The pandemic agreement talks resumed on Monday for two weeks, but parties only have a week to decide whether they have sufficient common ground to call a special World Health Assembly (WHA) in December to adopt the document.

Procedurally, 12 November is the last day by which a December WHA can be called. Negotiators will “stocktake” progress on Friday and decide by next Monday whether to call a December WHA or wait until next year’s regular assembly in May.

Several countries are pushing for a December agreement amid growing geopolitical uncertainties including the imminent US election, and outbreaks of mpox, H5N1 and Marburg.

A Donald Trump victory could mean the US withdrawal from the negotiations and withholding their dues from the World Health Organization (WHO), which Trump did during the COVID-19 pandemic.

US and African negotiators pushed for the December WHA during the opening of the 12th meeting of the intergovernmental negotiating body (INB), while others including stakeholders, cautioned against sacrificing content for speed.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned negotiators not to make “the perfect the enemy of the good”, stressing that no party will get all their demands.

“With the proposals on the table, I believe you have the ingredients in place to meet your objective,” Tedros told the INB, which has been negotiating for almost three years.

He also said that reaching agreement would provide hope that, “despite political and ideological differences between countries, we can still come together to find common solutions to common problems”.

Africa, US push for December adoption

“The Africa group is resolute in its ambition to finalise the agreement process by December 2024. This timeline is not arbitrary, but a moral imperative,”  said Tanzania, speaking on behalf of the Africa Group of 48 countries.

For Ethiopia’s Ambassador Tsegab Kebebew Daka, “the outstanding issues are not that many, but are those that require political decisions to ensure whether the language in the current text addresses the shared threat of the next pandemic and the challenges that our countries are facing on the ground”.

US Ambassador Pamela Hamamoto told the INB: “There’s no question that this pandemic agreement will have real-world consequences. The recent declaration of mpox as a public health emergency of international concern (PHEIC) demonstrates just how relevant our work remains. 

“Concluding these negotiations is a priority for the United States, and we seek to facilitate an effective agreement by year-end, if at all possible.”

Hamamoto said that the Friday stock-take was crucial to “carefully assess progress made and accurately identify areas of convergence, as well as issues that will require further discussion before consensus can be reached”. To assist, she appealed to the INB bureau to develop a framework of clear  criteria for member states to consider to make the December call.

At a stakeholder briefing last week, the INB Bureau stressed that they are aiming for a document that can grow in the future – in other words, what commentators have described as a pandemic agreement “lite” that can provide the framework for more detailed plans about contentious issues such as the proposed pathogen access and benefit-sharing (PABS) system.

‘Consensus is the silver bullet’

But many countries advocated caution, including the European Union (EU). EU Ambassador Lotte Knudsen called for “pragmatic solutions that work for all of us” given that “a number of key issues are still outstanding”

“To proceed with calling a special session, we all need to be fully convinced that the agreement will be ready for adoption. This is too important an objective to make any leap of faith that is not properly grounded in tangible progress in the negotiations,” Lotte stressed.

The agreement’s test is whether it will make a substantial difference to improving prevention, preparedness and response on the ground, she added.

“The content will be far more important than the timing of its adoption. Consequently, our top priority remains to achieve a meaningful and impactful agreement that can command large, ideally universal, participation.”

Comparing the agreement to food, Germany’s Bjorn Kummel stressed that negotiators had to ensure that the “dish needs to be tasteful to all of us” for it to be adopted by all 194 member states.

“Consensus is the magic bullet here,” Kummel stressed.

Equity challenges

Malaysia, on behalf of the 35 countries making up the Equity Group, spelt out the mountain that still needs to be climbed to change the status quo in favour of low and middle-income countries.

The Equity Group’s key concern is how the proposed PABS system ensures that countries sharing information about pathogens with pandemic potential can benefit from vaccines, therapeutics and diagnostics (VTDs) developed as a result.

“We cannot leave all the critical details for the PABS system for the future,” Malaysia noted.

The Equity Group’s demands to ensure fair and equitable benefit sharing include a clear link between access and benefit sharing, making 20% of real-time production of VTDs available to LMICs during a pandemic and annual payments for access to PABS by entities that may profit, such as pharmaceutical companies.

Appeal from the coalface

Meanwhile, Rwanda’s Minister of State for Health Dr Yvan Butera said that his country’s outbreak of the deadly Marburg virus shows that the world is “prone to shocks at any time and anywhere”.

When asked by Health Policy Watch whether he had a message for INB negotiators, Butera said “being able to work together collaboratively to handle these situations efficiently” is essential.

“The capacity to be able to prevent, rapidly detect, respond, and deploy innovative tools in terms of prevention, therapeutics and  diagnostics, is extremely important,” said Butera.

“And then sharing the knowledge so that it can shape better policies or better tools to contain and control future diseases that have potential to become outbreaks, epidemics or pandemics.”

Meanwhile, Africa CDC’s lead on mpox, Dr Ngashi Ngongo, stressed that “benefit-sharing really resonates”.

“If you have used the viruses and pathogens from an African country to develop vaccines, it is really common sense that, in the distribution of the medical countermeasures, those that also contributed with the pathogens also get a share,” said Ngongo.

“Perhaps the lines were a bit hard at the first time, but we are hoping, with everything that has gone behind the scenes, that both sides will be able to come to to a compromise.”