Pandemic Accord/new international instrument

Founded
Work in progress.
Governance
World Health Assembly (WHA) of the World Health Organization (WHO).
Funding
Not applicable.
Description

The Covid-19 pandemic demonstrates how current international frameworks, including the International Health Regulations, fall short in prevention and control of public health emergencies of international concern. In response, global leaders and international agencies called for a new international instrument for strengthening prevention, preparedness and response to those emergencies. The objective is to build a more robust global health architecture that will protect future generations, enhancing the surveillance of and resilience to health threats, access to medical products, mutual trust between countries and implementation of countermeasures.

At a special session of the WHA in 2021, WHO member states decided to establish an intergovernmental negotiating body (INB) to identify substantive elements and develop a working draft of a WHO convention, agreement or other international instrument, referred to as ‘Pandemic Accord’. At its third meeting, in December 2022, the INB discussed a conceptual zero draft of the instrument. Negotiations on the text start in 2023, with the aim of presenting the final instrument for approval to the 77th WHA in 2024.

Photo credit: UN Photo/Elma Okic

Strengths

  • Can strengthen political commitment by involving the highest level of global governance.
  • Broadens the scope of pandemic preparedness and response beyond the health sector.
  • Through provisions on conditions to public funding for health innovations, the instrument can contribute positively to for instance global production capacity and equal distribution of these products, and thus enhance global access.
  • Can fill gaps in the current legal framework, for instance on how intellectual property rights for medical products would apply during public health emergencies of international concern.
  • Can adopt an approach to funding for pandemic preparedness and response that is more equitable, predictable and sustainable, and draws from a multilateral facility to which all countries contribute based on an agreed ‘ability to pay’ formula, with allocations based on need.

Weaknesses

  • Risk of a weak instrument that does not address the most relevant matters, e.g. potential lack of provisions on equity and sharing of data, know-how and intellectual property regarding medical products.
  • The conceptual zero draft contains four different text options about intellectual property (IP), only one of which makes mention of the risk that IP pose to the affordability and availability of pharmaceutical products.
  • Risk of an instrument that pushes further private financing of healthcare instead of calling for international collaboration to strengthen domestic public resources.
  • The conceptual zero draft of the new instrument does not mention the bottlenecks arising from inequalities in the global financial architecture and how these obstruct funding for pandemic prevention, preparedness and response.
  • The legal status of the new instrument is still not fully defined and, therefore, its applicability and impact remain uncertain.
  • Risk of further fragmentation of the international governance system, which can lead to less effective outbreak-management.
  • It is particularly difficult for resource-limited countries to engage in negotiations whilst they cope with the Covid-19 aftermath and other crises.
  • Enforcement requires political will, which is not apparent everywhere.

Review

The negotiations on the new instrument will be lengthy, which is unavoidable for an inclusive and thorough process. However, the impact of Covid-19 is still felt, and now combines with that of other – pre-existing and newly emerged – crises (financial, war-related and food) that deepen long-time inequalities. Reforms are needed urgently to effectively deal with the current and future pandemics and other – often related – threats. These are reforms in areas such as finance, intellectual property rights protection, and transfer of know-how and technology for key medical products. It is important that these reforms are not stalled in the Pandemic Accord process, but are soon addressed in other policy processes, e.g. at the United Nations and World Trade Organization.

In relation to the content of the Pandemic Accord, an advantage of this newly established pandemic preparedness instrument is the broad scope it could encompass. It can accommodate recognized omissions of the current framework and include agreements with relation to equity, equality, health systems strengthening, trade (and intellectual property), and the One Health approach (recognizing the interconnection between the health of humans, animals and our environment).

A successful new instrument should be strongly rooted in a human rights approach, enshrine an approach to funding that is fair and sustainable, and include provisions that diminish health risks globally and magnify equal access to medical products.

Among them we recommend clauses on conditions to public funding for the research and development (R&D) of medical products, technology transfer to maximise production capacity, transparency regarding pricing, and options to remove intellectual property barriers to ensure the instrument has optimal impact. It should adopt an approach to funding for pandemic preparedness and response that is based on fair share financing where countries contribute according to ability to pay and allocations are based on need.

As mentioned above, reforms in these areas are urgent, and countries must not postpone action. These reforms can and must be tackled sooner rather than later, and can be supported in due time by this new international instrument.

The content of the conceptual zero draft of the instrument in relation to financing is not very promising. It remains vague on measures required to realise sustainable and predictable financing. Worse, when addressing the need to strengthen domestic financing, the draft calls for greater collaboration with the private sector instead of asking for greater international collaboration to strengthen domestic public financing, for instance through greater collaboration on global tax rules, fighting illicit financial flows and cancelling debt. In doing so, the draft ignores the large body of evidence about the crucial importance of public funding for primary healthcare and universal health coverage.