Opinion Can WHO’s Pandemic Agreement launch a new era of global health cooperation?

The WHO Pandemic Agreement spells out the principles, approaches, and tools for better international coordination to strengthen the global health architecture for pandemic prevention, preparedness and response including equitable and timely access to vaccines, therapeutics, and diagnostics. It is clarified that the WHO (through this agreement) will not “direct, order, alter or otherwise prescribe the national and/or domestic law;” in other words, a pandemic will not in any manner undermine the sovereignty of a member state. The agreement is also in alignment with the amended International Health Regulations (IHR) adopted in last year’s WHA to strengthen international rules to better detect, prevent and respond to outbreaks.

What happens next? Beyond the euphoria of this “watershed” agreement the devil will be in the details that lie ahead. The FCTC took two years to come into force. As a key next step to the agreement’s implementation, an Intergovernmental Working Group (IGWG) will draft and negotiate an annex to establish a Pathogen Access and Benefit Sharing system (PABS) that will be considered by the next year’s WHA. The agreement will only then be open for signature and consideration of nearly 60 ratifications to come into force, including those by the national legislative bodies.

The IGWG has another important task — setting up of the Coordinating Financial Mechanism for pandemic prevention, preparedness, and response. The PABS System will link and enable the industry and companies to have access to and be able to utilise pathogen samples and sequence data with benefit-sharing obligations. The private parties accessing materials through PABS may be required to pay contributions to WHO, enter into contractual commitment to share a percentage of pandemic-related products with WHO in case of a pandemic (the target is 20 per cent, of which 10 per cent is a donation) and, potentially, agree to a wide range of non-financial benefit-sharing that include technology transfer, non-exclusive licensing, affordable pricing and global access commitments. The national Access and Benefit Sharing (ABS) provisions will also need to align with the Agreement; India will likely need to amend the Biological Diversity Act, 2002 accordingly. Alongside, the Global Supply Chain and Logistics Network (GSCL), a worldwide system that connects all the businesses and processes involved in moving goods from their origin to the consumer, will play a catalytic role to “enhance, facilitate, and work to remove barriers and ensure equitable, timely, rapid, safe, and affordable access to pandemic-related health products.”

There are several significant but fuzzy domains — enforcement mechanisms, funding pathways and, above all, a synergistic and non-contentious sharing of products and interventions by advanced economies with less endowed countries who are expected to contribute data including genetic sequencing of pathogens.

The One Health (OH) approach is a central doctrine in the Pandemic Agreement. For each member state this entails “developing, implementing, and reviewing relevant national policies and strategies that reflect a One Health approach across the human-animal-environment interface.” India’s National One Health Mission (NOHM) with an integrated framework encompassing 13 government ministries/ departments is a step in the right direction but a work in progress.

The soul of OH is a multi-disciplinary approach and multi-sectoral collaborations that call for synergy across field sciences, analytical approaches, and laboratory science; the critical barriers are in the realm of politics and governance, though, and not technical. Actors with diverse sectoral and disciplinary expertise are required to work across ministries/ departments and navigate tacit institutional hierarchies and allocate leadership roles. A critical determinant is the extent to which these resonate with high-level political agendas and are amenable to buy-in across sectors. Accountability, transparency, and trust are essential ingredients but can be elusive. The key to success will be consultative and collaborative leadership that promotes innovation, adaptation, and flexibility in terms of political, financial, and administrative accountability.

The writer is professor and chairperson, Centre of Social Medicine & Community Health, JNU, and member of the One Health Working Group, World Federation of Public Health Associations