Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 
Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? 

Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. 

“I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. 

Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB).

The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. 

A Pandemic Treaty Is Not Essential 

Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. 

“Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.”

According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. 

And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. 

Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. 

Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross

In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. 

Treaty Would Need Strong Member State Alignment 

At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society.  

“If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. 

Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN)

Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). 

And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty.

Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. 

Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined.

“If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. 

“A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said.

Stronger Business Case Needed For Investing In Health Systems in LMICs 

Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the  Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. 

“We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.”

Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems.   

“Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working.

“COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.”

In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments  lacking public transparency and accountability: 

“Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ”

In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez.

“Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. 

In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. 

“There is a need for investment, but the investment at the level that is required is not coming through.”

Regional Initiatives and Grassroots Action As Way Forward 

Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre

“There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. 

“Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. 

“And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far…

“On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.”

Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response.  

While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. 

A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict.

That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation.  In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. 

“It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” 

Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health…

“So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. 

“We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.”

Image Credits: WHO, The Global Fund / John Rae.

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