Brendan Shaw examines the protracted efforts of global stakeholders to come together around a global pandemic treaty and outlines the benefits of constructive engagement on the part of the pharmaceutical industry to find new solutions, policy approaches and business models moving forward.
You never want a serious crisis to go to waste
Rahm Emanuel, former Chief of Staff to US President Barack Obama, 2008 during the Global Financial Crisis
The pandemic accord – a generational commitment that we will not go back to the old cycle of panic and neglect
Dr Tedros Adhanom Ghebreyesus, Director General, World Health Organization, Report to Member States at the 76th World Health Assembly, May 2023
As delegates and observers trickled out into the Swiss spring air in late May as this year’s World Health Assembly wrapped up in Geneva, more than one person commented to me that there was a sense of deja vu around the discussions to establish a new global pandemic treaty.
The global pandemic treaty
A key agenda item at this year’s WHA was the review of progress on negotiations for the proposed new global pandemic treaty, or what the World Health Organization is at this stage calling an ‘accord’. It’s a new instrument where the countries of the world hope to agree on strategies to manage future pandemics informed by the experience of the Covid-19 pandemic.
To avoid problems that emerged in the global response to the Covid-19 pandemic, there was a push by many governments to negotiate a new legal treaty that would govern how countries and international organizations respond in the event of a future pandemic. The initial zero text of the accord, released in February this year, included provisions to address issues such as patent waivers on essential medicines, vaccines and devices during pandemics, genetic benefits sharing, access to pathogens, and country notifications of emerging communicable diseases and epidemics.
The accord under negotiation is being developed to complement other provisions that guide pandemic responses including the International Health Regulations (IHR), although exactly how that’s going to happen in practice is not yet entirely clear and hasn’t been finalised.
The current deadline for completing negotiations is the next World Health Assembly in May 2024. However, past experience suggests that this is ambitious. Several commentators have already suggested this timetable is unlikely to be achieved, in part due to ongoing major disagreements among countries negotiating the treaty.
In his opening address to this year’s Assembly, World Health Organization Director General, Dr Ted Adhanom Ghebreyesus, said that the accord would be a general commitment that the world will “will not go back to the old cycle of panic and neglect” which has characterised the history of pandemic preparedness, or lack thereof.
Back to the future
However, for a negotiation that is ostensibly about managing the future, some of the discussion and histrionics in Geneva during Assembly week seemed to hark back to disagreements of the past going back 30 or 40 years.
The experience of the Covid-19 pandemic revealed a range of important issues that need to be addressed in preparation for future pandemics. Things like deadlines for countries to notify the WHO of outbreaks, processes for declaring pandemics, avoiding vaccine nationalism, encouraging international collaboration, and ensuring timely supply chains in emergency conditions were all things revealed by the Covid‑19 experience where the world needs to do better.
Looking forward to the future is key here.
But some of the discussions and commentary leading up to this year’s World Health Assembly seemed to less reflect the ‘we’re all in this together’ sentiment seen when the pandemic started in 2020, and more like people with axes to grind on perennial arguments that have plagued (pardon the pun) global health debates for decades.
Some have said that the pandemic treaty should primarily be about encouraging compulsory licensing, overturning patents, greater transparency of R&D costs and medicine prices being too high.
These positions were argued by people with apparently little appreciation of the irony that they were physically able to participate in these debates in person in Geneva at all precisely because of the vaccines, medicines and diagnostics developed by an industry and the system they were railing against.
The risk is that attempts by some to rehash old debates end up contributing to the cycle of ‘panic and neglect’ that has characterised previous post-pandemic environments.
If we don’t all work together to learn the real mistakes coming out of the pandemic, we risk making them again.
Outcomes from the World Health Assembly
After the Assembly in May, some commentators expressed fears that some of the proposed provisions in the draft text concerning IP waivers and benefits sharing were being watered down. The problem is that some of the earlier proposals in the zero draft risked undermining the very system that was able to develop and supply to the world Covid vaccines, medicines, diagnostics and other medical technologies.
Locking countries to work together in a global approach is one thing. Undermining the development of new medical technologies is a whole different problem.
As discouraging as some of the commentary has been, in fact the process for negotiating a pandemic ‘accord’ has progressed during and since May’s Assembly.
Negotiations on topics such as research and development, liability risk management, technology transfer, access and benefits sharing, supply-chain and logistics, and regulatory strengthening are all being negotiated among countries, with a view to arriving at a draft text for consideration at next year’s WHA.
In his closing comments to the WHA in May, Dr Tedros challenged nations to take the ‘generational opportunity’ to learn from the lessons from the Covid-19 pandemic and finalise the text of the accord at next year’s 77th Assembly in May 2024. This came with a warning to be wary of ‘fake news’ in some of the commentary around the proposed accord.
Since May, negotiations have continued although at times although are ‘not easy’ according to diplomats. Informal sessions have been introduced between the formal discussions to help build trust between the different negotiators and smooth the process of the accord negotiations.
What does it mean for the pharmaceutical industry?
The opportunity for the pharmaceutical industry is perhaps to engage with these discussions constructively and find a positive way forward.
There’s no doubt, some of the proposals being put forward by some countries and groups like automatic IP waivers for technology, and compulsory acquisition of technologies are just bad.
But there are lessons to be learned from the pandemic for governments, stakeholders and industry.
The industry, through its trade group the IFPMA, has done some good work already in promoting things like the 100 day mission on future vaccine development and Berlin Declaration on future pandemic responses.
This sort of constructive engagement should continue.
It’s imperative the pharmaceutical industry is at the table in discussions about a new system for managing future global pandemics.
Finding win-win solutions to that both spur the commercial development of future vaccines, medicines, medical devices and diagnostics, while ensuring the people of the world get access to them in a timely and equitable way is one of humanity’s great challenges.
Covid showed us how important getting this balance right is.
The pharmaceutical industry has come out of the pandemic proving its worth to a whole swathe of people who previously didn’t much know or care about the industry. This puts the industry in a good position to be one of the constructive players in the post-Covid policy debates about pandemic management and global health.
Engaging constructively with critics to find new solutions, policy approaches and business models might even turn up some interesting surprises.
There’s no guarantee in this, but it’s worth a shot.
Brendan Shaw is Principal of Shawview Consulting and an Adjunct Professor at the Pharmacy School, Faculty of Medicine and Health, at the University of Sydney.
