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The initial assumptions on the apparently narrow and technical nature of the IHR are now being tested, with realpolitik inevitably now shaping these negotiations. As WHO member states get deeper into discussing and negotiating the proposed amendments to the IHR, it is becoming obvious that several difficult choices will need to be made in order to make this instrument better fit for purpose.

Various stakeholders including some developed countries, have shown propensity to focus on surveillance, broadly, prevention-related measures, that they feel would likely attract consensus more easily. But developing countries continue to push for fairer treatment of response related amendments to the IHR, including notably equity proposals such as access to countermeasures among others.

In August 2023, Johnson & Johnson (J&J) reduced the price of the lifesaving tuberculosis (TB) medicine, Bedaquiline, from US$272 to $130 per treatment course of six months for many low- and middle-income countries (LMICs). This price reduction was the result of a competitive tender by the Stop TB Partnership’s Global Drug Facility (GDF), an international pooled procurement mechanism for procurement of TB health products, and represents a watershed moment in the decade-long struggle for expanding access to Bedaquiline.

Though fast disappearing from public and political consciousness, COVID-19 continued to cast a long shadow in the discussions on Pandemic Prevention, Preparedness and Response at the UN High Level Meetings in New York this week where a declaration was accepted.

This clears the way, and sets the stage for deep negotiations in Geneva to take these discussions to a logical conclusion in the form of a new instrument to address pandemics and to amend the IHR.

In Geneva, diplomats met today for a resumed session of the intergovernmental negotiating body for a stocktaking session at the conclusion of informal consultations on certain provisions. A negotiating text for a pandemic accord is expected to be ready by mid-October as we reported previously.  

In this story we bring you a quick wrap of key statements from countries and other actors.  

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.  

This paper presents a political economy analysis of global inequities in access to COVID-19 vaccines, treatments, and diagnostic tests. We adapt a conceptual model used for analysing the political economy of global extraction and health to examine the politico-economic factors affecting access to COVID-19 health products and technologies in four interconnected layers: the social, political, and historical context; politics, institutions, and policies; pathways to ill-health; and health consequences. Our analysis finds that battles over access to COVID-19 products occur in a profoundly unequal playing field, and that efforts to improve access that do not shift the fundamental power imbalances are bound to fail. Inequitable access has both direct effects on health (preventable illness and death) and indirect effects through exacerbation of poverty and inequality. We highlight how the case of COVID-19 products reflects broader patterns of structural violence, in which the political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South.

New Delhi, 23 August (K M Gopakumar) – The Group of 20 health ministers have refused to endorse the establishment of an interim platform for medical counter measures (MCM platform).

The World Health Organization (WHO) and a few developed countries have been aggressively pushing in various international fora, including G20 and the UN General Assembly, to obtain endorsement for the establishment of the MCM Platform.

G20 heath minsters met on 18-19 August in Gandhinagar, India. This year’s G20 Presidency is held by India.

However, the WHO Director-General’s Tweet wrongly conveys that there is consensus on the establishment of an interim mechanism.  The Tweet states: “I welcome @g20org consensus on an inclusive interim mechanism for equitable and timely access to vaccines, tests, therapeutics and other medical countermeasures in the face of pandemics. We encourage continued dialogue among Member States to broaden support on all aspects of the mechanism”.

… The two issues of underdiagnosis and restricted access to low-cost TB drugs are inseparable, says Helen Cox, an epidemiologist at the University of Cape Town in South Africa, who specializes in TB. “Patents on drugs like bedaquiline make TB so expensive to treat,” she says, adding that many high-burden TB countries are reluctant to fund diagnostic services. “If you don’t diagnose the problem, you don’t have to pay for the treatment.” She’s hopeful that the recent J&J-GDF agreement will encourage these countries to invest into diagnosing TB. … Currently, U.S.-based corporations such as Cepheid hold a monopoly over TB DNA diagnostic tests such as GeneXpert MTB/RIF and MTB/RIF Ultra, which are priced at $9.98 per test cartridge. The Doctors without Borders/Médecins Sans Frontières Access Campaign, which advocates for affordable medical treatments, has argued that public funds largely underwrote the development of these tests.