Equity and intellectual property (IP) rights are – unsurprisingly – the most important and trickiest issues facing countries negotiating the terms on which the next global pandemic will be addressed.

This emerged at a World Health Organization (WHO) briefing on Thursday addressed by Precious Matsoso, co-chair of the Intergovernmental Negotiating Body (INB) crafting a pandemic accord, and Dr Ashley Bloomfield, co-chair of the working group on amendments to the International Health Regulations (IHR).

Matsoso said that IP was being raised in discussions about how to “stimulate innovation” and “facilitate access” to pandemic-related products, including vaccines and medicines.

Meanwhile, Bloomfield said that a key discussion in the IHR working group was how to “effectively put equity into operation through the regulations”, particularly aiming at improving member states’ capacity to address future pandemics. 

“[The discussions] are around the funding for that, and they are around access and benefit sharing and, in particular, access to the technologies that are derived from the sharing of viral samples – in particular vaccines, but also treatments,” said Bloomfield, adding that these were also issues being discussed by the INB.

Combined processes

There is only a year left for both to complete negotiations on both a pandemic accord and changes to the IHR, the only globally binding rules to guide international disease outbreaks. Both the draft accord and proposed amendments are due to be presented to the 2024 World Health Assembly.

As there is significant overlap in the work of the INB and the IHR working group, they are currently planning a joint meeting, said Matsoso.

“Member states in a number of meetings have raised this issue of the overlaps and duplications, and they’ve called on us to bring these processes closer and ensure that we can delineate those areas that belong to different parts,” said Matsoso.

“We see this as a continuum because, you can imagine, if you’re in a country, and you’re hit with a pandemic and you have to refer to both these instruments once they’re adopted, there must be a systematic way in which they are followed,” said Matsoso.

“Our task is both bureaus (technical leads for the two processes)  is to help member states to organise this in such a way that there’s coherence and the synergy, but also a continuum so that they don’t see [the two instruments] as separate processes.”

Bloomfield added that the bureaus “have met several times already together, virtually, and our last meeting most recent meeting was just a couple of days ago”.

At that meeting, bureau members had started to “shape up this request that we’ve got from both processes from the member states to hold a joint session to start to address these issues that we have in common”. 

For some member states, the same representatives are negotiating in both the INB and the IHR working group. Meetings have thus usually been organised “adjacent and back to back” to help these representatives, primarily from African countries and small island states.

Pandemic oversight

One of the weaknesses of the IHR is that there is insufficient monitoring, oversight and compliance with the regulations.

The US, Africa region and the European Union have all made proposals to address this gap, said Bloomfield.

“There’s quite a lot of similarity between those proposals so there’s work underway to see if we can get a single convergent proposal,” he said. 

“The tenor of the discussion we have had is very much of the flavour that we should be looking to how we can incentivize and support countries to implement the IHR in full and to comply with their obligations, rather than sanction,” he added.

Matsoso said that, within the INB, proposals had been made about peer review mechanisms, adding that “punitive measures have not been shown to work anywhere… But there must be some accountability mechanisms”.

National sovereignty

Panellists expressed surprise at the ongoing mis-and disinformation about how the pandemic negotiations would result in member states losing their national sovereignty to the WHO.

WHO Principal Legal Officer Steven Solomon described the two processes as “some of the most transparent in the history of WHO’s work on global health instruments”. 

“Member state-driven means that member states decide and, in the context of preparing instruments like this it means specifically that member states, countries, make the proposals,” said Solomon.

“Countries do the drafting country, do the negotiating, the work and finding consensus. Countries make the decision on what is to be agreed and then, under the Constitution, countries adopt whatever the outcome might be in the World Health Assembly,” he added. 

“Even at that point, this does not mean acceptance by a country after adoption in the Health Assembly, which is a formal act. Then countries individually must consider and decide whether they accept what was adopted in the Health Assembly. So there’s nothing automatic that happens in terms of the entry into force of whatever will be adopted at the Health Assembly.  Countries themselves will decide to accept or not the outcomes of that process of the assembly.”

Bloomfield also stressed that, despite the “myths and disinformation”, “member states are in the driving seat and they are the decision-makers”.

“It’s not really an issue that is troubling the discussions we’re having in the working group because all those people are fully aware of the mandate they have from their governments.”