Europe Cannot ‘Treaty’ its Way Out of the Pandemic
WHA special session meets in Geneva in a hybrid format

A special session of the World Health Assembly is under way this week with just one item under consideration – Pandemic Treaty.

Will a pandemic treaty be able to help address deficiencies in global solidarity, and improve access to essential lifesaving medicines, vaccines, and tools?

The short answer is no. Not without the political will to hold corporations to account with the same vigour the treaty hopes to hold errant countries to account. And, not without the willingness to adequately resource and distribute capacities, away from rich countries to poorer countries and regions of the world.

The instrument that currently enables global public health responses to transnational spreads of infectious diseases is the International Health Regulations (IHR). There is a growing acknowledgement that the IHR, adopted in 1969 and revised in 2005 following the SARS outbreak, needs further revision and expansion of scope to include pandemics and zoonotic spillovers, guarantee just and equitable responses, and strengthen the ability of the World Health Organisation (WHO) to monitor, investigate, and work with national governments. A new proposal for an international treaty on pandemics is now on the table, championed by Germany, the  European Union and the United Kingdom, and as of last night, with the cautious support of roughly 100 other nations.

Timing of treaty critical with Omicron and vaccine inequity

Obviously, the timing is important. COVID-19 cases are still on the rise. Omicron – the new variant of concern – has been now detected in 11 countries. The WHO predicts 500,000 deaths in Europe alone by March. In spite of vaccine availability, Europe is struggling to increase full coverage of vaccines above 70%. Past weeks have seen street protests in Austria, Belgium, Croatia, Italy, and the Netherlands. This is therefore a sad and telling marker of egregious inequity — rich countries are ramping up boosters while millions in poor (and rich) countries are yet to receive their first shots.

These catastrophic failures in global cooperation and solidarity cannot be attributed to limitations in global frameworks and agreements alone.

Rich countries lacking ‘political will’ to share necessary resources

Demonstrators outside of the European Parliament just before a vote on a controversial proposal to waive IP related to COVID vaccines and treatments

What is clearly lacking is the political will to share essential resources and tools by rich countries. The DG of the WHO has said that the world cannot afford to wait until the pandemic is over to start planning for the next one. As we stare at another year of rising infections and deaths, we seem resigned to the reality of vaccine inequity and more deaths in this pandemic.

We know why people in poor countries have no access. A TRIPS Waiver proposal before the World Trade Organisation (WTO), officially backed by 63, and supported by 100 other countries, is being blocked, mainly by the EU, UK, Norway, Switzerland, and other countries that propose the pandemic treaty.

This proposal calls for a temporary waiver on intellectual property (IP) rights for all essential medical technologies including vaccines, transparency in regulatory information related to its development, lifting any and all forms of IP and their enforcement through any dispute settlement mechanisms, and sufficient duration for the production and supply of these technologies necessary to overcome the pandemic. This switch and bait tactic — diverting attention away from their lack of support for the waiver by proposing a new treaty — reeks of bad faith.

A TRIPS waiver will urgently allow medicines, vaccines and other essential tools be produced more widely, increasing access. A recent New York Times report outlines the capacity that exists around the world to immediately start the production of quality mRNA vaccines that will not only increase vaccination coverage but also guard against new variants.

Shift from protectionism of big pharma to sovereignty for poor countries over essential medicines

Countries such as India have grappled with exporting vaccines to Europe and the US, while failing to vaccinate their own citizens.

At the heart of a free-market ideology adhered to by rich countries, lies a protectionist tendency. Patent laws have allowed Big Pharma to build monopolies and reap immense profits while they are willing to let millions remain unvaccinated. Even in the time of an extreme health emergency, rich countries are unwilling to put people before profits. Furthermore, companies have secured maximum protection from countries seeking vaccines, against any liability through secretive and abusive agreements. The governance capture of public agenda by the private and influential philanthropists is complete.

It is important that we learn the right lessons from this pandemic before we rush into a new treaty. Even with the best of intentions, IHR, or any treaty for that matter, will only go so far if capacities, and all of the resources needed to implement recommendations do not exist in countries.

Any future frameworks or treaties must therefore resist corporate interests and ensure distributed capacities in a manner that poor countries and regions have sovereignty over essential medicines, materials, and supply chains. The colonizing impulse to centralize control over agenda, response, and supply chains must be resisted. A positive instance of distributed capacity, in the aftermath of the 2013-2016 Ebola outbreak in West Africa, is the creation of the Africa CDC in 2017. On the other hand, the creation of the WHO Health Emergencies Programme in 2016, is an instance of a centralizing initiative that also distracts from WHO’s essential norm-setting functions in global health, further weakening its role as an impartial actor.

Decolonization of global health requires de-imperialization for ‘pandemic insurance’

The need for country-led supply-chain sovereignty comes at a time when public health practitioners and scholars are increasingly vocal about the need for decolonization of global health. Successful decolonization requires, a conscious de-imperialization. It is not just about letting go of power and control but an intentional and deliberate recognition and transfer of knowledge and capacities. Decolonized and distributed capacities will also serve as a sort of ‘pandemic insurance’ in the future when global solidarity is lacking or non-existent.

A fundamental shift in mindsets is required to successfully counter a pandemic. Because no amount of treaty-making will cover the fact that we see people, especially in poor countries, as expendable and not deserving of protection. We now live in a multipolar world with rising nationalism and trenchant inequalities. Global solidarity requires that we share pains as well as gains. It is imperative that we privilege lives over profits, privilege equity over nationalism, and privilege social justice over corporate monopolies. This further requires that we see people in poor countries as not deserving of charity but as those with a right to human and health security. And importantly, not just within national borders but globally.

The IHR needs to be strengthened. Perhaps we need a treaty. But countries that oppose the TRIPS waiver need to demonstrate that they are willing to put public health before corporate interests. Unanimous support for a TRIPS waiver is the required show of good faith needed for further engagement on a pandemic treaty, for sceptical nations and hesitant civil society groups. WTO Ministers should no longer use COVID-19 transmission as an excuse to delay decisions that could help bring the pandemic to a halt.

Dr. Unni Karunakara, Senior Fellow – Global Health Justice Partnership, Yale Law School.

Dr. Unni Karunakara was International President of Médecins Sans Frontières / Doctors Without Borders (MSF) from 2010-2013. He has been a humanitarian worker and a public health professional for more than two decades, with extensive experience in the delivery of health care to populations affected by conflict, disasters, epidemics, and neglect in Africa, Asia, and the Americas. He was Medical Director of the MSF’s Campaign for Access to Essential Medicines (2005-2007) and co-founded VIVO, an organisation that works toward overcoming and preventing traumatic stress and its consequences.

Dr Karunakara is an Assistant Clinical Professor at Yale School of Public Health and a Visiting Professor at Manipal University, India. In addition, he has held various academic and research fellowships at universities in South Africa, Zimbabwe, Uganda, Germany and the United Kingdom, focusing on the demography of forced migration and the delivery of health care to neglected populations affected by conflict, disasters and epidemics. Karunakara also served as the Deputy Director of Health of Columbia’s University’s Earth Institute, Millennium Villages Project (2008-2010), and was Assistant Clinical Professor at the Mailman School of Public Health (2008-2017),

Image Credits: Giacomo Carra/Unsplash, @Right2Cure , Flickr – New York National Guard, Rob van Uchelen.

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