Reflecting on the up-to-date global experience of the coronavirus disease 2019 (COVID-19) pandemic is of crucial importance in order to draw conclusions needed for the design of policies aiming the prevention of new epidemics and the effective protection, preparedness and response of any new emerging. Ongoing environmental destruction, excess mortality by COVID-19 and non-COVID diseases reflecting the dismantlement and commodification of both public health services and healthcare services, deep economic crisis, increasing and deepening social inequalities are the main characteristics raised by the pandemic. The causes of the causes of all these are the dominant rules of the capitalistic system, driven mainly by the unlimited greed for profit on the expenses of the majority of the society. The effectiveness of any proposed correction of this system is discussed and the need for another society responding to the needs of the population is argued.
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The COVID-19 pandemic has highlighted that as a global community, we need to strengthen systems to prevent, prepare for and respond to public health emergencies. Member States and the World Health Organization have agreed that in order to achieve this we must amend the International Health Regulations and negotiate a new international legal agreement on pandemics, the ‘Pandemic Accord’.
The success of the amended IHR and the pandemic accord will depend not only on the text of these instruments themselves but on the capacity of governments to work with their people to implement its obligations, in times of both calm and crisis. The inclusion of civil society perspectives in the drafting, negotiation, implementation, monitoring, and compliance of these instruments is the only way to ensure that the content of the instruments is centred on the needs of the poorest and most vulnerable communities and groups. And it is the only way to build trust and mobilise support for the implementation of amended frameworks and treaties.
We are writing on behalf of some public interest stakeholders invited to participate in the Pandemic Treaty Negotiations and other civil society organizations sharing their concerns and expectations about the “Conceptual Zero Draft of the proposed WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response” (the Pandemic Treaty) which is expected to be published by the INB Bureau in mid-November and form the basis of formal negotiations after the next INB session on December 5-7, 2022.
A global mechanism to share intellectual property (IP), know-how and technology for the production of essential medical innovations can play a key role in responding equitably and effectively to a pandemic. It can help maximize global production of and access to these products and increase self-sufficiency of low- and middle-income countries.
For this reason, the World Health Organization (WHO) set up the Covid-19 Technology Access Pool (C-TAP) at the beginning of the Covid-19 pandemic. Unfortunately, C-TAP has not reached its full potential as only a limited amount of research institutes and not a single private pharmaceutical company have shared their knowledge around Covid-19 technologies through this mechanism.
A year ago, the second Special Session of the World Health Assembly (WHASS) unanimously agreed to start a diplomatic process for a new binding instrument aimed at ensuring the international community is better prepared for the next health emergencies. The establishment of an Intergovernmental Negotiating Body (INB) at the WHO paved the terrain for a proper negotiation, which has started to unfold. The INB will be releasing the “conceptual zero draft” of the treaty text in early December 2022.
Whatever the outcome of the process, one of the inescapable pillars of any new international agreement is addressing how to finance pandemic prevention, preparedness and response (PPR). This is the reason why the Geneva Global Health Hub (G2H2) decided to embark into the contentious relationship between the international financial architecture and current health financing models, towards highlighting the pitfalls the world must avoid to ensure a healthier post-COVID world.
Universal health coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship. It is key to achieving the World Bank Group’s (WBG) twin goals of ending extreme poverty and increasing equity and shared prosperity, and as such it is the driving force behind all of the WBG’s health and nutrition investments.
UHC allows countries to make the most of their strongest asset: human capital. Supporting health represents a foundational investment in human capital and in economic growth—without good health, children are unable to go to school and adults are unable to go to work. It is one of the global economy’s largest sectors and provides 50 million jobs, with the majority held by women.
COVID-19 has highlighted the urgent need for collective action to augment the existing global health security financing system and to mobilize additional resources to build health systems and strengthen capacity for pandemic prevention, preparedness, and response (PPR). Avoiding future pandemics requires investing substantially more in PPR; these investments will help avert the much larger costs that the world would incur if we were to be caught unprepared for the next global health crisis. Countries must step up domestic investments in the core capacities needed to strengthen health preparedness and prevent and contain future pandemics, in accordance with the International Health Regulations. This must be complemented by enhanced external financing, particularly for developing countries.
1. COVID-19 has highlighted an urgent need for global collective action to substantially scale up investments and support to strengthen the capacity of developing countries to prevent, prepare for, and respond to the next pandemic. The pandemic has demonstrated that investing in prevention, preparedness, and response (PPR) is a global public good that benefits every nation—regardless of income or wealth. This requires investments at the country, regional, and global levels. It is the collective responsibility of the international community to ensure that the necessary investments in PPR are made, on an urgent and sustained basis, so that low-income and lower-income countries and regions are better prepared to face the next pandemic.
Key messages:
1. A global Pandemic Preparedness and Response (PPR) architecture consists of five sub-systems that are interlinked and must be deployed at national, regional and global level:
- Surveillance, collaborative intelligence, and early warning
- Prioritized research and equitable access to countermeasures and essential supplies
- Public health and social measures and engaged, resilient communities
- Lifesaving, safe and scalable health interventions, and resilient health systems
- PPR strategy, coordination, and emergency operations
2. The case for investing in PPR is clear. The frequency and impact of pandemic-prone pathogens are increasing. Modest investments in PPR capacities can prevent and contain disease outbreaks, thereby drastically reducing the cost of response and the broader economic and social impacts of a pandemic or large-scale outbreak. Such investments will also help address longstanding challenges that are key drivers of mortality today, including HIV/AIDS, tuberculosis, malaria and anti-microbial resistance.
The Member States of the WHO are about to commence the most significant negotiations that could set the paradigm for international legal obligations for preparedness and response to future pandemics. These negotiations focus on amendments to the International Health Regulations (2005) (IHR) as well as the negotiation of a treaty or other legal instrument under the WHO Constitution that will complement the IHR to ensure better preparedness and response to future pandemics, drawing from the experiences of the ongoing COVID-19 pandemic. The most critical consideration for developing countries in these negotiations will be mainstreaming equity concerns, currently missing from the existing rules and mechanisms available globally to enable developing countries to effectively prevent and respond to a pandemic outbreak. In this context, this brief suggests some elements of equity that should be pursued through specific textual proposals by developing countries through amendments to the IHR.