In the last two years, the 194 member nations of the World Health Organization have been working together to draft an international agreement focused on pandemic prevention, preparedness, and response. This effort stems from the necessity to enhance the world’s readiness for upcoming pandemics. The result of these discussions, led by governments, was shared at the World Health Assembly’s annual gathering in May 2024, with nations needing additional time to finalize this groundbreaking global pandemic agreement. Consequently, talks have been prolonged until May 2025. Precious Matsoso has been chosen as the co-chair of the Intergovernmental Negotiating Body, which was created after global governments decided in December 2021 to devise an international pandemic pact. With over 25 years of executive experience in health management both on a national and international level, she discusses with Nadine Dreyer the challenges of drafting the agreement and her optimism in finalizing it.
During the COVID-19 outbreak, vaccine distribution was unfair, benefitting people in wealthier regions while pushing impoverished nations to the end of the line. Issues surfaced when wealthy nations were accused of hoarding medicines for local use, affecting the supply for other countries. One study suggested 1.3 million deaths occurred in lower-income areas due to vaccine distribution imbalances. In the initial seven months of the global COVID-19 vaccination effort, over 80% of doses went to affluent and upper-middle-income countries.
The core aim of the proposed agreement is to guarantee fairness in accessing tools for pandemic prevention and healthcare for everyone. This landmark treaty will be only the second of its kind following the 2003 Framework Convention on Tobacco Control, which seeks to reduce global smoking. The initial article of the accord that was approved addressed human resources and the healthcare workforce, ensuring protection for these individuals. They are on the front lines, and when vaccines are available, they should be prioritized. Additionally, it emphasizes conditions like fair work and safe environments.
Financial discussions are nearing completion, as funding is crucial for the treaty’s success. Referring back to the COVID-19 pandemic, many countries struggled due to inadequate preparedness financing. It wasn’t just about funds for preparedness; several nations lacked enough resources to combat COVID. A well-coordinated financial system is necessary. There’s debate over establishing a new funding mechanism versus reforming the existing Pandemic Fund. Launched by the World Bank in 2022, it was the first global financing system to offer grants to help low- and middle-income countries bolster their future pandemic readiness. Some argue instead of establishing a new fund, the focus should be on enhancing the Pandemic Fund’s efficiency and fairness, revising its governance, and addressing criticisms about decision-making being concentrated among a few wealthy countries and philanthropies. Others believe further funding is needed, stating that member states shouldn’t only request money but should also invest in pandemic readiness. There should be a systematic approach to identifying deficiencies.
Countries must also secure domestic financing instead of solely awaiting external aid, showing their commitment. Comprehensive evaluations are necessary to pinpoint deficiencies. With both human resources and money available, progress can be made toward combating future pandemics, depending on one’s perspective of success—seeing the glass as half-full or half-empty. Several negotiators, due to their ideologies, may maintain their stances even with extended timelines. A decade later, they might still cling to their views, necessitating alternative resolution approaches.
New groups have emerged, like Friends of the Treaty, promoting the pandemic agreement as some perceived others weren’t earnest about it. Groups like the Group for Equity, largely from developing nations, lobbied for equal access and benefit-sharing of pathogens. Friends of One Health, primarily from Europe and the UK, pushed for a framework considering the interconnections between humans, animals, plants, and the environment.
Informal meetings among member nations were encouraged to facilitate negotiations, fostering dialogue as trust was a concern. Developed countries, including the US and several developing nations like South Africa, emphasized the importance of supply chain and logistics: identifying medicines, vaccines, required quantities, and ensuring transparency in cost and other relevant data on products, including raw materials.
Two major negotiation challenges are centered on a Pathogen Access and Benefit-Sharing System and technology transfer. Disagreements about the Pathogen Access and Benefit-Sharing System revolve around sharing data on pandemic-causing pathogens and establishing a method for worldwide vaccine and medicine distribution during global health crises. The African region and Group for Equity insisted on pathogen sharing as crucial for the treaty. They demanded access to genetic materials and pathogen samples from developing nations and shared benefits like vaccines and diagnostics derived from them.
Technology transfer involves geographically diverse production through mechanisms like compulsory licensing and product data, especially aiding developing countries. Developed nations have shown support for voluntary technology transfer goals but criticized mandatory technology transfer requirements.
At the process’s commencement, the World Health Assembly mandated obtaining input from all 194 countries before drafting any documents. Member states were required to outline essential elements for the pandemic treaty, which was challenging given the variety of views, perspectives, and priorities with strict timelines. The process was highly prescriptive with tight deadlines. Throughout, all 194 member states presented their positions on every treaty article, with differing views on including aspects like gender, equity language, liability, and compensation.
The challenge remains: creating an agreeable solution for all parties. The Pandemic Treaty must be balanced, not weak. Weak provisions won’t drive change, only perpetuate the status quo. Additional time is needed to find compromise language and persuade some about unresolved matters.