NEW YORK – A long-awaited political declaration by United Nations (UN) member states on more effective pandemic preparedness and response was approved at a High-Level Meeting (HLM) on Wednesday – without the anticipated political objections raised by 11 member states including Russia in a letter to the global body earlier in the week.

The declaration is a milestone insofar as it signals recognition by the world’s heads of state that pandemic threats are existential threats, much more than simply health emergencies, said Carolyn Reynolds, co-founder of the Pandemic Action Network, which has pushed for a broader approach to pandemic preparedness and response since the onset of the COVID pandemic: 

“Pandemic prevention, preparedness and response is so much more than a national health issue; it is a national and global security and economic issue. Like climate change, pandemics are a global systemic risk and existential threat to humanity, and we need to treat them as such.”

No real commitments

At the same time, the declaration has been bitterly criticised as a text that is largely rhetorical and devoid of real commitments, beyond the pledge to convene another high-level meeting in 2026. During the member state comments following the plenary, heads of state from the world’s leading countries were noticeably absent, with most of the interventions led by ministers of health. 

Maybe they should have called this the not-so-high-level meeting for Pandemic Prevention, Preparedness and Response?

Call to action unheeded.

Lots of nice words about how countries are already more prepared. And a call to focus on the #PandemicAccord.

History will judge. pic.twitter.com/b3UMtAkhmP

— Nina Schwalbe (@nschwalbe) September 20, 2023

At least for the upcoming year, the ball is now back in the court of World Health Organization (WHO) member states, which must come to agreement on an effective pandemic accord that places equity at the center of the global response, said former New Zealand Prime Minister Helen Clark, co-chair of the Independent Panel, the WHO-appointed body that issued a scathing report on shortcomings in global pandemic response in 2021.  

WHO member states also must agree to revisions in WHO’s International Health Regulations (IHR) that empower the Organization to “sound the alarm rapidly with evidence and without bureaucracy,” Clark said.

“The Geneva processes, they must be ambitious,” Clark told the HLM. “A new pandemic accord can commit countries to strengthen national health systems surveillance, solidarity and equity. This is the world’s next opportunity. Please don’t miss it in Geneva.”

Governance: who leads?

Critics have also expressed misgivings about the ability of WHO, representing politically weak health ministries, to oversee and enforce the kinds of tough, binding commitments that would be needed for effective pandemic response.  Those concerns have been behind the push to make UN fora platforms for pandemic debate and decisions.

Advocates for more UN-centred action have proposed the creation of an independent pandemic governance mechanism in the office of the UN Secretary-General, and/or a UN Global Threats Council, to oversee the implementation of any pandemic accord approved by WHO member states.

“I continue to believe that action at the head of state and government level is so needed to help break the cycle of panic and neglect, which sets in around pandemics and to sustain political momentum around preparedness and response,” said Clark, who has called for the creation of a UN-hosted Global Threats Council. 

“And then on accountability. independent monitoring of country preparedness is needed to guarantee our mutual assurance, compliance and accountability with international agreements.” See related story.

Leaders Suggest UN May Be More Appropriate to Lead Pandemic Response Than WHO

R&D and tech transfer 

And a pandemic accord is only the beginning. There need to be much broader reforms in mechanisms to finance improvements in developing country health systems, as well as ensure R&D and technology transfer, HLM speakers  emphasized.  

“There has to be a pre-negotiated and financed end-to-end ecosystem for medical countermeasures,” Clark said.”Every region on earth needs the technology, the knowledge and the local capacity to stop outbreaks when and where they occur, and essential supplies to safeguard human life must be accessible. No country should be at the mercy of global markets to protect their citizens. 

Drowning in debt

As for finance, while some $2 billion has been gathered for a new World Bank managed Pandemic Fund, that is woefully inadequate in comparison to the sums required for debt-burdened countries to improve their health systems and prepare hospitals, data systems and laboratory facilities to meet future threats, critics have said.  

An SDG “stimulus” package including “deep” reforms to the international financial architecture is needed to empower countries, UN Deputy Secretary-General Amina Mohammed stressed. 

“Many developing countries are drowning in debt,” Mohammed told the high level meeting, echoing remarks at a SDG Summit on Monday. 

“Today Africa spends more on debt service costs than on health care and education. We need a finance boost so that countries can invest in universal, resilient health care; their populations have a right to [access]. 

“We’re calling on countries to support the stimulus to scale up affordable long-term financing by at least $500 billion per year, and to support the development of an effective debt-relief mechanism that supports payments, suspensions, longer lending terms and lower rates for developing countries that are drowning in debt – and create the fiscal space to spend on the health that people have a right to [enjoy].”

Strong signal, but not binding 

The declaration is a strong signal that countries are committed to learning the lesson of the COVID pandemic.and strengthening the world’s defenses against pandemics, said WHO Director General Dr Tedros Adhanom Ghebreyesus.  

“For too long, the world has operated on a cycle of panic and neglect. When an epidemic or pandemic strikes, response is in crisis mode and when it passes, they move onto the next crisis and fail to learn the lessons that could prevent or mitigate the next epidemic or pandemic,”  said Tedros, speaking at a press briefing shortly after the declaration’s approval. 

The WHO Intergovernmental Negotiating Body (INB) will resume meetings on the Geneva pandemic accord text and discussions on the text in November, with further meetings scheduled for December and January, said Dr Jaouad Mahjour, head of the WHO Secretariat supporting member state negotiations in the INB and in a parallel body for revisions to the IHR. 

Key divisions have emerged between developing and developed countries over Pandemic Accord language around equity and access to the diagnostics, treatments and vaccines that would be needed to counter any future pandemic. 

At the same time, there are geopolitical divides over the process by which new pathogen threats might be reported more rapidly and effective action taken, with fears that such commitments could somehow erode national sovereignty.  

“The process is a bit slow and there are contentious issues that have to be addressed,” said Tedros of the Geneva negotiations. “But the good news is that the areas are now identified and member states are going to get into real negotiations on the issues that are dividing them, and I hope that they will have a way to address these differences and find common ground.”

“Today’s agreement is very historic and we hope it will give energy, it will give negotiation energy and push it forward.”