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Despite much lost sleep for members of the World Health Organization’s (WHO) intergovernmental negotiating body (INB) this week, it is impossible for consensus on a pandemic agreement to be reached by the end of Friday (10 May), the last day of this final round of negotiations.

Various negotiators Health Policy Watch that they did not see how the deadline could be met, especially as on Thursday co-chair Precious Matsoso ruled out extending talks to the weekend, saying that member states needed to travel back to their countries.

The agreement was supposed to be presented to the World Health Assembly (WHA)  which starts on 27 May, for ratification. But now that this will not happen, sources close to the process say that two possible scenarios are being discussed.

The negotiations for the WHO Pandemic Agreement have brought attention to issues of racism and colonialism in global health. Although the agreement aims to promote global solidarity, it fails to address these deeply embedded problems. This Viewpoint argues that not including the principle of subsidiarity into Article 4 of the agreement as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity, as a structural principle, empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. By integrating subsidiarity, the agreement could have ensured contextually appropriate responses, empowered local communities, and achieved justice in global health. This paper discusses the elements of subsidiarity—namely, agency and non-abandonment—and highlights the need to strike a balance between them. It also maps the principle of subsidiarity within the Pandemic Agreement, emphasising the importance of creating a practical framework for its implementation.

The world is neither on track to meet the Sustainable Development Goals (SDGs) nor is it leveraging emerging opportunities to effectively address global concerns such as extreme hunger, poverty, conflict, and climate change. Global concerns have outpaced existing structures for international cooperation and coping.

To forge a global perspective, the United Nations Office in Nairobi is currently hosting the 2024 United Nations Civil Society Conference under the theme Shaping a Future of Global and Sustainable Progress. Bringing together more than 2,000 participants from civil society organizations, academic institutions, think tanks, member states, private sector companies, UN entities, change-makers, and other relevant stakeholders from across the globe.

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The negotiations on the Pandemic Agreement took a decisive turn this week, when at least two African countries became a part of a wider cross-regional group lending their support for a proposal that also reportedly has the backing of the EU and the U.S., in the context of the critical provision on Pathogen Access and Benefit Sharing, according to multiple sources.

Some of these countries are now being referred as the Group of Friends, who presented their proposal at a drafting group session this week, at the Intergovernmental Negotiating Body meeting underway in Geneva.

Countries discussed a revised proposal from the INB Bureau that builds on the informal proposal brought by the new group and on earlier feedback from member states. The drafting group is considering Article 12 on PABS, where countries are negotiating text in a plenary format in late evening sessions. Sources told us that what is now on the table is only a couple of paragraphs that capture, principles, components and proposed modalities for such a mechanism.

In this story we discuss the prevailing political dynamics, and the substantives elements of the PABS discussion.

The draft text of the World Health Organization pandemic accord reaffirms countries’ rights to use to the full the flexibilities contained in the World Trade Organization TRIPS Agreement and the Doha Declaration on TRIPS and Public Health. However, in reality, countries that do use TRIPS flexibilities encounter complaints and pressure from the European Union and other countries (such as the United States) not to use them to their full extent.

It is, therefore, no surprise that countries are seeking additional assurances in the pandemic accord, which is in its final days of negotiations before it is meant to go to the World Health Assembly. In March, a group of developing countries proposed the following wording:

4bis. The Parties shall not challenge, or otherwise exercise any direct or indirect pressure on the Parties that undermine the right of WTO Members to use TRIPS flexibilities at any multilateral, regional, bilateral, judicial or diplomatic forum. 

The governance of intellectual property in health emergencies caused much grief during the pandemic of COVID-19, when countries struggled to agree on the trade response in swiftly addressing the access to medical products. The pandemic petered out, even as countries, as members of the World Trade Organization, ultimately failed in articulating such a response. Since then, the discussion has moved to the WHO, as countries are working to put in place legal mechanisms around Pandemic Prevention Preparedness and Response.

As the UN’s only technical agency, and as the nucleus of global health policy-making, WHO has been seen as an important venue for safeguarding health from commercial interests.

YJ: We are together this afternoon to discuss an issue that both of us are very interested in, which is the quality of health care services especially in public health services. We are limiting our discussion to the Indian scenario.  So, if you permit, may I start shooting off questions that I would want you to answer as well as you know.

TS:  Yes, we should focus on the problems and challenges that public providers and health care managers encounter when they work at improving quality of care as well as some of the policy challenges in this area.

YJ: Let me start with a very generic question.  When we talk about quality of healthcare, what is it that you think of?

TS: In a broader sense, quality refers to specific attributes of a process that ensures that user-needs are met.  In the context of health policy, we understand universal access to healthcare services as universal access to quality health services. In other words, the right to health care is a right to quality healthcare. In this context the specific attributes would be:

The WHO is announcing the publication of six country case studies that explore the ecosystem for local production of pharmaceuticals, vaccines, and biologicals in low- and middle-income countries (LMICs). This comprehensive research underscores WHO's ongoing commitment to supporting member states in strengthening local production to improve access to essential medical products.

The six countries included in the study are Bangladesh, Kenya, Nigeria, Pakistan, Senegal, and Tunisia. The case studies were conducted by the Local Production and Assistance (LPA) Unit,  within the Innovation and Emerging Technologies (IET) Department, part of the Access to Medicines and Health Products Division, at WHO. The LPA Unit's mission is to support sustainable local production and technology transfer in LMICs, helping them achieve timely and equitable access to quality, safe, and effective essential medical products.

“The world is off track to reach most of the Triple Billion targets and the health-related Sustainable Development Goals,” said World Health Organization (WHO) Director General  Dr Tedros Adhanom Ghebreyesus. 

His comments were part of the WHO Results Report 2023 released on Tuesday.

The triple billion targets involve one billion more people benefitting from universal health coverage, one billion more people better protected from health emergencies, and one billion more people enjoying better health and well-being by 2025. 

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While negotiations on the Pandemic Agreement  are close to the finish line, the world is already witnessing the next emergency in the making:  Highly Pathogenic Avian Influenza (HPAI). It is currently raging through the planet from Antarctica to the United States, infecting birds, cows and other mammals.

WHO Chief Scientist Jeremy Farrar has already labelled HPAI a “global zoonotic – animal- pandemic”.  With avian influenza having reached new forms of cross-species transmission, infecting dairy cows and even cats that drank their milk – HPAI risks turning into the next human pandemic.

It is precisely the type of global health challenge that the pandemic agreement should address, especially when considering that HPAI has a human fatality rate of 56%. The latest outbreak is a wake-up call. It shows the great urgency for effective global instruments to prevent other pathogens from evolving the extent to which HPAI already has.