Will a pandemic treaty help to save the multilateral system?

This is an onsite edited excerpt of the G|O Briefing newsletter

“At its heart, the pandemic is a crisis of solidarity and sharing. The lack of sharing of information and data by many countries in the early days of the pandemic hindered our collective ability to get a clear picture of its profile and trajectory. The lack of sharing of biological samples hindered our collective ability to understand how the virus was evolving.

“The lack of sharing of PPE, tests, vaccines, technology, know-how, intellectual property, and other tools hindered our collective ability to prevent infections and save lives. And the lack of a consistent and coherent global approach has resulted in a splintered and disjointed response, breeding misunderstanding, misinformation, and mistrust.”

Echoing his op-ed in The G|O, this was the diagnosis with which the Director-General of the World Health Organization (WHO), Tedros Ghebreyesus, opened the special session of the World Health Assembly (WHASS) this week. In short, the multilateral system failed us just when it was needed most.

The response to the COVID-19 pandemic naturally gave this gathering unprecedented weight and scope. Its aim was to agree to a pathway to negotiating a pandemic treaty—a set of principles, rules, measures, and mechanisms to prevent a repetition of the tragic chaos that prevailed at the outset of COVID-19—as well as to address the central issue of accessibility and equity in vaccine distribution. The proposed treaty is an instrument that should, for many, be the inaugural agreement of a post-covid era.

To widespread praise, a consensus was indeed reached on the creation of an international negotiating body (INB) tasked with delivering a plan to “strengthen pandemic prevention, preparedness, and response.”

If governments and global health activists alike were encouraged by the creation of the INB and by the breadth of its mandate, the sudden irruption of the omicron variant served as an early warning on the ability or willingness of the international community to learn the lessons of the recent past, as well as revealing the deep mistrust prevalent in Geneva.

While welcoming the creation of the international body, African countries such as Ghana, Botswana, and South Africa also immediately denounced what they consider their unfair ostracization, a situation they found galling and difficult to understand given that they were exemplary in sharing all the information available on the new variant of concern. The transparency was applauded by the US and the EU. “I am personally grateful to the leadership of President Cyril Ramaphosa,” said Ursula von der Leyen, head of the European Commission. “South Africa’s analytic work and transparency in sharing its results was indispensable in allowing a swift global response.”

Xavier Becerra, the US Secretary of the Department of Health, had similar remarks. “We express our gratitude and support to the government of South Africa for moving so swiftly and transparently in alerting the world [to] this latest development,” he said. The kudos, however, was of no consolation to the South African government. Speeches may have been full of praise, but on the ground, at the very same moment, the reality was markedly different: 42 countries were closing their borders and air connection with the continent. “We appreciate the message of support,” declared South African Health Minister Joe Phaahla, bitterly, “but the actions of your government do not say that to our people. The travel bans are just making things more difficult, and [are] in contradiction to what you are saying.”

This contradiction was immediately exploited by China and India, as both countries rushed to announce they were donating additional doses of vaccines to the African continent, where the situation is bleak, with less than 10% of countries having met their vaccination targets.

It is under this shadow, and with the multilateral system under stress, that the negotiations for the treaty will start. The lack of vaccine in South Africa (and across most of the Global South), coupled with the omicron surge, may lead to increased pressure on the contentious issue of IP rights, the subject of heated debate both at the WHO and at the WTO.

As the North is hoarding vaccines and even starting to offer booster shots to segments of the population who might not be at a high risk of being contaminated, the anger is now palpable among global health actors and activists, who have pushed for a speedy transfer of technology and a temporary waiver on COVID-19 vaccines and equipment.

“The recent emergence of another new, more transmissible variant is a telling example of how this virus continues to mutate, particularly in the absence of equitable access to the right COVID-19 medical tools to deal with it,” said Candice Sehoma, South Africa Advocacy Officer for the MSF Access Campaign. “With millions of lives at stake, the world can’t afford to waste any more time.”

In his speech, Tedros also issued a warning: “The fabric of multilateralism has been frayed. The big question that remains is whether this multilateralism will be rescued through a new treaty or whether it will expose its vulnerability.”

“I think it's a historic moment,” reacted Thiru Balasubramaniam, Geneva representative of Knowledge Economy International (KEI), in a briefing before the UN press in Geneva.

But here, diplomats and WHO officials are under no illusion that the path to a pact will be long and arduous. “There is still a long road ahead,” said Tedros in his closing remarks. “There are still differences of opinion about what a new accord could or should contain.” The reality is that today different governments have different (and sometimes divergent) ideas about the multilateral system and what role its institutions should play over the coming decades.

The idea of a treaty (in other words, a legally binding instrument) is, at this point, unacceptable for some of the major powers. Russia has warned that it will not support any agreement that goes beyond the existing remit of the International Health Regulations—a catalog of measures that member states must abide by but that many consider being weak and without teeth, as violators suffer no sanctions. And for China, any attempt to create international inspection missions to monitor outbreaks—along the lines of UN nuclear inspectors—will represent a thick red line.

The US favors stronger International Health Regulations and has misgivings about a treaty. WHO watchers, however, admit that the US played a decisive role during the discussions and that this created a new dynamic, motivating many member states and leading to the creation of the INB.

For KEI’s director James Love, often critical of the US position, “Colin McIff, the American co-chair of the working group, paid a very constructive role in moving [this] forward. There was some concern earlier that the US would be holding back on the idea of a full treaty. I think that as the report was put together over the last six months, many countries felt more comfortable with the fact that issues of equity [and] transparency would be front and center. That broadened the support from the initial sponsors and ended up creating a much more inclusive group,” he told The G|O, during a virtual meeting with the Association of the UN correspondents (ACANU).

“I think it shows how important it is for countries to talk to each other because it's been a very intense interaction amongst the many member states under the leadership of Colin McIff and the Ambassador from Indonesia. But it is key, these days, that countries talk to each other to sort these problems out,” added medical expert and activist Ellen ‘t Hoen during the same meeting.

Optimistic voices claim that health can overcome many of the geopolitical stalemates and worries, and therefore a strong treaty may arise as a hope for a new pattern of cooperation amongst countries. An oft-cited example is the agreement reached between the Soviets and the Americans at the height of the Cold War to defeat a common enemy: smallpox.

That vaccine had first been developed in 1796, but it took another 184 years and millions of deaths for smallpox to be eradicated. Today, meanwhile, it remains unclear how the new legal instrument might succeed in solving the central issue of the current crisis: access to vaccines and treatments. The process, which must be completed by 2024, will deal with issues such as equity and transparency—all in very short supply in response to COVID-19 in 2020 and 2021.

-JC