The Global Pandemic Agreement: Time to Get Serious

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Shawview Consulting’s Brendan Shaw laments the descent into nationalism that COVID-19 – like past pandemics – has led to, and outlines his hopes that the World Health Assembly’s new accord on pandemic prevention, preparedness and response will lead to a more unified, global approach to future pandemics.

 

When Professor Eddie Holmes of the University of Sydney tweeted the genomic sequence of the then mysterious coronavirus via Twitter to the world on 20 January 2020, it was a graphic demonstration of the best of human science, ingenuity, technology and global collaboration.

It was an example of the global community working at its best.

But news in the last couple of weeks that a new Omicron variant of COVID-19 has broken out in southern Africa and is fast spreading around the world is a reminder of why we need to get better at working together to beat pandemics.

Also deeply unfortunate was the world’s reaction to South Africa’s immediate notification of the Omicron variant. Almost immediately, the country was effectively being punished through travel bans imposed by a range of countries.

This is what makes the world’s decision last week to start work on a new global pandemic agreement all the more important.

To date, as a collective humanity, we have not learned how to work together to beat pandemics.

We need to get this right.

Discussions around a new global pandemic agreement are crucial for governments, the pharmaceutical industry and for the future health of people around the world.

 

World Health Assembly agrees to negotiate new pandemic agreement

In the wake of the experience of dealing with COVID-19, a special session of the World Health Assembly last week agreed to commence negotiations on a new international agreement to guide global responses to future pandemics.

The near consensus among all countries to go ahead with the negotiations came despite some countries apparently having reservations about national sovereignty being compromised.

The process is due to start by March 2022 and continue through to May 2024 when the Assembly will be asked to sign off on the new agreement – whatever that will look like.

As opposed to the existing International Health Regulations (IHR) on public health emergencies, this proposed agreement could have stronger binding commitments on governments to cooperate internationally and collaborate with World Health Organization and other agencies to fight future pandemics.

It could also empower these agencies to become more effective in monitoring and give them greater pandemic management enforcement powers.

The proposal has a lot of support from governments, but it will be interesting to see the extent to which countries like China, Russia and the United States accept an agreement that empowers epidemiologists from the WHO or some other international body to enter a country and enforce international monitoring and reporting of potential pandemic diseases.

Try as I might, I find it difficult to imagine the WHO parachuting ‘black ops’ epidemiologists into a country with their test tubes and monitoring kits like a crack team of US Navy Seals entering foreign territory under the cover of darkness.

It is encouraging, at least, that a large swathe of countries from around the world proposed that negotiations commence in a document called ‘The World Together’.

There is also debate whether a new global pandemic agreement is the best way to go or to instead just enforce the IHRs that have already been agreed over many years.

 

A foil for vaccine nationalism?

Professor Holmes’ Twitter feed was an example of the global community working at its best.

At its worst, we have seen situations earlier this year where millions of front-line health workers in low-income countries – nurses, doctors, paramedics and the like – could not get vaccinated while gorillas at the San Diego Zoo were already being immunised.

It doesn’t matter who you are, where you live or who you work for, this is just not acceptable.

As a species, we don’t do ourselves any credit by letting this happen.

Even today, less than 8% of Africa’s 1.2 billion people are fully vaccinated, while only one in four health workers in Africa are fully vaccinated.

Across the world, while around 75% of people in high- and upper-middle-income countries have received at least one dose of a COVID vaccine, in low-income countries less than 6% have received at least one dose of a vaccine.

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Back in September UN Secretary-General, Antonio Guterres, slammed world leaders, calling the hoarding and throwing out of excess vaccines by wealthy countries an ‘obscenity’ while many low- and middle-income countries still had no vaccines.

And way back in January, World Health Organization head, Dr Tedros Adhanom Ghebreyesus, called the inequity in vaccine distribution a ‘catastrophic moral failure’.

These guys haven’t been mincing their words.

Meanwhile, the international initiative to supply vaccines to low-income countries, COVAX, has suffered protracted delays due to things such as insufficient funding from countries and vaccine supply constraints.

The emergence of the Omicron variant in southern Africa is precisely the global risk that under-vaccinated populations in low-income countries present.

For months, experts, WHO head, Dr Tedros, other WHO officials, and others have all been saying that we need to ensure all of humanity has equal access to COVID-19 vaccines to prevent precisely this sort of thing from occurring.

But instead, as with earlier pandemics, such as SARS in 2002 and H1N1 in 2009, we have increasingly gravitated to variations of ‘vaccine nationalism’.

Done properly, it’s conceivable a new global pandemic agreement could overcome some of the problems with the existing IHRs which have not been successful in managing pandemics.

 

Lessons not learned

But the failures to learn from past pandemics have not just been with vaccines.

COVID-19 exposed flaws in our health systems and our failure to learn the lessons from managing past pandemics.

The truth is that this is not the first time we have experienced these global problems in managing pandemics.

After the SARS, MERS, H1N1 and Ebola outbreaks, the IHRs were reviewed and it was often found that countries were not doing what they had signed up to do. Countries were not always notifying WHO early enough either because they were not required to, because they feared the consequences, or because they were just not being cooperative.

In addition, governments were not sharing virus strains and genetic sequences quickly enough as intended under the Nagoya protocol on benefits sharing under the Convention on Biodiversity.

Countries were also not putting enough general priority on pandemic preparedness.

By way of example, under the United Nations’ Sustainable Development Goals for Health, the only key performance indicator for pandemic preparedness was ‘International Health Regulations capacity and health emergency preparedness’, where many countries have not scored well for a long time. No other metrics were developed.

Various earlier warnings about the need to prepare for pandemics ranging from academics, experts, and groups like the Global Preparedness Monitoring Board were, in most cases, ignored.

 

Implications for the pharmaceutical industry

Now that the world has agreed to start work on a new international pandemic agreement, the pharma industry should engage in this.

The international pharma association, the IFPMA, has already said that more needs to be done to guarantee equitable access to things like vaccines and medicines and that it will be involved in the negotiation process for any agreement.

This is a good thing.

It will be critical to have the private sector at the table in these discussions for several reasons.

It will be important to ensure the negotiations have a long-term view on how to manage and avoid future pandemics. This will include ensuring that the incentives are there for companies to do the research, development and manufacturing of new vaccines and treatments for emerging pandemic diseases.

While innovative ways to expand supply and achieve equitable distribution will be important, stripping back the incentives like intellectual property and junking sensible purchasing is not going to help encourage constructive responses to future pandemics.

We have already seen in previous pandemics like SARS in 2002 and H1N1 in 2009 that companies face a lot of disruption and risk when suddenly called on to develop new pandemic vaccines. Some companies got caught out investing in the development of vaccines that then suddenly were no longer wanted, and governments have previously reneged on their contracts and not paid for their vaccine orders.

So, we’re going to have to get better at this if we want the vaccine companies to be ready and able to help fight off the next pandemic.

In the same way that South Africa is effectively being punished right now for immediately reporting the emergence of the Omicron variant, it would be ironic if out of all this discussion of a pandemic agreement the pharmaceutical industry was punished because it delivered new COVID vaccines and treatments to the world in record time.

In addition, a system where governments or WHO provide earlier declarations or notices to companies to prepare for an emerging virus, to complement the work of groups like the Coalition for Epidemic Preparedness Innovations, is useful and overdue.

During the COVID-19 pandemic pharma companies have engaged in some extraordinary partnerships to expand the supply of vaccines, and this sort of new partnership thinking is going to have to expand for future pandemics.

Companies have collaborated and contributed in various ways, some previously unheard of.

And all stakeholders should continue finding new ways to work together against pandemics, such as through things like the ACT Accelerator and the IFPMA’s Five Point Plan.

 

Going global

Ultimately, the issue is about how we can work better together globally to respond to future pandemics.

This is important because often our response to date to COVID-19 and past pandemics like H1N1 and Ebola has descended into nationalism.

Ultimately, infectious diseases and pandemics don’t care about borders, languages, nationalities or ideologies.

Pandemics just kill … people. The world over.

If pandemics don’t care about nationalism or nationalities or borders, then maybe our future strategy to protect ourselves as a species needs to work the same way.

Here’s hoping last week was the first step in securing that future.


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