While there is unanimous agreement that equity is the essential ingredient in any future pandemic treaty ‘recipe’, World Health Organization (WHO) member states are unclear about how can it be incorporated practically.

This emerged from an informal consultation on how to “operationalise and achieve” equity convened on Wednesday by the WHO intergovernmental negotiation body (INB), which has been charged with shaping the treaty or instrument to pandemic-proof the world.

It is the second of four informal consultations planned before the INB reconvenes in December to negotiate a draft agreement to be presented to member states. The first focused on legal issues, while the third – taking place on Friday – will consider the thorny question of intellectual property. The fourth, on 14 October, will consider “One Health”.

Poor countries fighting for crumbs

Expert panellists sketched the all-too-familiar picture: WHO member states in poorer countries being unable to get access to vaccines, personal protective equipment (PPE) and other essentials at the height of the COVID-19 pandemic.

Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University said that her country had the highest per capita COVID deaths in the world.

“Even though we had the economic resources, what was really tragic and dramatic was the fact that we could not access any of the products that were needed as an emergency,” said Garcia. 

“I’m talking about PPE; and we only had access to vaccines very late, which means that a lot of people died, when in other countries vaccines were already available.” 

Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance, said that the number one equity measure in a “binding treaty” should be to ensure manufacturing capacity across all regions.

“Countries and all groups must ensure that, as well as quickly detecting and responding to threats together, the key medical countermeasures – PPE, diagnostics, treatments, and vaccines – are manufactured and shared equally,” said Alakija.

“We have to take this opportunity to enshrine rules and procedures so that all lives are treated equally, not just those in the global North.

“We cannot end up in a situation where rich countries are able to gobble up supply and poor countries are left fighting over crumbs, as we did for much of 2021.”

Resources for developing country manufacturers

Mohga Kamal-Yanni, senior health advisor for the People Vaccine Alliance, said that the WHO had produced an equitable access framework in 2020, before there were vaccines, which showed which parts of the population should be prioritised once there were f vaccines, starting with health workers globally.

“It was supposed to be health workers across the whole world, but what happened is that the framework was used within countries, but not across countries,” said Kamal-Yanni. “Rich countries did not look at this globally, they looked at it nationally. So, in fact, you can define equity and you can actually put up practical mechanisms to help ensure equity, but, how do you implement it? How do you get the political will for it to be implemented?”

Rajinder Kumar Suri, CEO of the Developing Country Vaccine Manufacturers Network (DCVMN), said that one of the most critical challenges during COVID-19 was funding.

“It is of utmost importance to create innovative financial mechanisms and organise funds in advance to avoid any such a reoccurrence,” said Suri, who represents 42 manufacturers.

Suri also pointed out that, although there was $5.6 billion available for product development, only 5% was allocated to the developing country vaccine manufacturers.

“But when we look at the total production volumes, almost 60% of the global production was contributed by developing countries,’ said Suri.

Yuanqiong Hu, senior legal and policy advisor for Medicins sans Frontieres (MSF) Access Campaign highlighted barriers to access to vaccines – including the liability agreements manufacturers required all countries to sign that slowed down access.

“The lack of true international solidarity, collaboration and collective vision about how the future of equity issue can only be addressed politically,” she added.

Some of the “enforceable mandatory measures” that MSF suggests for entrenching equity include ensuring that life-saving medical products – vaccines, therapeutics, diagnostics and other tools – are developed, produced and provided as “global public goods”.

“We think there should be clear and enforceable mechanisms to establish obligations for member states and to regulate and behaviours of private and public sectors,” she added.

At the end of the consultation, INB co-chair Precious Matsoso highlighted some of the other points made by panellists and member states, including the importance of considering “existing instruments” – a number of people felt that the International Health Regulations could be adjusted to meet the challenges of future pandemics.

“We need a binding, pragmatic document that commits countries to work together, meaning we need to push for collaboration in a responsive and cost-effective way,” Matsoso concluded.

Image Credits: Peter Biro/EU Civil Protection and Humanitarian Aid.