Colombia has appealed for a new “method” to settle the outstanding annex of the Pandemic Agreement, after World Health Organization (WHO) member states failed to reach agreement last week after almost a year of talks.

Talks on a Pathogen Access and Benefit Sharing (PABS) system were due to wrap up last Friday night, but have since been extended to July, with a resolution in that regard being prepared for the World Health Assembly, which starts on 18 May.

“There is one fundamental point that we request be included in the resolution: extending the negotiating period makes no sense unless the negotiating method is changed,” Colombian  Ambassador Germán Velásquez told the Intergovernmental Working Group (IGWG) shortly before the meeting closed last Friday evening.

“It is not possible to continue seeking consensus in the same way. Why not introduce the concept of ‘progressive consensus’? Once a majority has been reached on specific points, a vote should be held if necessary, and negotiations should continue.”

Colombia is part of the Group for Equity, a large cross-regional alliance of countries that has been pushing for a PABS annex that ensures the inequity of the COVID-19 pandemic, where wealthy countries commandeered all the scarce vaccines, is not repeated.

The proposal for voting also has the support of some civil society groups, notably Pedro Villardi, from Public Services International, a trade union federation with over 30 million members.  

“If we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations,” Villardi told a recent briefing on the negotiations.

Increasingly frustrated

The Group for Equity and the Africa Group – which represent the vast majority of member states – have become increasingly frustrated by what they see as developed countries protecting the interests of their pharmaceutical companies instead of levelling the playing field ahead of future pandemics.

The PABS system is due to govern how dangerous pathogens are shared during public health emergencies and how any medical products (benefits) that accrue from this information are shared. 

The dispute, mainly between developed and developing countries, hinges on how countries that share pathogen information can benefit from any vaccines, therapeutics or diagnostics (VTD) developed as a result.

The Group for Equity and Africa want mandatory benefit-sharing, with the terms set out in standard contracts between the WHO and pharmaceutical companies.

Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. 

According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by pharmaceutical companies that sign up to PABS – but only during a pandemic, not a public health emergency of international concern (PHEIC).

‘Deep regret’

At the close of last week’s talks, South Africa – unusually speaking both for Africa and the Group for Equity – expressed “deep regret” that IGWG is “still far from reaching consensus on the text of the Pandemic Agreement annex”.

“We have engaged constructively and in good faith, including by putting forward concrete proposals. We also considered other approaches, but found, ultimately, that these fall short of the IGWG mandate to deliver a PABS annex that preserves the principle of an equal footing between access and benefit sharing,” said South Africa.

“Approaches that risk decoupling these elements, or introducing fragmentation from the outset, are not sustainable foundations for the system we are tasked to build, and may only legitimise the unfair status quo regarding access to essential health products,” added South Africa, referring to a “hybrid” proposal put forward by some European countries during informal negotiations.

The two groups are “strongly united” on a PABS system that is “fair, equitable and capable of correcting long-standing imbalances, including inequitable access to VTDs and unjust extraction of our genetic resources”, said South Africa.

“A credible landing zone requires legal certainty at a point of access on how benefit-sharing obligations will be operationalised and enforced. This is neither excessive nor unreasonable. It is fundamental to trust in the system.”

Convergence

Nepal, speaking for WHO’s South East Asia region, stressed “the importance of ensuring that the PABS system preserves the intrinsic linkage between access and benefit-sharing. 

“Approaches that risk weakening this relationship or introducing fragmentation from the outset would not provide a sustainable or equitable foundation for the system we are mandated to establish,” Nepal cautioned, apparently also in reference to the “hybrid” option.

Meanwhile, another diverse group represented by the Dominican Republic, but including Australia, the Bahamas, Barbados, Malaysia, Mexico, Norway and Singapore, offered to be a bridge to find “convergence” for a “sufficiently clear, credible and operationally effective” PABS system.

Meanwhile, the EU also expressed regret at the failure to reach agreement, expressing its full commitment to “finalise and agree on a PABS system that will make a real difference and truly change things on the ground”.

‘Disservice to humanity’

The next IGWG will be from 6 to 17 July, and the new aim is for a PABS annex to be ready for next year’s World Health Assembly. 

Closing Friday evening’s session WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged that the talks have been “a roller coaster”.

“Real progress was made on the PABS annex, but important differences remain. Please stay engaged. We need everyone. My one piece of advice is this: please approach the outstanding issues with a sense of urgency, because the next pandemic is a matter of when, not if,” said Tedros.

Echoing this warning, Helen Clark and Ellen Johnson Sirleaf, co-chairs of The Independent Panel for Pandemic Preparedness and Response, said that “a lack of action to prevent and prepare for the next pandemic threat is a disservice to humanity”. 

They called on governments to do more on pandemic prevention, preparedness, and response (PPPR): “All countries must be able to detect and rapidly report outbreaks which may pose an international threat.”

However, they also acknowledged that many low- and middle-income countries are impacted by high debt levels, and a sharp decline in development assistance. 

“Leaders have an opportunity to demonstrate their commitment to protect humanity at the upcoming UN High-Level Meeting on PPPR in New York in September. 

“There, they must make progress to fill enduring gaps in PPPR including on co-ordination, financing, equity, and accountability. They should also make it clear that the PABS Annex must be finalised to enable the WHO Pandemic Agreement to proceed.”