One Health
Recent health emergencies (mpox, SARS, Ebola, and most likely COVID-19) began with the spillover of a pathogen from animals to humans. Zoonotic pathogens account for around 75 percent of all emerging diseases, and their spillover into human populations is driven by deforestation, agricultural intensification, wildlife trade, and climate change. Global regulation of these drivers of disease alongside disease surveillance at the human-animal-environmental interface could significantly reduce the risk of future outbreaks. To address these complex risk areas, negotiators have been deliberating how to integrate a One Health approach, which acknowledges the interconnectedness of people, animals, and ecosystems, and requires multi sectoral coordination. The current draft would require states to address the anthropogenic drivers of spillovers and implement One Health workforce training and education programs. Generally, rich countries are the primary supporters of these measures, while low- and middle-income countries (LMICs) expressed reservations about the measures due to financial constraints or their potential impact on agricultural industries. By the close of negotiations, a path emerged to include One Health in the treaty as an annex, but the outcome remains uncertain.
Research and Development, Technology Transfer, and Intellectual Property Flexibilities
The prevailing narrative of COVID-19 was the inequitable distribution of vaccines. By late 2021, high-income countries had fully vaccinated 75 percent of their populations while fewer than two percent in the poorest countries had received a single dose. Commitments to equitably share not just vaccines but the means of their production, including research and manufacturing capacities, know-how, and technology, is therefore important for justice and preventing epidemics wherever they occur.
Negotiators from the Global South have sought to address the concentration of manufacturing capacity in a few rich countries and transform the current charity-based distribution model into an end-to-end ecosystem that would treat vaccines, tests, and treatments as global public goods. Draft treaty provisions request states to promote the acceleration of research and development capacity building in developing regions, transfer of technology and know-how, and intellectual property flexibilities to achieve sustainable and rapid access to countermeasures for all countries. If implemented, these provisions would be the first codified international rules on diversified research and development. But they have been fiercely contested. LMICs have advocated the inclusion of compulsory measures for the transfer of technology and know-how during emergencies, while high-income countries and the pharmaceutical industries headquartered there support the use of “voluntary and mutually agreed terms” and the preservation intellectual property protections as research incentives.
Pathogen Access and Benefit Sharing
The treaty’s make-or-break proposal is a new multilateral system of pathogen access and benefit sharing (PABS). The new PABS system would require all parties to share scientific information while binding manufacturers that use PABS system materials to, in the event of a pandemic, reserve 20 percent of their real-time production (ten percent as a donation and ten percent at affordable prices) for the World Health Organization (WHO) to distribute on the basis of public health need. Prompt notification of surveillance and epidemiological information can track and contain outbreaks at their source. When states share not just outbreak data but pathogen samples and sequence information, laboratories and pharmaceutical manufacturers can initiate research and development into lifesaving countermeasures like vaccines, tests, and treatments. Despite this, the international legal system does not require this sharing, and countries can be disincentivized from sharing without the promise of access to countermeasures born of the materials shared. A PABS system would address these inequities. Agreement on the percentage contribution is tenuous, but would represent an important minimum threshold in an emergency. Yet there is no guarantee that manufacturers will use the PABS system, and the draft is silent on whether ratifying nations should use their domestic lawmaking power to compel them.
Financing
Failure to invest in public health made the world vulnerable to COVID-19, and it remains vulnerable. Accordingly, the treaty calls on parties to strengthen financing for Pandemic Treaty and IHR implementation by intensifying domestic financing, mobilizing additional financing resources, and leveraging multilateral financing mechanisms. But the primary reason states failed to build core health capacities in the first place is a lack of resources, both domestically and through multilateral mechanisms. LMICs still need an additional $10.5 billion per year for adequately financing pandemic preparedness, however the World Bank’s Pandemic Fund has committed only $312.7 million to countries and remains badly underfunded. Accordingly, the current draft would establish a Coordinating Financial Mechanism for surge financing in developing countries’ emergency responses and to support capacity building the treaty and the IHR. However, WHO Member States, adopting amendments to the IHR, decided that “future instruments on … pandemic prevention, preparedness and response” can use the IHR Coordinating Financial Mechanism. So to avoid duplication, negotiators are likely to adopt this approach in lieu of establishing a financing mechanism under the Pandemic Treaty.
Governance
Finally, international agreements need good governance, involving transparency, accountability and inclusive participation, and effective monitoring and enforcement mechanisms to promote compliance. However, the current draft falls short on accountability. Some upsides include the establishment of a Conference of the Parties convened by WHO and comprised of states party to the treaty, empowered to “regularly take stock” of its implementation, review its functioning every five years, and hold extraordinary sessions if needed. In previous iterations of the draft treaty, an independent implementation and compliance committee was considered, but has since been eliminated. This is significant, as the treaty creates important commitments for states which are rendered meaningless in the absence of accountability mechanisms, leaving parties reliant on the goodwill of others which, as COVID-19 demonstrated, is inadequate in an emergency.
Conclusion
The draft treaty presented to the Health Assembly represents considerable progress, and the adoption of IHR amendments will surely inject renewed momentum to ongoing treaty negotiations. But the job is not yet finished. Adoption of a pandemic treaty remains urgent, as the next pandemic may imminently emerge and humanity is currently terribly unprepared. A failure to adopt strong commitments and mechanisms would only replicate the failures of COVID-19, leaving the world less fair and less secure.
