Building Effective Coalitions for the Pandemic Accord: Insights from the Negotiations of the Framework Convention on Tobacco Control [Guest Essay]
Building Effective Coalitions for the Pandemic Accord: Insights from the Negotiations of the Framework Convention on Tobacco Control [Guest Essay]
Newsletter Edition #29 [Treaty Talks]
Hi,
History often holds valuable lessons.
We live in a remarkably different world, even from five years ago. Nevertheless, insights from decades ago might still be useful in shedding light to understand the current context and societal impulses not immediately obvious under the urgency that dictates our present.
In today’s edition, we bring you a guest essay on the lessons from the negotiations on the Framework Convention on Tobacco Control that could offer clues on tackling and understanding the beast we are confronted with today - the negotiations towards a Pandemic Accord. As a range of stakeholders from overworked diplomats, to resigned activists try to keep up the momentum in these crucial and important negotiations, we hope you find this contribution useful.
Leah Shipton, who works at the intersection of public health and political science, has authored this essay, distilling the past into an insightful analysis relevant for current global health negotiations, while also noting how the nature of the beast has changed over the years.
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Watch out for our reported edition in the coming days.
Until later!
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
I. GUEST ESSAY
Building Effective Coalitions for the Pandemic Accord: Insights from the Negotiations of the Framework Convention on Tobacco Control
By Leah Shipton
Though different, and separated by decades in time, the current negotiations towards a Pandemic Accord can use lessons from the negotiations of the Framework Convention on Tobacco Control (FCTC)
The FCTC negotiations show that coalitions can be effective at strengthening treaty obligations when members have diverse sources of authority, which they use in collaboration to advance a shared vision for the treaty based on credible evidence and moral claims that they agree on.
Between 2000-2003, in an effort to tackle the globalization of the tobacco epidemic, Member States of the World Health Organization (WHO) negotiated the FCTC. Since coming into force in 2005, the FCTC has facilitated implementation of tobacco control measures and strengthened national policy and legislative frameworks for tobacco control.
Those in favor of negotiating a strong FCTC had an uphill battle from the start. Powerful actors like the tobacco industry and several states (China, Germany, Japan, Russia, and the United States) did not support the convention, and the WHO and health sector delegates to the negotiations were inexperienced with treaty-making.
Despite these less-than-ideal conditions, the FCTC emerged from negotiations with an unexpectedly strong and detailed set of obligations – certainly more than the “general system of governance” initially intended. What explains this unlikely outcome? And what lessons does it offer for other treaty negotiations, especially the pandemic accord?
Authority Dynamics in the FCTC Negotiations
Based on firsthand accounts and scholarship of the FCTC negotiations, this analysis shows that the distribution and uses of authority[1] by different stakeholders during the negotiations help explain the treaty’s unexpected strength.
Specifically, a diverse coalition of pro-tobacco control actors collectively held the most institutional, expert, and principled authority during the FCTC negotiations. They used their authorities in unison to strengthen its obligations. They were able to do so because they agreed on an overarching vision for the treaty, on the evidence and moral claims justifying it.
Their vision was that the treaty was necessary to address the tobacco epidemic and the tobacco industry’s role in it. They drew on evidence of the cause-and-effect relationship between tobacco use and poor health and documentation of the industry’s harmful conduct. They mobilized around moral claims that tobacco control was a public health issue and the tobacco industry was problematic. United in these areas, members of the pro-tobacco control coalition used and coordinated their respective authorities together to strengthen FCTC provisions and overcome the dreaded ‘lowest common denominator’ treaty.
Institutional Authority during the FCTC Negotiations
The WHO Secretariat and Member States had default institutional authority during the negotiations and were largely pro-tobacco control. This included the WHO leadership, especially Director-General (DG) Gro Harlem Brundtland, who saw the FCTC as a legacy item for her tenure. These actors used their institutional authority to minimize tobacco industry presence and anti-tobacco control state’s influence in the negotiations and to amplify the principled and expert authority of pro-tobacco control actors who did not have default access to the negotiations.
For instance, DG Brundtland rallied for strong provisions and advocated for the creation of the UN Task Force for Tobacco Control comprised of experts who intervened to correct damaging ‘myths’ about tobacco control measures circulated by anti-tobacco control actors.
Many states pushed for NGO participation in the negotiations while blocking entry for the tobacco industry, and sent only health sector delegates who were resolute about strict treaty obligations.
Finally, the WHO’s region-based negotiating structure made it harder for anti-tobacco control states to influence regional proposals because they were minorities in their regional groupings. Moreover, its inefficiency left little time to negotiate significant topics, potentially sparing them of prolonged scrutiny from anti-tobacco control actors.
For their part, the smaller coalition of anti-tobacco control states used their institutional authority to dilute the FCTC provisions. This included sending finance, agriculture, and trade ministry, and even tobacco company representatives to serve on their delegations.
Expert Authority during the FCTC Negotiations
Turning to expert authority: there were three general areas of expertise relevant to the FCTC negotiations: biomedical (causes and treatment of tobacco-related diseases), policy (tobacco control measures), and legal (international lawmaking).
The first two were held firmly by pro-tobacco control actors. The third was mixed. Here, the coordinated use of expert authority by pro-tobacco control actors gave them an edge. In addition to the presence of the myth-busting UN Taskforce, a coalition of 500 civil society organizations from the Global North and South with expertise in these three areas were granted access to the negotiations at the insistence of some Member States.
Drawing on their expertise, these organizations gave educational seminars, written recommendations for FCTC provisions, technical briefings, monitored industry activities and proceedings, and consulted with state delegations. Their expertise was especially influential for the roughly 34-39% of state delegations during the six formal negotiating sessions that did not have legal counsel or diplomats experienced with treatymaking on their delegations (see ‘List of Participants’ documents). In this way, the combined use of institutional and expert authority by pro-tobacco control actors counteracted the limited treaty-making experience of state delegations.
Principled Authority during the FCTC Negotiations
Principled authority was indisputably held by pro-tobacco control actors, especially NGOs. They used their authority to name and shame any actor seen as interfering with the negotiations, and successfully framed tobacco control as a global (not Western) public health (not trade or economic) issue. Following the leak of documents detailing the tobacco industry’s decades of nefarious conduct, anti-tobacco control actors had little principled authority to stand on in defense of an unquestionably harmful product.
Tobacco companies attempted to build some principled authority by using a coalition of tobacco farmers as a ‘front’ group to stop negotiations and by launching unsuccessful corporate social responsibility campaigns.
Insights for the Pandemic Accord Negotiations
This brief analysis suggests two insights for stakeholders keen to see a strong treaty emerge from negotiations in general – whether the pandemic accord, a potential alcohol control treaty, or the ongoing plastic treaty negotiations (which, given the health consequences of plastic, should have more attention in global health than it is getting).
First, establishing relationships and consensus among a diverse coalition of actors with multiple sources of authority is an important preparation step ahead of formal negotiations. This coalition should agree on the overarching vision for the treaty and the evidence base and moral beliefs justifying it. Second, stakeholders should identify and map out the authorities held by each member in the coalition and strategize how to coordinate their authorities for maximum impact. The aim here is to ensure that each coalition member is using their authority to move the treaty negotiations in the same direction based on shared vision, evidence, and moral beliefs.
While analyzing the pandemic accord negotiations after they conclude will no-doubt offer more robust insights, a ‘view from now’ struggles to find these conditions in the negotiations.
Vision
To begin, there does not seem to be a shared vision underpinning and encompassing the entire scope of the pandemic accord. There have been mixed views on treaty necessity from the start. Many countries were and remain hesitant given that managing the ongoing Covid-19 pandemic was already demanding their full attention, and because there is limited evidence that a new instrument is the solution to what is often seen as a problem of waning political commitment.
The ‘Group on Equity,’ which introduced itself during the fifth Intergovernmental Negotiating Body (INB) on Monday of this week, may indicate an emerging country coalition envisioning the treaty as tool for placing clear access obligations on the development and production of pandemic-related medical technologies. Even then, this vision applies only to specific articles of the accord.
There is also no shared vision that reigning in the pharmaceutical industry is a core purpose of the treaty (more on this later). Thus, unlike during the FCTC negotiations, Member States and the WHO are not using their institutional authority to block industry as extensively from formal participation in the pandemic accord negotiations.
Institutional access to the negotiations (except the drafting sessions) has been extended to a variety of non-state actors in official relations with the WHO (a mix of NGOs, philanthropic foundations, intergovernmental organizations, and industry associations), and those classified in ‘Annex D’ (mostly regional or international intergovernmental organizations) or ‘Annex E’ (which has the least access and appears to be largely a mix of universities, research groups, civil society groups, and some philanthropic organizations).
On request (from whom, it is not clear), the INB Bureau also extended institutional access to a select group of experts from public and private sectors for four ‘informal, focused consultations.’
Evidence
Stakeholders involved in the pandemic accord also do not appear to have the same high-level, indisputable, agreed-on evidence claim to leverage during the negotiations.
The pandemic accord’s enormous scope makes it challenging to even identify what that overarching evidence base would be – beyond the obvious observation that existing approaches to pandemic prevention, preparedness, and response are insufficient. While there seems to be agreement on this latter point, there is disagreement on the cause of that dysfunction.
The remaining evidence is about the substantive elements of the treaty (e.g., One Health, pathogen access and benefits sharing, intellectual property). Accordingly, expert authority is distributed among actors from various sectors with expertise on these elements.
This type of evidence is challenging to unify around because it does not apply to the entire treaty and is often less definitive.
An example from the FCTC negotiations may be illustrative here. At the time, the impact of tobacco advertising bans on tobacco consumption was still being debated; some studies found (comprehensive) bans effective and others did not.[2] Despite this, Article 13 of the FCTC contains relatively strong and detailed provisions on banning tobacco advertising.
The intuition here is that even though the evidence for specific tobacco control measures was mixed (as is often the case in the complex study of health policy), the rock-solid evidence for the cause-and-effect relationship between tobacco use and poor health served as an irrefutable indication that something had to be done. Pro-tobacco control actors could lean on this (and the available evidence that bans were effective) to advocate for strong, detailed provisions on this issue.
Moral Claims
Moral claims circulating during pandemic accord negotiations include asserting medicines as a global public good and framing access to medicines as a public health rather than as a trade issue.
While the stated commitments to equity are perhaps unanimous, the ideas about how equity should be translated into the substantive elements of the pandemic accord are varied and contradicting. This makes equity a confusing principle to mobilize around, considering that actors publicly attach themselves to it on the basis of their own definition.
Principled authority during the pandemic accord negotiations is reasonably similar to that of the FCTC negotiations – held by civil society and Global South countries that have suffered access barriers for medical technologies during the Covid-19 pandemic. However, there does not appear to be a civil society coalition comparable in size, cohesion, organization, presence, and tactics, to the Framework Convention Alliance active during the FCTC negotiations.
Criticism of the moral character of the pharmaceutical industry and efforts to exclude it from negotiations are less prominent as compared to the loud, unabashed disapproval that the global health community collectively held toward the tobacco industry and channeled into tactics to shame any actor seen to be on industry’s side. Shaming and shunning the tobacco industry was arguably easier given that implementing tobacco control measures did not rely as heavily on industry’s cooperation. And even then, pro-tobacco control actors faced the reality that some issues, such as regulating the tobacco supply chain, could not be done without involving industry.
This reality is unavoidable for the pandemic accord given the reliance on industry for developing and producing medical technologies. Of course, segments of civil society and some Member States are outright in their concerns with the pharmaceutical industry’s participation in the negotiations. Nevertheless, whether for practical or normative reasons, the point stands that the united front (involving a large portion of Member States, civil society, and WHO Secretariat) against industry that was the centerpiece of the FCTC negotiations is muted during the pandemic accord negotiations.
Pooling Authority Helps Overcome the Odds
Overall, as compared to the FCTC negotiations, the distribution and uses of authority during the pandemic accord negotiations are less concentrated and coordinated, respectively. Are these splintered authority dynamics contributing to the conditions for a ‘lowest common denominator’ accord? While only time will tell, the latest draft of the pandemic accord indicates such a direction.
It goes without saying that there are important differences between the FCTC and pandemic accord negotiations. These include issue area, products, scope, and degree of reliance on industry cooperation. The pandemic accord negotiations are also taking place in the context of a far more fragmented global health governance architecture, with COVID-19 continuing to rage in some parts of the world, and more tumultuous political, economic, and environmental conditions that have hollowed out the capacity and resources of public sector and civil society actors.
The lesson of this analysis, however, is not to recreate the exact conditions of the FCTC negotiations. The aim instead is to show that pooling authority matters for overcoming the odds. And although the pandemic accord negotiations may be too far along for major course corrections, there are lessons here for coalition building and action during treaty negotiations.
Get clear on the unifying vision, evidence, and moral claims. Map out and diversify the authorities among coalition members (without betraying that unity – it is a tough line to walk). And use each member's authority synergistically to strengthen the treaty based on those areas of agreement.
[1] In their 2010 book, Who Governs the Globe?, Avant and colleagues define authority as “the ability of an actor to induce deference” (p.9) from others.
[2] Note that these cited studies are illustrative of a larger debate. While this essay cannot comment on the specific policy evidence stakeholders drew on during negotiations of Article 13 in the FCTC, it may be the case that actors involved in the negotiations emphasized certain types of policy evidence more than others. Potentially illustrative of this, the study by Saffer & Chaloupka (2000) is more widely cited and the language of ‘comprehensive ban,’ which their article argues for, is used in the FCTC text.
About the author: Leah Shipton has a background in public health and is currently a PhD Candidate in the Department of Political Science, University of British Columbia, where she studies multi-stakeholder partnerships and non-state actors in global health governance.
Write to Leah: lshipton@student.ubc.ca
See our earlier piece from March 2023: Civil Society in Pandemic Accord Negotiations – Lessons from The Framework Convention On Tobacco Control
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