As we approach the final months of member-state negotiations over a World Health Organization Pandemic Accord, due to come before the World Health Assembly in May, the efforts to forge a consensus have witnessed modest progress. However, the original divide between developed and developing countries on key issues such as finance, access and benefit sharing, transfer of health technologies, and ‘One Health’  approaches to pandemic prevention, continue to cast a long shadow over the process. Some critics worry that an accord, if and when one is achieved by the 2024 deadline, may be less meaningful in terms of substance and impact, because of the compromises required to reach an agreement.

This issue of the Governing Pandemics Snapshot, the latest in the Geneva Graduate Institute series, recaps highlights of the past six months of negotiations. It takes a closer look at three strategic issues:

• The conundrum of parallel negotiations over a new ”Pandemic Accord’ alongside negotiations over revisions to existing WHO International Health Regulations governing health emergencies;
• Proposals for turning the new Pandemic Accord into a WHO Pandemic “regulation” – sidestepping the thorny issue of country ratification;
• Complex issues around the sharing of pathogen genetic sequence data (GSD), essential for the development of new medicines and vaccines – but also a resource that developing countries assert needs recompense from the pharma industry.
  

Key negotiation highlights: a recap of the past months

Following our last update in July 2023, several more sessions of the Intergovernmental Negotiating Body (INB), the WHO member state-led body negotiating the text, took place throughout 2023 and until the end of the year.

The sixth meeting of the WHO member state Intergovernmental Negotiating Body (INB), convened on July 17-21, 2023, had special significance as it centered around the draft compilation text of the proposed WHO Convention, Agreement or Other international Instrument (CA+). That draft, published in June, was developed by the six-member state body guiding negotiations, known as the “Bureau”. The “Bureau” text laid out multiple options for language on key, disputed issues related to issues such as access to medicines and vaccines, pathogen sharing, and One Health.

The July INB meeting was preceded by a series of informal inter-sessional meetings. These sessions, guided by volunteer co-facilitators, aimed to foster understanding and dialogue on key articles of the Bureau’s text. The sessions focused on a specific set of topics including Research & Development (R&D), Access and Benefit-Sharing, and Global Supply Chain and Logistics.

The practice of supplementing the formal INB sessions with informal meetings continued after INB 6, becoming a regular feature of the negotiation process. Following this approach, the INB Drafting Group, also open to all INB members, convened again from September 4-6, engaging in discussions on the three aforementioned topics. Additionally, they addressed articles related to  “One Health” approaches to preventing pandemics (e.g. through better management of pandemic risks related to AMR, livestock, wild animal trade and deforestation), as well as the co-development and transfer of technology and know-how.

Intersessional work persisted throughout September; this culminated in a one-day meeting of the INB Drafting Group on September 22. The group mandated the Bureau to prepare a new text of the pandemic accord in mid-October, intending to set the stage for the commencement of textual negotiations during INB 7 in early November and December 2023.

UN adopts political declaration on pandemics

In late September 2023, the spotlight shifted from Geneva to New York City, where a High-Level Meeting on Pandemic Preparedness and Response unfolded on the sidelines of the 78th United Nations General Assembly. The purpose was to convene Heads of State to highlight the issue and secure commitments from UN Member States to strengthen pandemic prevention, preparedness, and response (PPPR) at the global level. The result was a non-binding UNGA political declaration. Despite its symbolic political significance, the declaration was criticized for being rhetorical and lacking tangible commitments by member states to take concrete steps on policies and investments that could improve prevention, preparedness, and response.

Pandemic Accord “negotiating text” and a fresh round of criticism  

In October, the spotlight shifted back to Geneva where the Bureau unveiled the proposal for the Negotiating Text of the WHO Pandemic Agreement. Unlike the June version, this negotiating text selected just one option for language and approach to each of the contested articles, incorporating what the Bureau viewed as language with the greatest potential for agreement.

However, the text faced significant criticisms. To name a few, developing countries expressed concerns over the heavy burden imposed by proposed pandemic prevention and surveillance measures.

Those objections including even the very general reference in Paragraph 8 of the preamble to the support for the “One Health” approach to “multi-sectoral collaboration at national, regional and international levels to: safeguard human health; detect and prevent health threats at the animal and human interface, zoonotic spill-over and mutations; and sustainably balance and optimize the health of people, animals and ecosystems […]”.

Developing countries also objected to what they regarded as relatively weak provisions on equitable access to medicines, vaccines and other countermeasures.

Conversely, several developed countries voiced firm opposition to a reference to countries to: “commit to agree upon, within the framework of relevant institutions, time-bound waivers of intellectual property rights to accelerate or scale up the manufacturing of pandemic-related products to the extent necessary to increase the availability and adequacy of affordable pandemic-related products [Article 11.3 (a)].

Civil society stakeholders have, meanwhile, lamented the perceived lack of ambition in provisions ensuring more equitable access to pandemic-related products, including the lack of reference to “access” provisions in relation to public R&D funding for medicines and vaccine development.

Others noted the absence of clear financing commitments for pandemic preparedness and response, and the intention to postpone many contentious issues post-adoption, risking a dilution of the accord’s substance and impact.

The INB 7 unfolded over the period of November 6-10, resuming on December 4-6. This time, civil society stakeholders were invited to be physically present at the WHO premises, although not in the room where the proceedings were held.

This phase primarily involved an initial reading of the negotiating text, during which Member States suggested edits or deletions and thus contributed to yet another revision of the draft text.

So, rather than allowing for the beginning of formal negotiations, the INB 7 process resulted in a lengthy and intricate “rolling text,” with each and every option incorporated once again – as had been the case in June. It appeared as if parties held firm in their stances, showing no inclination to yield ground on their original positions and increasing mistrust among negotiators.

This raises the question: are we moving backward instead of forging ahead?

Tackling additional challenges as we near the finish line

With the May 2024 deadline looming forward, at least three additional challenges stand out.

Firstly, process. The current approach to negotiations is perceived as lacking effectiveness. The iterative textual method used so far involves the repeated issuance of new document versions by the Bureau, with member states subsequently incorporating edits without substantial engagement in real negotiations. The October text, which was originally  30 pages, had thus ballooned to around 100 pages by the end of the INB 7 sessions in December. This prompts legitimate questions about the ability of this process to bring parties closer to the finish line.

Secondly, time. The intricate and contentious nature of the issues at hand, combined with extensive small group work outside the official timetable, adds to the complexity. This year, there are only 19 official negotiation days scheduled for full INB group meetings on the calendar. So achieving any result poses a formidable challenge even to the most seasoned and well-intentioned diplomats.

Thirdly, momentum. Amidst a myriad of pressing global issues competing for political attention, focus, and financial resources, and with leading actors like the United States worldwide gearing up for nationwide elections in 2024, there is a shadow of uncertainty around the commitment of member states to embrace new global health rules and to prioritize pandemic prevention. Obtaining such commitments will likely be even more difficult if the current May 2024 deadline for the conclusion of negotiations and WHA review is pushed back – diminishing the sense of urgency and focus.

The next months will reveal if these challenges are surmountable.

Link to the other topics in this month’s issue of Governing Pandemics Snapshot here:

• Should two trains become One?: the IHR vs Pandemic Accord Conundrum- by Suerie Moon 
• Turning the Pandemic Accord into a WHO regulation: can it work? by Gian Luca Burci
• Genetic Data Tightrope: Navigating the Emerging Rules for GSD/DSI – by Adam Strobeyko