Leanne Coombe and James Scheibner
The 77th World Health Assembly (WHA), held from 27 May – 1 June 2024, promised to be historic.
In the wake of COVID-19, the event marked the deadline for countries to come together on an agreement for how countries collaborate to prepare for, and prevent, future pandemics.
Preparation for the World Health Organization’s (WHO) first convention, treaty, agreement or other international instrument on pandemic prevention and preparedness started in December 2021 and was anticipated by public health experts as a crucial step to ensure that the world was better equipped for future outbreaks.
So, what happened?
In the lead up to the meeting, concerns grew that agreement would not be reached.
Tensions between countries rose and negotiations on key issues stalled, particularly regarding the licensing of intellectual property and equitable access to life-saving products such as vaccines and medicines.
The Public Health Association of Australia and the Australian Fair Trade and Investment Network called on the Australian Government to support strong provisions in these critical areas, to potentially influence other countries and reach consensus.
Nevertheless, on the last day of negotiations prior to the WHA, Mr Roland Driece – co-chair of the Intergovernmental Negotiating Body – confirmed that agreement on some sections of the draft treaty had not been reached.
WHA participants were called on to continue to “take this process forward” and on 1 June – the final day of the WHA meeting, the 194 member countries resolved to extend negotiations with the aim of reaching an agreement within the next 12 months.
Amendments to the International Health Regulations
While negotiations on the Pandemic Agreement were extended, one of the welcome outcomes from the WHA was critical amendments to strengthen the legally binding International Health Regulations (2005) (IHR).
These changes are designed to improve surveillance and cooperation mechanisms for preparedness and response to pandemic emergencies.
Significantly, the IHR now includes a clear definition of ‘pandemic emergencies’ that will enable the WHO to officially trigger a higher-level alarm than the existing determination of a public health emergency of international concern, activating a more effective international response.
Other amendments to the IHR may form a foundation for the ongoing treaty talks, given the overlap in their intent.
A key sticking point for the treaty negotiations to date has been around data sharing and equitable access to pandemic response products (such as protective equipment, tests, vaccines, and medications).
Low- and middle-income countries have, and are continuing to argue for, automatic access to products directly derived from the supply of pathogen genomic data, and for more equitable access to affordable products to avoid the lower vaccination and higher death rates seen during the COVID-19 response.
These items are predominantly being contested by high-income countries where large pharmaceutical industries are located.
The amended IHR provides a commitment to strengthening equity and access to pandemic products.
It establishes a coordinated funding mechanism to “equitably address the needs and priorities of developing countries, including for developing, strengthening and maintaining core capacities.”
In addition, the amended IHR includes a provision requiring the WHO to support Member States in implementing geographically diversified manufacturing of health products.
Under these provisions, the WHO must also support States in promoting “local production of quality, safe and effective relevant health products.”
Improvements in workers’ rights
Another sign that agreement can be achieved in ongoing treaty talks is the consensus already reached on the text in the Pandemic Agreement article related to the health workforce.
This section emphasises the need to ensure decent and safe work, maintain a skilled workforce, safeguard ethical international recruitment, address inequalities and violence, and maintain essential services.
In support of these initiatives, during the week of the WHA the WHO released the National Workforce Capacity for Essential Public Health Functions Collection.
This Collection consists of an overarching operational handbook to support national contextualisation and implementation, and three additional guides for operationalising initiatives to assess and strengthen the capacity of the public health workforce.
Ongoing negotiations
The amendments to the IHR have been critiqued by health policy scholars such as Nina Schwalbe, on the grounds that they do not contain an enforcement mechanism.
The divisions over technology transfer and intellectual property protections will also remain a considerable challenge to overcome in subsequent negotiations over the Pandemic Agreement.
The draft treaty also requires countries to commit to developing two separate international instruments in following years.
These instruments would require a One Health approach to pandemic responses and would establish a system for sharing pathogen genomic data in exchange for pandemic response products. Negotiation around this requirement is likely.
Whether high-income countries reach an agreement with low- and middle-income countries over the scope of the treaty is unknown.
We will continue to urge the Australian Government to push for a treaty agreement that will provide equitable outcomes for all countries and avoid the vaccine-hoarding and price-gouging we saw during the COVID-19 pandemic, that prevented access to life-saving products for people who needed them the most.
Leanne Coombe is Policy and Advocacy Manager, Public Health Association of Australia, an Honorary Associate Professor at the School of Public Health, University of Queensland and Co-Chair, Professionals’ Education and Training Working Group, World Federation of Public Health Associations. Dr James Scheibner is a Law Lecturer in the College of Business, Government and Law at Flinders University.
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