Time for Top Leaders to Join Pandemic Negotiations
Members of the drafting group of the intergovernmental negotiating body (INB).

Two final – and likely sleepless – weeks of negotiation on the pandemic agreement begin on Monday, and negotiators have been urged to bring in their principals to ensure speed up decision-making.

The negotiations may well be extended but, for now, this ninth meeting of the World Health Organization (WHO) intergovernmental negotiating body (INB) is set to end on the eve of the Easter weekend on 28 March and includes a weekend session.

“Since we have now a few weeks left, I think the engagement of the highest level of leaders will be important to give you more space for compromise because it’s through compromise and collaboration that we can get to the finish line,” WHO Director General Dr Tedros Adhanom Ghebreyesus told negotiators at the last INB meeting.

Tedros also appealed to the leaders of the G20 to assist with the negotiations when he addressed them this week.

“Your leadership is now needed more than ever, with the deadline approaching for the pandemic agreement and amendments to the International Health Regulations,” Tedros told the leaders who were meeting in Brazil.

Lack of consensus on critical areas

Noting that the World Health Assembly is less than 10 weeks away, Tedros told the G20 that the was a lack of consensus at the INB on “critical areas”.

Four INB subgroups have been working to find solutions on four key issues, One Health; sustainable production, technology transfer and supply chains; pathogen access and benefit sharing; and implementation support and financing, he added.

“The subgroups have each submitted their reports to the INB bureau, which has integrated their recommendations into the revised text of the agreement, which was circulated to member states last week. Starting on Monday next week, the INB will meet for the final time, and I sincerely hope that member states will begin to converge on these key issues,” Tedros urged.

“If we miss the opportunity to put in place a pandemic agreement and a stronger IHR, we risk losing momentum. More importantly, we risk leaving the world exposed to the same shortcomings that hampered the global response to COVID-19: a lack of coordination, a lack of sharing information, and a lack of equity.”

Civil society concerns

The Pandemic Action Network (PAN) has highlighted “the agreement’s unclear legal status, intellectual property questions, and pandemic prevention, preparedness, and response financing strategy” as  “top concerns”. 

PAN and others have developed a civil society version of the pandemic agreement that they aim to present to negotiators – also civil society organisations are not allowed to be in the room during the negotiations.

Meanwhile, in a laudable sign of transparency, the Europe Union has published its text-based proposals.

However, anything can happen in the next two weeks of negotiations as negotiators are fond of stressing: “nothing is decided until everything is decided”.

Practical questions left to COP?

Many practical questions about how the pandemic agreement will be implemented – including how to finance countries’ pandemic prevention, preparedness and response (PPPR) – seem likely to be left to the proposed Conference of Parties (COP).

For example, according to the latest pandemic agreement draft, a “Coordinating Financial Mechanism” will support the implementation of the pandemic agreement and the International Health Regulations (IHR) (see Article 20).

But Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds, told a Geneva Global Health Hub (G2H2) media briefing on Tuesday that “final decisions about the details of the coordinating mechanism are being offloaded to the Conference of the Parties (COP), which I think is a wise decision given the circumstances”. 

“There are only nine negotiating days left and there are lots of details to work through. But I think it’s only wise if the COP is representative, inclusive, proportional to risk and deliberative, meaning a move away from business as usual,” said Wallace Bown.

He added that in his conversations with INB negotiators, “what they want to do is make the wording strong enough to show that there’s a commitment to a coordinating mechanism and a commitment to financing those”.

Africa holding out for equity

Dr Jean Kaseya

Africa Centre for Disease Control and Prevention Director General Dr Jean Kaseya told Health Policy Watch recently that he had travelled to Geneva to discussion the pandemic agreement negotiations with African ambassadors.

“The African Union Assembly approved the common African position. That is the tool that is leading that is facilitating the discussion for the pandemic treaty,” said Kaseya.

“But let me tell you there are only two words for me summarising this pandemic treaty. The first one is equity. The second one is respect. These are the two words that are really driving Africans who are negotiating. You have got everything around these two words. When we are talking about financing, when we talk about pathogen access and benefit sharing, everything is around respect and equity.”

The Africa Group of 47 member states plus Egypt have been pushing hard for countries that share the genetic and biological information of pathogens with pandemic potential to derive benefits in return from manufacturers who make products from this information.

Preserve ‘innovative ecosystem’, urges pharma 

However, the head of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has described the latest draft as “a step backwards rather than forwards”.

IFPMA Director-General Thomas Cueni, appealed for the agreement to both “take steps to ensure equity in access to medicines and vaccines in future pandemics” while also “preserving the innovation ecosystem that delivered a vaccine just 326 days after the SARS-CoV2 genome sequence was first sequenced”.

Article 12 of the current draft proposes that manufacturers pay an annual subscription fee to a yet-to-be-formed World Health Organization (WHO) Pathogen Access and Benefit-Sharing (PABS) System in exchange for “rapid, systematic and timely access to biological materials of pathogens with pandemic potential and the genetic sequence data (GSD) for such pathogens”.

The article also proposes that manufacturers provide “real-time contributions of relevant diagnostics, therapeutics or vaccines” with 10% free and 10% at not-for-profit prices during public health emergencies of international concern.

But Cueni believes that “conditions, uncertainties, and negotiations surrounding pathogen access will cause delays in the developing medical countermeasures, leading to significant public health consequences, including loss of lives and unnecessary economic pressures”.

‘Compromise and collaboration, not competition’

Meanwhile, Tedros said that although time is tight, “if there is political commitment to have a deal we will have the agreement by May 2024”,

“Instead of really competing on issues, we have to focus on constructive problem-solving. It is not the problem of the North. It is not the problem of the South. It’s our problem. This is about preparing the world to fight a common enemy. So compromise and collaboration will be the way forward rather than competition.” 

He told the G20 that “there is no reason negotiations on the pandemic agreement and the IHR cannot be finalised in the next 10 weeks”, but that this will require “courage and compromise” – and leadership.

“The leadership of G20 countries in the next nine weeks, and especially in the next two weeks, is vital. We cannot – we must not – miss this generational opportunity.”

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