The latest draft of the pandemic agreement, while deferring many operational issues, keeps equity hopes alive in many aspects – including by cementing in-principle agreements on a pathogen access and benefit-sharing (PABS) system, a global supply chain and logistics network and geographically diverse “capacities and institutions” for research and development.

READ: WHO Pandemic Agreement draft_16 April 2024

The streamlined 23-page draft was sent to World Health Organization (WHO) member states on Tuesday night ahead of the final meeting of the intergovernmental negotiations body (INB) on 29 April.

The “minimum” components of the envisaged PABS system – one of the most contentious aspects of the negotiations – include the reservation of 20% of pandemic-related health products for the WHO for distribution to those most in need, and “annual monetary contributions from PABS System users”.

The basis for the PABS system, to be administered by the WHO, is “the fair, equitable and timely sharing of benefits, both monetary and non-monetary, arising from access to PABS material and information”.

But the “modalities, terms and conditions, and operational dimensions” of the PABS system will be “further defined in a legally-binding instrument, that is operational no later than 31 May 2026”, according to the draft. 

Ditto the mechanisms for a One Health approach, also to be decided in future and operational by 31 May 2026. 

As reported earlier by Health Policy Watch, the WHO’s 194 member states’ obligations to secure themselves against pandemics are codified in the draft – particularly in Articles 4,5 and 6. Meanwhile, some of the international obligations are there – but are still aspirational rather than practical.

‘Differences are not huge’

Ambassador Amanda Gorely, Australia’s representative to the UN in Geneva, told an event in the city on Wednesday that all delegations “need to come together and focus on finding consensus on these high level commitments, and on the institutional structures and further processes”.

“We have been working closely with our Ethiopian colleagues on Article 12 negotiations, which have been amongst, I think, the most intractable in terms of divergent positions. So we really appreciate and acknowledge the fact that the Bureau has been working very hard and indeed circulated a revised text last night, which we’re all now trying to digest and prepare to engage on in the next session,”  Gorely told a high-level discussion at the Geneva Graduate Institute’s Global Health Centre.

While Australia is generally aligned with the western bloc of countries, it has been working to resolve differences between the key power blocs.

“Negotiators who have been listening carefully to each other for many, many months, and know where common ground can be found, need to be empowered to make the agreement that we need to see happen.

“It’s really up to the negotiators and our governments, to enable them to be able to navigate where the landing zones are and of course, the Bureau has an essential role to play in that,” Gorely told the meeting, convened by the Geneva Graduate Institute’s Global Health Centre, the, Global Preparedness and Monitoring Board (GPMB) and Pandemic Action Network (PAN) to assess progress in the pandemic negotiations.

Ethiopian Ambassador Tsegab Kebebew Daka told the same event that “the differences are in the text are not huge”.

They are mainly differences of ideas and they’re not that many. So we can come to an agreement,” said Daka, a key negotiator for the Africa group.

What next?

So who takes this further? Once the draft has been agreed on, hopefully by the end of the INB’s ninth meeting on 10 May, it goes to the WHO’s World Health Assembly (WHA) which convenes from 27 May to 1 June. 

Once the draft and its accompanying resolution are passed by the WHA, some of the outstanding issues will need to be finalised. The WHA draft resolution proposes creating working groups on the key outstanding issues – namely the PABS system, One Health and financing – particularly to help low-and middle-income countries to implement all the provisions.

The draft’s Article 21 makes provision for a Conference of the Parties (COP) to be convened by the WHO “not later than one year after the entry into force of the WHO Pandemic Agreement”. The COP will determine the venue and timing of subsequent regular sessions at its first session, and shall “regularly” take stock of the implementation of the agreement, and review its functioning every five years.

Nina Schwalbe, head of Spark Street Advisors, who has been closely monitoring the negotiations, notes that the text “has no provision for monitoring compliance or details on state reporting requirements other than ‘periodically’,” and that also “notably missing is a working group for accountability or any type of Compliance Committee”.

🚨The proposed WHO #PandemicAccord is released.

💥It has no provision for monitoring compliance or details on state reporting requirements other than “periodically.”

🛑This leaves Member States with no accountability for any of their treaty commitments (weak or strong).

🧵 pic.twitter.com/bbAJxJMA7r

— Nina Schwalbe (@nschwalbe) April 17, 2024

Reduction in transparency

Meanwhile, James Love, director of Knowledge Ecology International (KEI), said that “there has been a significant reduction in the transparency obligations, although a few important provisions have survived, for example, on the terms in government funding agreements”.

The article Love referred to is in Article 9 (research and development), which states that: “Each party shall ensure that government-funded research and development agreements for development of pandemic-related health products include, as appropriate, provisions that promote timely and equitable access to such products and shall publish the relevant terms.”

Transparency about how public money is spent on pharmaceutical R&D has long been a demand by medicines access activists.

The clause elaborates on the types of provisions that could access, listing them as “licensing and/or sublicensing, preferably on a non-exclusive basis;  affordable pricing policies; technology transfer on mutually agreed terms; publication of relevant information on research inputs and outputs; and/or adherence to product allocation frameworks adopted by WHO.”

Love also pointed to the removal of some wording related to using TRIPS flexibilities to enable access to medicines, which he described as “unfortunate”.

Image Credits: ULISES RUIZ / Getty Imageses Contributor, UNICEF.