Common but Differentiated Responsibilities: The Equity Principle Guiding Climate Change, and the Reforms for Pandemic Prevention, Preparedness & Response [Guest Essay]
Common but Differentiated Responsibilities: The Equity Principle Guiding Climate Change, and the Reforms for Pandemic Prevention, Preparedness & Response [Guest Essay]
Newsletter Edition #195 [The Files In-Depth]
Hi,
We are witnessing and living through intersecting crisis as these past weeks have shown, with record temperatures in some parts of the world, and severe flooding in other regions.
Experts say that an accelerating climate crisis will also unleash pandemics. These fast-paced consequences that we are already facing need a shift in the way we think about tackling these challenges holistically.
It is therefore perhaps an opportune time to see if some of the principles used to address climate change could be applied to deal with future health emergencies.
In today’s edition, Yassen Tcholakov, a Canadian physician who has also worked in the climate space, shares his perspectives on the application of Common but Differentiated Responsibilities for global health.
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Until next week!
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
I. GUEST ESSAY
Common but Differentiated Responsibilities: The Equity Principle Guiding Climate Change, and the Reforms for Pandemic Prevention, Preparedness & Response
by Yassen Tcholakov
Several developing countries are keen on embedding the principle of Common but Differentiated Responsibilities (CBDR), to meet equity objectives in the on-going global health reforms currently under negotiations. However, there is also resistance among both developed and a few developing countries on incorporating this principle from environmental policy into global health.
This article will strive to describe the origins and meaning of CBDR and describe how it is being currently being brought up in discussions related to pandemic reforms looking at both the INB and the WG-IHR. Parallels will be drawn between how the concept is implemented in environmental policies and how it could be implemented in global health policy with an effort to highlight the nuances and complexities involved in translating this principle from one context to another.
Origins and meaning of CBDR
The concept of CBDR originates in environmental policy negotiations with some of its precursors present already discussed the middle of the last century and was formalized during the Earth Summit in Rio in 1992 in the text of the United Nations Framework Convention on Climate Change (the treaty which would give us the Kyoto Protocol and later the Paris Agreement).
UNFCCC Article 3
“1. The Parties should protect the climate system for the benefit of present and future generations of humankind, on the basis of equity and in accordance with their common but differentiated responsibilities and respective capabilities. Accordingly, the developed country Parties should take the lead in combating climate change and the adverse effects thereof…”
CBDR is fundamentally a concept aimed at addressing equity in international relations through which richer countries take on greater obligations to address a common goal and its consequences. It acknowledges taking into account that countries have a different share of historical and current responsibility for the problem and that they are not equal in their capabilities to address it. Thus, some countries have an obligation to contribute more to resolving a problem (to whose creation they also contributed a greater amount), and some countries currently have more means of resolving the issue and should help others. Equity in this sense implies amongst other things, ensuring that countries in different circumstances are treated differently and in practical terms, this can be implemented through financing, technology transfer and technical support.
In climate negotiations, CBDR was not only embedded in the text of the UNFCCC but has been applied concretely in subsequent environmental agreements. For instance, in the Kyoto Protocol, only Annex B countries (essentially, developed countries) were given quantified emission reduction commitments. This, however, proved contentious and challenging.
Thus, the Paris Agreement shifted the perspective of CBDR from the 'guilt' of past pollution to an obligation to cease future pollution, a transition which implies that countries with a history of high emissions and those that have leveraged fossil fuels for development should proportionately contribute to the transition to a low-carbon world economy.
Having established the origins and purpose of CBDR in the context of climate change, let's now consider how this concept could apply in the realm of policies for pandemic prevention preparedness and response policies drawing comparisons to the Paris Agreement.
CBDR in the Pandemic accord vs the Paris Agreement
Concept and related examples
o Climate change
§ “Holding the increase in the global average temperature to well below 2°C above pre-industrial levels and pursuing efforts to limit the temperature increase to 1.5°C above pre-industrial levels, recognizing that this would significantly reduce the risks and impacts of climate change” - Paris Agreement (2015)
o Pandemic preparedness and response
§ “The WHO CA+ aims for a world where pandemics are effectively controlled to protect present and future generations from pandemics and their devastating consequences, and to advance the enjoyment of the highest attainable standard of health for all peoples, on the basis of equity, human rights and solidarity, to achieve universal health coverage, while recognizing the sovereign rights of countries, acknowledging the differences in levels of development among countries, respecting their national context and recognizing existing relevant international instruments. The WHO CA+ aims to achieve greater equity and effectiveness for pandemic prevention, preparedness and response through the fullest national and international cooperation.” - Zero Draft WHO CA+ (2022)
Historical responsibility
o Climate change
§ Countries which started using fossil fuel energy during the industrial revolution contributed significant amounts to the current CO2 in the atmosphere and thus bear an important historical responsibility for climate change.
o Pandemic preparedness and response
§ Developed countries, which have benefited the most from globalization, have also been the main drivers of international travel and trade, increasing the risk of pandemics spreading globally.
Modern-day responsibility
o Climate change
§ High-income countries remain among the greatest CO2 emitters per capita while emerging economies are rapidly catching up as people gain greater access to energy.
o Pandemic preparedness and response
§ Overconsumption mostly driven by high-income countries is a root cause for the encroachment on natural habitats, and the increasing proximity between humans, domestic animals and wildlife, thus increasing the risk of pathogen spillover.
Common obligations
o Climate change
§ All parties have the common obligation of transparently disclosing their emissions and working collaboratively with others to decrease emissions over time.
o Pandemic preparedness and response
§ All member states have the common responsibility of strengthening their capacity for health emergency response (as described in the International Health Regulations) and transparency when detecting potential threats.
Differentiated obligations
o Climate change
§ High-income countries are expected to lead in reducing emissions and to provide financial, technological, and capacity-building support to other parties.
§ Fossil fuel-producing countries may also have differentiated obligations.
o Pandemic preparedness and response
§ High-income countries are expected to lead in supplying emergency preparedness resources for pandemics and to provide financial support and access to technology to other member states.
§ Countries with high levels of international travel and trade or higher risk practices such as high levels of antibiotic use could also be subject to differentiated obligations.
Modern-day capabilities
o Climate change
§ High-income countries have greater financial capabilities to invest in climate action and should provide funding to other countries to support their efforts.
§ Some countries, particularly those in low-lying coastal areas, have greater vulnerability to the impacts of climate change, such as the sea-level rise and extreme weather events. They require greater support to adapt to these impacts and build resilience.
o Pandemic preparedness and response
§ High-income countries have greater financial capabilities to invest in pandemic preparedness, response and recovery and should provide funding to other countries to support their efforts.
§ Some countries have stronger surveillance and early warning systems for detecting and responding to potential pandemics, more advanced laboratory systems and greater scientific expertise, and should share technology and know-how.
§ Some countries have greater manufacturing capacity and more advanced production processes for pandemic-related products, such as vaccines, diagnostic tests, and personal protective equipment, and should help others set up such systems where needed.
With the concept of CBDR now juxtaposed in the contexts of climate change and pandemic response, it is instructive to examine how this principle has been incorporated into other global health agreements.
CBDR in other global health instruments
While at different moments in the current negotiations CBDR, has been presented as a novel concept in the international public health policy space, it is worth noting that differentiation is already present in existing global health instruments.
For instance, the Framework Convention on Tobacco Control (FCTC) recognizes the specific needs of “tobacco growers and workers [...] in developing country Parties, as well as Parties with economies in transition” (Article 4.6) and also acknowledges the specific needs of developing country Parties and Parties with economies in transition with respect to transfer of technology, technical, scientific and legal expertise (Article 22.1) and with respect to the provision of financial resources (article 26.4 and 26.5).
Similarly, the IHR also contain elements of differentiation in their approach to global health security. They recognize that the capacity to detect and respond to public health threats varies across countries and emphasizes the need for international cooperation to strengthen the public health infrastructure in countries with weaker health systems. This includes namely measures such as providing technical assistance and resources to improve disease surveillance and outbreak response capabilities.
(To be sure, some developed countries emphasize the universal application of the IHRs. But such an understanding of universal application puts greater burden on regions like Asia and Africa. For example, while developing countries already share their genetic resources and samples, they have been unable to access countermeasures adequately, even as developed countries end up accessing both the information and the resulting countermeasures.)
We have seen how CBDR has been integrated into existing global health instruments, let us now delve deeper into how this principle is shaping the negotiations towards a new pandemic accord.
CBDR in the pandemic accord
In the initial stages of the negotiations, the CBDR principle was not explicitly mentioned in the Outline of the substantive elements and the focus was on the "right of assistance" to affected states. However, the concept of recognizing a shared responsibility for pandemic health risks was rapidly introduced as early as during the second meeting of the INB in the Working draft in July 2022. The preamble acknowledged the significant differences in countries' capacities to prevent, prepare for, respond to, and recover from pandemics. The principle was further elaborated in Article 3 and Article 4, emphasizing the shared and differentiated responsibilities guided by the principles of equity and respective capabilities. Despite this odd naming “shared” instead of “common”, the principle was first presented as an already agreed upon international principle dealing with equity. However, it is important to note that even at this early stage, the geopolitical divide on the issue was obvious. Reservations by high-income countries were quickly expressed and reiterated in every subsequent discussion on the matter. Despite this, the concept has not been deeply delved into by member states and has only occasionally been engaged in by civil society.
The third INB meeting saw the further refinement of the CBDR principle in December 2022. The Conceptual zero draft emphasized the common but differentiated responsibility by all States Parties and relevant stakeholders. The principle was also incorporated into Article 4, highlighting the specific needs and special circumstances of developing countries.
The fourth INB meeting in February 2023 saw the CBDR principle being further nuanced in the Zero draft of the WHO CA+. The principle was emphasized in the preamble and was expanded in Article 4 to include the notion that states with more resources relevant to pandemics should bear a commensurate degree of differentiated responsibility. This version of the text also highlighted the need for full consideration of the specific needs and special circumstances of developing countries. However, at the same time, a leaked version of the negotiation text provided valuable insights into the positions of various member states on the CBDR principle showing that several countries wanted to remove the principle of differentiation including Australia, New Zealand, Monaco, Thailand, and the European Union and that some wanted to get rid of the paragraph dealing with CBDR in Guiding Principles’ article altogether including the US, Israel, Japan, Canada, and the United Kingdom.
At the fifth INB meeting in April and June 2023, the Bureau’s text presented three options for the CBDR principle in the "Bureau’s text of the WHO convention". The options ranged from maintaining the principle of CBDR with a focus on the provision of adequate health and social measures (Option 7.A), to a more diluted version that only acknowledged common responsibilities and different capabilities (Option 7.B), to the option of not including the principle at all (Option 7.C). Additionally, this version of the text introduced a new article dealing with “Implementation, acknowledging differences in levels of development” – which provides an operational article to implement key elements of CBDR. Nevertheless, similarly as with the other article, three options were presented for Article 17, including an option to not have this article.
CBDR in the amendments to the IHR
In the ongoing work of the Working Group on Amendments to the International Health Regulations (WG-IHR), the principle of CBDR has also emerged as a contentious subject of negotiation Malaysia, India, and Bangladesh, among others have suggested amendments incorporating CBDR in several IHR articles, including Article 3 (Principles), Article 5 (Surveillance), Article 13 (Public Health Response), and Article (44 Collaboration and Assistance). The amendments propose that developed states and the World Health Organization (WHO) should assist developing nations and strive to establish a mechanism for monitoring and ensuring the implementation of obligations (under Article 44).
Furthermore, a new paragraph related to a financial mechanism for equity in health emergency preparedness and response is proposed. The experts’ IHR Review Committee also stated that a lack of sufficient finance and funding at both international and national levels hinders the implementation of IHR obligations.
Nevertheless, in this context as well, CBDR emerges as a key point of contention with the sentiment expressed by countries in the WG-IHR negotiations are very much the same as those in the INB negotiations with a visible divide between high-income countries and the rest of the world :
“The idea of Common but Different Responsibilities in the context of International Health Regulations goes against the principle of universal application and we believe that you cannot have different response when it comes to important legal obligations that have been undertaken pursuant to IHR.” - US delegate, February 2023
CBDR could address historical inequities in global health
As the world grapples with the enormity of pandemic threats, it is crucial to negotiate a robust pandemic accord. The CBDR principle could be a significant element in these negotiations, offering a pathway to address historical inequities in global health and to construct a more resilient system capable of tackling future crises. Addressing equity is intrinsically complex yet it is one of the fundamental reasons why treaty negotiations were initiated. Furthermore, it does not just stand on its own merit but also acts as a potent driver for cooperation, incentivizing the fulfilment of obligations. The principle of CBDR carries substantial potential to guide how equity is addressed within the sphere of international relations.
As a foresight exercise, we can envision two scenarios ahead:
In the first scenario, wherein the CBDR principle is broadly accepted and implemented, we may see a more equitable and effective pandemic response. Acknowledging the differentiated capacities of nations and allocating obligations accordingly could lead to an improved and inclusive global health governance system. More developed nations shouldering greater responsibilities can contribute to closing the existing resource gaps, encouraging the development of robust health infrastructures even in traditionally resource-constrained countries. This collective enhancement would augment the overall capacity of the international community to both prevent and respond to future pandemics, helping the accord to fulfill its core objective.
However, in a second scenario, if the CBDR principle is rejected or adopted in a very diluted form, the pandemic accord may struggle to meet its objectives. An uneven distribution of responsibilities could overwhelm less capable nations during health crises, leading to an inefficient and unjust response. Failure to consider the unique needs and vulnerabilities of developing countries could perpetuate existing global health inequities, diminishing the resilience of the global health system in the face of future crises and put all populations at greater risk. This could also create greater barriers to adoption and we may end up having a pandemic accord with insufficient membership to even hope to meet its objectives.
Despite being extremes, those scenarios underscore the weight of the ongoing negotiations specifically on CBDR in shaping the future of global health governance and our ability to effectively respond to future pandemics. Striving towards equity and inclusion through the careful implementation of the CBDR principle may prove vital in realizing a pandemic accord capable of meeting the grand challenge posed by global health crises.
Yassen Tcholakov is a public health physician working in infectious disease epidemiology in an indigenous region of Canada. Yassen is also an assistant professor at McGill. He has been involved in the global health space for over a decade and also has experience in climate change negotiations having represented health NGOs in the Paris agreement negotiation process. He can be reached at: yassen.tcholakov@mcgill.ca
Also see from us: Is There a Case for “Common but Differentiated Responsibility” in Global Health?
II. UPCOMING WORKSHOPS
i. Global Health Journalism Through Newsletters: August 17, 2023
ii. Global Health Negotiations at WHO: August 24, 2023
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