Mexican Ministry of Health video promoting vacccination in April 2021. As in many countries, critics alleged that the government’s moves in the early stages of the pandemic were not aggressive enough.

In December 2021, as the COVID pandemic continued to rage, WHO Member States established an Intergovernmental Negotiating Body (INB) to draft an international agreement on pandemic prevention, preparedness, and response (PPPR).

The outcome of the negotiations is to be presented at the 77th World Health Assembly, which will meet next week in Geneva.

Over the past two years, negotiators have worked tirelessly to meet this challenge, facing numerous obstacles along the way, including a very ambitious timeline for extremely complex negotiations.

As we await the outcome of this last-minute, adrenaline-fueled effort, the progress made so far is significant and represents the foundational steps toward improved global pandemic preparedness.

Even if some elements are left open for more detailed discussion in future negotiations, the advancements already achieved are significant – and should be secured by the WHA.

The proposal: an improved global PPPR set of rules

At the launch of the negotiating process, after extensive consultations with a broad spectrum of stakeholders, Member States spearheading this initiative began outlining the foundation for a new global, equitable system of PPPR.

Since the release of the Conceptual Zero Draft, in November 2022, the ambition for this instrument has remained high. Over the six iterations of the draft treaty text released in the past 18 months by the INB Bureau—two co-chairs and four vice-chairs from each of the WHO regions leading the process—the aim has been to cover the entire framework of pandemic prevention, preparedness, and response. 

The intention of negotiators has also been to ensure synergy and complementarity with the International Health Regulations (IHR), a task made more complex by the parallel process to amend the circa 2005 IHR  launched by the Health Assembly in 2022.

The draft pandemic document addresses diverse and complex areas such as One Health, global supply chain, local production of health products, research and development, transfer of technology and know-how, access to pandemic products, pathogen and benefit sharing, and sustainable and predictable financing for PPPR. Its overarching goal is to achieve health security with equity in all these aspects.

At each step of the negotiations, the scope of the work has largely remained true to the original ambition. The depth of certain provisions has certainly evolved, based on political acceptability. 

Some key provisions of initial drafts have now disappeared

WHO member states going line by line in May 2024, in an effort to agree on the proposed WHO instrument on pandemic prevention, preparedness and response.

Some significant exceptions have emerged on key provisions. For instance, reference to human rights and accountability mechanisms, such as a strict reporting system and an implementation and compliance committee, have largely been eliminated from the current draft. However, the core building blocks of the agreement remain intact.

In this final negotiating stage, Member States are negotiating each article line-by-line. As they progress on their work, they use green highlights for parts with consensus and yellow highlights for parts that have reached consensus in working groups but not yet in plenary sessions.

While it is not possible to predict the outcome of these negotiations, an analysis of the green and yellow text as displayed in the draft document on May 10 indicates there would be significant changes, and to some extent improvement, in global readiness and response if the agreement is to be adopted.

Local production and R&D: a first-time step towards equity

Cape Town’s Afrigen Vaccines & Biologics. The pandemic highlighted the dearth of investment in vaccine R&D and manufacturing in developing countries.

On local production of pandemic products, the draft text attempts to respond to the concentration of manufacturing in a few countries in the world. It requests Member States to take measures to achieve more equitable geographical distribution and rapid scale-up of the global production of pandemic-related health products.

This aims to increase sustainable, timely, and equitable access to such products, and reduce the potential gap between supply and demand during pandemic emergencies. The text goes on to identify other collaborative measures Member States will endeavor to take, such as, for instance, supporting skills development and capacity-building, and promoting and incentivizing public and private sector investments. 

While it is not perfect, this is the first time that, to our knowledge, an international, legally-binding instrument seeks to expand local production of health products.

The provisions on research and development (R&D) yields a similar conclusion. While some delegates remain concerned about the imposition of new transparency obligations on R&D and tying global access conditions to publicly funded R&D, there appears to be consensus on the rest of the article. 

Notably, this would also be the first time an international treaty seeks to make R&D for health products more equitable and collaborative.

Pathogen and benefit sharing: a make-or-break article

Most countries agree that pathogen sharing needs to be timely and reliable – creating sharing mechanisms, while ensuring equitable benefit sharing, is challenging.

The draft agreement ambitiously aims to establish a Pathogen Access and Benefit-Sharing (PABS) system as part of the Agreement, which would represent a new and binding obligation for nations that ratify the treaty.

Ensuring timely and reliable sharing of pathogen samples and genetic sequence information, along with equitable sharing of benefits arising from their utilization, is crucial for PPPR and access to health technologies. However, over time, it has become clear that a detailed articulation of PABS would be impossible to achieve by the May 2024 deadline – partly due to the complex technicalities that are involved.

For instance, while draft versions of the text had aimed to define a fixed proportion of vaccine and medicines set-asides to be offered for free or at concessionary prices in the event of a pandemic, agreement on a percentage has remained elusive and may not be responsive to changing conditions in a crisis. Similarly, how to ensure equity alongside other disease priorities remains an issue. 

Additionally, agreement is still lacking on other key aspects of the future system. Issues such as the use of standardized, legally binding contracts, user registration requirements, intellectual property rights, its relation with other international instruments, and equitable access to scientific and monetary benefits are still under discussion.

The negotiators of the PABS system will also have to take into account the parallel discussions concerning the establishment of a multilateral access and benefit sharing mechanism under the UN Convention on Biological Diversity.

Agreement on ‘principles’ seems to be most likely outcome

Ethiopia representing the Africa group at pandemic agreement negotiations in March 2024.

In light of such complexities, negotiators seem to be close to agreeing on principles to be included in a future PABS instrument, listed under draft Article 12, with a proposal to finalize the details by May 2026 through a process open to all WHO member states – and to be launched by the World Health Assembly.

There is, however, agreement on a reaffirmation of  the principle of national sovereignty over biological resources.

Additionally, the emerging broad international recognition that the rapid sharing of pathogen samples and associated genetic sequence information should be linked to equitable benefit-sharing is significant. It responds to a key ask by developing countries to operationalize equity – even if some argue it doesn’t go far enough. 

Overall, it would be the first time governments agree on principles tailored for addressing ABS for pandemics in a legally-binding instrument.

The outstanding points can be addressed in future negotiations regarding the full operational details of the PABS system. 

One Health 

Live animal markets have been a hotspot for pathogen transmission to humans – one of the many issues that One Health principles aim to address.

Negotiators have worked intensively on how to integrate the One Health approach into the Pandemic Agreement. This approach acknowledges the interconnection between the health of people, animals, and ecosystems, marking its first inclusion in an international legally binding instrument.

Developed countries are the main supporters of this approach, while several developing countries have shown concern about the binding regulatory burden as well as the associated costs that One Health provisions in the agreement might impose on them.  Some developing countries have also expressed a concern that tight prescriptions on One Health may result in unpredictable obstacles to their agricultural trade. 

Despite these concerns, there seems to be a consensus on the importance of the inclusion of One Health as an essential approach to PPPR, especially in light of the fact that it is estimated that 75% of all emerging infectious diseases are zoonotic, along with the adoption of selected measures that consider national circumstances. Further discussions after the World Health Assembly have been proposed, potentially to be included in a future Annex, but the outcome remains uncertain and will likely depend on the negotiations’ final stages. 

A glass half full: the road ahead

The current state of the Pandemic Accord can be seen as a glass half full. The green and yellow text represent a considerable step forward from the state of international law before the launch of the negotiations, promising significant improvements in global pandemic readiness and response.

To ensure the glass continues to fill, countries must establish a robust framework for ongoing work. This framework should list a common agenda of unresolved questions, outline guiding principles, and set a strict timetable for completion.  Delegates, on their side, must demonstrate the same determination and resilience they have shown over the past two years.

As the WHA approaches, the international community awaits the outcome with keen anticipation. If the international community can maintain its focus and commitment, the Pandemic Accord will not only represent an improvement over the status quo but also pave the way for a more resilient and equitable global health system.

Daniela Morich is Manager and Advisor at the Governing Pandemics Initiative hosted by the Global Health Centre at the Geneva Graduate Institute. 

Adam Strobeyko is a postdoctoral researcher for the Governing Pandemics Initiative.

Suerie Moon is co-director of the Global Health Centre.

Gian Luca Burci is Adjunct Professor of international law at the Geneva Graduate Institute.

Ava Greenup is a Project Associate of the Governing Pandemics Initiative. 

Image Credits: @RicardoDGPS, Chris Black/WHO, Rodger Bosch for MPP/WHO, NIAID-RML , lihkg.com.

An information and prevention campaign coupled with HIV testing in Côte d’Ivoire at a public transport hub. Despite outreach efforts, new infections from HIV/AIDs still are not declining fast enough to reach 2030 Sustainable Development Goals.

New WHO data show that new infections from HIV/AIDS are not declining fast enough. Also, syphilis along with other sexually transmitted infections (STIs) are increasing in many regions of the world, contrary to the ambitious targets set by the Sustainable Development Goals and WHO member states for ending the epidemics of AIDS, viral hepatitis B and C and sexually transmitted infections by 2030.

Altogether STIs caused 2.5 million deaths in 2022, according to the new WHO report, Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030, published Wednesday.

And the estimated number of deaths from viral hepatitis rose from 1.1 million deaths in 2019 to 1.3 million in 2022 despite the availability of effective prevention, diagnosis, and treatment tools. In 2022, around 1.2 million new hepatitis B cases and nearly 1 million new hepatitis C cases were recorded, the report also finds.

“The rising incidence of syphilis raises major concerns”, said WHO Director-General Dr Tedros Adhanom Ghebreyesus, in a press briefing on Wednesday. “Fortunately, there has been important progress on a number of other fronts including in accelerating access to critical health commodities including diagnostics and treatment.

“We have the tools required to end these epidemics as public health threats by 2030, but we now need to ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they set themselves”.

Increasing incidence of sexually transmitted infections

Four curable STIs – syphilis, gonorrhoea, chlamydia, and trichomoniasis – account for over 1 million infections daily. The report notes a surge in adult and maternal syphilis (1.1 million) and associated congenital syphilis (523 cases per 100,000 live births per year) during the COVID-19 pandemic. In 2022 alone, there were 230,000 syphilis-related deaths.

In 2022, member states set a target to reduce adult syphilis infections tenfold by 2030, reducing cases from 7.1 million to 0.71 million. Yet, new syphilis cases among adults aged 15-49 years actually increased by over a million cases in 2022 reaching as much as eight million, with the biggest increase in the Americas and the African Region, the WHO report found.

HIV infections among risk groups

Meanwhile, new HIV infections only declined from 1.5 million in 2020 to 1.3 million in 2022 – an inadequate trajectory to meet SDG target 3.3 to ‘eliminate the epidemic of AIDS’ by 2030. Five key population groups — men who have sex with men, people who inject drugs, sex workers, transgender individuals, and individuals in prisons and other closed settings — still experience significantly higher HIV prevalence rates than the general population. An estimated 55% of new HIV infections occur among these populations and their partners.

The picture is no better with HIV-related deaths, still reaching high numbers. In 2022, there were 630,000 HIV-related deaths, 13% of these occurring in children under the age of 15 years.

New data also show an increase in multi-resistant gonorrhoea. As of 2023, out of 87 countries where enhanced gonorrhoea antimicrobial resistance surveillance was conducted, 9 countries reported elevated levels (from 5% to 40%) of resistance to ceftriaxone, the last line treatment for gonorrhoea. WHO is monitoring the situation and has updated its recommended treatment to reduce the spread of this multi-resistant gonorrhoea strain.

Gains in expanding service access

Efforts by countries and partners to expand services for STIs, HIV and hepatitis are nonetheless chalking up gains. WHO has validated 19 countries for eliminating mother-to-child transmission of HIV and/or syphilis, reflecting investments in testing and treatment coverage for these diseases among pregnant women. Botswana and Namibia are on the path to eliminating HIV, with Namibia being the first country to submit a dossier to be evaluated for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis.

Globally, HIV treatment coverage reached 76%, with 93% of people receiving treatment achieving suppressed viral loads. Efforts to increase HPV vaccination and screening for women with HIV are ongoing. Diagnosis and treatment coverage for hepatitis B and C have seen slight improvements globally.

Image Credits: JB Russel/ The Global Fund/ Panos, WHO.

Prof Sharon Lewin, director of the Cumming Global Centre for Pandemic Therapeutics

During the COVID-19 pandemic, therapeutic development took a backseat to vaccines – a potentially disastrous gamble had vaccines not been found.

In future pandemics, therapeutics and vaccines should be treated equally – particularly as COVID-19 treatment options remain expensive and mostly only available in high-income countries, speakers told at a webinar this week hosted by the Cumming Global Centre for Pandemic Therapeutics in Melbourne.

During the first 12 months of the COVID-19 pandemic, $91 billion was publicly invested globally in vaccines compared to just $4.6 billion in therapeutics. 

“The first COVID-19 vaccine was approved in July 2020 and delivered to people in December 2020. However, the therapeutic drug, Paxlovid, was only first administered in late 2021 and approved by the US Federal Drug Administration in May 2023,” according to Cumming Centre, which is based at the Peter Doherty Institute for Infection and Immunity.

“If Paxlovid and Molnupiravir, or a similar therapeutic drug, had been available at scale in July 2020, in line with COVID-19 vaccine approval, millions of lives globally could have been prevented.”

Problems with ACT Accelerator

One of the problems during COVID-19 was the structure of the Access to COVID Tools Accelerator (ACT-A), the global structure that was set up to ensure low and middle-income countries had access to health products such as tests, vaccines, treatments and PPE, said Eloise Todd, executive director of the Pandemic Action Network.

ACT-A was divided into four separate pillars – vaccines, therapeutics, diagnostics, and a ‘health systems connector’.

Civil society warned from early on that unless ACT-A had “a single fundraising strategy and a single entity that’s going to spend against an epidemiological strategy, you’re essentially setting up a competition between those forces”, added Todd.

Sure enough, “by September 2021, the vaccines pillar had achieved 95% of its fundraising target and the therapeutics pillar, just 19%”, she said, adding that the “vaccine gold rush approach” undermined the holistic management of COVID.

Generics also “came too late in the process to have an impact in lower middle income countries”, said Todd.

Eloise Todd, executive director of the Pandemic Action Network.

“When the next threat comes around, the epidemiological approach we need to take means that we have to have a bird’s eye, focused view on saving lives from Day One. So by all means, let’s have the R&D for vaccines, but we have to have the R&D for therapeutics. We also have to look at how to repurpose existing therapeutics.”

Shingai Machingaidze, co-chair of the Science and Technology Expert Group (STEG) of the International Pandemic Preparedness Secretariat (IPPS), said that the development pipeline for therapeutics faced “multiple hurdles, including long development timelines, regulatory challenges, and the need for robust clinical trial infrastructure growth globally”. 

A key recommendation of an expert review of the COVID-19 response commissioned by the G7 and G20 was the need for a global coalition focused on therapeutics, she said, adding that the IPPS is currently working on establishing such a coalition.

The aim is not to create a new entity but to bring together the existing entities and to ensure sustained R&D funding to develop at least two Phase 2-ready therapeutic candidates against individual viral pathogen families of greatest pandemic potential, added Machingaidze.

Shingai Machingaidze, co-chair of the Science and Technology Expert Group of the International Pandemic Preparedness Secretariat

HIV: No vaccine but effective ARVs

“Imagine a situation where we have a new pandemic, and we can’t make a vaccine or it takes 10 years to make a vaccine, not one year,” said Prof Sharon Lewin, director of both the Doherty and Cumming centres.

“As an example, after 40 years of research for HIV, there is still no HIV vaccine. However, therapeutics, but what I mean here is direct-acting antivirals or drugs that stop HIV from replicating, have turned HIV from a death sentence to a chronic manageable disease,” she added.

“Direct-acting antivirals can fill a gap. They can be a second layer of protection, or they can actually be the only intervention we have. So we need to really think hard about how we can make them better, make them faster and make them equitable.”

The Cumming Centre was launched in September 2022 as a joint venture of the University of Melbourne and Royal Melbourne Hospital following a $250-million donation from Geoffrey Cumming, making it the “biggest philanthropic gift in the history of Australia”, said Lewin.

“We’re not a drug company, nor do we plan to do what companies already do well,” she added. 

“We plan to expand the pipeline for drug companies to ultimately commercialise and implement new therapeutics, so our goal is to focus on new platform technologies to develop therapeutics at speed for pathogens of pandemic potential.”

The centre’s goal is to provide “really long-term funding” to  projects that are “high risk, but also high reward”, added Lewin.

“We need treatment solutions, not only for pathogens that we know about but for pathogens that are totally unexpected. And we need to be able to develop those solutions in a much shorter time frame than what’s currently possible with our current technologies. I personally think this can be done but it will need new science, new ideas and transformational changes in how we approach therapeutics.”

Lewin added that her centre had a smaller focus on anti-microbial resistant (AMR) pathogens “because we think the likelihood it of causing a global pandemic is much smaller than a viral cause”.

Over-the-counter treatment can significantly boost global productivity, according to the Global Self-Care Federation.

The rising cost of healthcare is one of the most significant burdens on countries, especially low- and middle-income countries. Research has shown that self-care can be critical in reducing unnecessary expenses for healthcare systems. Global self-care activities generate substantial monetary and healthcare workforce savings, totalling at least approximately $119 billion per year, according to a policy brief published by the United for Self-Care Coalition.

“Increased access to self-care products and services could further alleviate the burden on health systems by freeing up resources and time for healthcare providers to attend to more serious conditions,” explained Judy Stenmark, Director General at the Global Self-Care Federation (GSCF). “Globally, a total of 10.9 billion individual hours and 1.8 billion physician hours are saved every year through self-care practices.”

content

The United for Self-Care Coalition is advocating for a WHO resolution on self-care by next year. It will hold a Global Summit at the 77th World Health Organization (WHO) World Health Assembly (WHA) to highlight why self-care is critical to achieving Universal Health Coverage (UHC). This dialogue will bring together a diverse set of stakeholders to advance the call to codify self-care as a vital component of the healthcare continuum.

Currently, there are WHO guidelines on self-care. However, the coalition believes that a resolution would better provide a framework for self-care’s integration into future economic and health policies and promote awareness of its importance. It said it would drive political commitment and help encourage countries to mobilise resources.

What is self-care?

According to GSCF, self-care can be defined in several ways. First, adopting a healthy lifestyle by staying active and eating nutritious foods while avoiding unhealthy habits like smoking and drinking too much alcohol.

Next, using both prescription and over-the-counter medications responsibly.

Finally, self-recognition, monitoring and management. This includes assessing your symptoms and seeking help from a healthcare professional when needed, monitoring your condition to track any changes, and managing your symptoms independently, with healthcare professionals, or with others with the same condition.

Does it work?

In a general sense, self-care empowers individuals to manage many health conditions conveniently and effectively on their own, leading to greater access to quality healthcare, the federation said. It also enables individuals to take control of their health and well-being, motivating them to enhance their quality of life. Self-care can be essential for preventing certain conditions and speeding up recovery when prevention isn’t possible.

Finally, self-care helps with rising healthcare costs.

“Short-term investments in self-care lead to demonstrable long-term savings for governments and healthcare industries across the world,” GSCF said on its website. “Self-care eases the workload of strained healthcare systems by enabling them to allocate resources more efficiently and effectively.”

In a policy paper highlighting the importance of self-care to reduce non-communicable diseases (NCDs), GSCF provided the following data points:

  • Over-the-counter treatment can significantly boost global productivity, resulting in around 40.8 billion productive days and $1,879 billion in welfare benefits.
  • Future cost savings are estimated at approximately $178.8 billion annually, with productivity gains reaching 71.9 billion productive days annually.
  • Additional self-care practices, including preventive care, oral health care, and the use of vitamins and mineral supplements, can further enhance these benefits.

The First Global Self-Care Summit, themed “Self-Care in Action Empowering Health and Well-Being,” will take place on 28 May at 6 p.m. CET in Geneva. Representatives from key countries such as Costa Rica, Malawi and Egypt have signed on as co-hosts of the event and the hope is that they and others will offer official support for the resolution.

To register, click here.

“We are actively pursuing the adoption of a WHO Resolution on Self-Care because self-care is a fundamental component for the sustainability of our health systems and for the health and well-being of everybody,” GSCF’s Stenmark concluded.

Image Credits: Shutterstock.

South African President Cyril Ramaphosa (left) visits Aspen Pharmacare manufacturing facility during the pandemic.

CAPE TOWN – Moderna tried to extract a huge price for its COVID-19 vaccine from the South African government at the height of the pandemic, according to the local NGO, Health Justice Initiative (HJI), in revelations made public this week.

The US-based pharma company wanted to charge $42 per vaccine in mid-2021 when vaccines were scarce, reducing this to $32.30 in the third quarter and $28.50 by the fourth quarter.

In comparison, Pfizer offered its vaccines for $10 per dose over the same period – which, although less than a quarter of Moderna’s ask, was still higher than the price paid by the European Union.

Moderna also expected South Africa to pay to transport the vaccine from its European offices, and demanded broad indemnification clauses and a 15-year confidentiality agreement, according to HJI.

Ultimately, South Africa did not procure vaccines from Moderna.

HJI resorted to the High Court in South Africa to get the correspondence between its government and drug companies during the pandemic, and released a second round of analysis of the documents this week, following a previous analysis in September 2023.

HJI director Fatima Hassan said that their analysis of the negotiation documents, done with the help of the nonprofit consumer advocacy organisation Public Citizen, “reveals a pattern of bullying and attempts to extract one-sided terms, especially by pharma giants Moderna and Pfizer all while they profiteered from a global health emergency”. 

“What these documents make clear is that corporations can and will exploit the conditions of public health emergencies to coerce governments, particularly those in low-and middle-income countries, into accepting unreasonable agreements on the supply of life-saving medicines,” said Jishian Ravinthiran, a researcher with Public Citizen, addressing a media briefing this week.

“International efforts to address future global health emergencies, like the pandemic accord, must include robust provisions and safeguards to rein in these corporate interests and ensure the rapid, equitable supply of vital countermeasures for everyone.”

HJI director Fatima Hassan

Pfizer pursued secrecy

Pfizer wanted a 10-year non-disclosure agreement, but the negotiation documents show South African officials did try to include provisions to “mitigate the unfettered power and control Pfizer sought to exercise over the supply agreement, but that was largely unsuccessful in the end”, said HJI. 

Pfizer rejected provisions that would have permitted the disclosure of confidential information in emergency circumstances and for bolstering transparency and trust in the vaccination programme. 

This is despite South African government officials referring the World Health Assembly’s (WHA) resolution about the transparency of markets for medicines, vaccines, and other health products, and warning that these provisions may hamper oversight from lawmakers and the country’s Auditor General.

“The totality of the agreements signed and the negotiation records show that these companies shamelessly wanted secrecy, and no transparency and that they profiteered at the public’s expense during the pandemic,” said Hassan. 

The report concludes that contractual bullying by monopolistic pharma corporations undermined South Africa’s vaccination programme to the detriment of its people. It calls for mandating transparency around procuring lifesaving vaccines and medicines using public funds in any health emergency.

Voluntary mechanisms fall short

Prof Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at the O’Neill Institute at Georgetown University in the US, said that the South African example was a lesson for those negotiating a pandemic agreement in Geneva at present.

Georgetown University’s Matthew Kavanagh (left) and Luis Gil Abinader.

“There has been a lot of talk [in the negotiations] about how we can use voluntary mechanisms in the middle of a pandemic to secure access; that countries will share their technology and that the best we should do is just secure a certain percent of vaccine doses for the World Health Organisation because that is what will secure equity,” said Kavanagh.

“But here we have a G20 member unable to secure equity. What do you think was happening in low and middle-income countries that have far less power than South Africa?”

He added that the evidence gathered from the South Africa negotiations shows that vaccine production had to be decentralised to LMICs, although with tech and knowledge transfer.

“Until we do that, no low and middle income country is going to have enough power to actually get equitable access. That is something that needs to be at the negotiating table in Geneva.”

Need to ‘do better in future’

Public Citizen’s Peter Maybarduk

Public Citizen’s Peter Maybarduk said that similar “extraordinary deference to drug companies” had emerged in Brazil and Colombia where “contracts or fragments of contracts have come to light over the years”.

He described the “extraordinary secrecy” as a major problem: “Fragmenting the world down into many health agencies, who do not know what the other is exactly negotiating and what terms are being set, very much reduces public power, transparency, and the ability of health agencies to make informed decisions, let alone the collective action that’s really necessary to have a global health response.

“Ideally, we’d want health agencies the world over coordinating and understanding where [vaccine] doses are going, when, on what terms, so that we can get as many vaccines to as many people as possible in as short a time as possible,” added Maybarduk.

“Instead, we have a commercial practice being managed by companies under extraordinary secrecy with long-term bars on disclosure. We’re going to have to do better in the future.”

Maybarduk said that the pandemic agreement provides some options for improvement, including conditions on public research and development grants that underpin much pharmaceutical investment.

“But we’re going to need national action as well and some concerted collective action to set different expectations for vaccine contracts and contracting during public health emergencies.”

South Sudan’s Minster of Health, Elizabeth Chuei, receives a COVID-19 vaccine in March 2021, delivered by the WHO co-sponsored COVAX vaccine mechanism.

Sixteen leading scientists and manufacturers involved in vaccine development and production worldwide issue an urgent call for a pandemic accord that can be a ‘win-win for all.’ The full list of authors is available below.

Health misinformation was not invented during COVID-19 but was certainly brought to a higher, more malevolent  and destructive pitch during the pandemic.  That hostile crusade has since been (mis)directed at two landmark agreements, the Pandemic Prevention, Preparedness and Response Agreement (Pandemic Agreement), and amendments to the International Health Regulations (IHR), that are currently being negotiated by WHO’s 194 member states for approval at the World Health Assembly.  

The overarching goal of ensuring that the world will deal more equitably with the next pandemic appears to be elusive as we near the deadline of May 2024 for the close of the negotiations.

Several social media and news outlets have claimed that the WHO is negotiating two instruments that will afford the agency far-reaching powers in case of a future pandemic. 

Member-state led talks

WHO member states negotiate a proposed agreement on pandemic prevention, preparedness and response at the ninth meeting of the Intergovernmental Negotiating Body (INB) in May, 2024.

While the WHO is the global custodian of human health, the WHO is not negotiating these agreements – the 194 member states are.  Aside from being untrue, the false claims undermine the goals of the Pandemic Agreement and its ability to ensure that it remains centered around the key pillars of access, equity, and global health security. 

Moreover, these false claims gainsay the grim facts of the COVID-19 pandemic and the lethal consequences that the lack of equitable access to life-saving medical countermeasures imposed on the greater part of the world’s population.  

The Pandemic Agreement and the IHR amendments do not grant WHO far-reaching powers and do not compel member states to surrender national sovereign rights.  

Rather, they seek to ensure that, by working together, the global community can ensure the health of all. The Pandemic Agreement is an important and empowering step in that direction.

Powerful instrument for for all people

The Pandemic Agreement is a powerful instrument for mankind and, while recognising that the WHO is the internationally-recognised lead agency, it is important to remember that WHO member states initiated these processes, remain the main players in the negotiations, and are themselves, not WHO, responsible for the outcome. The World Health Assembly (WHA), not WHO, decides on the content and adoption of the agreement.

It should be borne in mind that the Pandemic Agreement is NOT written for low- and middle-income countries, but for all countries to secure health security for all peoples – rich and poor. This is critical as pandemics do not stop at country borders, nor put all within a country’s population at similar risk. 

Fostering a value system that emphasises equity, as demonstrated through commitments to equal access to vaccines and therapeutics for all people, no matter who they are or where they live is central to such an outcome.

For this to happen, the agreement we need is one that will ensure access by providing a clear pathway to enable access and equity. 

The world already has several instruments and treaties, such as the flexibilities under the World Trade Organization’s Trade-related Aspects of Intellectual Property (TRIPS), and the COVID-19 Technology Access Pool, now repositioned as H-TAP (Health Technology Access Programme), which have not yet been used to their full potential. 

Implementation roadmap

A doctor providing essential health services to children in a refugee camp in north-west Syria during the COVID-19 pandemic.

The agreement’s success will be measured by how it can provide a better roadmap and enable more effective use of complementary agreements and instruments. We must not just discuss notions of technology access, transfer, production and equitable access but move beyond the words on paper to implementation.

There must be clarity on leadership and the need for one entity to lead and govern the implementation of the entire agreement – where health is the focus. WHO, as the directing and coordinating authority in international health work, should be empowered, and supported to effectively execute its mandate with WHO still being accountable to the WHA. 

But WHO alone cannot protect the world; there are many other essential players – regional health agencies, governments, public and private agencies, funders, civil society organisations, communities, research, development entities, as well as academic and public health institutions. 

Building trust for consensus amongst all these players is complex: it requires a clear view on the barriers to trust.

Moving the needle toward consensus amongst the 194 World Health Assembly states with a few days left to go will require a strong effort to eliminate the fundamental misunderstandings about  the Agreement and bring forth its acceptance. 

Why support a pandemic agreement?

The COVAX initiative spearheaded the distribution of millions of doses of COVID-19 vaccines to dozens of countries, including Barbados [portrayed here]. But excessively large developed country vaccine pre-orders sharply curtailed availability in lower-income countries for months.
Why should we join a movement to ensure that a pandemic agreement is agreed to by all governments and is adopted as soon as possible?

The answer is both simple and profound: in the face of the COVID-19 pandemic, people were often afterthoughts, and some countries used the worst pandemic in a century to further their own geopolitical and domestic political agendas rather than to unite to advance life-saving solutions together, effectively, efficiently, equitably, and justly both globally and within their own country. 

During the pandemic, it was governments (many elected by the people) that chose – or did not choose –to impose lockdowns to quell waves of COVID-19; it was governments that chose – or did not choose – to impose travel restrictions. 

When high-income countries pre-ordered far more vaccine doses than they could ever use, and indeed, millions upon millions of doses were disposed of, rather than being shared with health workers, elderly people, and immune-suppressed patients in lower-income countries when demand was high, it was governments that justified these excesses. 

Act-Accelerator and COVAX partners, including the WHO, which works for its 194 member states, did their best to streamline access to vaccines, diagnostics, and therapeutics. 

But WHO is only as strong as governments of the member states wish it to be – WHO cannot force governments to do anything.

A win-win for all

At present, there are several issues in the agreement still to be resolved. Higher income countries are worried about their autonomy and pharmaceutical corporations based in those, about profits, while lower-income countries in all regions, including those across Africa, are requiring mechanisms that will prevent gross inequities from recurring. 

The pandemic agreement is not designed to be detrimental to the autonomy of nations or the profits of private firms but a win-win for all by preventing gross inequalities in access to vaccines, therapeutics, and diagnostics.

Some of the mechanisms being discussed involve nesting within WHO several time-bound processes that would alert governments when the first signs of a dangerous outbreak are being detected; that would require governments to share information about nascent outbreaks anywhere on the globe; whereby pandemics that threaten all people everywhere result in the equitable sharing of life-saving medical interventions – with industry, researchers, and governments agreeing in advance to a level of essential benefits-sharing that will save lives while fostering scientific innovation.

Researchers at the WHO mRNA hub hosted by Afrigen Biologics in South Africa.

Central role of technology transfer

Paradoxically, ensuring the spread of technical know-how and manufacturing capacity to lower-income countries, which is central to these outcomes, is a strong area of disagreement amongst WHO’s Member States about the Pandemic Agreement, although the WHO has been leading an effort over the past two years to do just this. 

South Africa is at the centre of this shift, and there is real hope that it will change the game for mRNA vaccine production in Africa and the use of other vaccine manufacturing technologies. 

A global pandemic agreement that addresses the issue of technical know-how for manufacturing will ensure that the next time around, the global community is prepared ahead of time to accelerate this shift. Ultimately, when governments agree on principles like sharing and equity, it is ordinary people who benefit. At the same time, in the face of conflict and chaos, it is ordinary people who suffer.

A better path to global equity

To be clear, the Pandemic Agreement will not be enacted in isolation. Other established instruments, especially those that govern intellectual property and trade, will support and continue to co-exist working together to enhance access in a synergistic manner. 

The agreement is a means to better address equity globally and must be owned by all governments.

We urge all of those who are curious about the Pandemic Agreement and its agreement process to learn more and join millions of others around the world to urge all governments to get the job done, to find a way to bequeath to future generations the sort of pandemic agreement which, will ensure a swifter, fairer response for a better healthier world for all. 

Prof Petro Terblanche is managing director of Afrigen Biologics, South Africa, which hosts the WHO’s global mRNA technology vaccine hub.

Dr Jerome Kim is Director General of the International Vaccine Institute, South Korea.

Rajinder Suri is CEO of Developing Countries Vaccine Manufacturers Network, India.

Prof Padmashree Gehl Sampath is CEO of the Africa Pharmaceutical Technology Foundation, Rwanda.

Prof Kiat Ruxrungtham is founder and co-director of the Vaccine Research Center  at Chulalongkorn University, Thailand. 

Frederik Kristensen is managing director of the Regionalized Vaccine Manufacturing Collaborative and Coalition for Epidemic Preparedness Innovation.

Ramon Rao is CEO of Hilleman Laboratories, Singapore, which translates early discovery of vaccines and biologics for infectious diseases into affordable products with global health impact.

Prof Sarah Gilbert is Saïd Professorship of Vaccinology at Oxford University UK, and co-developed the Oxford-AstraZeneca COVID-19 vaccine.

Prof Glenda Gray is president of the South African Medical Research Council South Africa. 

Boitumelo Semete is  CEO of the South Africa Health Products Regulatory Agency, South Africa.

Prof Noni MacDonald is professor of paediatrics (infectious diseases) at Dalhousie University in Canada.

Charles Gore is executive director of the Medicines Patent Pool Switzerland.

Dr Amadou Sall is CEO of the Institute Pasteur Dakar in Senegal and Director of the WHO Collaborating Center for Arboviruses and Viral Hemorrhagic Fever.

Prof Cristina Possas is an infectious diseases expert at the Institute of Technology on Immunobiologicals (Bio-Manguinhos) at Fundação Oswaldo Cruz (Fiocruz) in Brazil.

Dr Simon Agwale is CEO of Innovation Biotech (Nigeria and USA).

Image Credits: Chris Black/WHO, UNICEF, International Rescue Committee, PMO Barbados, Kerry Cullinan.

Three years ago, Dr. Garry Aslanyan searched for a global health podcast he wanted to listen to. When he could not find one, he decided to start his own.

“I like podcasts as a tool in other areas, such as politics and current affairs,” Aslanyan told Health Policy Watch. “Podcasts allow for the most open discussions, and people can get access to them wherever they are. I also like that you get to know the guests in addition to the topic of concern.”

Aslanyan pitched for TDR to produce the “Global Health Matters” podcast. Now, with an ever-growing following and having covered dozens of topics on his weekly show, he shared insights into making the podcast with Health Policy Watch.

Guests

Aslanyan emphasised that the key to a successful podcast is having guests who genuinely engage listeners. Crafting questions that encourage guests to open up is equally crucial. To achieve this, Aslanyan continually researches the show’s topics in advance, ensuring he fully understands the context of his discussions with guests. However, the joy, he said, is that “to this day, every time I record, I learn something. I think that the listener should also have that experience.”

As part of the booking process, Aslanyan and his producer speak to the guests in advance to make sure they are a good fit and serve the role he wants on the show. Other times, his guests have guided him to find people who can bring a particular perspective.

Global Health Matters podcast guests
Global Health Matters podcast guests

Last year, TDR introduced a new segment to the podcast called “Dialogues.” This Season 3 feature involves conversations with thought leaders and authors. The goal is to discuss their books and delve into their motivations and the individuals behind them.

“This is a different way of approaching global health — not just from global health people,” Aslanyan said.

Dr Garry Aslanyan is the executive producer and host of the Global Health Matters podcast.
Dr Garry Aslanyan is the executive producer and host of the Global Health Matters podcast.

Recording

Global Health Matters produces the podcast using Riverside FM, a platform Aslanyan finds superior to Zoom or Google Meet. Riverside FM records each guest on a separate track, preventing noise interference and ensuring that issues like a bad connection from one guest don’t affect the overall audio quality.

He admitted that if there had not been a pandemic, making the podcast would likely have taken 10 times the effort. However, today, 99% of the guests he wants to host are prepared with the equipment they need to make it happen — wherever they are.

Aslanyan records from home to ensure a quiet environment and avoid interruptions. The podcast’s technica; producer also requires guests to complete a tech check in advance to confirm they know how to connect to Riverside FM and use the appropriate microphone and headphones. There have been times when guests in some countries need a better Internet connection. In those cases, if it is not super expensive, he usually asks them to switch to 4G.

Marketing

Aslanyan stressed that having a good communications strategy when launching your podcast is essential to ensuring people know it exists and growing listeners.

He also said that, if possible, offering multiple languages is helpful, especially for a global podcast.

Global Health Matters is in English, but TDR tries to promote it in at least four languages, including providing transcripts.

“It gets easier after you start,” Aslanyan said. “With time, you get a better sense of quality — what is a quality topic or quality guest. You don’t need to figure out everything at once.

“Just getting started is important. And keep at it.”

 

Listen to the Global Health Matters podcast on Health Policy Watch.

Visit the podcast website.

Image Credits: Global Health Matters.

WHO Director General Dr Tedros Adhanom Ghebreyesus in a press briefing Tuesday, urging member states negotiating a pandemic accord to ‘get it over the line’.

Senior WHO officials sounded a cautiously optimistic note Tuesday about the prospects for WHO member states to somehow wrap up down-to-the-wire negotiations on a landmark Pandemic Accord in time to submit a final agreement to the World Health Assembly, which begins next Monday, 27 May.

Meanwhile, they heralded the milestone agreement “in principle” to amend the circa 2005 International Health Regulations, which set out in detail the processes by which countries prepare for, detect and respond to any global disease outbreak or epidemic – designated as a “Public Health Emergencies of International Concern.”

“Along with strengthened International Health Regulations, the pandemic agreement remains our best shot, and indeed our generational opportunity, at making sure next time a virus hits, we have a plan to get critical health tools to people quickly, effectively and fairly,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in a pres briefing on Tuesday.

“It will save lives and I’m asking country leaders to give it one last big push to get it over the line next week.”

Extra sessions convened this week 

The ninth meeting of the Intergovernmental Negotiating Body (INB) ended inconclusively on 10 May, but negotiators were back at it again this week.

The Intergovernmental Negotiating Body, which includes all WHA member states negotiating the accord, convened in overtime sessions again this week, after failing to reach a final agreement by the original 10 May target date that had been set.

When talks resumed on Monday, negotiators were pessimistic about reaching a final agreement by the WHA deadline, saying talks would likely have to continue for weeks or months beyond that.

Text in key sessions remained a mass of yellow and white – indicating a lack of full agreement on wording.

However, in the past 48 hours, more and more text has been “greened” signaling final agreement among member states, said Mike Ryan, WHO’s Executive Director of Emergencies, sounding more upbeat Tuesday.

“We’re very pleased to see a lot of greening of text yesterday in key areas like around the global health emergency workforce,” Ryan said. “So we’re seeing a very high level of willingness to move forward.

“But there are clearly some key areas in which the member states still have some distance between them – and they really boil down to areas around access and benefit sharing;  the value of set- asides of vaccines; some issues related to prevention and One Health and other issues related to financing,” he admitted.

“Many, many times in these situations when there’s much at stake, it is very often it is the at last minute agreement. But what I would say is that the atmosphere in the room the determination of the participants is very high.

“There is a huge commitment on behalf of our member states to take this forward. But the devil is in the detail.”

Options before the INB

Mike Ryan, WHO Executive Director of Health Emergencies

If the members states don’t reach full agreement, the INB could still opt to present “a text that’s not completely agreed with a few issues to be resolved, which could be resolved during the Assembly itself, when ministers are here,” Ryan added. He noted that the 2021 WHA resolution mandating the negotiations requires the member states to present the “outcome” of the negotiations this May – no matter what that is.

“And there are other options at the disposal of the World Health Assembly, such as to suspend the Assembly and to have a special assembly [to decide on any outstanding issues],” Ryan noted.

Even so, he added that “it is my personal believe that the member states will make this.  I sense they’re getting closer and closer.  They’re inching towards agreement,” he said.

He echoed remarks by others involved in the talks, underlining that the outstanding gaps are now more about technical wording than about principles.

“It’s more about having a common understanding of the language, rather than a massive difference,” Ryan said.

“Everyone is committed to vaccine sharing and sharing of [medicine products].  Everyone’s committed to the sharing of data and the sharing of [pathogen] samples. Everyone’s committed to a One Health approach for the prevention of the next pandemic.

“Everyone is committed to building a stronger and global health emergency workforce. Everyone is committed to strengthening supply chains are brought down during the pandemic. Everyone’s committed to investment in research – and then having mutually agreed technology transfer to broaden the base of of pandemic product production in the future. There is agreement on the outcome or what we want.  But this is a negotiation between member states and these negotiations have legal implications. The language is important when it comes to arrangements that could bind the country later. So countries are being exceptionally careful around the language has been chosen.”

Rebuffing critics who say accord impinges on countries’ sovereignty

Ryan and othe WHO officials also issued a strong rebuff to critics of the accord, who have claimed it would impinge on member states’ sovereignty.  See related story here:

Disinformation: Anti-WHO Convoy Heads to Geneva for World Health Assembly

He described the potential accord as “a collective security arrangement” that could only be reached, in fact, between sovereign states.

“This [a pandemic agreement] will allow us to better prevent, better prepare, and better respond to any future pandemics, but it is only possible through international cooperation. And for those out there who who speak about this being in some way a breach of national sovereignty, in fact, this kind of work that we do together is in fact, I think… an absolute expression and definition of your sovereignty.

“To be truly sovereign means to engage with others confidently. When you are truly independent and fully confident in your own nation, that is when you reach out and work with others on issues of common concern,” Ryan said, adding. “Confident nations working together to find solutions for the betterment of their peoples.”

In the COVID era, he added, WHO and countries built new processes almost “from scratch” to confront a pandemic the likes of which had not been seen for at least a century.

“We do not want to be standing that far behind the starting line the next time around. So we’ve learned a lot of lessons,” he said. “I think the member states now have it at their responsibility to be able to give us a set of rules and a set of processes that we all agree in the future will help us prepare better.”

New WHO strategy, WHO finance and draft climate resolution among other hot-ticket WHA items

The impacts of global warming on health, including workers’ health, are much more apparent today than in 2008, when the last WHA resolution on climate and health was approved.

While the prospective pandemic accord has been stealing the media thunder in the lead-up to the WHA, the annual meeting of the global health body is awash in other critical issues that will leave a mark on global health for years to come.

On the eve of the WHA, WHO will formally launch a first-ever “investment round” designed to channel the oft-chaotic patterns of voluntary contributions from member states and philanthropies more systematically to priority needs and organizational areas of work.

“The Investment Round is designed to ensure that voluntary contributions, which are currently the majority of our funding, will be more predictable, flexible, and sustainable,” Tedros said at Tuesday’s briefing.

Paired with that is a detailed “Investment Case” which makes the argument for WHO’s financial priorities, and expected outcomes, to be presented on Tuesday, 28 May, at the WHA.

A draft climate and health resolution, led by the Netherlands and Peru is curently being negotiated by member states. It would be the first health and climate resolution to come before the WHA since 2008, when climate ranked as a much lower global health concern.

The key focus of that resolution was on health sector adaptation to climate change – with little regard for the role the health sector might be able to play in slowing the pace of global warming.  Proposed language in the new resolution, in contrast, would also aim to mobilize the health sector to play a more proactive role in climate action – as urged by an expanding array of civil society organizations. This includes fostering more green, low-carbon health facilities that are more climate resilient, as well as offering a healthier setting for both patients and staff.

Pending ‘silence procedure’ for draft climate and health resolution

Senior WHO Advisor Bruce Aylward says draft WHA climate resolution is close to agreement.

While full and final agreement on the text, first shared at the January 2024 Executive Board, has not yet been reached, the hope is that it will be finalized this week, in time for the WHA, WHO officials said at the briefing.

“There was broad consensus on all major elements of the climate change resolution,” said senior WHO advisor Bruce Aylward. “There’s a couple of outstanding issues … but I think … our member states are in a strong position to be able to successfully conclude that one by the time we get to the assembly itself. It’s our understanding that that resolution will go into what we call a silent procedure in the very near future and if it’s not broken, then there will be considered by the Assembly next week.”

And critical debate and decisions also are expected on a range of other WHA draft decisions, reports and resolutions related to WHO’s work in health emergencies; in conflict zones, including Ukraine and Gaza; communicable diseases, antimicrobial resistance, noncommunicable diseases, mental health, women’s health and the reform of WHO itself.

Finally, member states also are set to approve a new WHO global strategy, its “Fourteenth Global Plan of Work”, to guide “the agency’s operations from 2025-2028. The new strategy “sets a course for getting the world back on track to hit the health related-Sustainable Development Goals (SDGs),” said Tedros.

WHO insiders say the strategy also echoes the health-related SDGs – and that will ease the mission of monitoring progress against goals. The last WHO Global Plan of Work (GPW)  and it’s ambitious “Triple Billion” goals for improving the health of three billion people worldwide by 2023 was knocked far off course by the COVID pandemic. But critics said that the so-called Triple Billion goals also demanded enormous energy and resources to track and monitor – diverting attention from the SDG health goals, targets and indicators, agreed to by the UN General Assembly in 2015.

Image Credits: WHO , Unsplash.

World’s leading medicine agencies, including US Food and Drug Agency and European Medicine Agency have gained official WHO recognition as Listed Agencies

WHO has expanded its list of trusted national regulatory authorities from three to 36 agencies – including the United States Food and Drug Adminstration (FDA), the European Medicines Agency (EMA) as well as the European Medicines Regulatory Network (EMRN), composed of the European Commission, and thirty national regulatory agencies.

The WHO Listed Authorities (WLAs) are intended to reflect agencies that follow the highest level of regulatory standards and practices, for reviewing medicines and vaccines quality, safety and efficiency – and therefore can be used as guideposts for other countries to follow.

“With leading regulatory authorities joining our list, we are stronger and more united to improve access to quality, safe and effective medicines and vaccines for millions more people,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a press briefing on Tuesday. 

He noted that the approval “covers all regulatory functions, including generics, new medicines, biotherapeutics and vaccines.”

The three previous agencies on the WLA included the Ministry of Food and Drug Safety of the Republic of Korea, the Swiss Agency for Therapeutic Products (Swissmedic) and Singapore’s Health Sciences Authority. The latter received a WHO sign of approval for an “expanded scope” of work “including all regulatory functions” in the recent round – the same level as the other 35 WLAs, Tedros said.

The initiative to create a register of WHO Listed Authorities was launched  in 2021 during the COVID pandemic when time-consuming regulatory reviews slowed some countries’ approvals of critical medicines and vaccines – particularly in low- and middle income countries. Earmarking the WLAs aimed to formalise the process whereby countries with fewer resources could follow the lead of other reputable drug agencies in their deliberations on the approval of new medicines and vaccines . 

The  first agencies – from Switzerland, Korea and Singapore – were granted the WHO WLA designation in late October 2023, as Health Policy Watch reported. 

WLAs Criteria and competences

To attain  the WLA designation, agencies need to apply to  the WHO-Listed Authorities Technical Advisory Group (TAG-WLA).

Applicants must already be listed as a Transitional WHO Listed Authority, reaching a maturity level 3 as per a set of Global Benchmarking Tools and other criteria. Next, the advisory group evaluates the agency’s  qualifications for a more advanced designation.

On the list itself, there is also a hierarchy of status. For instance, Singapore’s Health Sciences Authority (HSA) was designated as a WLA for some regulatory functions in the initial list of October 2023. But in the recent review,  it received WLA designation for an expanded scope of functions, including market surveillance and control. 

“As WLAs, these agencies can be relied on to reassure quality and safety of medicines and vaccines to streamline processes, optimize resources, and expedite access to medicines and vaccines,” Dr Yukiko Nakatani, WHO’s Assistant Director-General stated in a press release.

Attaining the WLA designation also means a commitment to continuous improvement and excellence in regulatory oversight: a quality the working group says EMRN, HSA and US FDA demonstrate, WHO said.

Meanwhile, the list of 36 agencies representing 34 countries may expand further, with several stringent regulatory authorities now pending evaluations, WHO said.

Image Credits: DNDi.

Anti-vaxxers protesting against COVID-19 measures in London in 2022.

Some of the most vocal global right-wing conspiracy theorists and anti-vaxxers are heading to Geneva at the end of this month (May) to agitate against the World Health Organization (WHO) and its pandemic agreement – including a Trump loyalist linked to the 6 January 2021 storming of the US Capitol.

An alliance of right-wing groups, conspiracy theorists and alternative health practitioners calling itself “The Geneva Project” has planned a closed meeting on 31 May, while on 1 June it hosts a 150-minute invitation-only press conference and a public protest to coincide with the end of the World Health Assembly (WHA).

The protest outside the United Nations headquarters aims to “declare independence from global institutions such as the World Health Organization and World Economic Forum while celebrating cultural and individual sovereignty”, according to a press release from the group.

One of their key – and false – claims against the pandemic agreement and the amended International Health Regulations (IHR) is that they will give WHO the power to supersede domestic laws and declare lockdowns and other measures during pandemics and public health emergencies.

Protest speakers include Trump campaigner Dr Kat Lindley, UK anti-vaxxer Dr Aseem Malhotra, biologist and author Bret Weinstein, and Swiss lawyer Philipp Kruse.

Lindley is Texas president of the far-right Association of American Physicians and Surgeons. She was in Washington DC in 2021 during the 6 January assault on the US Capitol, using her Twitter account to call on “patriots” to “answer the call” and “#StopTheSteal”, according to the Fort Worth Star-Telegram.

Malhotra is a cardiologist who has campaigned against COVID-19 vaccines globally, including in South Africa, where he supported a court bid by an anti-vaxx group, the Freedom Alliance of South Africa (FASA), to stop the government from administering the Pfizer vaccine.

Weinstein hosts a podcast in the US that promotes anti-vaxxers and has steadily promoted the animal anti-parasite medicine, Ivermectin, as an effective treatment against COVID-19.

Recently, he was part of perpetuating an astonishing conspiracy linking the attempted assassination of Slovakian Prime Minister Robert Fico with that country’s “courageous rejection of the WHO’s audacious Pandemic Preparedness Treaty and International Health Regulations”.

This conspiracy has been repeated by Republican far-right Member of Congress Marjorie Taylor Greene. Meanwhile, Meryl Nass, a US doctor who had her license suspended for COVID-19 misinformation, intimated in a webinar hosted by Robert F Kennedy’s Children’s Health Defense that WHO Director-General Dr Tedros Adhanom Ghebreyesus was linked to the assassination. 

The Geneva Project mainly consists of far-right groups from the US, including the Brownstone Institute, which claims its “motive force” was policy responses to the COVID-19 pandemic of 2020, and “a willingness on the part of the public and officials to relinquish freedom and fundamental human rights in the name of managing a public health crisis”.

Brownstone president Jeffrey Tucker is also a senior economics columnist for Epoch Times, an international media company founded in the US by supporters of the Chinese dissident group, Falun Gong.

Epoch Times “has become a key media source for COVID-sceptic and anti-vaccine movements in France, Italy and Spain,” according to openDemocracy. It was the major funder of Trump advertisements over six months in 2019 outside of his presidential election campaign, NBC found.

Other supporters include a chiropractic practice, a group called Treehouse Living, the Alliance for Natural Health and Freiheitstrychler, the Swiss nationalists who made themselves known during the pandemic for ringing cow bells in protest against COVID-19 laws.

Some of the members of ‘The Geneva Project’.

‘Political opportunism’

Dis- and misinformation exploded during the COVID-19 pandemic, and has gathered momentum as the deadline for negotiating a pandemic agreement at the WHO has approached.

As previously reported by Health Policy Watch, African anti-rights groups and anti-vaxxers met in Uganda earlier this month where there were calls by speakers to reject the pandemic agreement and disinformation that the agreement was a WHO power grab that would undermine member states’ national sovereignty.

Even mainstream media outlets such as the UK’s Daily Telegraph, Newsweek and Sky TV Australia have given prominence to anti-pandemic agreement views in the past few weeks.

Sky News Australia’s recent focus on the WHO pandemic agreement featured a single guest who called on his country to reject the agreement.

Eloise Todd, the executive director and a co-founder of Pandemic Action Network (PAN), says that “some of the recent spikes in disinformation have come about through political opportunism from electioneering politicians”, and that the truth about the pandemic agreement needs more coverage.

“It was national leaders – prime ministers and presidents – of many political stripes that first suggested an international pandemic agreement in late 2020. Even at the height of COVID-19, leaders recognized they needed a roadmap towards better cooperation for future crises,” says Todd.

“Much of the recent disinformation has been around national sovereignty, and yet the wording of the pandemic agreement could not be clearer: ‘Nothing in the WHO Pandemic Agreement’ can be used to ‘direct, order, alter or otherwise prescribe the national and/or domestic laws….such as ban or accept travelers, impose vaccination mandates or therapeutic or diagnostic measures, or implement lockdowns’, ” said Todd, quoting from the draft agreement.

She adds that those responsible for disinformation need to be “held to account: the individuals, those that back them and the companies that enable the spread”. 

Fakes news and disinformation flourished during COVID-19

‘Treat disinformation like organised crime’

Justin Arenstein, CEO of Code for Africa, argues that the best defence against disinformation is to target covert actors and deliberately deceptive behaviour.

“Rather than pumping billions of dollars into endless literacy initiatives that have questionable or partial impacts at best, let’s also put resources behind following the money so that we can better identify covert and criminal behaviour, and the shadowy bad actors who are pulling the strings,” Arenstein told a recent United Nations Information Committee meeting on information integrity.

“What we should instead be doing is treating disinformation and other coordinated info-manipulation for what it is: organised crime. The ‘digital mercenaries’ who offer info-manipulation, surveillance and trolling as a commercial service all operate covertly, and their core service is to mislead and subvert the public. That’s a criminal enterprise,” says Arenstein, who has worked to combat the “infodemic” in Africa for the past few years.

He also calls for positive initiatives to strengthen online trust, such as investing in “the champions who are creating trustworthy, credible content” such as Wikipedia, the Free Encyclopedia, and transparency tools like CrowdTangle that help people to understand who the hidden puppet masters are.

Fake news and disinformation continue to undermine public health and trust in vaccines, with consequences such as outbreaks measles in middle-class areas in the US and Europe where vaccination rates have dropped.

These occurences are likely to become more widespread and harder to manage unless global health organisations and governments take far bolder steps to address the infodemic.

This is the second in our two-part focus on disinformation.

See PART 1: African Anti-rights Groups and Anti-Vaxxers Unite in Global Campaign Against WHO

Image Credits: Sarah le Guen/ Unsplash, Jorge Franganillo/ Unsplash.