[GUEST ESSAY] One Health: A Bargaining Chip in the Pandemic Agreement Negotiations?
Newsletter Edition #88 [Treaty Talks]
Hi,
In the final stretch of the negotiations towards a new Pandemic Agreement anchored at World Health Organization, countries are discussing whether they should commit to stronger obligations on One Health - an area that is also governed by other international normative agencies.
While most WHO member states acknowledge the importance of One Health considerations in the context of health emergencies, many developing countries have concerns on the implications of committing to new provisions on account of capacities and resources. Questions have also been raised on the surveillance outcomes from such obligations.
The possibility of a One Health instrument flowing out of the INB process is on the table - as proposed by the Bureau of the Intergovernmental Negotiating Body in April 2024. Whether such an outcome will become real will depend on a number of factors including negotiations on other articles in the Pandemic Agreement related to financing, and to the system on Pathogen Access and Benefit Sharing.
In this edition, we bring you a timely essay from Nina Jamal, an indefatigable activist affiliated with FOUR PAWS, an animal welfare organization. She has been working with countries in the context of these negotiations.
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I. GUEST ESSAY
[GUEST ESSAY] One Health: A Bargaining Chip in the Pandemic Agreement Negotiations?
By Nina Jamal
Jamal is the Head of Pandemics and Campaign Strategies at FOUR PAWS - a global animal welfare organisation.
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.
WHO currently assesses the public health risk to the general population posed by HPAI as being low. However, by the time the WHO declares HPAI as a Public Health Emergency of International Concern (PHEIC) it might be too late. The question is, how do we make sure the pandemic agreement can prevent other pathogens from evolving into outbreaks, epidemics or pandemics before communities and animals suffer?
It is pivotal to get to the roots of the problem. We know, that most emerging infectious diseases are zoonotic, yet it would be completely wrong to blame it on animals.
The drivers are clearly human-caused: factory farming, fur farming and wildlife trade, private keeping of wild animals, and habitat destruction have long been identified as major culprits for the spillover of diseases from animals to humans. When animals and nature suffer, humans suffer.
Given that a staggering 75% of emerging infectious diseases in humans have animal origin, it is obvious that the One Health approach, which recognises the interconnectedness between human, animal, and environmental health, needs to be at the very foundation of the Pandemic Agreement.
Instead of deeply anchoring One Health in this instrument, what we have been seeing at negotiation tables in Geneva is One Health being used as a bargaining chip, even running danger of being carved out of the Pandemic Agreement altogether.
Bargaining away One Health
During the negotiations One Health has been pitted against other important provisions on Pathogen Access and Benefit Sharing, tying the level of ambition and fate of collective action on “prevention and preparedness” to that of “response”.
This is a questionable tactic because the objective should be to develop meaningful, workable provisions for all stages of prevention, preparedness and response. Preventing outbreaks before communities and animals suffer saves more lives and relieves strained health systems. By bargaining away One Health, the Pandemic Agreement runs the danger of collapsing like a house built on weak foundations.
Behind closed doors, member states resorting to this tactic admit their support for One Health, some of them even being One Health champions. Paradoxically, among the vocal opponents are member states that have already set up strong interministerial coordination, data interoperability on national level and One Health coordination at the highest levels in their presidential cabinets.
Their contention is mainly due to a lack of resources, means of implementation, and the wish to progressively build capacities to be able to fulfil One Health obligations in a manner that is not too prescriptive and fits their contexts.
Buying time at the cost of One Health
The effectiveness of the Pandemic Agreement is weakened because One Health is not only used as a bargaining chip, but also runs the danger of being sacrificed altogether.
The INB Bureau leading the negotiations, proposed to define One Health in a separate instrument because essential details remain to be clarified for it to be operationalised. This came as a surprise to member states. The Bureau explained that the instrument can be anything member states chose it to be.
More important than the form is certainly what this instrument will strive to achieve and how its objectives will be enabled. To be successful, the contents must include a clear common pathway on how to effectively prevent disease outbreaks at their source before communities and animals suffer. The instrument must invest in strengthening One Health capacities so that implementation is enabled.
Yet the proposal of this instrument raises new concerns of possibly ruining One Health’s chances in other fora. There are two substantive questions tied to the development of a One Health instrument under the WHO, which need to be addressed:
Will it be under the remit of the World Health Assembly and negotiated by health ministries or under the Pandemic Agreement’s Conference of the Parties and involving relevant national and international institutions responsible for One Health implementation?
Will it be only about One Health in Pandemic Preparedness, Prevention and Response or One Health in general?
One Health is a transdisciplinary approach to tackle complex health challenges, going beyond pandemic prevention, preparedness and response. Every health challenge that is tied to several sectors, such as plastics, chemicals, food safety, antimicrobial resistance, would benefit from developing strategies within a One Health approach.
If a One Health protocol is developed under the auspices of the WHO, some member states are concerned that it will reduce chances that a broader One Health agreement can be developed in other fora or that when One Health is discussed in other international processes that it will be deprioritised, as parties might want to wait for the conclusion of discussions on a One Health instrument within the WHO first.
To mitigate these concerns, it is crucial that the One Health instrument is anchored within the Pandemic Agreement, focused solely on pandemic prevention, preparedness and response. The development of such an instrument must commence immediately after the 77th World Health Assembly, in May 2024, until the first Conference of the Parties (COP) rather than after the COP first meets. The instrument’s development must involve ministries working not only on human health but also animal and environmental health as well as international institutions tasked to advance One Health globally. Given the multitude of challenges that can be addressed via the One Health approach, the instrument should not curtail future chances of developing further One Health instruments.
One Health as the foundation of the Pandemic Agreement
As negotiations are expected to come to an end, the next days and hours will be decisive for how countries will prevent, prepare and respond to pandemics in the future.
Looking at the lessons learned from COVID-19 and the current HPAI outbreak, it is obvious that global efforts need to begin at the source. Prevention at source takes place by tackling the activities that enable pathogens to emerge in animals and spill over between species and then to humans, before animals and humans get infected.
Efforts should never only focus on the stage after an outbreak and be limited to “symptom control”. When strategies tackle the factors that drive emergence, re-emergence, spillover and spillback of pathogens, we have the highest chances that communities' health and that of their animals will be protected.
Success is only possible if WHO member states who require support can access financial and technical resources, receive capacity building and can call upon specialised intergovernmental organisations like WOAH, UNEP and the FAO, if they need their assistance.
And most important of all, One Health must be reinforced in the final distance of these negotiations. One Health is the cement binding important elements of this pandemic prevention, preparedness and response mechanism.
To make the Pandemic Agreement meaningful and effective, its construction must include One Health as an important pillar, or it will fall apart in the long run. Omitting One Health as a bargain or at the cost of time will come at a high cost, with animals and humans paying the price with their health.
The author is currently advising countries on the negotiations of the Pandemic Treaty, providing expert advice. Get in touch with Jamal here: Nina.Jamal@vier-pfoten.org
II. PODCAST CORNER
Climate change’s impact on health
Most climate change predictions show an upward trend in temperature for at least the next nine decades. Rural communities whose health and livelihoods depend on the environment are more vulnerable to climate change. In recent years, persistent droughts have made Maasai communities in northern Tanzania vulnerable to sleeping sickness, a disease spread by the tsetse fly. Paul Gwakisa of Sokoine University has dedicated his research to helping the Maasai people better understand and prevent outbreaks of sleeping sickness in their communities. Pierre Quiblier of the UN Environment Programme also speaks about global efforts to better tackle climate change through an integrated “One Health” approach that brings together sectors such as agriculture, health and the environment.
Garry Aslanyan is the host and executive producer of the Global Health Matters podcast. You can contact him at: aslanyang@who.int
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