Member states have been given nine days to comment on the ‘Zero draft of the Political Declaration on Pandemic Preparedness and Response, due to be adopted at the United Nations (UN) High-Level Meeting (HLM) on 20 September – with insiders describing the draft as “underwhelming”.

The HLM is essential for boosting waning political commitment to pandemic preparedness and response amid a myriad of urgent post-COVID recovery issues vying for politicians’ attention and financing.

The 14-page “zero-draft”, sent to member states on Monday with a comments deadline of 14 June, is deferential to the two ongoing negotiations on the pandemic accord and International Health Regulations (IHR)  amendments being conducted by the World Health Organization (WHO). These will only conclude in May 2024.

🚨 The "Zero Draft" political declaration for the UN General Assembly High-Level Meeting on Pandemic Preparedness and Response is out.

There is little new. Most content reiterates ongoing discussions.

At 14 pages, it is not the "short" document many had called for.

Quick 🧵 pic.twitter.com/mqxaZwlp2T

— Nina Schwalbe (@nschwalbe) June 6, 2023

However, it also contains clauses that encapsulate the same red flags as in the two WHO pandemic negotiations – including how to ensure more accountability over public funds invested in the research and development (R&D) of vaccines, medicines and other tools; intellectual property constraints and technology transfer to low- and middle-income countries.

Alternative R&D funding mechanisms

While recognising the importance of the private sector in pandemics, the draft encourages the appropriate use of “alternative financing mechanisms” for R&D. This includes support for “voluntary initiatives and incentive mechanisms” that can separate R&D cost from “the price and volume of sales” and “facilitate equitable and affordable access to new tools” such as vaccines and therapeutics.

The draft encourages member states to investigate “innovative incentives and financing mechanisms” for public-health-driven R&D, such as stronger and transparent public-private partnerships and partnerships with academia.

However, the draft also asserts that “domestic public resources” are the “main source of financing for pandemic prevention preparedness and response”. To maximise these, member states are encouraged to pool resources, identify new revenue sources and improve public financial management.

“There should be language on the need to internationalise the rights to use government-funded inventions and know-how, either as global public good or to pool on a share and share alike basis,” said Jamie Love, director of Knowledge Ecology International (KEI),

Seventeen equity clauses

There are 17 clauses devoted to equity, along with the acknowledgement of the need to “build trust” after COVID-19, when wealthy nations bought up and hoarded vaccines when supply was scarce – at the expense of low- and middle-income countries.

Support for the development of local and regional “manufacturing, regulation and procurement” also features, alongside a commitment to promote the transfer of technology to enable this.

However, Love said that reference to benefit sharing is limited to pathogens of pandemic potential, “which KEI sees as a weak basis for equity provisions, and we are disappointed there are no incentives to open source other inputs to countermeasures, such as data, inventions, know-how or cell lines, even though these are inadequately supplied”.

The draft also affirms the importance of universal health coverage based on primary healthcare, and the need to protect and train health workers – but steers clear of addressing the ongoing poaching of LMIC health workers by wealthier nations.

Role of WHO?

The draft also affirms the centrality of WHO as the “directing and coordinating authority on international health work”  in relation to pandemic prevention, preparedness and response.

However, the Independent Panel for Pandemic Preparedness and Response has recommended the formation of a Global Health Threats Council by a UN General Assembly resolution that comprises the heads of state from each of the UN’s regional groupings and is independent of the WHO. 

“Pandemic readiness extends beyond health, and heads of state and government have no tradition of travelling to Geneva to report to the WHO Executive Board or World Health Assembly (WHA). An effective [Global Health Threats] council with adequate participation should not be solely under the mandate of the WHO; instead, it needs to operate with a strong General Assembly mandate and independence from the WHO,” Independent Panel leaders wrote in a recent article for Think GlobalHealth. 

The first reading of the zero draft for member states takes place on 12-13 June, with two other readings planned before a final draft is presented on 24-25 July.

Image Credits: John Samuel, UN Photo/Manuel Elias, @TheIndPanel.