At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations.

“The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors.

“It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.”

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”.

“As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros.

“I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week.

Handful of outstanding issues

Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement.

Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D.

The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials.

“Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. 

“You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked.

“On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. 

“Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.”

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. 

“The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer.

“To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting,  regulatory challenges, limited absorption capacity and export restrictions,” he added.

“The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added.

Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. 

Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring.

Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday.

Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO.