As pandemic treaty negotiations kick off again at the World Health Organization (WHO) in Geneva this week, countries face a stark choice. Will they decide to move ahead on a new system that vests an independent entity with greater powers to monitor their own national alert and responses – in the name of faster pandemic response for everyone?
An initiative to create a new treaty to redress the key weaknesses seen in the global response to the Covid-19 pandemic is enjoying a flurry of last-minute support from countries and global health advocates ahead of a World Health Assembly special session starting Monday.
The three-day meeting at the World Health Organization (WHO) in Geneva comes the world continues to struggle with Covid-19 deaths and cases, with countries now trying to contain the new and potentially more contagious Omicron variant.
“The ongoing chaos of this pandemic only underlines why the world needs an ironclad global agreement to set the rules of the game for pandemic preparedness and response,” said WHO director general Dr Tedros Adhanom Ghebreyesus in a media briefing last week in the lead up to the milestone event.
Over 100 countries are now backing the treaty initiative, initially championed by Germany, the European Union, and the United Kingdom but also supported by key countries in Latin America, Asia, and Africa, such as Chile, Kenya, Rwanda, Korea, and Thailand.
A draft decision document calling for the creation of a negotiating group to draft the treaty, or instrument, was published on Sunday in a further sign of growing support.
The United States and a number of other former treaty sceptics have also joined as co-sponsors – including India, Japan and Pakistan. Their co-sponsorship, along with all 54 member states of the African Group, suggests good prospects for passage of a WHA decision that would kick-start intergovernmental negotiations no later than 1 March 2022. China and Russia, however, were noticeably absent as co-sponsors of the draft text.
The negotiations would aim to conclude a draft agreement by May 2024, in time for the 77th World Health Assembly, which would then have to be approved by a two-thirds majority, said the official draft.
The fact that the United States had signed onto the draft decision to launch negotiations represents a significant softening of its previous opposition, observers said.
Strong public statements of support have also recently been registered in: a recent BMJ op-ed by some 32 ministers of health; as well as appeals by the former co-chairs of the Independent Panel for Pandemic Preparedness and Response; and the ad-hoc Panel for a Global Public Health Convention, to name just a few.
“There’s now a groundswell of support,” said Dame Barbara Stocking, former head of Oxfam Great Britain and leading voice in the latter, in an interview on Friday.
Revamping International Health rules
Stocking cited what she described as three fundamental problems with the existing International Health Regulations (IHR), drafted nearly two decades ago:
“There is no compliance mechanism. The IHR was written for all health hazards and not for all pandemics, while the problem with pandemics is that they have exponential growth. You can’t wait and see what happens. And the whole precautionary principle is not there.”
The Independent Panel, in a report earlier this year, called the IHR’s alert processes “analogue” measures that aren’t at all fit for purpose in a digital age. Specifically, the regulations:
Don’t explicitly require countries to notify WHO of new and emerging pathogens of concern – unless national health authorities have determined there is “significant risk of international spread” and/or “significant risk of international traffic or trade restrictions.” Under those vague criteria, China in fact, had no clear obligation to notify WHO of the “novel coronavirus” spreading in Wuhan when the government did so in early January 2020;
Lack any clear mechanism for monitoring, reporting or verification of countries’ preparedness and response. In fact, the word “monitoring” only appears two times in the IHR text with respect to monitoring the arrival of individuals or freight at country borders;
Lack clear reference to obligations for pathogen-sharing essential for rapidly developing treatments. Treaty sceptics, however, say the Nagoya Protocol of the Convention on Biodiversity provides a framework for such pathogen sharing along with the sharing of research benefits, such as new vaccines.
Emerging out of the era of the first SARS outbreak in 2002-3, a more deadly but less contagious virus, the IHR also is highly preoccupied with curbing countries’ excessive use of penalising travel restrictions.
In contrast, in the SARS-COV2 era, much higher volumes of international travel proved to be one of the most efficient spreaders of a more contagious virus, critics say. A new treaty or instrument negotiated today would need to take a more fine-tuned approach so that critical trade and supply chains remain open but new viruses or variants are better contained.
There are mounting fears in some countries that they could share pathogens or information about emerging risks, only to be punished rather than rewarded.
That, in fact, is precisely what South Africa experienced this week after sharing information about a new SARS-CoV2 variant of concern, Omicron (B.1.1.529) - only to see the United Kingdom, the European Union and Israel immediately halt flights and bar entry to citizens from the same southern African countries that had reported on the virus variant.
From Geneva to UN General Assembly Summit
Precisely in response to such concerns, there is also building momentum for a summit convened by the UN General Assembly, to be held soon after the WHA session. There, world leaders would be called upon to take a stance, adopting a political declaration and roadmap for beating down Covid.
That roadmap would include, presumably, steps to ensure more sustainable financing for low- and middle-income countries’ pandemic preparedness and vaccine access.
On the table are ambitious proposals for a $10 billion a year preparedness fund and a $100 billion emergency response fund.
Although if the recent series of G20 Summits, as well as the Glasgow Climate Conference, offer any example, wrestling actual delivery of the funds from the same rich countries that support the pandemic treaty initiative may not be an easy feat.
Bottom up approaches may be better, critics say
That is one of the reasons why civil society critics, such as Carlos Correa, director of the Geneva-based South Centre, continue to maintain that the whole pandemic treaty exercise is potentially futile.
Speaking at an event hosted Wednesday by the Geneva Global Health Hub (G2H2), Correa advocated for a more of a “bottom-up” approach that would focus on building countries’ health systems as well as developing more regional vaccine and manufacturing capacity.
This approach could be financed by offering LMICs more generous debt relief and greater access to IMF special drawing rights, he added. An agreement on a pandemic waiver on Intellectual Property related to Covid medicines and vaccines, being debated at the World Trade Organization (WTO), would meanwhile provide an effective legal framework for stimulating more regional production of needed vaccines and medicines, he and other civil society critics of the treaty maintain.
If nothing else, WHA special session will likely greenlight next steps
For the moment, however, trade representatives from the global North and South remain deadlocked over the IP waiver proposal. Trade ministers were due to come head to head on the issue at the WTO Ministerial Conference (MC12) this week, however, the gathering was cancelled at the last minute on Friday after Switzerland and other countries imposed travel restrictions in response to the emergence of the new Covid variant, Omicron.
As the WHA special session was planned from the start as a hybrid session, it was largely unaffected by the emergency Swiss travel rules. Monday's opening saw a few dozen countries attending in person at WHO headquarters, while others joined online virtually. Meanwhile, the global panic triggered by Omicron will only add more impetus to the Director General's appeal to world leaders to band together around a pandemic treaty.
Despite hesitations and hiccups, it’s expected that the three-day WHA session will yield at least a green light for beginning intergovernmental negotiations on a treaty instrument, based on the draft decision text as well as the discussions of a WHA Member State Working Group that has been meeting over the past several months.
Whether Sunday's draft is the final one, however, remains to be seen. Like most WHA agreements, the aim is to reach a consensus. And that means coming up with a text that China and Russia would not vote against - even if they abstain or express reservations.
Stocking, too, expects a pre-drafted WHA decision to begin "intergovernmental negotiations” will be approved. As for how those talks will proceed after the three-day session? Figuring that out will be no easy feat, she admits:
“How do you do it? They will have to work out the modalities of doing negotiations with 194 countries.”