After agreeing to negotiate a deal on how to handle future health crises, an early proposal reveals the divides countries will have to overcome before they can reach an agreement.
An early draft of what the future treaty on pandemics could contain was circulated among delegations on Wednesday, as countries were gathered in Geneva at the World Health Organization (WHO) to discuss the future of global health until 7 February.
States agreed in December 2021 to hash out an agreement on how to deal with global health emergencies, after Covid-19 exposed the many weaknesses of the world’s health systems.
Countries now have a bit more than a year to decide what stays and what goes from the 32-page document that will serve as a basis for negotiations, which will kick off at the end of the month.
Next pandemic just around the corner
A little over three years ago, Covid-19 first took the world by surprise, shaking even the most robust of health systems to their core. The virus has so far killed more than 6.8 million people, while also causing major disruptions to economies, with companies closing down and people losing their jobs.
Experts have warned that this is just a glimpse into what the future holds as factors including climate change, deforestation and wildlife trade increase the chances of pathogens jumping between animals and then to humans, before triggering a pandemic.
What does more equity mean?
One of the main shortcomings of the pandemic that the treaty intends to fix is unequal access between countries to vaccines, tests, masks and other pandemic-related products. A report by the People’s Vaccine Alliance from this week said that wealthy countries had been hoarding Covid-19 and Monkeypox tests, leaving poorer countries to pay hefty prices for their economies.
The first line of the WHO’s so-called “zero draft” doesn’t mince its words, calling the show of solidarity and equity in Covid-19 response a “catastrophic failure of the international community”.
The text suggests that countries could be asked to give 20 per cent of their own stocks to the WHO, with half in the form of donations and the other half at an affordable price. The proposal also states that countries with manufacturing facilities would help ship the products according to schedules agreed between manufacturers and WHO.
A diplomat in Geneva stressed that the document was “very broad” and that it was at this stage a compilation of different proposals made by countries. While the document was what was “expected” and “in line with the bureau’s mandate”, the diplomat voiced concerns that many of them could be challenging to get endorsed by all members.
Avoiding north and south divide
One of the major points of contention is intellectual property rights. The issue is raised extensively throughout the text, urging countries not to let IP agreements get in the way of protecting people’s health – an issue that has caused a major rift between north and south.
Discussions on IP rights have so far mainly taken place at the World Trade Organization (WTO). A South-led proposal to waive IP rights for Covid-19 vaccines getting through last year only after lengthy and strained negotiations, despite initial opposition from Switzerland, the European Union, the United States and other rich Western countries that host pharmaceutical giants.
But resistance to see the move go further at the WTO, blocking an initiative to extend the Covid-19 vaccine waiver to tests and therapeutics, has forced its proponents to look for other battlegrounds.
Enter the WHO pandemic treaty. The text has eight paragraphs on IP rights, reflecting stronger or softer stances. While one phrase describes IP rights on “life-saving medical technologies” as an outright threat to global health, others raise concerns about its adverse effects on prices. In another one, IP rights are recognised as important for medical development.
With such a wide range of positions, it remains to be seen what the final text will say. The diplomat said that if there was to be an agreement, classic north-south divides should be avoided, noting that “intellectual property rights could pose a challenge in the negotiations”.
An opportunity for trade-offs?
Another proposal that is likely to face strong pushback is putting in place a system for sharing pathogens with potential for pandemics. Countries would be required to share information within a matter of hours of an outbreak – though an exact number of hours is left open to discussion.
Countries hold different views on how much and what data they want to share. China was criticised by the WHO early this year for not providing all the relevant information concerning the Covid-19 outbreak. The country also came under heavy criticism at the beginning of the pandemic for refusing to cooperate with investigations on the origins of the pandemic.
Nicoletta Dentico, director of the Society for International Development’s global health and justice programme, noted that “while some might hope that the treaty becomes an agreement to relaunch the WHO unaccomplished agenda on access to medicines, it's a fact that this vision reduces the scope of the agreement to be negotiated, which is not a desirable outcome”.
But as is often the case with negotiations, trade-offs can play a key role. In an article published this week, Suerie Moon, co-director of the Global Health Centre of the Graduate Institute, suggested that “the pandemic treaty may offer an opportunity for a package deal”.
“If industrialised countries agree to share IP and technology, developing countries may agree to share the pathogen samples and related genomic sequencing data that is essential for both surveillance and the rapid development of diagnostic tests and vaccines,” she wrote.
What about prevention?
Dentico regretted that while there were pages and pages on measures to prepare and respond to future global health emergencies, “prevention strategies regarding spillover events are not to be seen”.
“Antimicrobial resistance, which is the current pandemic, only has a few lines and they refer to the need to do research and development to address them,” she said. “This means they haven’t understood at all the nature of antimicrobial resistance.”
The document does open the door for collaboration with other relevant treaties such as the Biodiversity Convention or the group created in 2021 to work on the links between human health and the environment.
It also calls on governments to address drivers such as climate change and land-use change, and to develop national plans centred on a one health approach. But it doesn’t go into detail of what these measures should look like nor does it set any targets.
“There is a risk of a missed opportunity,” Dentico said. While stressing that vaccines and drugs were key to addressing health crises, she pointed out that health systems in the zero draft were addressed after medical products “in a very general definition”, calling it “totally counterintuitive”.
“This biomedical vision clashes with reality. Counter-measures don't live in isolation, they need people, the implementation of a real One Health vision, and health systems,” she said.
“This is an indication of how western medicalisation of health, with the industrialisation that goes with it, has hijacked the political culture around health.”
Nothing agreed until everything agreed
With the deadline set for May 2024, the clock is ticking fast. On one hand, it responds to the sense of urgency for the matter at hand. On the other hand, it raises questions about whether countries will be able to overcome such huge divergences in a little over a year and reach the needed consensus.
At the same time, countries are negotiating reforms to the International Health Regulations (IHR) that have governed how countries handle global health emergencies since they were adopted in 1969. Issues around data and technology sharing are also being raised there.
Moon suggested in her article a possibility of “nothing is agreed until everything is agreed”, causing talks to drag on beyond the intended deadline.
If states manage to strike a deal, it will need to be ratified by 30 of them before entering into force, which could also push the day that the world has a new pandemic treaty further down the line.