The WHO working group met to consider 307 amendments proposed by governments to update current regulations. February 2023. Credit: World Health Organization (WHO)

By Ashka Naik and Nicoletta Dentico
GENEVA, Mar 13 2023 (IPS)

As countries recently gathered in Geneva for the fourth round of negotiations on the WHO proposed pandemic treaty or accord, close examination of the current text by civil society experts has revealed significant gaps.

Critical concerns about the underlying vision of the draft text have been highlighted in a public statement led and endorsed by civil society organizations globally. The statement has been shared with the Intergovernmental Negotiating Body (INB4) that is mandated with the pandemic treaty negotiation.

These concerns still stand true. And it is urgent that the INB begins to tackle them before the next round of negotiations are upon us.

First and foremost, our analysis focuses on the fact that several parts of the text rely on voluntary arrangements, and that the binding regime of the text appears discouragingly vague and weak. One such instance relates to the principle of “common but differentiated responsibilities in pandemic prevention, preparedness and response,” which the draft borrows from the climate instruments.

This notion is extremely important to avoid pandemics, and it cannot be made voluntary, if the world is serious about the goal of reaching systemic capacity to respond to future health crises.

The draft text’s failure to provide safeguards or an accountability framework regarding the role of the corporate sector is another major source of concern. The WHO negotiation places the new UN’s ‘whole of society’ approach – which has been pushed in other negotiating fora – at its core through multistakeholderism, against the backdrop of striking and unfettered geopolitical power asymmetries. The involvement of the private sector in the COVID-19 response has been extremely problematic.

Countries desperately needing a concerted effort to tackle the pandemic were held ransom to the whims of power and profits of both the philanthropic and pharmaceutical industry.

The proposed treaty or accord mustn’t make the same mistakes, and all attempts to bring the corporate sector into the negotiation of any pandemic prevention, preparedness, or response must be strictly regulated at best, and prevented whenever there is a risk of public interest health policies being hijacked for profit.

It is clear that the financing approach outlined in the draft text blatantly ignores that the global financial system has historically prevented low- and middle-income countries from investing in public health.

Tax dodging by corporations, lack of fiscal and policy space for domestic resource mobilization, and crippling national debts are major barriers that prevent many countries from strengthening their public health services and institutions.

In low-income countries, debt has increased from 58% to 65% between 2019 and 2021. Thirty nations in sub-Saharan Africa have seen a debt-to-GDP ratio exceeding 50% just in 2021.

While the current draft misses taking into account the challenges of the global financial architecture, there is a blind spot with no substantive acknowledgement that public health crises are often engendered or exacerbated by a systematic destruction of the planet, at the intersection of the climate and environmental crises, food insecurity, and the mounting inequality crisis enshrined in gender and racial discrimination.

So far, the draft text hardly does justice to the urgency of preventing pathogen spillover at the animal-human interface. A narrow focus on the biomedical approach to dealing with future pandemics, without considering these intrinsic systemic factors, is bound to remain largely insufficient in dealing with any future pandemics.

Way Forward

Governments and various relevant socio-political actors engaged in the WHO diplomatic initiative on the pandemic treaty or accord have different and diverging interests and the Intergovernmental Negotiating Body (INB), which has done impressive work to keep pace with the agreed negotiations’ roadmap, has to reckon with these diverse political demands and conflicting pressures.

However, it is clear that to carry out the original intent of the new pandemic treaty or accord, unambiguous wording is needed that conveys a binding character of the agreement. This also means that the multistakeholder model under which the entire process of the treaty is being managed has to be re-examined and re-imagined instead of its current ‘whole of society’ form.

In future, none of the promises made by member states in the WHO pandemic treaty or accord will result in the desired change needed if the robust and reliable compliance mechanisms that enable governments to be held accountable are absent.

These demands are not unique to this treaty, but have similarly been made by civil society in ongoing negotiations in the UN on climate change and in the UN treaty on business and human rights. These were also incorporated into the tobacco control binding policy that the WHO established nearly 20 years ago.

At the same time, public health, public governance, public systems, and public funding must be at the center of the pandemic planning, prevention, and response. It is important to finally recognise that the global financial architecture must be overhauled, especially for low income and developing countries to have sovereign control over their fiscal and policy space, and to resource their public health needs through progressive taxation policies.

It is imperative to understand that the private sector cannot fulfill the current funding gaps and needs no leveraging by international development and financial institutions. Healthcare privatization is not the way to go to face the health challenges of the present and the future.

Lastly, all efforts must be made to make sure that the text creates a deliberate interconnection between the right to health and the right to a healthy environment, now explicitly adopted as a human right by the United Nations, as well as the rights of nature to exist and thrive.

It is about time that this global public health discourse reckons with the reality of populations and the environments from the ground, rather than from the ivory towers of corporate investors and vested policy-making.

Ashka Naik is the Director of Research and Policy at Corporate Accountability, and directs its food program, which focuses on structural determinants of food systems, nutrition, and public health

Nicoletta Dentico leads the Global Health Justice program at Society for International Development and co-chairs the Geneva Global Health Hub (G2H2)

IPS UN Bureau

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The World Health Assembly (22-28 May) is expected to discuss the pandemic treaty.Credit: World Health Organization (WHO)

By Nicoletta Dentico
ROME, May 12 2022 (IPS)

In what has been defined a historic consensus decision aimed at protecting the world from future infectious diseases crises, on 1st December 2021, the special session of the World Health Assembly agreed to kickstart a global process to draft and negotiate a convention, agreement or other international instrument to strengthen pandemic prevention, preparedness and response.

According to the World Health Organization (WHO) Director-General, the decision marked “a once-in-a-generation opportunity to strengthen the global health architecture to protect and promote the well-being of all people”.

The process officially started with the constitution of the Intergovernmental Negotiating Body (INB), whose task is weaving the texture of the negotiation, based on a treaty working draft, by 1st August 2022. The INB is mandated to submit the outcome of its work for consideration by the 77th World Health Assembly in 2024.

The WHO does not have a consolidated experience in exercising its binding normative power, having used it only twice in seventy-four years. Well before the pandemic, the health agenda negotiated at the WHO had propelled experts and civil society organizations to call for hard rules to replace voluntary regimes, insufficient to address escalating challenges and expanding determinants, which now include trade rules, environment, digitalization.

On the other hand, as illustrated in the Geneva Global Health Hub (G2H2) report on the genesis of the pandemic treaty, there are piercing geopolitical issues that require scrupulous mapping of reality and a questioning attitude, now that the international community is projecting itself towards a pandemic future.

Does the world need a new pandemic treaty?

After months of debates in the WHO Working Group on Pandemic Preparedness and Response (WGPR), there remains a lack of deep contextual evidence on the problems that the new instrument could and should help solve.

There is not even an official definition of what a pandemic is in legal terms. COVID-19 has not been the only pandemic raging the world – global cancer figures are staggering and doomed to grow due to the effects of COVID and climate change.

Other existing pandemics (like antimicrobial resistance) are not exclusively triggered by zoonotic events – most of which are caused by wildlife trading, alongside nature loss, industrialized livestock production and habitat destruction. Shouldn’t binding measures to prevent and respond to such crises address the widespread destruction of ecosystems, instead?

Pandemics are neither a destiny nor a natural phenomenon. The WHO Independent Panel on Pandemic Preparedness and Response report explains that they are the undesirable result of multiple governance failures, starting from lack of international cooperation.

This unfortunate conjuncture should be understood, yet to date, there is no comprehensive analysis of the reasons why governments did not comply with the existing WHO binding legal framework designed to face health emergencies: the International Health Regulations (IHR), last reviewed in 2005 (after SARS).

IHR obligations should have guided countries to engage in sharing information and cooperating for contrasting SARS-CoV-2 unknown and aggressive contagion. What went wrong? It may be that IHR are prominently skewed towards prevention and detection of pathogens, and limited on response steps to prevent transmissions.

But couldn’t they be seriously revised and updated, as in the past, to include the new contents deriving from COVID-19’s unprecedented lessons instead of a push for a new treaty?

The WHO Emergency Committee and alarm system must be reformed, along with the strengthening of the legal obligations and compliance of cooperation rules: this is the terrain where most IHR violations have occurred.

One Health approaches surely need integrating in the negotiated review, to build a better prevention and response capacity on the harsh lessons of COVID-19. A clear uncompromising priority assigned to sustainably financing universal public health systems and their workforce, as the reliable safeguard for societies when outbreak emerge, must supplant persisting policies skewed to health privatization and financialization, too uncritically promoted by the WHO. Existing IHR provisions need updating and strengthening to this end.

Ultimately, the critical tension between global health security requirements and the management of existing science must be resolved in the interest of public health rather than private profits – COVID-19 makes it very clear that it’s not an easy game.

Meanwhile, things are being made more complicated. Now that the pandemic treaty negotiations are being led by the INB, in parallel to the IHR review led by the US, new layers of diplomatic intricacies are surfacing in terms of content and process overlaps, ushering dwindling expectations.

The lack of a shared vision is matched by the accelerated pace of the INB negotiation, for which governments are not ready – uneasiness emerged in recent European consultations on the treaty elements that were to be provided by 29th April.

Both the WHO and the INB claim to be looking at the precedents of the WHO’s only other treaty as guidepost, the breakthrough Framework Convention on Tobacco Control (FCTC), while civil society organizations have been instrumental in paving the way to the FCTC and challenging the playbook of the tobacco industry, they now sit at the very margins of the diplomatic process, advocating in the paucity of spaces and restrictions of time allowed in the first round of public hearings.

Thanks to the FCTC’s long negotiations involving broad and consistent civil society participation, the WHO first global health treaty has strict provisions and guidelines on conflicts of interest.

Twenty years later, the fact that macroeconomic forces have been allowed to shape a new political platform for global governance through multistakeholderism, it does not necessarily favor the best scenario for pandemic treaty-making.

The WHO is weakened and under-resourced, while the corporate sectors that have profited from the pandemic in terms of market dominance – pharma companies, big tech, etc. – seemingly support this new negotiation, deemed to institutionalize the super public and private partnerships assembled in 2020 by major philanthropic actors for COVID-19 response.

Governments for their part are still grappling with the pandemic and its turbulent socio-economic effects. Meanwhile, exactly like one century ago, the pandemic tsunami gets tangled with a war of international proportions doomed to transform the world and the international community.

The tang of the Russian invasion of Ukraine is starting to poison Geneva’s health circles. This is not a good foreboding.

IPS UN Bureau

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