addressing shortcomings identified during past epidemics and pandemics. These amendments not only signify global solidarity but also provide impetus for the negotiation of an international Pandemic Agreement, which is crucial for addressing future health crises on a global scale.

Navigating the Proposed Global Pandemic Agreement

In March 2021, amidst the relentless grip of the COVID-19 pandemic, a beacon of hope emerged as a group of world leaders unveiled an ambitious initiative for a new treaty on pandemic preparedness and response. This monumental endeavour, championed by global stakeholders and endorsed by the World Health Organization (WHO), has since been meticulously crafted, debated, and negotiated under the auspices of a newly-established Intergovernmental Negotiation Body.

At the heart of this initiative lies a profound commitment to fostering an inclusive, comprehensive approach that transcends national boundaries. Emphasising an "all of government and all of society" paradigm, the proposed treaty seeks to fortify national, regional, and global capacities to confront future pandemics with resilience and efficacy. Central to this mission is the enhancement of international cooperation, envisaged to bolster alert systems, facilitate data-sharing, promote research, and galvanise the production and equitable distribution of vital medical and public health counter measures such as vaccines, medicines, diagnostics, and personal protective equipment.

Acknowledging the existing framework provided by the International Health Regulations (IHR), the proposed treaty is poised to complement and reinforce these provisions, laying a robust foundation for a coordinated international response in the face of pandemics.

In October 2021, the Working Group on Strengthening WHO Preparedness for and Response to Health Emergencies (WGPR) unveiled a 'zero draft' report of the proposed global agreement. This comprehensive document, a testament to meticulous analysis and foresight, outlined the potential benefits of a new WHO convention, agreement, or international instrument dedicated to pandemic preparedness and response. Among its key recommendations, the report underscored the imperative of cultivating high-level political commitment, embracing a holistic "whole-of-government" and "whole-of-society" approach, tackling issues of equity, amplifying the One Health framework, and fortifying health systems to enhance their resilience against future crises.

The wheels of progress turned decisively during  November 29 -  December 1, 2021, when the World Health Assembly convened in a historic special session to deliberate on the proposed treaty and chart a course forward. This momentous gathering marked only the second special session of its kind in the history of WHO. It was during this session that the World Health Assembly unanimously endorsed the establishment of an Inter-governmental Negotiating Body tasked with the formidable mandate of drafting and negotiating the agreement.

At the 77th World Health Assembly meeting, WHO member states were expected to vote on the text of the global pandemic agreement prepared by the Intergovernmental Negotiating Body, yet consensus remained elusive within the allotted timeframe. Despite this initial setback, all countries unanimously decided to extend negotiations for a global pandemic treaty by one year, with the collective aim of reaching agreement on critical matters.

The WHO identifies three primary objectives for the agreement:

·       Promoting equitable global response

·       Safeguarding national health systems

·       Fostering cooperation among member states during pandemics

The draft text of the agreement outlines its overarching goal as, "aiding in the prevention, preparedness, and response to pandemics". The provisions under negotiation include definitions, aspirational goals for pandemic preparedness and response, logistical aspects such as supply chain management and communication strategies, and mechanisms for oversight and implementation. However, contentious issues such as financing, pathogen access and benefit sharing, Intellectual Property Rights (IPR), and the concept of common but differentiated responsibilities remain subjects of debate.

The agreement, once finalised, may be adopted as a treaty, regulation, or resolution/ decision, each with varying implications. While a treaty is favoured for its comprehensive scope and influence, it requires a higher threshold for approval and ratification by member states. Alternatively, a regulation would take immediate effect for all member states, albeit with potential limitations, while a resolution or decision would signify a weaker form of agreement without binding legal obligations.

Ultimately, the adoption of the pandemic agreement holds the potential to significantly enhance global pandemic preparedness and response, contingent upon the consensus reached among WHO member states.

Implications of Extended Negotiations

The decision to extend negotiations on the global pandemic agreement was announced on the concluding day of the 2024 World Health Assembly, WHO's annual gathering in Geneva, Switzerland. Mr. Lawrence Gostin, a health law and policy expert at Georgetown University, describes the extension as a positive outcome, signifying the ongoing political will to achieve consensus. Shri K. M. Gopakumar, a researcher with the Third World Network, views the one-year extension as reasonable, cautioning against rushed deliberations that could undermine the process's legitimacy and exacerbate inequalities.

Negotiating Points

As the Zero Draft was the starting point for negotiations, the substantive provisions and content of the treaty continue to change. Currently, the parties are negotiating on issues such as:

·       The definition, means, and procedure for declaring a pandemic, and what this actually means in practice for states.

·       How the treaty would work alongside the International Health Regulations?

·       Key international principles that will guide the treaty, such as human rights, sovereignty, equity, solidarity, transparency, accountability and more.

·       How to achieve equity in the global supply chain for pandemic-related products, and access to relevant technologies?

·       Strengthening the resilience and responsiveness of health systems.

·       How states and the WHO should be coordinating and cooperating in pandemic preparedness and response?

·       How to finance pandemic preparedness and response initiatives?

·       Setting up a new Governing Body for the treaty - a COP or Conference of the Parties.

·       Other general legal issues relating to the treaty, such as amendments, withdrawal, and dispute settlement.

Essentially, the negotiations entail two key components: open sharing of scientific data and equitable allocation of medical counter measures. Under this framework, nations would commit to transparently sharing vital scientific information in real-time, including surveillance data and genomic sequences of pathogens. This exchange of data is crucial for early detection and response to outbreaks, as well as for the development of vaccines and therapeutics.

Moreover, the treaty emphasises fairness and justice in the distribution of medical tools developed using shared information. Equitable allocation of these tools is not only a matter of ethics but also serves the collective interest of curbing the spread of disease and preventing the emergence of dangerous variants.

A cornerstone of the proposed treaty is the establishment of a robust Pathogen Access and Benefit Sharing (PABS) system. This system would ensure prompt sharing of scientific data while also guaranteeing equitable sharing of benefits derived from the use of pathogens. Such a system could mandate the allocation of a portion of pandemic products for distribution by the World Health Organization (WHO) based on need and effectiveness.

However, the success of the treaty hinges on several unresolved issues. These include questions regarding financing, governance, and the integration of the One Health approach, which recognises the interconnectedness of animal, human, and environmental health. Additionally, there is a need for effective mechanisms to monitor and facilitate compliance with the treaty's provisions.

Hence, there is an urgent need for political will and compromise to reach an agreement on the pandemic treaty. A failure to do so could undermine trust and international cooperation, ultimately leaving the world more vulnerable to future pandemics.

(The author is Correspondent of a leading national daily. Feedback on this article can be sent to feedback.employmentnews@gmail. com)

Views expressed are personal.