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Pandemic Treaty talks should prioritise substance over speed so that equity is not sacrificed

Pandemic Treaty talks should prioritise substance over speed so that equity is not sacrificed
Lauren Paremoer
By Lauren Paremoer
6 Nov 2024
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If the negotiators rush to conclude talks on the treaty with the existing proposals, the Global South will not be in a better position to respond when the next pandemic comes.

This week, negotiators are meeting in Geneva for the 12th round of negotiations (4 to 15 November) to conclude a Pandemic Agreement (PA). Though the 77th World Health Assembly provided time until May 2025 to conclude the negotiations, the Bureau of the Intergovernmental Negotiating Body (INB), which is coordinating the negotiation, is aiming to conclude the negotiation process “as soon as possible”, as articulated in the opening comments of the co-chairs during the 12th INB meeting.

During the same session, World Health Organization (WHO) director-general, Dr Tedros Adhanom Ghebreyesus, also “urged” negotiators “to complete the agreement before the end of this year” and indicated that he believes this is “possible”. 

In practice this would mean concluding the negotiations by December 2024 and adopting the PA at a special session of the World Health Assembly in the same month. 

The Africa Group, including South Africa, are advocating for the conclusion of the negotiation in December 2024. In the group’s opening statement at the start of this week’s meeting it said it was “resolute in its ambition to finalise the agreement process by December 2024”. However, it would be mistaken in doing so if the PA does not deliver on its mandate “to develop a new instrument for pandemic prevention, preparedness and response with a whole-of-government and whole-of-society approach, prioritising the need for equity”.  

Since the start of this process, several versions of the PA text have been generated. Unfortunately, over time equity-promoting measures have disappeared from the text, thereby drastically diminishing the agreement’s potential to advance the ability of Global South countries to institutionalise effective national and regional pandemic responses. The following unresolved issues are critical in addressing the existing inequalities to prepare and respond to disease outbreaks such as Covid-19 or mpox. 

Pathogen access and benefit sharing 


One of the most important debates about promoting equity involves article 12 of treaty text, which deals with pathogen access and benefit sharing (PABS). The most recent version of the text, circulated on 2 November, indicates that WHO member states have come to a consensus on “underscoring the importance of promoting the rapid and timely sharing of ‘materials and sequence information on pathogens with pandemic potential’ (hereafter PABS Materials and Sequence Information) and, on an equal footing, the rapid, timely, fair and equitable sharing of benefits”. However, currently, member states have no agreement on how to operationalise the timely sharing of pathogens or sequence information and the benefits emanating from their use. 

Global North countries have repeatedly put forward arguments that access to pathogens should be largely unconditional, and refuse to link benefit-sharing obligations as a precondition to accessing pathogen or sequence information. They have also opposed proposals for ensuring such databases are governed by public entities, such as an intergovernmental organisation like the WHO. 

Global South countries have indicated their willingness to share access to their sovereign resources (pathogens) and recognise that this is important for developing diagnostics, therapeutics and vaccines to contain health emergencies and pandemics. However, they have also emphasised that such access should be governed by the principles of transparency, good governance, equity and the right to health. This position is clearly informed by the vaccine apartheid the Global South experienced during the Covid-19 pandemic and recent mpox emergency. During the Covid-19 pandemic Global South countries freely shared pathogen and digital sequencing information with the world but failed to gain access to the medical technologies developed as a result – and sometimes even experienced travel and trade bans because of pathogen sharing. 

Placing pathogen access and benefit sharing on an equal footing in the treaty is one way to prevent this extractivist dynamic from being replicated during future pandemics. Mechanisms for doing so should be specified in relation to public health emergencies of international concern, which may be regional, and to pandemics (which are global and more extensive in their impact than public health emergencies of international concern). 

The best way to do this is to ensure the WHO has access to a meaningful proportion of real-time production of pandemic-related health products during pandemics. The Africa Group has proposed a figure of 20% of real-time production (10% free of cost and 10% at a not-for-profit price) during pandemics. It has proposed 15% real-time production, with at least 50% of it free of cost, during a public health emergency of international concern (such as the recent mpox outbreak). The group has also proposed that manufacturers be under an obligation to supply a certain percentage of products free of charge at the request of the WHO to contain an outbreak before it becomes a public health emergency of international concern or a pandemic – such as the Ebola outbreaks. 

In contrast, the latest negotiating text proposes only 10% of real-time production with a minimum of 5% free of charge to operationalise benefit sharing during pandemics. There is no mention of any specific percentage that would apply during a public health emergency of international concern. Though the 20% figure is modest, 20% of real-time production is likely to reach a much greater proportion of populations in need than the 5% proposed in the text. 

The Africa Group’s proposals can be understood as an effort to ensure pathogen sharing contributes to the public good, rather than enabling profiteering or deepening existing North-South inequalities. It should not give up on its proposals for a meaningful, transparent and equitable PABS system and should stand firm in advancing these proposals, rather than rushing to conclude the negotiation by December 2024 without effectively addressing fair and equitable benefit sharing

More obligations, few financing mechanisms


The March 2024 version of the text acknowledged the importance of measures such as debt relief, debt suspension and debt cancellation in helping Global South countries to respond to the multiple intersecting crises pandemics create. The word “debt” appears nowhere in the current text despite the World Bank acknowledging that the Covid-19 pandemic “triggered the largest global economic crisis in more than a century”. This crisis disproportionately affected women, who ironically were at the forefront of delivering the formal and informal, unpaid caregiving work required to survive the pandemic. 

Though the text introduces many new obligations on states with respect to pandemic prevention and surveillance, it creates no new mechanism, governed by and accountable to WHO member states, that guarantees the already overburdened economies of the Global South access to financing for their implementation. 

These oversights should be addressed by ensuring the text establishes mechanisms for sustainable and fair financing of pandemic preparedness. These financing mechanisms should speak to the precarious state of many economies in the Global South.  

Scaling back the WHO’s authority


Article 11(4) of the March text states: “The WHO Secretariat shall work towards the improvement of access to pandemic-related products, especially during pandemic emergencies, through transfer of technology and know-how, including through cooperation with relevant international organisations.” This language is tentative (“shall work towards”) but at least recognises the authority of the WHO to undertake technology transfer work outside of pandemics but also “especially during pandemic emergencies”. 

In the September version, the text provides no leading role for the WHO in this regard. It now only says: “The Parties shall, in collaboration with WHO, identify, assess and, as appropriate, strengthen and/or develop mechanisms and initiatives that promote and facilitate the transfer of technology”. The current text means the WHO will have no mandate under the Pandemic Agreement to facilitate technology transfer to achieve geographically diversified production of medicines, vaccines and diagnostics required for effectively responding to pandemics. 

Conditional language 


In relation to technology transfer, it is also worth noting that the new text adds a disclaimer: strengthening existing technology transfer mechanisms and initiatives, or developing new ones, will only be done “as appropriate”. Without a more binding commitment to technology transfer, the risk is that Global North countries (and the powerful industries registered within their borders) will be able to define what counts as “appropriate” measures. During the TRIPS waiver campaign, for example, pharmaceutical corporations lobbied the US government to reject the waiver request partly on the grounds that temporarily suspending corporations’ intellectual property rights (IPRs) was not an appropriate strategy for facilitating rapid technology transfer during a pandemic. However, research conducted by the MSF Access Campaign and others suggested that technology transfer initiatives could have contributed to the creation of new mRNA Covid-19 vaccine manufacturing hubs in Africa, Latin America and Asia. This expansion of production capacity never happened, and vaccine apartheid was deepened as a result. 

Prioritising equity is a ‘must’, not a voluntary endeavour 


In December 2021 the mandate given to the intergovernmental negotiating body was to create an instrument that prioritises equity in pandemic prevention, preparedness and response. Equity was prioritised by WHO member states in their call for a new instrument, which “acknowledge[ed] the need to address gaps in preventing, preparing for and responding to health emergencies, including in development and distribution of, and unhindered, timely and equitable access to, medical countermeasures such as vaccines, therapeutics and diagnostics”. However, there is nothing in the current negotiating text to translate this objective into reality. 

All proposals related to equitable access are conditional and acknowledged only through non-binding language in the current text – “as appropriate”, “voluntary and mutually agreed terms”, “shall endeavour”, “in accordance with national law”. There is no concrete equity-related provision in the negotiating text except the abovementioned access to 10% of real-time production under article 12 to facilitate predictable access to health products or technologies. 

If the negotiators rush to conclude the negotiations with the existing proposals, Global South governments and people will not be in a better position to respond when the next pandemic comes. South Africa and the Africa Group must prioritise substance over speed and avoid the early conclusion of the negotiations to avoid equity being sacrificed in this process. DM

Lauren Paremoer is an associate professor in the Political Studies Department at the University of Cape Town.

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