Next week, leaders from 194 member states will gather for the 77th World Health Assembly (WHA), where global health security and pandemic preparedness will be high on the agenda.
The big news is that after more than two years of drafting, negotiations and an extended deadline, a “Global Pandemic Agreement” is scheduled to be presented for voting to member states at the end of May. At this final hour, it is still uncertain if a satisfactory version of the agreement can be reached. Reports from our colleagues on the ground indicate that negotiators are working late into the night, with several contentious issues still under debate. This could lead to various outcomes: a pared-down version of the agreement might be presented to the assembly, an extension might be granted or there could be some interim solution.
This agreement is essentially a plan that participating governments will be asked to adopt to coordinate an effective, swift and equitable global response to future pandemics. It will complement the existing International Health Regulations (IHR) 2005, which are also being amended, and signifies a willingness to ensure global unity in the face of a health crisis and high-level cooperation in those circumstances.
This is important because existing frameworks failed to adequately protect countries during the Covid-19 pandemic, which resulted in 15 million deaths and caused trillions of dollars in economic losses. In the future, climate change and urbanisation are expected to increase the frequency of pathogens jumping from animals to humans, raising the risk of infectious-disease outbreaks spreading across borders. This is also an ongoing problem with impacts that are evident today, including an mpox (monkeypox) epidemic in parts of the Democratic Republic of Congo and H5N1 bird flu affecting livestock in the United States. With a 38 per cent chance of facing another pandemic in our lifetimes, a robust plan for enhanced global cooperation is essential.
The key points of the agreement are clear and essential. In line with the Tony Blair Institute for Global Change’s priorities in global health, it focuses on enhancing disease surveillance, embedding risk-reduction strategies and improving health-system preparedness to tackle future outbreaks more effectively, among other topics. Ensuring equitable access to pandemic tools like early-warning surveillance kits, medicines, vaccines and diagnostics, as well as sharing data, is crucial. Additionally, fostering cooperation between governments, research institutions and the private sector, among other stakeholders, is crucial for research and development. This collaboration enhances data-sharing and leverages expertise and resources more effectively.
However, negotiations have been challenging and have revealed a divide between many countries in the Global North and Global South on some major issues.
Many developed countries are focused on reforms to enhance biosecurity, including measures for faster, more effective and standardised sharing of pathogen samples and data. This is crucial for the global community to quickly identify emerging threats and for research organisations, both public and private, to collectively use this information to develop new diagnostics, vaccines and therapeutics.
Developing countries are actively pursuing funding mechanisms to bolster their biosecurity measures and guarantees of fairer access to vital innovations in times of pandemic. In all countries, better financing for pandemic preparedness and response is needed, especially if it also makes health systems more resilient overall. The goal is to secure long-term funding for pandemic prevention, preparedness, response and recovery, especially in developing countries.
The Tony Blair Institute’s view is that governments and global actors must invest in innovation and in their life-sciences and health sectors – not only for delivering routine health-care but also in ways that will support an emergency response. This is important so that parts of the health system are “Always On” and able to quickly pivot and scale in an emergency. A good example of this is the setting-up of prevention programmes for adults that can be used to provide vaccinations in an emergency, as has previously been described by TBI. For this we need governments to build strong, resilient health systems and partnerships with the private sector and research institutions. The issue is that political interest in pandemic preparedness, and consequently funding, tends to decline as we move further away from a health emergency. Therefore, at a political level, leaders need to make the case for immediate action, and show why this effort is valuable now and not in some distant and uncertain future. Also, that it will yield both health and economic gains and demonstrate that there is a clear demand for these services.
A significant point of debate during negotiations has been the proposed Pathogen Access and Benefit-Sharing System (PABS). This system would require countries to share pathogen samples and genetic data in exchange for a guaranteed allocation of diagnostics, treatments and vaccines, ensuring equitable global distribution. While promoting fairness in access is paramount, any provision that might impede swift and unrestricted access to pathogen data for urgent research and development during a health crisis must be avoided. Due to the complexities involved, there is a possibility that some aspects of PABS will be outlined at a later date, possibly in a separate instrument. Another complicated area is the inclusion of a “One Health” approach in the agreement, which would see an interlinked environmental, animal and human approach to the management of zoonotic diseases that can be spread between animals and humans. Although these are both critical issues, we must not let the perfect impede progress. Considerations about the most essential infrastructure and tools must take precedence.
There has also been some speculation in some countries that the agreement would cede a nation’s sovereignty to the World Health Organisation (WHO), allowing it to dictate national measures concerning public health, like local immunisation-programme rollouts and lockdowns. The reality is that there are explicit clauses protecting national laws and policies in the existing regulations, and so there is no possibility that the agreement could force any country into a lockdown situation or to close borders. Some concerns have also been raised about sharing health data and its privacy implications. However, current regulations maintain confidentiality and anonymity, limit data retention and mandate explicit consent from travellers for sharing health data, all of which remain unchanged in the draft revised text.
With 2024 being a busy election year, in some countries, some candidates have used the agreement negotiations as campaign leverage, in some instances going so far as threatening to withdraw from global institutions like the WHO. This makes it crucial to finalise agreements promptly. However, in case a global agreement isn’t reached, countries like the United States are taking independent measures to ensure cooperation by securing bilateral biosecurity deals with 50 countries. The European Union and China are expected to pursue similar initiatives if global talks fail.
Four years on, it might feel like global cooperation on a pandemic agreement might not be important for the electorate, but it presents an opportunity for politicians to demonstrate their commitment to the health of their citizens and long-term economic stability. And, as we all learned during Covid-19, diseases do not respect borders, and so we will have to cooperate with other countries whether we like it or not. The Global Pandemic Agreement will help us get there more efficiently.