United Nations member states are almost certain to break the silence on the final draft of the Political Declaration on Pandemic Prevention, Preparedness and Response (PPPR) that was sent to them recently– but likely for all the wrong reasons.

Armenia and Rwanda, the co-facilitators of the declaration negotiations, put the “final” text of the declaration for the High-Level Meeting (HLM) on PPPR in September under the silence procedure on 28 July.

The silence procedure means that member states have a certain period during which to object – or break the silence – otherwise the text is regarded as agreed on.

Health Policy Watch can exclusively share the UN HLM on PPPR Political Declaration Final Text for Silence Procedure. However, it is unlikely to be adopted unchanged.

The text identifies all key problems haunting the world’s pandemic preparedness, but its key weakness is its failure to provide concrete steps to address these.

Ideological red flags

Yet, as recent UN negotiations have shown, the red flags for member states are unlikely to be the lack of a sound implementation plan but rather ideological objections. 

For example, the text identifies climate change as one of the issues straining developing countries’ pandemic prevention, preparedness and response. But at the recent HLM on Road Safety last month, the United States was the lone vote against that political declaration – in part because it mentioned climate change.

The PPPR declaration also recognises that women and girls are among the groups disproportionately affected by pandemics, and calls for “gender equality” to be mainstreamed “into all policies and programmes”.

It also calls for “universal access to sexual and reproductive health care services” by 2030, and the reaffirmation of “commitments to ensure universal access to sexual and reproductive health and rights (SRHR) in accordance with the Programme of Action of the International Conference on Population and Development (ICPD) and the Beijing Platform for Action”.

The ICPD, adopted by 179 member states in 1994, calls for the “universal access to a full range of reproductive health services, including family planning”.

Meanwhile, the Beijing Platform, adopted a year later by 189 member states, establishes that all people have “the right to attain the highest standard of sexual and reproductive health” and that their right to make reproduction decisions should be “free of discrimination, coercion and violence”.

However, SRHR has become highly contested in the UN, with several countries claiming that, by linking sexual and reproductive health to rights, the UN and the World Health Organization (WHO) are trying to promote universal access to abortion.

In recent years, conservative countries – several countries in the Middle East and Africa, the Trump administration’s US, Russia and Pakistan – have objected to the term “sexual and reproductive health and rights” during UN and WHO sessions.

The positive aspects of the text

“The final draft contains positive language on foundational elements that – fully acted upon – would lead to a stronger pandemic readiness system,” according to a group called The Friends of the HLM on PPPR.

The co-convenors of this group are The Elders, FOUR PAWS, The Independent Panel for Pandemic Preparedness and Response and Resilience Action Network International (rani). 

The positive aspects identified by The Friends include that it welcomes the adoption of the Pandemic Agreement and amendments to the International Health Regulations (2005) and calls for the timely conclusion of the pathogen access and benefit-sharing (PABS) negotiations. It also promotes geographically diversified research, development and manufacturing of health tools, and calls for “the need for financing preparedness”.

The group also approves of “recognising a One Health approach to prevent spillover of pathogens from animals to humans” and “the importance of data, tools and assessments that facilitate action-oriented plans, and science and evidence-based monitoring”.

And the real problems…

But Helen Clark, on behalf of The Friends’ co-convenors, notes: “At a time when the Ebola Bundibugyo emergency is now the second largest Ebola outbreak in history, we need measurable commitments which put effective multi-sectoral plans into action, serious money on the table, and ensure real accountability.

“The ultimate test of this declaration is simple: will its implementation make the world measurably safer? Member States have an opportunity now to ensure that it does,” adds Clark, who is co-chair of The Independent Panel and a member of The Elders.

The Friends identify four key gaps in the draft and urge “an infusion of urgency and ambition”. 

The first weakness is the lack of “concrete commitments or timelines” to fill the financing gap, including the $15 billion needed annually to prepare for pandemics.

“The complexity and slowness of disbursing funds for the current Ebola emergency and the question marks around funding for successful tests, treatments, and vaccines underscores the dire need for reliable and rapidly disbursed surge financing,” The Friends note, recommending “a financing tracker to ensure transparency and identify areas where gaps persist”.  

Weakness Two lies in the failure to “strengthen the capacities of veterinary, animal, and environmental health services” given that more than 70% of emerging infectious diseases in humans are zoonotic,– including the recent mpox, Andes hantavirus and Ebola Bundibugyo outbreaks.

The third weakness is its failure to recognise current gaps in monitoring, “including monitoring of equitable access to medical countermeasures, operational readiness, financing, and the social dimensions of resilience”.

Finally, The Friends highlight that the Secretary General gets almost five years to report back on the implementation of the political declaration.

“This is too late to follow up on commitments from this meeting, and will take momentum from an already neglected agenda,” they note, proposing a report within three years instead.

The HLM is set for 25 September, the last Friday of the UN General Assembly. The date has been criticised by the Independent Panel and others, as many delegations leave New York on that day and may not attend.

Many hope that high-level political engagement at the HLM will give fresh impetus to the PABS talks, the final piece of the Pandemic Agreement, which have made little progress for months.

Inequality fuels pandemics

Meanwhile, a recent study published in the New England Journal of Medicine warns that the “dominant model of pandemic preparedness has focused on technical capacities: stronger laboratories and surveillance, more effective vaccines and medicines, faster emergency response”.

Yet, argue the authors, including Nobel Prize-winning economist Joseph Stiglitz,  some of the most “prepared” countries have mounted the most ineffectual responses in real time.

“Among the officials and experts charged with stopping pandemics, the current understanding of what drives pandemic risk for the world is proving to be insufficient. The missing element, we believe, is inequality,” say Stiglitz and co-authors Matthew Kavanagh, Monica Geingos,  Winnie Byanyima and Michael Marmot, for the Global Council on Inequality, AIDS, and Pandemics.

“The co-occurrence of increasing pandemic frequency and increasing inequality is not coincidental – it reflects a self-reinforcing cycle: inequality makes outbreaks more likely to become pandemics, then drives their severity and duration, while pandemics deepen inequality, making future outbreaks harder to control and fueling the next cycle,” they argue.

They argue for an “inequality-informed response” to prepare for pandemics, proposing four approaches.

The first involves addressing the social determinants that drive outbreaks to become pandemics, for example, ensuring social protection including expanded unemployment insurance and paid sick leave “so people can follow public health guidance without impossible trade-offs”.

Image Credits: X/Tedros Adhanom Ghebreyesus.