Historic Public Hearings on WHO Pandemic Instrument; Some Unhappiness with Process
The last Ebola patient leaves a treatment centre in the Democratic Republic of Congo at the end of March 2021, marking the countdown to declaring the end of that pandemic.

The World Health Organization (WHO) convened public hearings for only the second time in its history on Tuesday, asking interested parties what substantive issues should be contained in its proposed international instrument on pandemic preparedness and response.

The first and only other WHO hearings were held 22 years ago in the run-up to the adoption of the Framework Convention on Tobacco Control, according to WHO principal legal officer Steven Solomon.

Welcoming the public hearing, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that informed opinion and active public cooperation are of the utmost importance to improve health, and it was important to learn from the COVID-19 pandemic to ensure the world is “better prepared” for the next pandemic. 

Tedros had been mandated by last year’s World Health Assembly Special Session to convene public hearings to inform the work of the Intergovernmental Negotiating Body (INB) which is in charge of negotiating the pandemic instrument or treaty.

INB co-chair, South Africa’s Dr Precious Matsoso, described the hearings as “remarkable” and “historic”.

Dr Precious Matsoso, INB co-chair

Narrow responsibility

However, the Civil Society Alliance for Human Rights in the Pandemic Treaty warned that the consultative process risks being “inadequate”.

“While this week’s public hearings reflect the INB’s stated objective to consult the public to some extent, it has interpreted its responsibility to do so very narrowly,” according to the alliance.

“The INB has allocated minimal time to engaging with the wide range of stakeholders who could inform the process and improve both the legitimacy and quality of the Treaty that emerges.”

Dr Meg Davis, from the Global Health Centre at the Graduate Institute in Geneva, also said that participants had been given no indication of whether or how their submissions would be included in the negotiations and recommended policymaking models to ensure meaningful civil society engagement.

A number of organisations gave two-minute speeches focusing on a wide range of issues including ‘One Health’, research and development (R&D) and intellectual property rights at the hearings, which continue on Wednesday and then reconvene in mid-June.

Equity means sharing Research and Development

Professor Suerie Moon, co-director of the Global Health Centre at the Graduate Institute in Geneva.

All member states have committed to equity at the heart of any pandemic instrument, but Professor Suerie Moon, co-director of the Geneva Graduate Institute’s Global Health Centre, told the hearings that “equity requires collective research and development of vaccines, drugs and diagnostics”.

Pointing out that COVID-19 has led to the development of technology transfer hubs in South Africa and the Republic of Korea, Moon warned that “there’s a risk that new factories will sit idle in the next emergency unless the new international instrument forges agreement on obligations to share knowledge, data and intellectual property before and during future emergencies”. 

“It’s unlikely, however, that countries or companies will do so out of the goodness of their hearts,” added Moon. “To make such sharing feasible, we have to tie it to commitments to jointly finance research and development to share pathogen samples and genomic sequencing data. In other words, the key idea is collective research and development for collective benefit.”

Acknowledging that intellectual property was a difficult issue, Moon nonetheless said that if equitable access was to become a reality “the new instrument must include the nuts-and-bolts provisions to make sharing technology for pandemics the new normal”. 

To address IP, Knowledge Ecology International (KEI) recommended that governments should “agree to collectively use exceptions to intellectual property rights that are permitted in existing trade agreements and treaties”.

“A model for this is the WIPO Marrakesh Treaty for the Blind, which mandates its members to use exceptions in copyrights to enhance global access to works made accessible to persons who are blind or have other disabilities,” according to KEI’s James Love.

KEI also proposed “a robust chapter on transparency”, adding that “the lack of transparency in many areas for the current pandemic is an appalling and unnecessary policy failure, and one that both makes it more difficult to manage a pandemic response, and undermines the public’s trust in institutions”.

Rachael Crockett from the Drugs for Neglected Diseases initiative (DNDi) stressed the need to co-ordinate R&D as a substantive element of the new instrument. DNDi wants R&D priority setting, and “globally agreed norms and binding rules that govern the R&D process, including transparency and open sharing of research, data, knowledge, technology, and equitable allocation of health tools”.

Sharing pathogens

IFPMA’s Grega Kumer

Grega Kumer from the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) said “any system should be built on what worked well during the COVID pandemic, in particular, immediate sharing of pathogens and a robust response from the IP based private sector”. 

The IFPMA presented eight core principles, including that the negotiation process should be “inclusive and transparent, involving the private sector and all critical contributors to pandemic preparedness efforts”.

“Any system should allow for immediate access of pathogens and genetic sequence data and correct the negative effects of access and benefit-sharing legislation,” said Kumer.

The IFPMA also supports more equitable access to tests, treatments and vaccines “based on medical need, thus enhancing solidarity and facilitating emergency financing to institutions procuring for developing countries”, and the protection of supply chains ”from arbitrary export restrictions and other trade barriers”. 

“While the public sector might play a larger role in pandemic setting, the system should build on the private sector strengths for R&D, manufacturing and distribution,” he concluded.

One Health is key

The need for any pandemic instrument to adopt a One Health approach also emerged as a key theme.

Dame Sally Davies, speaking for the UN Global Leaders Group on Antimicrobial Resistance (AMR), said that they wanted AMR to be integrated alongside a primary focus on pandemics. 

“The next pandemic could be drug-resistant, or could depend on antimicrobials to mitigate it,” said Davies, saying that one health surveillance needed to be at the heart of any pandemic treaty to enable “rapid, transparent and responsive protection”. 

Governance principles

The Panel for a Global Health Convention believes the instrument must be governed by four non-negotiable principles, according to Dame Barbara Stocking.

“Solidarity, because we’re all in this together, and solidarity is in our own self-interest,” explained Stocking. “Equity: there must be equal access to vaccines and treatments, but also an equal voice in decision-making. Transparency in reporting data and samples. Accountability, as the lack of accountability of countries is the fundamental reason that we are in disarray.”

The hearings continue at 8am CET on Wednesday and can be followed live.

Image Credits: WHO African Region.

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