Sovereignty, power, and technology : the sticking points around the negociations for a "pandemic treaty."

Last May, the Independent Panel for Pandemic Preparedness and Response (IPPPR) shocked us by bluntly declaring that the COVID-19 pandemic was all but “preventable,” and that the global health system was “clearly unfit” to prevent another infectious pathogen from turning into a new pandemic in the future.

At least 5 million people have died from COVID-19 around the world, and the virus still kills around 50,000 people every week. The panel of experts urged the international community to get to work, and find ways to avoid a catastrophic repeat of a disaster of this magnitude.

The WHO itself is pushing for a wide-ranging arsenal of measures and reforms to existing instruments that should be contained in what is commonly referred to as a “pandemic treaty.” From the proponents of the treaty, the pressure is intense, with negotiations underway. “Pandemic reform agenda is moving, but not fast or cohesively enough,” fulminate Helen Johnson Sirleaf and Helen Clark (Co-chairs of the IPPPR) in a status report released on Monday (November 12).

“We urge Member States to spend less time debating commas in committees while a pandemic still rages, people are dying, and a new pandemic threat could arise anytime and anywhere,” said Clark. Next Monday (November 29), as a special session of the World Health Assembly convenes for three intense days of negotiations, the world will find out if the Member States have heeded the Co-chairs’ entreaty.

As it stands now, uncertainty prevails. Not because of a disagreement over the devastating effects of the COVID-19 pandemic or of what the next one could bring. The fate of the treaty is uncertain because of what it would mean—if it were ever to see the light of day—in terms of sovereignty, power, and national control of health systems.

The WHO can count on the staunch backing of the EU, but also from leaders in Asia, Africa and Latin America. Led by the EU, the health ministers of over 30 countries signed a joint statement this week, pushing for a deal: “A legally binding treaty, convention, or agreement, under the auspices of the WHO, has the potential to provide the world with an ambitious framework to better prevent, prepare for, and respond to future pandemics and epidemics,” they claim.

“A new international instrument should break the cycle of ‘panic and neglect’ and elevate high-level political attention for pandemic preparedness and response,” the like-minded group insists. “A new treaty should systematically convene signatories, driving and supporting stronger compliance through a regular review process, and ensuring that pandemic preparedness and response remain a regular feature on world leaders’ agendas.” Beyond the EU, the group includes countries such as Chile, Costa Rica, Kenya, Republic of Korea, Rwanda, the UK, Thailand, Tunisia, and Turkey.

China and Russia remain unconvinced. The US, for its part, is also having misgivings about the legal implications of a new multilateral treaty. Instead, Washington seems to favor a strengthening of the International Health Regulations (IHR)—a move supported by some civil society actors, as it might be politically less sensitive and thus easier to accept for Member States. Amending the IHR could also be a relatively quick process, as it would only require adoption by a majority of Member States, rather than a ratification. The word ‘relatively’ is key: In both cases the process is likely to be long and arduous.

Steven Solomon, Principal Legal Officer at WHO, claims that other treaties have been concluded in six months. “Can you do a treaty [this quickly]? Yes. It has been done,” he said, in a reference to the WHO constitution, signed in 1946. He admits, however, that “there was a great deal of political will” at that time—which may not be the case today. The opponents of such a treaty as it is—among them large countries such as India, Mexico and Brazil—argue that such an instrument might impinge on their national sovereignty and have a negative effect on innovation.

At least the ongoing discussions are all centered a recent draft report written by an expert group. Having a text to consider, even if some of its aspects are subject to disagreements, might help bring about a consensus.

For its defenders, such an agreement should remedy the ills that have plagued the uncoordinated, slow and inefficient response to the COVID-19 pandemic, and therefore the current discussions address two very critical issues: inequality in access to vaccines and treatment (what WHO’s D-G Dr. Tedros denounced early on as a “moral failure” on the part of the international community) and the issue of the investigation into the origins of the virus.

Contained in the draft, the demand for transparency—including the idea that sanctions could be imposed on countries not meeting their obligations—is extremely sensitive. One of the major disagreements between backers and opponents of a treaty revolves around having an international body endowed with the rights to conduct inspections wherever and whenever an outbreak might appear. Emerging countries claim that under the current proposal, there is no clarity about who would be in charge of such a body and what its true mandate would be.

Tropical countries fear they would be the targets of repeated inspections, as outbreaks are more frequent in such a climate. They also argue that these inspections could impinge on their sovereign right to adopt a national health system. Another proposal envisions the creation of decentralized independent WHO investigative teams in each country.

A further stumbling block relates to the sharing of biological samples. The EU is pushing for an automatic exchange of samples, without reciprocity. Emerging economies consider the proposal to be unbalanced if such sharing is not accompanied by a guarantee that they will have access to technologies, vaccines, treatment, and diagnostic equipment.

For developing countries, the absence of a debate on patents and access to medicines and vaccines makes it difficult to trust that any such new treaty would be balanced. There also are discussions within the WHO, which have prompted the co-chairs to warn about the “potential for protracted discussion at the World Health Assembly and the United Nations when the need for reforms is urgent,” asking countries “to work with purpose towards real results that will protect people.”

A reform package, says Clark, is needed “with urgency.” “The Co-Chairs stress that the reforms required now can both contribute to ending the current pandemic and preventing another,” they claim. “What is needed now is for countries to make a final push so that the opportunity to create a safer world does not slip through our fingers. We ask: if this pandemic representing a threat to the health and well-being of humanity worldwide cannot catalyze real change, what will?”

-JC