Comprising a million, informal, female health workers, India’s ASHA program, stands as the most prominent Community Health Worker (CHW) initiative both nationally and globally. Approaching nearly two decades since inception, ASHAs have become the cornerstone of India’s primary healthcare system and thereby a major contributor to the delivery of healthcare rights. At the 75th World Health Assembly (WHA) on May 22, 2022, ASHAs were honored with the Global Health Leaders Award, acknowledging their pivotal role in connecting marginalized communities with health services and recognizing their efforts in ensuring access to primary healthcare, amidst the challenges posed by the COVID-19 pandemic 1. As we commemorate World Health Day 2024, we felt it is an opportune time to pause and reflect on the uncertainties and problematics confronting the programme, both at the level of policy and at the level of the workers themselves.
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The Vice-Chair of the Bureau of the Intergovernmental Negotiating Body (INB), Dr. Viroj Tangcharoensathien of Thailand, has proposed a new timeline of May 2026 to conclude negotiations on a Pathogen Access and Benefit Sharing (PABS) System.
The Vice-Chair made this proposal in his presentation during the informal session on Article 12 held on 8 April at the WHO Headquarters in Geneva, a hybrid mode. The last slide of his presentation contains the new timeline, which states: “Terms, conditions and operational modalities of the PABS System shall be further defined in a legally binding instrument that is operational no later than 31 May 2026”.
World Health Organization members' negotiations on a pandemic preparedness treaty remain rocky less than two months before the intended deadline, as industrialized and developing nations butt heads over technology access.
Talks began in December 2021 with countries hoping to apply lessons from the slow COVID-19 response to prepare for the next pandemic. After two years of negotiating the contents, the plan was to reach an accord at the negotiating body's meeting last month.
That meeting ended on March 28 with no agreement, after failing to bridge the gap between India and African countries pushing for greater fairness in areas such as drug distribution, and the U.S., Japan and European countries seeking to avoid heavy financial burdens and transfers of valuable technology.
Global interest in the issue is also ebbing as countries focus on new crises such as the wars in Ukraine and the Middle East.
"If we miss this opportunity, we risk losing momentum," WHO Director-General Tedros Adhanom Ghebreyesus said on the first day of the meeting.
A major point of contention is how to handle technologies developed by drugmakers.
In the Geneva Health Files, we proposed a robust Pathogen Access and Benefits (PABS) system that imposes binding obligations on users of biological materials and genetic sequence data (GSD) to make mandatory monetary contributions. PABS is necessary but not sufficient to ensure equity. There is still important work to do on intellectual property waivers and technology transfers. But PABS is important. The Africa Group and the Equity Group are unlikely to acquiesce to a treaty without a strong PABS system. At the same time, GHF recently reported that the pharma industry is warming up to PABS, but wants unconditional access sans benefit sharing obligations. That’s a non-starter.
On Tuesday, 2 April 2024, Politico published the onscreen text WHO pandemic treaty text of Wednesday, 27 March 2024; the time stamp of this 110 page text is 12:44 CET. Article 11 of the proposed agreement contains provisions on transfer of technology and know-how. Nestled within article 11 is paragraph 4bis, the peace clause. The 27 March 2024 pandemic treaty text can be found here: https://keionline.org/misc-docs/who/inb9.wed.27march.pdf
WHO Member States have decided to hold another round of negotiations on the pandemic instrument with an aim to finalise it before the 77th World Health Assembly (WHA) to be held 27 May – 2 June in Geneva.
The lack of consensus during the 9th meeting of the Intergovernmental Negotiating Body (INB9) on the pandemic instrument led to the decision to hold the resumed session of INB9 based on a draft text prepared by the Bureau with the assistance of the WHO Secretariat.
Médecins Sans Frontières/Doctors Without Borders (MSF) acknowledges the progress made by member states negotiating the Pandemic Agreement. The current text shows notable improvements compared to the previous draft, particularly in areas such as stockpiling and allocation. It reinforces the importance of respecting flexibilities within the TRIPS Agreement and includes better language regarding access provisions in public funding agreements for research and development (R&D). We also commend the efforts made to enhance provisions related to technology transfer and licensing of government-owned or funded technologies. Transparency measures across supply chains and in public procurement agreements have also been improved.
However, there are outstanding issues that need to be addressed immediately to ensure a comprehensive agreement that prioritises the needs of people in humanitarian and resource-limited settings.
The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.
The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.
But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.
At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.
“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece.
Transparency
The negotiations on a WHO pandemic agreement should be more transparent. The negotiating texts with attributed country positions should be public and the meetings should be webcast. These are reasonable expectations. The World Intellectual Property Organization (WIPO) operates in this way; it even allows stakeholders to listen to informal negotiations on texts and has demonstrated an ability to adopt treaties on topics of considerable controversy and with commercial consequences.
There is considerable paranoia and misinformation about the WHO in social media, and the unnecessary secrecy of this negotiation is not helpful. While the texts are often leaked, both industry and several well-informed civil society groups have access, and some can afford to attend the negotiations, the general public is locked out. The lack of transparency erodes confidence in the WHO in general and the pandemic agreement in particular.
The capriciousness of memory!!! It was only four years ago, yet it is difficult to recall the Covid 19 days. They seem so unreal. Did we really go through them? Such extreme isolation. The excessive loss of friends and family members. The fear for one’s life and fear for the lives of loved ones. Fear of the unknown and great uncertainty about everything. It seemed as though our lives had come to a standstill, and we wondered whether we would ever get back to the normal routine. But, looking back at it now, it appears as if we had only hit the pause button, and life is back on its usual track. However, leaving behind an exacerbation of several negative and social trends: more inequality, more poverty, more unemployment, and yes, poorer health status.
The WHO declared the spread of Covid 19 to be a pandemic on 11 March 2020. India declared a nation-wide lockdown beginning from 23 March 2024. Both deserve to be called anniversaries. And being a death anniversary for an event that led to an estimated 7 million deaths (at least), it is time for a sober reflection.