Leading global health experts and activists have expressed frustration and disappointment at the draft political declarations on pandemics, universal health coverage (UHC) and tuberculosis that world leaders are expected to adopt at the United Nations General Assembly (UNGA) next week.

Key criticisms of the three declarations are that they offer no advancement on previous international agreements, are devoid of human rights safeguards and do not chart a clear path to improved access to healthcare and medicines, particularly in low-middle income countries and among vulnerable groups.

Next week there is an unprecedented focus on health at the UN. The Sustainable Development Goals (SDGs) Summit, which aims to  take stock of goals to end poverty by 2030, is on Monday and Tuesday. Wednesday brings a High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) and a climate ambition summit. On Thursday, there is a HLM on universal health coverage (UHC) and Friday brings a HLM on TB. (See links to the lineup here).

The political declarations for the three HLMs have been negotiated over the past few months, with much focus on the rushed talks on the draft pandemic declaration, which is notable only for being lacklustre and aspirational – rather than engaging in firm commitments.

Pandemic declaration: A missed opportunity

Rajat Khosla, director of the International Institute on Global Health at the UN University, described the draft pandemic declaration as a “big disappointment and missed opportunity.” 

The declaration “can be best described as half-hearted half-measures” with “some perfunctory references to rights,” Khosla told a webinar on Wednesday hosted by the O’Neill Institute’s Global Health Policy and Politics Initiative, Aidsfonds, and Love Alliance.

“The declaration does very little in terms of advancing the discussion on pandemic preparedness and response,” added Khosla.

Issues such as “addressing inequalities, vulnerable populations, accountability, international cooperation and funding” have “been all glossed over and with some very vague or weak language,” he added.

Instead of addressing some of the COVID-19 pandemic’s more distressing aspects – including criticisms of state ‘overreach’ in pandemic response, the collapse of international co-operation and lack of accountability of pharmaceutical companies – the declaration “spends more time re-emphasising national sovereignty as the key issue that needs to be safeguarded,” he added.

Language related to protecting vulnerable groups and addressing inequalities is “very weak”, offering “very little tangibility” or legal obligations in terms of transfer of technologies, or addressing countries stockpiling pharmaceutical products”.

Meanwhile, a detailed analysis of how the PPPR declaration squares up to key asks that have been made by over 100 community and civil society has been developed by the Coalition of Advocates for Global Health and Pandemic Preparedness. This shows that the declaration is particularly devoid of financial commitments to PPPR, the coalition concluded.

On a more upbeat note, however, Helen Clark is the eminent speaker due to address the pandemics HLM. As former co-chair of the Independent Panel for Pandemic Preparedness, she is unlikely to sugarcoat any pandemic shortcomings or shirk from what needs to be said about protecting the world against future pandemics, participants in the webinar predicted.

UHC: Virtually nothing new since 2019

The draft political declaration on UHC was similarly described as being a “missed opportunity” to expand on UHC commitments, as virtually all the measures in the 2023 declaration were also covered in the prior declaration adopted at the last UN HLM in 2019.

This is according to Luis Gil Abinader, a Fellow at the O’Neill Institute’s Global Health Policy and Politics Initiative.

Using digital health as an example, Abinader said that the 2019 declaration recognises the need to protect privacy in the digital environment, and a very similar recognition is made in the 2023 draft declaration – despite the possibilities of violations of human rights in the digital sphere becoming more evident in the past four years with the rise of artificial intelligence.

Erosion of gender and human rights

Lucica Ditiu, Executive Director of the Stop TB Partnership (STBP), confessed to being “a bit sour and grumpy and frustrated” by what she described as the erosion of long-established language on gender rights and human rights in all three declarations.

“My experience with the negotiations in the UN that I have attended this year was disastrous,” said Ditiu.

“I was in the room and I could hear with my own ears and see with my own eyes Member States literally saying ‘we don’t want to see any language around gender’; ‘can you remove everything that is about the rights of the key and vulnerable populations’. Bodily autonomy and integrity is like up there in the sky.”

“Even as weak, as watered down as these declarations are, as far as I understand, none of them is actually fully endorsed.” 

Tuberculosis: Some wins

The TB draft declaration, does, however, contain some wins, Ditiu and others agreed. But there remains uncertainty around  consensus support around the final draft, which “will go directly to the UN HLM without having clarity if the consensus was reached” as the silence procedure that the agreed-on declaration had been placed under was broken twice “for political terminology”. 

Notably, the latest draft offers “specific, measurable and time-bound targets to find, diagnose, and treat people with TB with the latest WHO recommended tools (para. 48 a and b), as well as time-bound and specific targets for funding the TB response and R&D (para. 62 & 68),” in the words of a civil society analysis of the TB declaration,

Another big win for the TB community is stronger language around a commitment “to strengthen financial and social protections for people affected by TB and alleviate the health and non-health related financial burden of TB experienced by affected people and their families” (para. 81) and to ensure that by 2027 “100% of people with tuberculosis have access to a health and social benefits package so they do not have to endure financial hardship because of their illness” (para. 48 c).

Other positive notes include the explicit recognition that it is a human right to enjoy the benefits of scientific progress.

But some key targets have also been watered down. And as per the general erosion of language around gender and human rights in HLM texts, none of the key asks related to ensuring that all national TB responses are “equitable, inclusive, gender-sensitive, rights-based and people-centred” were secured.

Ditiu also expressed frustration around some of the vague language used such as the need to “intensify national efforts to address TB”.

“Trying to translate this into something measurable for governments to be able to held accountable will be a hell of a job because everybody understands whatever from this.

Meanwhile, a general reference to “equitable, inclusive, people-centered” TB response that “promotes gender equality and respects human rights” is part of a long run-on text in paragraph 77 that dilutes the impact of the terms, she said.

“Actually, paragraphs 77 and 78 looks like a soup in which everybody throws everything in from vegetables to potatoes to shoes.”