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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.

A new “Zero+” version of a proposed World Health Organization pandemic accord being negotiated by member states has dropped previously strong language that conditioned use of public R&D funds to private sector commitments to price transparency and tech transfer of end products, among other measuress.

However, the updated draft text, obtained by Health Policy Watch, still contains ‘optional’ language linking developing countries’ sharing of pathogen information to a guaranteed supply of drugs, vaccines and other health tools that they would access a WHO distribution scheme.

While not a formal part of this week’s World Health Assembly (WHA) proceedings, the text drafted by the “Bureau” of six member states guiding the talks is being circulated this week as they prepare for another round of  negotiations over the new accord, scheduled by the Intergovernmental Negotiating Body (INB) 12-16 June.

The Zero Draft of the WHO CA+ is used as the basis for comparison using a thematic approach, with a consequent review of the relevant provisions in the Draft Bureau’s text of the WHO CA+. This comparison document includes only the following themes: objectives and scope, general principles and approaches, co-development and transfer of technology and know-how, research & development, access and benefit sharing, preparedness, readiness and resilience, one health, financing, preparedness monitoring and functional reviews, and governance (bodies, reporting, implementation, compliance, and committees).

Op-Ed by Mariana Mazzucato, professor at UCL and chair of the World Health Organization Council on the Economics of Health for All

Under its G20 presidency, India has proposed a medical countermeasure coordination platform to effectively deal with challenges of any COVID-like pandemic.

Dr Michael Ryan, Executive Director at WHO Health Emergency Programme in Geneva, who is attending the third G20 Health Working Group meeting being held here from June 4 to 6, said the future of health and pandemic preparedness is stronger with the leadership of India in this meeting.

"We are discussing the pandemic preparedness and response and how to chart a future path so that we all respond better to the next pandemic.

"India in G20's leadership is highlighting this issue and talking about how we work together on medical countermeasures, how we make better vaccines and drugs, how do we get them to people quicker, and how do we make the whole system fair so that people who really need things get them as soon as possible," Dr Ryan said, adding, "India is in a very strong position to do that."

The COVID-19 pandemic heralded unprecedented resource mobilisation and global scientific collaboration to rapidly develop effective vaccines. Regrettably, vaccine distribution has been inequitable, particularly in Africa where manufacturing capacity remains nominal. To address this, several initiatives are underway to develop and manufacture COVID-19 vaccines in Africa. Nevertheless, diminishing demand for COVID-19 vaccines, the cost competitiveness of producing goods locally, intellectual property rights issues, and complex regulatory environments among other challenges can undermine these ventures. We outline how extending COVID-19 vaccine manufacturing in Africa to include diverse products, multiple vaccine platforms, and advanced delivery systems will ensure sustainability. Possible models, including leveraging public–academic–private partnerships to enhance success of vaccine manufacturing capacity in Africa are also discussed.

In the aftermath of the World Health Organization’s (WHO) 76th World Health Assembly, the pace of WHO negotiations on: 1) a pandemic treaty and 2) amendments to the International Health Regulations (IHR) will intensify over the coming months. WHO’s informal list of intergovernmental meetings is published here: https://apps.who.int/gb/gov/en/intergovernmental-meeting_en.html.