51app

Intended for healthcare professionals

Opinion

Will the pandemic treaty make it over the line?

51app 2024; 384 doi: (Published 15 February 2024) Cite this as: 51app 2024;384:q395
  1. Clare Wenham, associate professor of global health policy1,
  2. Mark Eccleston-Turner, senior lecturer in Global Health Law2
  1. 1London School of Economics
  2. 2King’s College London

This is the question that is on the lips of many people working in global health as we enter into the final stretch of negotiations for a pandemic accord. Deliberations are taking place in the Intergovernmental Negotiating Body (INB), which was tasked with drafting an instrument in an ambitious timeline of two years—considerably shorter than most international legal negotiations—with an assumption that the severity of covid-19 would inspire the world’s governments to come together and seek a better path for preventing, preparing for, detecting, and responding to future pandemics.1 The Treaty text is meant to be finalised and agreed by May 2024.

However, two years on many fear that negotiations are stalling.2 Despite thousands of hours of formal and informal negotiations, and several rounds of draft texts, there still remain vast tides of differences between how countries are approaching the substantive content of these negotiations. The central issue remains equitable access to countermeasures (vaccines) and the associated technology transfer, and capacity development in this sector. To reach meaningful equity, high income countries would need to be willing to waive intellectual property protection, and make private pharmaceutical companies transfer technological capacity to manufacturers in the global south so they can make their own vaccines. In return, low and middle income countries would need to be willing to rapidly share pathogens, genomic data, and other pertinent information. Further gulfs remain between countries’ willingness to embed One Health, financing mechanisms, the scope and modality of the instrument, the role of common and differentiated responsibilities for implementation, and much more besides. Despite there only being a few months of negotiations left, these fundamental issues remain unsolved. The adage that has been central to the INB thus far has been that “nothing is agreed until everything is agreed.” And so it might be, in fact, that nothing is agreed by the deadline.

When the pandemic treaty was first proposed, we thought it was a bad idea.3 There were major gaps in the thought process: firstly, there had not been a comprehensive analysis of what went wrong with the previous piece of international law which governs outbreaks of infectious disease, the International Health Regulations. Thus, governments launched into a process of revising the IHR, as well as that of creating a pandemic treaty, without truly understanding the problems they were seeking to address with this new lawmaking. This means whatever is contained within the proposed treaty may not actually solve the problems it was seeking to fix.

Secondly, the very fact that there are two legal processes for pandemic preparedness and response happening at the same time is problematic. The very same diplomats and health policy experts are both revising the IHR and INB, and are moving debates between the different fora in the name of “synergy,” but really as an effort to ensure their preferred outcomes.4 This risks issues falling between the cracks, and more likely, that if one process fails or is delayed, the interaction between these processes means that neither will happen. Yet, there was political momentum to press ahead with the pandemic treaty, and not take these sequentially, for example, revising the IHR which is a more technical public health tool, and then adding an additional broader, more political treaty on top if needed. This demonstrates a further mismatch between form and substance—it was more important to be seen to be doing something politically, then actually working out whether this would improve pandemic preparedness.

Thirdly, the world seems to be seeking to fix political problems with technical solutions. The problems which determined the failures of global action during covid were wholly political—that governments didn’t act soon enough; that they didn’t share data; that they didn’t share vaccines; that they put travel restrictions on countries despite WHO advising against. These issues will not be solved by public health professionals negotiating the nuances of what digital format vaccine certificates should come in. Not least, because implementing and withstanding international law is a political choice anyway. These need political solutions—and it is this political level which has been missing from the negotiations thus far. The politicians were all too ready to start this process, but since then they have washed their hands of it. For many politicians, the word pandemic has become unpopular with electorates, and consequently this treaty has fallen into political backwaters with the process lacking the political commitment to bridge the remaining gulfs between states on substantive issues.

So what does the future hold? There are three potential outcomes. 1) There is a vanilla treaty agreed in May to keep to the deadlines that governments set themselves, but with technical experts unable to bridge political problems, any contentious issue gets taken out, and the treaty retains the status quo, and thus is a meaningless document for many. 2) It gets delayed—which is a problem with the looming US electoral cycle, and the rise of populism and nationalism around the world. Or, 3) the whole thing fails. This would mean that not even a pandemic can bring about effective multilateralism and willingness for international cooperation.

Whichever of these ends up occurring, what a waste of money it will have been: the two years of teams of public health professionals and civil servants working in every government on it, the countless trips to Geneva will run well into the millions. This is money that could have been much better spent actually implementing enhanced surveillance and response capacity, and much else besides.

Footnotes

  • Competing interests: CW declares consultancy fees from WHO/Euro. MET has worked as a paid consultant to WHO on access to vaccines and has provided advice and consultancy (all unpaid) to various governments throughout the treaty negotiations.

  • Provenance and peer review: commissioned, not externally peer reviewed.

References