It’s meant to be a legally binding deal that could prevent the next pandemic.
Originally proposed by European Council President Charles Michel in the worst days of the COVID-19 pandemic, the aim is to create a new set of rules to guide countries on pandemic preparedness and response.
But with countries fiercely divided on key issues and just 12 months left to agree, it’s looking increasingly likely that the text will end up as a damp squib.
As the who’s who of global health descends on Geneva in the coming days for the World Health Assembly — the annual meeting of the decision-making body of the World Health Organization — the fate of the treaty will be the main topic of discussion over glasses of champagne at swanky receptions.
The behemoth draft version of the text was ambitious, covering everything from access to vaccines to strengthening health systems so they can respond to health crises.
But with countries facing off over intellectual property rights and the rules around sharing medical products developed during a pandemic, a compromise with any substance looks increasingly difficult to reach.
“If the groups can give up a little bit and try to compromise, I think that in the middle, we might have something left … we might have something that is useful for the future,” said a Geneva-based diplomat, who requested anonymity to talk about confidential negotiations. However, they added that the “fallback position might be a treaty with a little bit of content — just a little bit.”
And then there’s the all-important question: How to ensure that countries actually comply with what’s agreed. “A treaty with no compliance mechanism is just a piece of paper,” warned Nina Schwalbe, founder of the public health think tank Spark Street Advisers and former senior official at UNICEF and Gavi, the Vaccine Alliance.
POLITICO walks you through the biggest sticking points:
Face-off with Big Pharma
There are two highly contentious proposals in the draft text. One calls on countries to take measures to support time-bound waivers of IP rights so that companies other than patent holders could make vaccines or treatments — an issue that countries never truly succeeded in solving during the COVID-19 pandemic. The second is to ensure that countries that share information about dangerous pathogens can access any resulting treatments and vaccines developed using this data.
Developing countries see these as central to ensuring equity in the next pandemic. But both are fiercely opposed by Big Pharma, which has the backing of some wealthy Western nations.
On intellectual property rights, the U.S. has taken a big red pen to the draft text, stripping out mention of waivers of intellectual property rights. It also wants to weaken provisions that would require pharmaceutical companies to license other manufacturers to produce their products.
For the debate over whether sharing information regarding new pathogens should be linked to some kind of benefit — potentially monetary — the line is less clear. The Global South, which is pushing to include the benefits link, has the biggest ask, said a second Geneva-based diplomat who also requested anonymity to talk about confidential negotiations. But a flat no from the Global North could see them lose timely access to those pathogens — something that could delay the development of pathogen-specific vaccines or treatments, and cost lives.
Too many cooks, too little time
When WHO members agreed in December 2021 to negotiate a pandemic treaty by May 2024, the deadline seemed a lifetime away. But a lot of time was lost at the start of the process on procedural matters, said the first diplomat. That delay was likely “strategic at some point also for some groups,” they said, without specifying who they were referring to.
There’s no denying that the text tries to cover a lot of ground, much of it highly controversial. Given that, the deadline of May 2024 is “an extreme challenge,” said the second diplomat. What may be necessary is a streamlining of sorts. “It’s not about lowering the ambition but maybe lowering the level of detail,” they said.
Ambassador Nora Kronig, head of the international affairs division in the Swiss Federal Office of Public Health, told POLITICO that there is still uncertainty about the scope and content of the treaty. “There’s still a lot of work ahead of us to make it tangible and realistic and implementable,” she said.
‘Just a piece of paper’
Perhaps the biggest question is how the treaty will actually be enforced.
“There hasn’t been a lot of discussion about this because it touches on the difficult issue about sovereignty and about having an international organization or other countries, [having] a look on what you do, [and] on how you prepare,” said the second diplomat.
In a draft text, countries including China, Russia, Iran, Namibia and Egypt express strong reservations about monitoring mechanisms such as a peer review process, where countries would carry out regular reviews of each others’ pandemic preparedness. Meanwhile, the EU, Canada and Switzerland have put forward proposals for stronger language on monitoring how ready a country is for a health crisis.
Some countries fear a naming and shaming process, but it doesn’t matter how well-prepared one country is, if another isn’t, said the first diplomat. “I think that we should be accountable to each other, and we should be transparent, and we should try our best to allocate resources and also to make the necessary changes to improve, and also to help others to improve,” they said.
Some observers want to go even further. Schwalbe would like to see a committee of independent people reporting on the treaty. “Whatever’s in it, we need to hold states accountable for what they’ve agreed to,” she said.
Ultimately, the outcome will be “the fruit of international negotiations,” said the second diplomat. “Of course, it will be the [lowest] common denominator.”
But their view is that if it binds countries on anything new then it’s worth something. “One could see anything that those countries agree upon [as] progress, even if it is watered down and it is incremental or iterative,” they said.