Should the corporate sector be allowed to engage in negotiations around the new binding instrument on pandemic prevention, preparedness and response that is being developed by World Health Organization member states? This week’s closed-door debate by WHO member states to decide who should get a seat around the table risks opening a Pandora’s box of vested interests. 

Twenty years ago the WHO Tobacco Convention (FCTC) initiative, the first treaty negotiated at the WHO in response to the globalization of the tobacco epidemic, set very clear ground rules. Governments included a specific statement that tobacco companies should neither participate in the negotiations of the convention nor in national tobacco policy-setting. 

Yesterday, some of the leading member state delegates gathered in Geneva for a week of deliberations on a first working draft text for a new legal instrument to govern global pandemic preparedness and response, steered by the International Negotiating Body (INB) nonchalantly hinted that business actors are welcome. Advocating for an all of society approach in the drafting process, the European Union, the USA and the United Kingdom, among others, trumpeted the need for the participation of corporate entities in the treaty’s early formulation and vision. 

The issue of which non-state actors can interact formally on the INB negotiations – beyond those already in official relations with WHO – is due to be discussed in detail this week on the basis of a short-list already submitted to member states in March outlining “proposed modalities of engagement for relevant stakeholders.” 

This list already recognizes a new and wider range of international and multilateral groups with direct corporate interests, in addition to the existing “non-state actors in official relations with WHO”.

Some 220 non-state actors already holding the coveted status of “official relations with WHO” include the International Federation of Pharmaceutical Manufacturers and Associations, as well as  agro-business foundations such as CropLife International, and private sector outliers, such as the International Air Transport Association, and the World Plumbing Council. 

Strikingly, only a few environmental health NGOs, notably the International Society of Doctors for Environment (ISDE), are recognized by WHO. None of the global environmental advocacy groups, such as Health Care Without Harm, the Global Climate and Health Alliance, or the Wildlife Conservation Society’s health programme, have been accredited so far – despite efforts to win a seat at the table.   

Expanding INB stakeholders list – who will win the prize? 

WHO member states are now set to expand the list of stakeholders in the INB negotiations even further, adding an as yet-to-be defined list of new actors as a proposed Annex E of the current list of recognized groups. This Annex E , effectively, is a blank check for the entry of still-more vested interests to the INB talks.  

Astonishingly, the WHO member state discussion and decision on these added non-state actors will be held behind closed doors – away from media scrutiny and without much possibility for intervention by existing CSOs.  

So will even more powerful pharma, agri-business and other vested interests be invited to join the talks, while environmental actors concerned with One Health issues critical to pandemic prevention, remain locked out of the room? 

The risks of this are high. And it is a looming question critical to the future direction of the talks. 

Post-democratic complacency sweeping public institutions 

The issues at stake here are but one more reflection of the post-democratic complacency sweeping across state and multilateral institutions, gradually transforming the relationship between public institutions and the corporate world. 

This is not happening only at the WHO. The global multilateral arena is visibly occupied by imaginations of sustainable development that maximize new market futures through the tropes of inclusiveness, transparency and innovation. 

In the context of the WHO, the proposed modalities for engagement for relevant stakeholders do not in fact propose any safeguards against corporate political interference in the pandemic treaty and its making. 

In fact, they pave the way to an ever-increasing range of entities to gain a foothold of status  with the organization – beyond the pharma and agribusiness interests, like CropLife International, already in recognized WHO relations.

Pervasiveness of pharma groups in disguise 

In the meantime, the dominance of pharma continues to grow, unregulated. 

We are referring here to the powerful public and private partnerships created by the philanthropic sector – mostly the Bill and Melinda Gates Foundation – over the last two decades, including groups such as Gavi The Vaccine Alliance, The Global Fund, and Coalition for Epidemic Preparedness Innovations (CEPI).  

During the pandemic, these Gates-funded hybrid organizations collaborated in the creation of a new ‘super public-private partnership’ the Act Accelerator (ACT-A), and its vaccine component, COVAX. This new structure was tasked with orchestrating the international response to the COVID pandemic – with governments’ complacent consent.   

Legally, these institutions constitute largely inaccessible jurisdictions of private foundations deeply inhabited by corporate logics, interests and staff. Although a “transition” of the Act-A and COVAX functions back to Gavi and its partners was recently announced, it remains to be seen if and how this prototype architecture of the early phases of pandemic crisis will give rise to new ‘super’ entities or functions, as part of the WHO pandemic legal accord. 

Several relevant stakeholders are advocating in support of this scenario. Whatever the future holds, during the recent pandemic we were confronted with a text-book example of global health privatization that ran counter to the obvious need for a strong public sector role in countering the crisis. 

So it should be no surprise that, despite early warnings, the INB continues to sideline concerns from civil society about the ambitions of the private sector in the tailoring of the treaty – as well as the need for more transparent discussions about who should be recognized as stakeholders, based on WHO constitutional principles.

Protecting from vested interests? 

While member states hold free-wheeling, closed-door discussions this Thursday and Friday, about their final list of INB stakeholders, the task of watchdog will pass to the WHO Secretariat and its legal team – also tasked with protecting the world’s public health agency from undue corporate capture along the lines of the Framework of Engagement with Non-State Actors (FENSA), approved by the World Health Assembly in 2016.  

How can WHO, the sole international institution mandated to achieve the highest possible standard of health for everyone on this planet, protect an in-house treaty–making process, and the negotiated norms on future pandemics, from the viral  influence of vested interests in their corporate and philanthropic variants? 

How will WHO member states safeguard this complex process from the power strategies that corporate lobbyists commonly exercise in the multilateral arena – in line with their mandate as duty bearers vis a vis the right to health? 

Big Pharma and Big Food are not Big Tobacco? 

The reluctance, when not outright opposition, to consider strict safeguards against corporate interference in managing future pandemics may be founded on one simple assumption: Big Pharma and Big Food are not  ‘Big Tobacco’. Pharmaceutical corporations save lives. Agribusiness provides food supplies. Tobacco corporations destroy health and lives. But this premise is profoundly mistaken and neglects three important facts wholesale. 

Firstly: pharmaceutical and agribusiness corporations, like any corporation, including tobacco, are primarily – and indeed statutorily – geared to profit-making. This is a reality that can, and indeed often does, produce tricky contradictions with policy-making purposed to improving the health of the largest public possible. 

The fact that COVID-19 vaccines were not initially made accessible to millions of people globally to protect the intellectual property rights of pharmaceutical corporations is a particularly germaine example of this. Pharma’s animal health branches, together with agri-business, are meanwhile making gigantic profits from the sale of antibiotics dedicated to the intensive production of livestock and pesticides that spur antimicrobial resistance and the risks of new pathogen emergence. 

Secondly: the pharmaceutical industry, like tobacco, has a troubling track record of market abuses and violations of international law that seriously undermined public health. Just a taste, to remind pandemic treaty negotiators? From Pfizer to AstraZeneca, some of the world’s largest vaccine manufacturers have paid hundreds of millions to billions of dollars to settle lawsuits on claims ranging from bribery and fraud to off-label drug promotion. In February, four leading pharma firms, including Johnson & Johnson agreed in US courts to pay out $26 billion on claims that their business practices fueled the opioid epidemic, which has caused rampant addiction, suffering, and death. Do we seriously want to treat entities like this as “partners” in crafting the vision and implementation of a pandemic treaty, after Covid-19?

Thirdly: the officially stigmatized tobacco industry is not giving up and expanding its reach into the pharma sector, now under the cover of the response to the COVID-19 pandemic. Tobacco industry interests in pharmaceutical corporations are widespread and growing, with corporations even holding intellectual property rights to life-saving vaccines and treatments.

One of the world’s largest cigarette manufacturers, Philip Morris International (PMI), owns a significant stake in COVID vaccine manufacturer Medicago. To make matters worse, the Canadian government, in contravention of the WHO FCTC, has partnered with PMI to produce the Medicago Inc. vaccine. This sparked a public outcry; Canada was not only violating its international commitments but deepening one epidemic through its response to another.

British American Tobacco (BAT), another global tobacco actor, has likewise been involved in supporting development of a COVID vaccine through a subsidiary, Kentucky BioProcessing (KBP). Thanks to the WHO FCTC, approval for global distribution of these vaccines will be premised on Big Tobacco divesting from these ventures.

Big Food and Agribusiness also threaten treaty’s integrity 

In the aftermath of the pandemic, Big Tech, Big Food, Big Agribusiness are increasingly jumping on the expanding market of global health products as well as the supply chain risks management.  

The intersection of these powerful interests – which promote spiraling use of antibiotics and pesticides in unsustainable methods of farming and intensive livestock production – ultimately threatens a balanced, reality-based approach to AMR and One Health in the INB negotiations. 

Yet, while many member states this week have underlined AMR as the silent pandemic that calls for One Health as the vital approach to pandemic prevention, others have questioned whether these issues are getting too much emphasis, saying that One Health is not well understood and lies outside of the range of WHO’s usual mandates. 

Given the growing systemic pandemic risks associated with unsustainable food chains and biodiversity destruction, focusing almost exclusively on surveillance and pharmaceutical solutions for the pandemic response iterates the disease-specific reductionistic approach that industry has thrived on for the last two decades. This must change in the pandemic treaty discussion.  

But  while there are active CSO groups, recognized by WHO, advocating for medicines access issues, as already noted, hardly any planetary health players are to be seen  in the pandemic negotiations, to pose cogent counter-arguments and perspectives on the human-animal-environment interface that One Health addresses.

Rhetoric aside, this means that the final outcome, whether its a treaty, convention or other legal instrument, may end up lacking any meaningful teeth to address the systemic determinants of zoonotic spillover events – related to unsustainable development, unhealthy and unsafe food production, and anthropogenic colonization of ecosystems. The WHO Secretariat and the INB will be dragged into merely enabling yet another new and splendid round of private-sector driven biomedical solutions.

The INB must set convincing and transparent criteria 

WHO delegates should not forget that, if they are serious about being inclusive, credible ground rules need to be created to bring transparency and order to today’s unregulated scene where conflict of interest policies render the multilateral landscape a confusing free-riding space. 

Since the WHO Secretariat and the INB point to the FCTC as their model for treaty-making, they should be mindful that the FCTC’s success has been largely attributed to member states’  precedent-setting controls against corporate manipulation. 

The INB must set convincing and transparent criteria to ensure that those negotiating, observing negotiations, and subsequently implementing the new treaty, convention or other legal instrument do not have conflicts of interest. Declaring those conflicts is not enough, if we are to build trust.

Negotiators should ensure any and all consultations with vested industries in developing the pandemic accord are publicly and immediately disclosed. This helps guard against self-serving industry influence over public health policy or the perception thereof.  

The COVID-19 pandemic has illustrated the centrality of universal public health systems in the management of a pandemic, and the inapplicability of market rules and principles in handling such an immense crisis in each country. We do not want to see future pandemics, and the global agreement supposed to prevent and respond to them, pave the way to new modes of exploitative health care marketization. Humanist ideals in global justice cannot be used to enhance the very practices that subvert it. 

It’s important that these and other strict guideposts be adopted for success. This will require less lip service be paid to the FCTC and more meaningful consultation with those WHO officials and civil society organizations intimately familiar with the Convention. There’s a lot to learn from that process that is relevant to the current one.

The success of the treaty and global pandemic response depends on it. Public health practitioners and human rights advocates the world over recognize as much. We implore the INB and the WHO delegates to do the same. 

Ashka Naik serves as the Research Director at Corporate Accountability, leading strategic research and equity-centered analysis of corporate power across issues, from public health to food systems. She is also pursuing her doctorate at the University of Massachusetts, where she explores the intersectionality of food security, women’s empowerment, and neoliberalism. 

Nicoletta Dentico, journalist and writer, serves as Director of the Global Health Justice Program at the Society for International Development (SID). She is co-chair of the CSO independent platform Geneva Global Health Hub (G2H2). 

Image Credits: Jernej Furman/Flickr, Max Pixel, WHO, FAO, Chris Vaughan, Flickr: Paul van de Velde, Van Boeckel et al, ETH Zurich.