Countries around the world have failed to reach consensus on the terms of a treaty that would unify the world in a strategy against the inevitable next pandemic, trumping the nationalist ethos that emerged during Covid-19 .
The deliberations, which were expected to form a central point of the week-long meeting of the World Health Assembly which begins Monday in Geneva, aimed to correct inequalities in access to vaccines and treatments between the richest and poorer countries which have become glaring during the Covid pandemic. .
Although much of the urgency around Covid has faded since treaty negotiations began two years ago, public health experts are still keenly aware of the pandemic potential of emerging pathogens, familiar threats like bird flu and mpox, and once-vanquished diseases like smallpox.
“Those of us who work in public health recognize that another pandemic really could be imminent,” said Loyce Pace, assistant secretary at the Department of Health and Human Services, which is overseeing the negotiations in its bridging role between the United States and the world. Health organization.
Negotiators hoped to adopt the treaty next week. But canceled meetings and heated debates – sometimes over a single word – have blocked agreement on key sections, including equitable access to vaccines.
The negotiating group plans to request more time to continue discussions.
“I remain optimistic,” said Dr. Jean Kaseya, director general of the Africa Centers for Disease Control and Prevention. “I think the continent wants this agreement. I think the world wants this deal.
Once adopted, the treaty would establish legally binding policies for WHO member countries, including the United States, on pathogen surveillance, rapid sharing of outbreak data, and manufacturing and supply chains. local supplies for vaccines and treatments, among others.
Contrary to the rhetoric of some politicians in the United States and Britain, this would not allow the WHO to dictate national policies on masking, or to use armed troops to enforce lockdowns and restrictions. vaccination mandates.
Next week’s deadline was self-imposed, and some public health experts said it was far too ambitious — most treaties take several years — for such a complex undertaking. But negotiators were scrambling to ratify the treaty before elections in the United States and several European countries.
“Donald Trump is in the room,” said Lawrence Gostin, director of the WHO Center on Global Health Law, who helped draft and negotiate the treaty.
“If Trump is elected, he will likely torpedo the negotiations and even withdraw from the WHO,” Mr. Gostin said.
During his tenure as president, Mr. Trump severed ties with the WHO and recently signaled that, if re-elected, he might close the White House pandemic preparedness office.
One of the biggest bones of contention in the draft treaty is a section titled Access to Pathogens and Benefit Sharing, under which countries would be required to quickly share genetic sequences and samples of emerging pathogens. This information is crucial for the rapid development of diagnostic tests, vaccines and treatments.
Low-income countries, including those in Africa, want to be rewarded for this information with rapid and equitable access to developed tests, vaccines and treatments. They also asked pharmaceutical manufacturers to share information that allows local companies to manufacture their products at low cost.
“We don’t want to see Western countries coming in and collecting pathogens, using them, making drugs, making vaccines, and not returning those profits to us,” Dr. Kaseya said.
Member countries have only ever agreed to one other health treaty, the 2003 Framework Convention on Tobacco Control, which strengthened controls on the tobacco industry and reduced smoking rates in participating countries . But they were shaken by the ravages of the Covid pandemic and the inequalities it reinforced to launch a second.
Countries are also working to strengthen the WHO’s International Health Regulations, which were last revised in 2005 and set detailed rules for countries to follow in the event of an outbreak that could cross borders.
In May 2021, an independent review of the global response to Covid-19 “revealed weak links at every stage of the preparedness and response chain.”
The pandemic has also increased distrust between richer and poorer countries. By the end of 2021, more than 90% of people in some high-income countries had received two doses of Covid vaccines, compared to less than 2% in low-income countries. Lack of access to vaccines is estimated to have caused more than a million deaths in low-income countries.
The treaty would be a recognition of sorts that an outbreak anywhere threatens the entire planet and that the provision of vaccines and other resources benefits everyone. Coronavirus variants that emerged in countries with large unvaccinated populations have spread rapidly across the world.
“Nearly half of deaths in the United States are due to variants, so it’s in everyone’s interest to have a strong agreement,” said Peter Maybarduk, who directs Public Citizen’s Access to Medicines program.
In December 2021, the WHO created a group of negotiators to develop a legally binding treaty that would allow each country to prevent, detect and control outbreaks, and would enable equitable distribution of vaccines and medicines.
More than two years after negotiations began, negotiators have agreed, at least in principle, on certain sections of the project.
But much of the goodwill generated during Covid has evaporated and national interests have come to the fore. Countries such as Switzerland and the United States have been reluctant to accept conditions that could affect the pharmaceutical industry; others, like Argentina, have fought against strict regulations on meat exports.
“It’s obvious that people have very short memories,” said Dr Sharon Lewin, director of the Cumming Global Center for Pandemic Therapeutics in Melbourne.
“But it can happen again, and it can happen with a pathogen that is much trickier to manage than Covid was,” she warned.
A proposal for the Access to Pathogens and Benefit-Sharing section would require manufacturers to set aside 10 percent of the vaccines that would be donated, and an additional 10 percent would be provided at cost to WHO for distribution to low-income countries. income.
But that idea proved too complicated, said Roland Driece, one of the leaders of the negotiations. “We found along the way that it was too ambitious in terms of deadlines.”
Instead, a working group established by the World Health Assembly will be tasked with refining the details of this section by May 2026, Driece said.
The terms of the proposed deal have generated some confusion. In Britain, Nigel Farage, a conservative radio host and populist politician, and other conservative politicians have claimed that the WHO would force richer countries to donate 20 percent of their vaccines.
But that is an incorrect reading of the proposed deal, Mr. Driece said. “It’s not the countries that should offer these vaccines, it’s the companies,” he said. Pharmaceutical companies would sign on to the system in exchange for guaranteed access to the data and samples needed to make their products.
Britain will not sign the treaty unless it “is firmly in the UK’s national interest and respects national sovereignty”, a spokesperson for the country’s health ministry told Reuters at the start of the month.
In the United States, Republican senators demanded that the Biden administration reject the treaty because it would “potentially weaken American sovereignty.”
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, has sharply criticized what he calls “the litany of lies and conspiracy theories”, stressing that the organization does not have the power to dictate national health policies. public health and that it does not seek such power either.
The secrecy surrounding the negotiations has made it difficult to combat misinformation, said James Love, director of Knowledge Ecology International, one of the few nonprofits with a window into the negotiations.
Allowing more people to access discussion rooms or see plans as they develop would help clarify complex aspects of the treaty, Love said.
“Also, the public could relax a little if they regularly read the agreement itself,” he said.
Some proposals in the draft treaty would require massive investments, another sticking point in the negotiations.
To monitor emerging pathogens, wealthier countries are adopting a so-called One Health strategy, which recognizes the interconnections between people, animals, plants and their shared environment. They want low-income countries to regulate live animal markets and limit trade in animal products – an economic blow for some countries.
Last month, the Biden administration released its own strategy for global health security, emphasizing bilateral partnerships aimed at helping 50 countries strengthen their pandemic response systems. The administration hopes to expand the list to 100 countries by the end of the year.
U.S. support would help countries, most of which are in Asia and Africa, strengthen their One Health systems and better manage outbreaks.
The U.S. strategy is meant to complement the global treaty and cannot serve as an alternative, public health experts said.
“In my opinion, this is the most important moment for global health since the founding of the WHO in 1948,” said Mr. Gostin. “It would simply be an unforgivable tragedy if we let this slip away after all the suffering from Covid. »
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