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The job of global health negotiators working on a new Pandemic Agreement, and to amend the International Health Regulations, was already stacked against all odds. This has become even more difficult with Israel’s retaliation on Palestine following attacks by Hamas. The incessant attacks by Israel on health facilities in Palestinian Territories, directly speaks to the mandate of the WHO. It was no surprise that the crisis, bled into the discussions on the seventh inter-governmental meeting on the Pandemic Agreement this week in Geneva. Undoubtedly the stench of war pervaded the sterilized confines of the WHO headquarters where member states met this week.

It is on this fractured, splintered notion of international cooperation that diplomats have to now sew together new and complex rules on surveillance, information exchange and access to medical countermeasures. Commitments on accountability and transparency are also being sought. Tough that.

Global health governance confronts two long-term problems. One of them is a growing fragmentation and misalignment of agendas and initiatives. The other is a problem of power, encompassing accountability, transparency, and meaningful voice. Inevitably the two problems are linked, and nowhere more so than when it comes to the financing of global health agendas. Each of these problems have intensified since the pandemic, as identified by numerous commissions and initiatives including the International Panel on Pandemic Preparedness and Response and the more recent Future of Global Health Initiatives process.

 The draft negotiating text on the pandemic instrument released by the Bureau of the Intergovernmental Negotiating Body (INB) is unbalanced, essentially serving the interest of developed countries without any concrete deliverables on equity.

This draft text is to be considered by the 7th meeting of the INB for conversion into a formal negotiating text. The 7^th meeting of INB is to be held at the WHO Headquarters, Geneva from 6-10 November.

Industry pans it, developing countries say draft “unbalanced” with a one-sided focus on prevention, falling short on obligations on response.

After more than two years of discussions on what countries would like to see in a Pandemic Accord, the Negotiating Text from the Bureau of the Intergovernmental Negotiating Body set up to broker this new instrument, has sought to strike a balance to in order to first draw countries into negotiations – but is being perceived as unbalanced and one-sided with a focus on prevention relative to obligations on response, diplomats said.

From suggesting provisions on pathogens access and the sharing of benefits, to language on One Health, from a new financing mechanism, to sustainable production, the draft might be able to get countries to begin text-based negotiations. Some developing countries hope to add text to strengthen the draft so that they can begin negotiations, diplomatic sources told Geneva Health Files.

We are all aware that negotiations, particularly of the WHO CA+, but also to some extent the WG-IHR, are in a difficult place. The central issues of concern are of how low and middle income countries can access epidemic and pandemic countermeasures equitably, and also the nature of any pathogens access and benefits system. There are many issues within these two areas, including distributed production of countermeasures across the world, the technology transfer, TRIPS matters and the balance between equity and the need to ensure that research and innovation continues in the pharmaceutical industries.

Countries have taken firm positions but some progress has been made through informal Member State led sessions on the relevant Articles. Even there, concerns have been raised in some countries, particularly the poorer ones, that they simply do not have the resource to engage with so many meetings. These informals have at least increased understanding of what are the underlying concerns of particular Member States.

Coalition of Advocates for Global Health and Pandemic Preparedness

For months, we have watched as Member States have tried to negotiate a UN Political Declaration on Pandemic Prevention, Preparedness, and Response (PPPR) ahead of the UN High Level Meeting in September.

With groups of Member States at odds on equity issues, these negotiations have gone severely off track.

This is the time to deliver a Political Declaration that is ambitious, timely, and in pursuit of a level of equity that has yet to be achieved in global health. As Directors of civil society and community organizations working globally on health, the HIV response, and pandemic preparedness, we see and experience first-hand the risk of failing to deliver, particularly for marginalized, criminalized, and under-resourced communities.

It is becoming increasingly clear that WHO member states may push for more time in order to conclude the negotiations towards a new Pandemic Accord. While this has not been formally discussed or decided yet, a number of diplomats in Geneva indicated this week that an extension will be inevitable in order to come up with a meaningful instrument.

Speaking on the sidelines of a drafting group meeting of the Intergovernmental Negotiating Body, several diplomats suggested that sooner than later, the decision to seek for more time will need to be addressed in the coming weeks. But countries are hesitant to be the first ones to volunteer to ask for more time, afraid of being seen as sabotaging the process.

In the last few months of reporting, this is the first time that there has been perceptible shift in the way countries talk - albeit privately - on the need for more time citing concerns around coming up with substantial provisions to make a new Pandemic instrument more effective.

The coming months will see WHO member states under intense pressure: first, to begin discussions on the basis of a text that will form the basis for negotiations towards a Pandemic Accord, and second, to conclude it within the stated deadline of May 2024. This pressure could mean making compromises by countries, forcing them to move from their long-held positions on contentious issues including on intellectual property, in a bid to achieve more defining goals in a Pandemic Accord such as on Access and Benefits Sharing, a few diplomatic sources have indicated.  

While July saw a crush of global pandemic-related meetings – some joint and some clashing – to accommodate tight schedules and northern summer holidays, achieving a pandemic-proof world is still a long way off. 

The two pandemic negotiations underway at the World Health Organization (WHO) have held individual and joint meetings over the past few weeks, with talks dominated by equity, early warnings for pandemics and financing.

The Working Group on amendments to the IHR (WGIHR) is strengthening the International Health Regulations (IHR), the only legally binding global rules governing health emergencies. 

Meanwhile, the Intergovernmental Negotiating Body (INB) is developing a pandemic accord to address other gaps that emerged during COVID-19 – particularly how to ensure equitable access to vaccines and medicines.

While July saw a crush of global pandemic-related meetings – some joint and some clashing – to accommodate tight schedules and northern summer holidays, achieving a pandemic-proof world is still a long way off. 

The two pandemic negotiations underway at the World Health Organization (WHO) have held individual and joint meetings over the past few weeks, with talks dominated by equity, early warnings for pandemics and financing.

The Working Group on amendments to the IHR (WGIHR) is strengthening the International Health Regulations (IHR), the only legally binding global rules governing health emergencies. 

Meanwhile, the Intergovernmental Negotiating Body (INB) is developing a pandemic accord to address other gaps that emerged during COVID-19 – particularly how to ensure equitable access to vaccines and medicines.