A crucial stocktake of the state-of-play of the World Health Organization (WHO) pandemic agreement talks on Friday afternoon (3 May) will determine the way forward for the final five days’ negotiations.

But progress has been slow in the past four days, according to reports – with differing opinions about whether a skeleton agreement can or even should be nailed down in time for the World Health Assembly (WHA) at the end of the month – or whether it should be deferred for another year.

An array of civil society organisations wrote to WHO Director-General Dr Tedros Adhanom Ghebreyessus last week expressing concern that the Bureau co-chairs of the intergovernmental negotiating body (INB) are pushing hard for countries to adopt an agreement that “perpetuates the status quo, entrenching discretionary, voluntary measures and maintaining inequitable access as the norm for addressing PPPR” [pandemic preparedness, prevention and response]. 

Meanwhile, 20 medicines access advocacy groups also issued an open letter over the weekend describing a pandemic instrument that does not deliver equity as a “failure”.

This group – which includes organisations from Brazil, South Africa, Kenya, Mexico and Peru – made various suggestions to make the PABS system more equitable, including that “all users that financially benefit from using the PABS system must be required to make monetary contributions to WHO especially to build resilient health systems in developing countries”.

However, over the past weekend,  AU deputy chairperson Dr Monique Nsanzabaganwa, told a meeting of African health ministers that postponing an agreement may not be in the continent’s interests “because we may postpone forever”. 

In a communique issued after the meeting, Africa called for “an international financing mechanism that is accountable to the Conference of Parties [envisaged to govern the agreement] and enshrining explicit commitments to new, sustainable, and increased funding support from developed countries for country-level PPPR in developing countries, debt relief and debt restructuring mechanisms including debt for PPPR swaps”.

PABS: Equity and bitter experience

The proposed WHO pathogen access and benefit-sharing (PABS) system (Article 12) remains the biggest sticking point, absorbing almost two days of the five-day talks so far, according to an INB report-back to stakeholders. By the end of Thursday, little progress had been made. However,  member states are to come up with a consensus on the text and bring it back to plenary, according to a stakeholder briefing.

🧫Yesterday they discussed PABS (art. 12) all day. Sentiment was that it was “return to square 1.”

🗺Countries (eg. not Bureau) will come up with a consensus on text and bring it back to Plenary.

📝They did this on Workforce (art. 7) – 80 member states collaborated on text.

— Nina Schwalbe (@nschwalbe) May 2, 2024

While it sounds dry and technical, PABS encapsulates all the inequity and heartache of past pandemics. It is also one place where developing countries have some leverage, given that many outbreaks originate in these countries from zoonotic transfer from animals to people – so they might well have first access to information about responsible pathogens.

In short, the PABS system wants to facilitate the rapid sharing of genetic and biological data of pathogens that could become global threats so that researchers and manufacturers can develop medicines and vaccines to prevent their spread.

Countries that share this information will be compensated with “access to pandemic-related health products, and other benefits, both monetary and non-monetary, arising from such sharing”  according to the proposal from text from INB’s 16 April draft.

Most tangible offer: 20% of the goods

Article 12.3 contains the agreement’s most tangible offering: that 20% of pandemic-related health products are allocated to the WHO for distribution – 10% as a donation and 10% at cost. 

This would ensure that the WHO, not wealthy governments playing to their electorates, could then distribute these products to those in greatest need. So, for example, if this had been the case during the COVID-19 pandemic, the WHO could have ensured that health workers and the world’s most vulnerable got early access to vaccines.

But as Nina Schwalbe of Spark Street Advisers and a key commentator on the process says: “Will 20% be the ceiling or the floor?” That still needs to be decided.

The INB co-chairs have proposed that the mechanics of the PABS system, as well as One Health implementation measures, should be finalised by May 2026 but the basic principles still need to be agreed on.

The INB also discussed surveillance (Article 4), diversified production of pandemic products (Article 10), and are reaching consensus on Cooperation (Article 19) and Financing (Article 20). Working groups have been established on Articles 4, 5, 10, and 11 to fast-track agreements, INB co-chairs told stakeholders this week.

4️⃣ CSOs are still relying on snippets from the corridor — but we might gain access to the Secretariat’s daily journal starting tomorrow 🙏 No confirmation yet on whether the Friday stocktake will be opened to relevant stakeholders.

— Pandemic Action Network (@PandemicAction) May 1, 2024

However, as the Pandemic Action Network (PAN) has noted, civil society organisations  “are still relying on snippets from the corridor” and there is “no confirmation yet on whether the Friday stocktake will be opened to relevant stakeholders”.

Image Credits: Nina Schwalbe.