With the declaration of two infectious diseases (Covid-19 and Monkeypox) as Public Health Emergencies of International Concern (PHIEC) since 2020, there is considerable global concern about the recurring risk of pandemics. Polio continues to be designated as a PHIEC. While many of the earlier infectious disease outbreaks were confined to a few countries, the rapidity with which microbes now race across a globalised world has made all countries feel extremely vulnerable. Such threats also call for increased cooperation among countries for sharing information and resources needed for a concerted global response. It is clear that no country can face such threats alone, however well-resourced it might be.
The World Health Organisation (WHO) had earlier led the development and adoption of International Health Regulations (IHR, 2005) to provide an overarching legal framework that defines the rights and obligations of countries when they observe public health problems which can pose cross-border threats. There is a requirement to report such outbreaks promptly to WHO and the international community. Declaration of a PHIEC is also guided by provisions in IHR. Rights and restrictions related to international travel are also encoded in IHR, which applies to 196 countries.
Covid-19 brought with it concerns about the inadequacy of IHR in ensuring timely and accurate reporting by countries. It also revealed how global solidarity was weakened when high income countries were not sharing vaccines, drugs and diagnostics in an equitable manner to enable an effective global response to a common threat. The consequences of such inequities were evident in the emergence of virus variants in under-vaccinated populations. Those variants then posed fresh threats to the highly vaccinated populations. The slogan “no country is safe till every country is safe” was no longer to be regarded as mere rhetoric. It was a reality that all countries had to recognise, as Covid rolled over and returned in repeat cycles.
In recognition of the need to further strengthen international cooperation for pandemic prevention, preparedness and response, WHO has now commenced the process for the development and adoption of a new international treaty. This would be developed through the deliberations of an International Negotiating Body (INB) in which the government led delegations of all WHO member countries would participate. They would deliberate and debate on the provisions proposed in a ‘Zero Draft’ prepared by the WHO secretariat and work towards a consensus document that is acceptable to all countries. That document would be finally adopted by the World Health Assembly convened by WHO.
The INB met at Geneva between July 18 and 21, 2022 and adopted a plan of work, with the stated intention of concluding the process by May 2024. The members agreed that the new international pandemic agreement should be legally binding. The INB aims to “ensure better preparedness and equitable response for future pandemics, and to advance the principles of equity, solidarity and health for all.”
As is the norm with all international agreements, individual governments will themselves determine actions to be taken under the accord, while considering their own national laws and regulations. When countries sign and ratify the agreement, or accede to it later after it comes into force, they agree to abide by the provisions of the agreement while reserving the right to decide on the mode of implementation within their territories. In the case of India, the Parliament has to approve the agreement and authorise the government to sign it.
Will the treaty really have the needed content and strength of implementation to serve its intended purpose? Lawrence Gostin, an internationally renowned expert on health law, offers three suggestions to make the treaty meaningful. First, he calls for wider civil society engagement in the process of development, going beyond the governments. Second, he calls for credible commitments and accountability mechanisms, including sharing of pathogens, genomic sequencing data, scientific information and the benefits of public health research. This must include access to vaccines and vaccine development technologies.
Third, Gostin also calls for greater international cooperation in pandemic prevention, not just pandemic response. Agreement on land and animal management, regulation of animal wet markets and measures to contain deforestation are proposed by him, to prevent cross-species zoonotic spillover of microbes. He also calls for regulating the use of antibiotics, to reduce the danger of anti-microbial resistance. The need for strengthening health systems in low and middle income countries, to make them more resilient to pandemics, is also highlighted by him.
While the treaty must address all of these elements, there are other agencies besides WHO who will need to align themselves with the provisions. The World Trade Organisation (WTO) is a powerful player which protects patent rights. The Doha Declaration of WTO provides for relaxation of patent rights in case of a public health emergency. However, the WTO has not yet agreed to a proposal from South Africa and India to waive patent rights on Covid-related technologies. These include vaccines, drugs and diagnostics. A compromise formula, providing a waiver limited to vaccines only, is being considered. The need for a more far reaching level of global cooperation, according primacy to global health, is being urged by advocates of a potent pandemic treaty. International law accords higher precedence to the most recent global treaty over pre-existing ones. So, the proposed pandemic treaty can break new ground.
How much of this can be accomplished by the new treaty remains to be seen. Often national interests, in many cases tied to industry interests, trump the spirit of global solidarity. Will the governments of the world heed the lessons of the three currently active PHEICs, to act with resolve and commitment to global good? Can civil society advocates and technical experts prevail on governments to adopt a truly potent instrument that will safeguard global health? We will know when the INB gets down to real business at its next meeting in December 2022.
*Prof. K. Srinath Reddy, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). The views expressed are personal.
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