What will be the cost of not achieving it? Experts say it will be immeasurable. Unknown future pathogens could have far more devastating consequences than SARS-CoV-2, which has claimed approximately 7 million lives and caused trillions of dollars in economic losses.
But despite negotiators cramming in extra time and new draft documents submitted in recent days, they have no plans to conclude a legally binding agreement by next month. Goals are never certain. The main issues revolve around access to critical information about new threats that may emerge, as well as vaccines and medicines that could contain them.
“This is the most critical moment for global health security since the World Health Organization was founded in 1948,” said Lawrence O. Gostin, director of the WHO Collaborating Center for People and Global Health Law at Georgetown University.
The context for today's negotiations is completely different. In the years following World War II, countries united around the principles of guaranteeing universal human rights and protecting public health. A unifying fear of the coronavirus has been replaced by concerns about a repeat of the injustices that tainted the response to the pandemic, deepening the rift between the Global North and the Global South.
“The trauma of the COVID-19 pandemic permeates the negotiations,” said Ellen t Hoen, a lawyer and public health advocate specializing in intellectual property policy. He said representatives of the WHO's 194 member states were looking backwards, not forwards.
The reason is obvious. A paper published in Nature in October 2022 showed that by the end of 2021, almost 50 percent of the world's population had received two doses of the coronavirus vaccine. However, large disparities existed between high-income countries, where vaccination rates were close to 75%, and many lower-income countries, where less than 2% of the population had received two doses. At the same time, South Africa, where the Omicron variant was identified, felt that instead of being praised for its scientists' epidemiological acumen and openness, they were punished with travel bans.
“We felt like we were beggars when it came to vaccine availability,” South African President Cyril Ramaphosa recalled at the 2023 World Financial Summit. “He felt that lives in the Northern Hemisphere were far more important than lives in the Global South,” he said.
The United States has expressed support for legally binding agreements, including leveraging purchasing power to expand access to medicines around the world. But the United States, like many European Union countries, is a target of mistrust because it is the center of a powerful pharmaceutical industry that is reluctant to loosen control over manufacturing know-how.
The main issues of contention concern access to pathogens and benefit sharing. In many ways, the difficult story of negotiating a pandemic agreement is the story being retold on the world stage of Henrietta Lacks, an African American patient whose cancer cells were used for years in research without her family's knowledge. Who can benefit from the samples and scientific information that often comes from disadvantaged populations?
high income Countries want assurances that samples and genetic data on emerging pathogens will be shared quickly to enable the development of tests, vaccines and treatments. Developing countries, where pathogens such as AIDS, Ebola and MERS have emerged in recent decades, want guarantees of benefits such as equal access to vaccines and collaboration with local scientists.
Almost two decades ago, the Indonesian government brought these contrasting priorities to the forefront by refusing to share avian influenza samples. WHO member states responded by developing the Pandemic Influenza Preparedness Framework (PIP), with major manufacturers agreeing to supply 10% of the influenza vaccines they produce to WHO for distribution.
No such agreement exists for other pathogens with pandemic potential.
“The PIP framework provides us with good guidance on what the means to share access and benefits will be,” said Alexandra L. Phelan, senior fellow at the Johns Hopkins University Center for Health Security. “But there are also areas where the pandemic agreement can improve.” In February, he co-authored a paper in Nature calling for a “science-to-science mechanism” to ensure vaccine equity in the next pandemic.
Phelan said new agreements could include obligations to share genetic sequence data and consider public health risks when deciding how to share medical products in emergencies. said. Unlike previous outbreaks, today there is no need to wait for pathogen samples to arrive in test tubes and in the mail. You can start researching vaccines and treatments based on genetic sequences attached to emails.
Even as negotiators wrestle with these points, the business is being disrupted by misinformation on social media. These include hostility towards the WHO and claims that any international agreement threatens national sovereignty – a claim that WHO Director-General Tedros Adhanom Ghebreyesus has denounced as “completely and categorically false.” is. ” Tedros said in early April that the final deal would not give the WHO the power to impose lockdowns or mask mandates in countries.
At the root of it all is a “lack of trust,” Hoen said. Like Mr Phelan, he is one of the external experts approved by member states to provide input into the negotiations, although he does not take part in the closed-door consultations. Some say he remains in the cafeteria, waiting for an opportunity to gather information or provide advice to national representatives when needed.
“This is a fairly opaque process,” Phelan said. “There are a lot of grumpy and unhappy people.”
In March, former British Prime Minister Gordon Brown, who is the WHO's ambassador for global health financing, wrote a letter to the WHO's 194 member countries urging them to work together for the common good after talks stalled. The letter was signed by a number of former presidents and prime ministers, along with global health and financial experts.
But at a time when so many people have fled the pandemic and chosen to ignore the “what-if” warnings that public health officials are still broadcasting today, signing on is a political challenge for our current political leaders. is not desirable. Same as before the pandemic. The new coronavirus was identified in China more than four years ago.
“Global leadership is absent,” said Nina Schwalbe, director of global health think tank Spark Street Advisors, another expert approved to provide input into the negotiations.
And in many ways, the coronavirus is making the world more vulnerable, Schwalbe and others argue, amid growing resistance to vaccinations and other preventive measures and exhausted public health officials. In some states in the United States, the powers of officials are limited by Congress.
On the other hand, climate change and increased interactions between human and animal populations are increasing the likelihood of zoonotic spillover events, given modern migration rates, and It's almost impossible to contain.
Efforts to study pathogens come with their own risks, with laboratories around the world engaged in medical and military research aimed at increasing the virulence of existing bacteria and viruses through “gain of function” research. It has become a threat. Accidental or Intentional Release.
And in March, the National Academies of Sciences, Engineering, and Medicine published a paper outlining new dangers. Nearly half a century ago, epidemiologists discovered that advances in gene editing and synthetic biology made it possible to revive pathogens, including the virus that causes the deadly and disfiguring smallpox (the only declared disease in humans). It is believed to have been eradicated following a vaccination campaign by
“New technology could allow nefarious actors to genetically engineer the smallpox virus from scratch or make it even more deadly,” said Gostin, chairman of the committee that wrote the National Academies report. There is a gender,” he said. “There is a real possibility that smallpox or other variola viruses could be leaked or intentionally released from a laboratory.”
Nature is also showing its strength.
Since the beginning of 2023, more than 12,000 mpox cases have been reported in the Democratic Republic of the Congo, resulting in According to the Centers for Disease Control and Prevention, 581 people have died and more than 700 people have been infected in the United States this year. Avian influenza has been confirmed in dairy cows in several U.S. states, and one dairy worker is being treated for symptoms. The new JN.1 strain of coronavirus is circulating.
After the ninth and likely final round of negotiations on the Global Pandemic Agreement concluded without an agreement in late March, Tedros declared after-hours negotiations and set a date for resuming negotiations in late April. The WHO Director-General described the pandemic agreement as an urgent generational opportunity, saying that such a global health agreement would be second only to the 2003 Framework Convention on Tobacco Control, which used new taxes and taxes. This is an example. Rules for labels and advertising targeting smoking.
Asked in early April if there was still a chance a deal could be reached, Tedros sounded cautious. “I believe it can happen,” he said. In mid-April, the policy nonprofit Health Policy Watch published a new draft minimum agreement to be sent to member states. While maintaining support for impartiality, key details are to be worked out over the next two years, by which time the leadership of many countries, including the United States, may have changed. Meetings are scheduled to resume on April 29th.
Some experts speculate that the original timetable was too short to unite 194 countries around such a divisive and complex topic, with many treaties taking years to complete. He noted that this process was complicated by parallel negotiations over the International Health Regulations. To prevent the spread of disease. The Biden administration also announced its own Global Health Security Strategy, which aims to combat health emergencies by leveraging U.S. leadership to accelerate investment in prevention and response among partner countries. That's all.
But past crises have shown that complex global negotiations can move quickly.
“A legally binding treaty was negotiated within six months after the Chernobyl disaster,” Schwalbe said, referring to the 1986 nuclear power plant disaster. “COVID-19 is an equally important disaster.”
