As the final Intergovernmental Negotiating Body (INB) meeting of
the World Health Organization (WHO) Pandemic Agreement approaches,
the AIDS Healthcare Foundation and the AHF Global Public Health
Institute are voicing significant concerns about the April 16,
2024, Proposal for the WHO Pandemic Agreement.
This latest iteration of the text, which has been significantly
watered down through the negotiation process, is filled with
platitudes, anemic in obligations, and devoid of any
accountability. Falling victim to least-common-denominator
policymaking in Geneva, this text now lacks the requisite power to
operationalize equity and achieve its intended objectives.
We express profound concern that developed nations have
vehemently defended the private interest of pharmaceutical
companies over the collective common interest of achieving global
health security in a sustainable and equitable manner. Such
disregard has been observed in the proposed compromise for the WHO
Pathogen Access and Benefit-Sharing System (PABS), which the Lancet
has described as not only “shameful, unjust, and inequitable” but
also “ignorant.”
Under the present terms of PABS, a mere 20% of pandemic-related
health products are guaranteed to the WHO in the event of a
pandemic. As the Lancet points out, such an arrangement will
effectively leave 80% of crucial vaccines, treatments, and
diagnostics “prey to the international scramble seen in COVID-19.”
Furthermore, such pandemic-related health products are now made
available only in the event of a pandemic rather than upon the
declaration of public health emergencies of international concern,
as previously proposed. In addition, we consider that monetary
financial contributions to PABS should not be “administered by WHO”
but rather directed to existing global health financing mechanisms
according to formulations agreed-upon in advance of the conclusion
of negotiations.
Have we learned nothing from the COVID-19 Pandemic?
While the INB co-chairs, vice-chairs and some delegates have
undoubtedly been working diligently to reach an agreement, a simple
fact remains: equity will not be operationalized without effective
mechanisms for accountability and enforcement.
Despite warnings by technical experts, the INB has persistently
failed to incorporate tangible provisions for accountability and
enforcement. In the current proposal, Article 8 language regarding
Preparedness Monitoring and Functional Reviews has been withered to
nothing; Article 19, Implementation and Support, contains no
reporting or verification requirements; previously proposed
mechanisms for an accountability committee have been deleted
instead of strengthened, and the text now moves forward without any
effective means for timely and accurate verification of party
compliance.
Calls for strong mechanisms of accountability in the pandemic
agreement are widespread but have not been heeded. They have been
made by the United Nations General Assembly and prominent
international bodies, including the Global Preparedness Monitoring
Board (GPMB) and the Independent Panel for Pandemic Preparedness
and Response (IPPPR). In addition to the GPMB and the IPPPR, the
Panel for a Global Public Health Convention and Spark Street
Advisors have also emphasized the critical need for independent
monitoring.
The absence of any form of independent oversight is concerning
because proven and practical experience confirms that relying
solely on state self-reporting mechanisms does not work. Yes,
instead of learning from the widespread delays and incomplete
self-reporting experience of the International Health Regulations
(IHR), the pandemic agreement promotes more of the same practices
that have compromised global health security in the past. To ensure
its objectivity and effectiveness, the agreement should, at
minimum, consider establishing an independent oversight body that
is “politically, financially, technically and operationally
independent of the WHO and donors.”
In addition to oversight, accountability also requires a clear
enforcement framework with incentives and disincentives for
compliance. The two major treaties under the authority of the WHO –
the Framework Convention on Tobacco Control and the IHR – are
described in the literature as “plagued by incomplete compliance.”
Incomplete compliance with the IHR, for example, “contributed to
COVID-19 becoming a protracted global health pandemic.”
Compliance, however, has largely been ignored by all parties and
brushed under the rug throughout the negotiations. This is
reflected in the current text, which does not mention the word
compliance even once. To this end, we echo the concerns of the
Panel for a Global Public Health Convention that the idea of a
Compliance and Implementation Committee should not have been
dropped from the text.
We also support the Panel’s assessment that an independent and
autonomous Conference of the Parties (CoP) is critical because
pandemics are not just a health issue but a “societal and
governmental priority” that requires a whole-of-government and
whole-of-society approach. We are, thus, concerned that
modifications to the proposed text, which now call for the WHO to
function as the Secretariat for the entire agreement, undermine the
independence of the CoP. We are also not clear how this agreement
will secure the necessary financial resources to achieve its
objectives.
To this end, we emphasize that member states should commit the
necessary funding to establish a fit-for-purpose pandemic
prevention, preparedness, and response architecture, taking into
account the existing global health financing mechanisms. “One of
the central failings of the IHR has been that its requirements for
states to collaborate, including with respect to mobilizing
financing, lacks specificity,” and that “without benchmarks,
formulas, or other such details” such “requirements have little
real force.” Here, the same mistakes are being repeated – most
notably through the lack of binding financial commitments in the
letter of the agreement. Furthermore, the removal of language from
Article 20, calling for the development of a five-year financial
implementation strategy is a step backwards.
We also highlight that the current text misses the opportunity
to effectively engage civil society and other non-government
actors. The sole mention of civil society, in Article 17, is
immediately followed by a caution regarding potential conflicts of
interest, as if conflicts only arise when civil society is
involved. Despite their critical contributions during the COVID-19
pandemic and numerous previous health crises, the voices of civil
society remain marginalized in the decision-making processes of the
WHO, the pandemic agreement negotiations and its implementation.
Moving forward, this could be solved by weaving civil society in
the fabric of the CoP to ensure its meaningful participation.
In the final stretch of negotiations, countries will be wise to
remember how we got here, what needs to be accomplished through
this pandemic agreement, and most importantly – what the
consequences will be if it fails. Hoarding of essential public
health goods, and policies that tolerate corporate greed to take
precedent over human lives should not be allowed anymore. We,
therefore, urge that delegates heed the warnings of experts and
take action to correct critical flaws in the proposed text. Empty
handshakes in Geneva will not prevent another global health
disaster, nor will it keep countries from trampling over each other
when the next pandemic comes.
AIDS Healthcare Foundation (AHF), the largest global AIDS
organization, currently provides medical care and/or services to
over 1.9 million clients in 47 countries worldwide in the US,
Africa, Latin America/Caribbean, the Asia/Pacific Region and
Europe. To learn more about AHF, please visit our website:
www.aidshealth.org, find us on Facebook:
www.facebook.com/aidshealth and follow us on Twitter:
@aidshealthcare and Instagram: @aidshealthcare
The AHF Global Public Health Institute is as a joint initiative
of the AIDS Healthcare Foundation and the University of Miami
created to engage in global public health policy analysis and
research to generate objective evidence that can inform
improvements in public health policy at the global, regional,
national and local levels, particularly for infectious diseases. To
learn more about the AHF Global Public Health Institute, visit
https://ahfinstitute.org/.
View source
version on businesswire.com: https://www.businesswire.com/news/home/20240424113454/en/
U.S. MEDIA CONTACT: Guilherme Faviero Director AHF Global
Public Health Institute at the University of Miami +1 561.929.9339
mobile guilherme.faviero@ahf.org
Denys Nazarov, Director of Global Policy &
Communications, AHF +1.323.308.1829 denys.nazarov@ahf.org