E-DRUG: The Lancet: Countries prepare for pandemic treaty decision
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https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02651-9/fulltext
WORLD REPORT| VOLUME 398, ISSUE 10315, P1951, NOVEMBER 27, 2021
Countries prepare for pandemic treaty decision
John Zarocostas
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02651-9/fulltext
Published:November 27, 2021
DOI:https://doi.org/10.1016/S0140-6736(21)0265
Health diplomats are negotiating over whether to craft a pandemic accord
ahead of a Special Session of the World Health Assembly. John Zarocostas
reports from Geneva, Switzerland.
Negotiations have intensified ahead of the World Health Assembly Special
Session (WHASS), from Nov 29 to Dec 1, 2021, that will discuss the crafting
of a new WHO-led international instrument on pandemic preparedness and
response. Proponents for a legally binding treaty have high expectations
that the session will give the go-ahead for its development.
The Special Session is an opportunity for a generational agreement, said
Tedros Adhanom Ghebreyesus, WHO director-general, on Nov 3, with hopes of
providing enhanced national and international capacities for implementing
the International Health Regulations (IHR), better data management, a
better mechanism for managing essential health commodities, and a sustained
mechanism for sharing pathogen samples.
Tedros conceded the stakes are high but, he noted, so are the rewards: 'the
pandemic is a crisis of solidarity that has been exposed and exacerbated by
fundamental weaknesses in the global health architecture: complex and
fragmented governance; inadequate financing; and insufficient systems and
tools.'
He said that voluntary mechanisms have only worsened these challenges,
arguing that: 'the only way we can solve them is with a binding treaty or
agreement between nations.' Such an accord 'could set out high-level,
agreed principles to strengthen solidarity, equity, [and] one health for
all', he said.
The single-issue WHASS - only the second in the agency's history - was
requested by WHO members after a series of critical reviews that shed light
on the weaknesses in dealing with the COVID-19 pandemic. In May, the
Independent Panel for Pandemic Preparedness and Response recommended a
pandemic framework convention using the powers under Article 19 of the WHO
Constitution and complementary to the IHR, to be facilitated by WHO to
address gaps in the international response.
Ilona Kickbusch, chair of the international advisory board at the Global
Health Centre (Geneva, Switzerland), told The Lancet that the existing
mechanisms and the IHR are not sufficient to prepare for, or to respond
well to, a pandemic. 'There is a lot of traction on trying to embark on
having a binding instrument that brings people together who have been
separated in a way. We've seen a very strong decoupling in global health
over the last 2 years, so there is a need to integrate many of the
initiatives'.
Excluding a last-minute diplomatic problem, WHO diplomats and experts
expect the assembly to approve the start of talks on a convention. 'I think
one thing seems quite clear now, there's enough support to begin
negotiations over a legally binding agreement, like the [2003] Framework
Convention on Tobacco Control, that's been pushed very hard by Europe and
the friends of the treaty', Lawrence Gostin, professor of global health law at Georgetown University (Washington, DC, USA), told The Lancet. 'While
they don't have major powers on board, like the USA, China, and Russia, I
don't think those countries are going to block it.'
Getting countries to agree to talks may require concessions to major powers
in some areas related to global governance and finance, diplomats
indicated. The same sources said that China and other powers were unlikely
to accept any agreements that eroded their sovereignty.
WHA might adopt opt-in or opt-out conventions or agreements, or non-binding
recommendations. Health diplomats are still trying to finalise a draft
decision that could be secured by consensus, with experts anticipating a
mixture of options, that include strengthening the 2005 IHR through
targeted amendments and adopting a new instrument, with an outline draft
going to WHA in May, 2022, and an accord to be negotiated by the WHA in
2024, or earlier.
Thiru Balasubramaniam, Geneva representative, Knowledge Ecology
International, an advocacy group, told The Lancet that the current
negotiations are an inflection point. 'The WHASS is a crucible to test
member states' resolve in reforming the architecture of the pandemic
response to truly tackle barriers related to the timely access to and
distribution of medical countermeasures and redress the lack of equitable
access, which has spurred the breakdown in the current global COVID-19
response.'
David Heymann, professor of infectious disease epidemiology at the London
School of Hygiene & Tropical Medicine (London, UK), agrees that equity is a
pivotal issue. He told The Lancet: 'If there is authorisation to embark on a treaty, as they did with the Framework Convention on Tobacco Control, the issues that WHO would want to ensure would be more equitable distribution of goods either during a pandemic or during a preparedness stage and I think that's a worthy goal as that's not covered in the IHR. The IHR does not talk about equity of different goods and it's been difficult.'
Article Info
Publication History
Published: 27 November 2021
Identification
DOI: https://doi.org/10.1016/S0140-6736(21)02651-9
Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
thiru@keionline.org