The Global Struggle For A Pandemic Treaty

After two years of political negotiations, 194 World Health Organization (WHO) member states failed to finalise a historic Pandemic Agreement

• It was an  international treaty designed to fortify global pandemic preparedness, implement mechanisms for prevention of the same, and reduce unconscionable inequities that were painfully obvious during the COVID-19 pandemic.

About WHO Pandemic Treaty

• Existing Mechanism: WHO already has binding rules known as the International Health Regulations (2005) which set out countries’ obligations where public health events have the potential to cross national borders. 
  • These include advising the WHO immediately of a health emergency and measures on trade and travel.
• Background of WHO Pandemic Treaty: In March 2021, an extraordinary call for a pandemic treaty was issued by 25 heads of government and international agencies, marking a pivotal moment in global health governance.

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Why did WHO’s Member States decide to create an accord for pandemic preparedness and response?

• Limitations of International Health Regulations: The existing International Health Regulations are already legally binding. However, they failed to prevent unjust travel or trade restrictions, and hoarding of vaccines and other medical countermeasures during the COVID-19 pandemic.
• Draft & Negotiation: In light of the impact of the COVID-19 pandemic, WHO’s 194 Member States established a process to draft and negotiate a new convention, agreement, or other international instrument on pandemic preparedness and response. 
• Need: This was driven by the need to ensure communities, governments, and all sectors of society are better prepared and protected, in order to prevent and respond to future pandemics.
  • The great loss of human life, disruption to households and societies at large, and impact on development are some factors cited by governments to support the need for lasting action to prevent a repeat of such crises.
• Balancing:  To ensure equity in both access to the tools needed to prevent pandemics (including technologies like vaccines, personal protective equipment, information and expertise) and access to health care for all people.

Key Developments at the 77th World Health Assembly (WHA)

Under the theme “All for Health, Health for All,” discussions were centered around the World Health Organization (WHO) new strategy for global health 2025-2028. 

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Few Notable Changes proposed are: 

• Amendments to International Health Regulations (IHR) 2005: 
• • Key Changes: The IHR amendments aim to enhance the ability of countries to prepare for and respond to Public Health Emergencies of International Concern (PHEIC) and introduce a new category for urgent international response — a Pandemic Emergency (PE). 
  • AIM: The amendments aim to ensure equitable access to health products during health emergencies and to mobilise financial resources to support developing countries in building and maintaining core health system capacities required under the IHR. 
    • National IHR: It mandates the creation of a National IHR Authority for better coordination.
  • Pandemic Emergency: It include the definition of a Pandemic Emergency, which represents the new highest level of alarm contained within the IHR and available for use by the WHO Director-General.
    • AIM: A Pandemic Emergency aims to trigger a more effective international collaboration in response to events that are at risk of becoming, or have become, a pandemic.

• INB: The 77th WHA extended the mandate of the Pandemic Treaty negotiating body, namely, the intergovernmental negotiating body (INB), stipulating that the proposed WHO Pandemic Agreement must be completed as soon as possible. 
  • Outcome to be discussed in 78th WHA: The outcome should be submitted for consideration at the 78th World Health Assembly in May 2025, or earlier if possible, at a Special Session of the World Health Assembly in 2024.

Contentious Issues in the Pandemic Agreement

Three key contentious issues in the latest draft of the Pandemic Agreement remain significant obstacles to its adoption: 

• Pathogen Access and Benefit Sharing (PABS) System:
  • AIM: To ensure that genetic resources and pathogen samples shared from developing countries (which are the most likely sources for such pathogens), are reciprocated with corresponding benefits such as vaccines and diagnostics that result from research and development on samples and data provided from the Global South.
    • Article 12: Pathogen Access and Benefit Sharing (PABS) system in Article 12, often seen as the “heart” of the agreement.
  • Latest Proposal – Donating a portion: Manufacturers of vaccines and diagnostics  primarily based in wealthy countries which are using genetic information from pathogens in low- and middle-income countries, would commit to donating a portion of their products to WHO for global distribution based on the principles of need and effectiveness.
  • Contention:
    • Low- and middle-income countries (LMICs) seek at least 20% of shared pandemic products.
    • High-income countries propose 20% as the maximum limit; some do not agree to even this.
• Technology Transfer and Intellectual Property:
  • Articles 10 and 11: Division over governance of production and technology transfer, and its implications on intellectual property, outlined in Articles 10 and 11
  • Challenges:
    • Reason for Vaccine Inequity: Intellectual property protections, export restrictions, and manufacturing limitations led to vaccine inequity during COVID-19.
    • Strong provisions for technology transfers and local production needed for self-sufficiency of LMICs.
  • Lack of consensus:
    • Technology Transfer Provision: The central issue is the conditions for technology transfer to “facilitate sustainable and geographically diversified production” through mechanisms such as product information sharing and use of WTO- Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities such as compulsory licensing. 
    • No Consensus: There remains a lack of consensus on the transfer of ‘know-how’ and the binding nature of these transfers. 
    • High-income countries: They advocate for Voluntary and Mutually Agreed Terms (VMAT), but the use of VMAT language could discourage countries, particularly LMICs, from adopting mandatory approaches recognised under the TRIPS Agreement.
    • Disagreement on Peace Clause: Peace clause requires member states to respect the use of the TRIPS flexibilities and not exercise any direct or indirect pressure to discourage the use of such flexibilities.

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• One Health Approach:
  • One Health: It is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems.
  • Draft Agreement: It requires member states to adopt a pandemic preparedness and surveillance approach that recognises the interconnection between the health of people, animals, and the environment 
    • It promotes a coherent, integrated, coordinated, and collaborative effort among all relevant organisations, sectors, and actors, as appropriate. 
  • Challenges:
    • High-income countries: Particularly the European Union, strongly supports One Health. 
    • LMICs: They view it as an unfunded mandate that imposes an additional burden on their already strained resources

Other Concerns Related to the WHO Pandemic Agreement

• Enforcement and Compliance: The enduring obstacle in international law is its enforcement
  • Lack of Robust Mechanism: International law often lacks robust enforcement mechanisms, leading to concerns about real accountability.
  • Monitoring and Evaluation: The effectiveness of the proposed Conference of Parties (COP) in ensuring compliance remains uncertain.
• Equity and Solidarity
  • Global North vs. Global South: Geopolitical discord and competing interests between higher- and lower-income countries hinder consensus.
  • Historical Inequities: Past experiences, like the COVID-19 pandemic, highlighted severe inequities in treatment access and vaccine distribution, raising skepticism about future commitments.
• National Sovereignty: Countries prioritize their sovereignty and may resist external interference or mandatory compliance measures imposed by international agreements.
• Financial Resources and Support: Ensuring equitable access to health products and supporting developing countries in building and maintaining health system capacities require significant financial resources.
• Sustainability: Long-term sustainability of the agreement’s provisions is a concern, particularly for low- and middle-income countries.
• Long-Term Access and Self-Sufficiency
  • Dependency on High-Income Countries: Developing countries’ reliance on “charity” from wealthier nations for medical products is seen as unsustainable.
  • Manufacturing Capacities: The need for diverse and geographically dispersed manufacturing capacities to ensure long-term access to medical products.

Way Forward

• Mutual Solidarity: Achieving global health security requires mutual solidarity and cooperation, recognizing that health threats do not respect borders. Countries must prioritize collective interests over individual gains.
• Diplomatic Efforts: Skilled diplomacy is essential to bridge gaps between countries’ interests and foster a cooperative spirit for the effective implementation of the Pandemic Agreement.
• Incentives and Support Mechanisms: Providing incentives for compliance, such as financial aid, technical assistance, and capacity-building support, can encourage adherence to the agreement. 
  • However, securing sufficient resources and equitable distribution of support poses difficulties.
• Strengthening International Institutions: Empowering international health institutions with greater authority and resources can enhance their capacity to enforce compliance and support member states in meeting their obligations.
• Strengthening Enforcement Mechanisms
  • Robust Compliance Framework: Develop a more stringent compliance framework to ensure member states adhere to the treaty’s provisions.
  • Regular Monitoring: Establish frequent and transparent monitoring mechanisms to track the progress of implementation.
  • Penalties for Non-compliance: Introduce penalties for countries that fail to comply with the treaty to ensure accountability.
• Monitoring and Evaluation Systems: An inclusive, transparent, and effective monitoring and evaluation system is crucial for accountability. 
  • However, designing and implementing such a system that is acceptable to all member states remains a significant challenge.
• Capacity Building in Low- and Middle-Income Countries (LMICs):
  • Technical Assistance: Provide technical assistance to LMICs to build their healthcare infrastructure and response capabilities.
  • Training and Education: Implement training programs to enhance the skills of healthcare workers in LMICs.
  • Infrastructure Development: Invest in healthcare infrastructure to ensure LMICs are better prepared for future pandemics.
• Conference of Parties (COP): The Pandemic Agreement proposes the establishment of a COP to monitor implementation and review compliance every five years. 
  • However, the effectiveness of this body depends on its authority, resources, and the willingness of member states to cooperate.

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Conclusion

• A core aim of the Pandemic Agreement — beyond ensuring the immediate availability of medical products during emergencies — should be to promote long-term and sustainable access to these products by diversifying production and enhancing regional manufacturing capabilities
• The coming months of negotiations are crucial. This treaty is not just for the next pandemic but also serves as a blueprint for a more equitable and resilient global health system.

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