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Timely and equitable access to effective medical countermeasures that are suited to the realities of the local health context is critical to stop disease outbreaks when and where they occur.

By Els Torreele, Dr. Joanne Liu, Michel Kazatchkine

The multiple overlapping discussions underway on medical countermeasures (MCMs) — vaccines, medicines, tests, and other health technologies to prevent, detect, and control disease outbreaks — must do more than tinker in the margins of the status quo. Learning hard lessons from previous experiences that failed to achieve timely and equitable access to such health technologies in large parts of the world, we must raise the ambition and design a truly transformative MCMs platform for research and development, manufacturing, and access centered on equity from start to finish.

The African region of the World Health Organization (WHO) has condemned the weakening of equity clauses in latest draft of the pandemic accord and called for this week’s negotiations to focus on principles and key areas of concern rather than the detailed text.

The 47 WHO Africa group countries made their submission at the resumption of the Intergovernmental Negotiation Body (INB) meeting in Geneva on Monday. 

“The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table,” said Ethiopia on behalf of Africa.

“However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realisation of equity.”

Access by affected countries to Ebola treatments is at a “standstill”, more than two years since their approval and five outbreaks of Ebola virus disease (EVD) later.

This was exposed by MSF Access Campaign in its recently launched report titled “Ensuring Access to New Treatments for Ebola Virus Disease”.

Sangeeta Shashikant (London) – Access by affected countries to Ebola treatments is at a “standstill”, more than two years since their approval and five outbreaks of Ebola virus disease (EVD) later.

This was exposed by MSF Access Campaign in its recently launched report titled “Ensuring Access to New Treatments for Ebola Virus Disease”.

Negotiations on a pandemic instrument will resume on 12 to 16 June at the World Health Organization’s headquarters in Geneva.

However, the Bureau of the Intergovernmental Negotiating Body (INB) has proposed a work programme for the resumed session of the 5th meeting of the INB that invites relevant ideas and concepts on a text prepared by the Bureau, instead of textual proposals from Member States.

Throughout the coronavirus disease 2019 (COVID-19) pandemic, inequities in access to COVID-19 vaccines, diagnostics and therapeutics have been vast and persistent. By the end of 2022, only 26% of people in low income countries had received a COVID-19 vaccine dose.¹ Less than one in 50 of the three billion diagnostic tests administered globally by March 2022 were performed in low income countries.² Further, low and middle income countries have had very little access to therapeutics, particularly antivirals such as nirmatrelvir–ritonavir (Paxlovid, Pfizer) and molnupiravir (Lagevrio, Merck Sharpe & Dohme).²

Throughout the coronavirus disease 2019 (COVID-19) pandemic, inequities in access to COVID-19 vaccines, diagnostics and therapeutics have been vast and persistent. By the end of 2022, only 26% of people in low income countries had received a COVID-19 vaccine dose.¹ Less than one in 50 of the three billion diagnostic tests administered globally by March 2022 were performed in low income countries.² Further, low and middle income countries have had very little access to therapeutics, particularly antivirals such as nirmatrelvir–ritonavir (Paxlovid, Pfizer) and molnupiravir (Lagevrio, Merck Sharpe & Dohme).²

Unless action is taken quickly, the gap in access to antivirals between high and low income countries seems set to repeat the inequities in distributing COVID-19 vaccines. 

The Zero draft on the Political Declaration on Pandemic Prevention, Preparedness and Response, for the United Nations General Assembly High-level Meeting in September 2023 reflects many of the themes being discussed in the context of the pandemic accord and the amendments to the IHR, including financing of research and development, sustainability of supply chains, referring to the importance of local manufacturing, among other key areas.

The 14-page document is now being considered by countries and they have until next week to provide comments. A final text is expected to be ready by July 26^th after at least two rounds of revision according to a preliminary plan. The declaration is scheduled to be adopted by September 20^th at the High-Level Meeting in New York.

This story presents key excerpts from the draft, with opinions from experts who seem divided on the approach to governance and accountability issues stemming from this political declaration.

Member states have been given nine days to comment on the ‘Zero draft of the Political Declaration on Pandemic Preparedness and Response, due to be adopted at the United Nations (UN) High-Level Meeting (HLM) on 20 September – with insiders describing the draft as “underwhelming”.

The HLM is essential for boosting waning political commitment to pandemic preparedness and response amid a myriad of urgent post-COVID recovery issues vying for politicians’ attention and financing.

The 14-page “zero-draft”, sent to member states on Monday with a comments deadline of 14 June, is deferential to the two ongoing negotiations on the pandemic accord and International Health Regulations (IHR)  amendments being conducted by the World Health Organization (WHO). These will only conclude in May 2024.

In today’s edition we bring you a guest essay from a group of human rights scholars, keen on shaping the discussions towards a new Pandemic Accord in a way that reflects such considerations in the governance of pandemics. In this piece, they pick apart current provisions and suggest priorities for the on-going negotiations.

The authors say, “Framing the substance of the Pandemic Treaty, human rights must be central to global health obligations, as the right to health provides a central normative foundation in preparing for and responding to pandemics.”

We hope you enjoy reading this timely and important commentary on a somewhat neglected area in the on-going negotiations of global health law reforms.