The global struggle for a pandemic treaty
The world must strive to overcome the obstacles as the treaty is a blueprint for a more equitable and resilient global health system.
(i) Introduction
The global community continues to grapple with the challenge of finalizing a Pandemic Treaty, a crucial step in strengthening global health systems. Despite two years of intense political negotiations, 194 World Health Organization (WHO) member states have yet to conclude a historic agreement aimed at improving pandemic preparedness and reducing the glaring inequalities revealed during the COVID-19 crisis. This proposed treaty is not only a plan for better management of future pandemics but also serves as a foundation for creating a more equitable and resilient global health system.
(ii) Key Developments at the 77th World Health Assembly
At the 77th World Health Assembly (WHA) in Geneva (May 27 – June 1, 2024), two major advances were made toward improving global health governance. First, a set of amendments to the International Health Regulations (IHR) 2005 was adopted. These amendments, shaped by more than 300 proposals from countries around the world, are designed to enhance national capacities for responding to Public Health Emergencies of International Concern (PHEIC). A new category, Pandemic Emergency (PE), was introduced to improve international responses to such emergencies. The reforms emphasize equity, aiming to ensure that during health crises, all countries, especially developing ones, have equitable access to health products and the financial support necessary to build core health system capacities. Moreover, the amendments mandate the creation of a National IHR Authority in each country for better coordination.
The second significant development was the decision to extend the mandate of the intergovernmental negotiating body (INB), which is responsible for developing the Pandemic Treaty. The member states emphasized the need for swift completion of the treaty, aiming to present the final draft at the 78th World Health Assembly in May 2025, or earlier at a special session in 2024.
(iii) Major Obstacles in Pandemic Treaty Negotiations
While these developments mark progress, significant hurdles remain in the adoption of the Pandemic Treaty. Three major areas of contention continue to delay negotiations: the pathogen access and benefit-sharing (PABS) mechanism, technology transfer and intellectual property rights, and the One Health approach, which integrates human, animal, and environmental health measures.
Pathogen Access and Benefit Sharing (PABS)
The most divisive issue centers on the Pathogen Access and Benefit Sharing (PABS) system, a crucial element outlined in Article 12 of the proposed agreement. This system is aimed at addressing the deep inequities in treatment access and vaccine distribution witnessed during the COVID-19 pandemic. Under the PABS mechanism, countries in the Global South, which are often the sources of dangerous pathogens, would share pathogen samples and genetic resources with the international community. In return, they would receive benefits such as vaccines and diagnostic tools derived from research on these samples.
However, negotiations have stalled over the specifics of the PABS system. Low- and middle-income countries (LMICs) are demanding that at least 20% of pandemic-related products like vaccines be shared with them. High-income countries, on the other hand, argue that 20% should be the maximum limit, with some countries refusing to agree even to that. Resolving this issue is critical as it underpins global efforts to ensure fair access to life-saving health products during pandemics.
Technology Transfer and Intellectual Property
Another contentious issue is the transfer of technology and the role of intellectual property (IP) rights. During the COVID-19 pandemic, the hoarding of vaccines by wealthy countries, coupled with export restrictions and IP protections, led to severe inequities in vaccine distribution. Many countries in the Global South were left without adequate supplies, further exacerbating the crisis.
Articles 10 and 11 of the draft Pandemic Treaty focus on these issues, calling for sustainable and geographically diversified production of vaccines and health products. The aim is to ensure that developing countries are not solely dependent on the goodwill of high-income nations. However, disagreements persist over how this technology transfer should be governed. Wealthy countries favor voluntary and mutually agreed terms (VMAT), which would allow them to retain control over the transfer of ‘know-how’ and technology. LMICs, meanwhile, are pushing for more binding commitments, such as compulsory licensing under the WTO’s TRIPS Agreement, to ensure they can produce necessary health products independently. The so-called ‘peace clause,’ which would prevent high-income countries from applying pressure to discourage the use of TRIPS flexibilities, remains a contentious point.
One Health Approach
The third major issue involves the One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health. The COVID-19 pandemic, believed to have originated from animals, highlighted the need for a comprehensive approach to public health. High-income countries, particularly the European Union, strongly support this approach, calling for integrated and coordinated public health measures across sectors. However, LMICs argue that the One Health approach is an unfunded mandate that would place additional burdens on their already overstretched health systems.
(iv) Enforcement and Compliance Challenges
A major challenge facing the Pandemic Treaty is ensuring compliance. International agreements often lack strong enforcement mechanisms, and the Pandemic Treaty is no exception. The International Health Regulations (IHR) have been criticized for their lack of accountability, and there are concerns that the same issues will affect the Pandemic Treaty. To address this, the draft treaty proposes the establishment of a Conference of Parties (COP) that would monitor the treaty’s implementation and evaluate its effectiveness every five years. However, it remains to be seen whether countries, particularly high-income nations, will agree to such an oversight mechanism.
(v) Long-Term Goals of the Pandemic Treaty
Beyond addressing the immediate need for medical products during pandemics, the Pandemic Treaty aims to promote long-term, sustainable access to these products. Diversifying production and enhancing regional manufacturing capabilities are key to achieving this goal. By ensuring that countries in the Global South can produce vaccines and other health products locally, the treaty could reduce global dependence on a few wealthy nations for critical supplies.
The issues of pathogen access and technology transfer are not mere technicalities; they are fundamental to the success of the Pandemic Treaty. Without meaningful progress on these fronts, the treaty risks falling short of its goal to create a more equitable global health system. However, the recent amendments to the IHR and the ongoing Pandemic Treaty negotiations signal unprecedented progress in international health law. As negotiations continue, the next few months will be critical in determining the treaty’s final form.
(vi) Conclusion
The Pandemic Treaty represents a blueprint for a fairer and more resilient global health system. While significant obstacles remain, international cooperation and mutual solidarity are essential to overcoming them. If successful, this treaty will not only prepare the world for future pandemics but also lay the groundwork for a more equitable and sustainable approach to global health.
