Pandemic Agreement Talks: The Final Toss - Access & Benefits Sharing Vs One Health? Health Financing Politics Come into Play as Africa Group Holds the Wild Card
Newsletter Edition #85 [Treaty Talks]
Hi,
In the final lap of the negotiations for a new Pandemic Agreement, a lot will depend on how united and determined the Africa Group will be. But the pressure is beginning to build.
For much of the last two years, Africa Group has been the engine in powering the equity agenda in these discussions. These countries have defined the expansive boundaries of this negotiation. As crunch time arrives, there are, of course pressures to shrink these aspirations.
In today’s story we bring you the state of play in these discussions.
Expect quick updates from us in the coming days as we bring you not only snapshots of how discussions are evolving, but as many insights as possible from those at the front-lines of this negotiation.
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I. UPDATE: INB9 RESUMED SESSION
Pandemic Agreement Talks: The Final Toss - Access & Benefits Sharing Vs One Health? Health Financing Politics Come into Play as Africa Group Holds the Wild Card
The Intergovernmental Negotiating Body set up to establish a new Pandemic Agreement resumed its discussions this week in a final lap aiming to conclude the negotiation, with numerous hurdles along the way to the finish line including process concerns, divergence on key issues and factors external to the World Health Organization.
Crunch time dawns in the hallways of WHO, where 194 countries are meeting to hash out a new legal instrument in a desperate face-saving exercise running against a vengeful clock. All-too-familiar fears of a H5N1 outbreak are snapping at the heels of governments, as they grapple with the big questions of a new health emergency architecture – from surveillance to financing, from Pathogen Access and Benefits-Sharing to One Health.
So here is the somewhat simplistic topline: the final toss for some countries will be about pushing for a PABS mechanism in lieu of agreeing to One Health provisions. Much will depend on the nature and seriousness of One Health obligations. But this is not a simple lever that developing countries can exercise. The buttons pushing a dedicated financing mechanism is under the thumb of a few developed countries. So, the promise of money will not come till developing countries also agree to One Health demands. And we are not even talking about tech transfer and intellectual property concerns yet.
You can well appreciate, how quickly these interlinked issues can descend into fog. And yet countries for now seem determined to make their way through these layers to arrive at consensus.
These discussions are tightly and continuously circumscribed by political and diplomatic influences behind-the-scenes.
The resumption of this week’s meeting was preceded by high drama in Addis Ababa, where African health ministers met at an event brokered by The Africa Centres for Disease Control. This was watched closely by everyone, including actors hoping to crack into the gaps in the African position on this negotiation.
In this story we bring you a snapshot of some of the emerging indications. We also discuss process matters that underpin the proceedings of the next two weeks.
THE SIGNIFICANCE OF THE AFRICA GROUP
In these two-year negotiations, some of the boldest and “maximalist” proposals like some have referred to them, have been from those who were hardest hit in the previous pandemic. The Africa Group has consistently laid the markers for this negotiation still fresh from the wounds of vaccine inequities. At the final stages, the issues that have been sticky are unsurprisingly, those that have been proposed by not only Africa Group, but also other developing countries that have more or less coalesced around these interests – be it PABS or financing.
So therefore, it is not overstating the importance of this group of countries. But as always there are nuances in positions within regional blocs. And these nuances become sharper and present themselves as differences, when you throw in concomitant commercial and political pressures.
At the Ministerial meeting in Addis over the weekend, sources familiar with the proceedings spoke about the lack of unity among countries within the Africa Group on an overall position on the INB negotiation (To be sure, the issues in the negotiations are diverse and countries have different interests and are at various levels of development).
For weeks now, there have been indications that while some African countries have aligned around a powerful Africa CDC, others have been led by negotiators in Geneva, and their capitals. The role of Africa CDC in these negotiations has been striking, also seen through the lens of the support received by this regional institution including from big donor countries.
There was confusion around the communiqué that was initially released by the CDC over the weekend during April 26th-27th. It has been alleged that CDC boss Jean Kaseya unilaterally released the communication without full consensus. This was withdrawn subsequently and a final one was issued on April 29th. A primary bone of contention was the reference to the World Bank Pandemic Fund – a position primarily held by developed countries in the context of PPPR financing.
A legitimate question to raise is why would the Africa CDC push for a role for the Pandemic Fund – a position that has been opposed by developing countries and African countries in particular. These countries have after all been pushing for a dedicated fund with a reform of representation and governance gaps in the existing structure of the Pandemic Fund. Well, it turns out that the Africa CDC had been considered for the first stage to be an Implementing Entity for the Pandemic Fund, just a few weeks ago.
The Internecine Wars In Health Financing
So, while there is staunch opposition by mostly developed countries to the creation of a new dedicated fund for PPPR under the aegis of WHO and its member states, there are other competing factors complicating the picture around the Pandemic Fund.
There have been indications of competing interests between the Global Fund to Fight AIDS, Malaria and Tuberculosis, and the Pandemic Fund, for example (including during the conception of the World Bank’s Fund). The Global Fund has defined its stake PPPR financing on the back of its role over the last 20 years. And the Pandemic Fund is not backing off.
(Also see Devex: “Why the US commitment to the Global Fund has cratered”)
Overlay this, with the darkening climate to raise funds for health, as agencies head for replenishments, at a time of shifting geopolitics in the backdrop of rising defence expenditures with on-going wars in Ukraine and Israel’s conflict in the Occupied Palestinian Territories.
The deal on PPPR financing will depend on the extent to which countries can be assured that the Pandemic Fund will act in their interest. “The Pandemic Fund is for the Pandemic Agreement. They have to work with this new instrument,” a developed country negotiator told us last week.
(Elsewhere, in climate finance discussions, stakeholders worry about a World Bank centered fund on Loss and Damage that has not taken off.)
Excerpts: Africa CDC Communiqué
(In bold, emphasis ours)
“…RECALLING the African Union Declaration on Accelerating the Implementation of IHR in Africa (2017), the amended Statute of the Africa CDC (2022), the Africa CDC Strategic Plan 2023-2027, and the Common African Position on Pandemic Prevention, Preparedness and Response adopted by the African Union Assembly of Heads of State and Government in February 2024;
ALSO RECALLING the International Health Regulations (2005), the WHO Regional Strategy for Health Security and Emergencies (2022-2030), WHO African Region’s Integrated Disease Surveillance and Response Strategy (2020-2030), and the UNICEF operational Response Plan for Public Health Emergencies (2024);
COGNISANT that Africa has been confronted by numerous outbreaks and other public health emergencies, with over 160 reportable public health events per annum, accompanied by lack of solidarity in addressing challenges, such as the COVID-19 pandemic, epitomized by the failure to share health products and technologies in a timely and equitable manner that adversely affected the African continent;
EMPHASISING the need for a joint robust pandemic prevention, preparedness and response system that ensures solidarity and equity against public health threats and guided by the main principles on fair and equitable allocation of pandemic-related products to African countries, technology transfer, multilateral pathogen access and benefit sharing system, regional manufacturing, sustainable financing mechanism, and the need for a robust and multisectoral governance mechanism that can insist on and support transparency and accountability for the benefit of Member States;
RECOGNISING the current limitations of the Pandemic Fund in terms of important gap in its financing and governance to better support Pandemic Prevention, Preparedness and Response, health systems strengthening, local production capacities in Africa, and the importance of additional sources of innovative financing, including through the African Epidemic Fund;
ALSO RECOGNISING our responsibilities, as AU Member States, for appropriate investment in our health workforce, surveillance system, local manufacturing, clinical trials, and Research and Development, as well as competencies in the IHR core capacities; EXPRESS OUR APPRECIATION for the support of the African Union, through the Africa CDC to African Member States in their ongoing negotiations for the Pandemic agreement.
COLLECTIVELY, WE RESOLVE AND COMMIT OUR GOVERNMENTS AND INSTITUTIONS TO:
1. ENSURE EQUITY IN THE DRAFT PANDEMIC AGREEMENT through:
a. A multilateral pathogen access and benefit sharing system (PABS), which provides legal certainty for both users and providers and ensures an improved access to pandemic-related health products, technologies with measures that establishes regionally-distributed production of pandemic related health products.
b. Commitments to organize and resource technical support on the range of matters covered by the draft agreement, including all equity-related provisions, as well as pandemic prevention and public health surveillance, preparedness, readiness, and resilience, and health and care workforce through WHO coordinated mechanisms that are accountable to the Conference of Parties.
c. Appropriate safeguards and limitations that should be placed on the use and sharing of data and information provided by State Parties to WHO, such that the information shared should not be used to the detriment of the interests of the State Parties providing the information such as disproportionate travel or trade bans, devaluation of credit rating and/or sovereign bonds.
2. PANDEMIC PREVENTION, PREPAREDNESS AND RESPONSE (PPPR)
a. Formulate coherent national and regional strategies for emergency preparedness and response and health workforce development, including community health workforce.
b. Enact domestic laws providing for broad exemptions and limitations to intellectual property to address public health emergencies.
c. Increase supply chain diversification and logistics streamlining (continental, regional and national), including through initiatives with other Global South countries.
d. Make incremental steps, in line with respective capacities and nationally self-determined priorities, on PPPR competencies.
e. Operationalize various WHO coordinated mechanisms such as on coordinating R&D and technology transfer, in a manner that such mechanisms are accountable to the Conference of Parties and take guidance from the Conference of Parties in their operations.
3. PREDICTABLE, SUSTAINABLE FINANCING AND GOVERNANCE
a. Call for an International financing mechanism that is accountable to the Conference of Parties and enshrining explicit commitments to new, sustainable, and increased funding support from developed countries for country-level pandemic prevention, preparedness and response in developing countries, debt relief and debt restructuring mechanisms including debt for PPPR swaps.
b. Accelerate the operationalisation of the financing of the African Epidemic Fund.
Behind-the-Scenes Dynamics:
Sources involved in the preparation of the African position suggest that while countries remain steadfast on pushing their original proposals, there is also greater recognition about what will be possible in Geneva where G7 countries have effectively held onto their positions on surveillance, financing and IP related matters.
While the CDC ministerial revealed inadequate preparation, stakeholders are still hopeful that African negotiators will be able to do their own thing to defend and negotiate their positions if their ministers leave them alone.
But the risk of political bosses or even ambassadors undoing the careful work of technical experts and diplomats in Geneva, is not limited to developing countries. Some developed country diplomats caution against bringing in Ambassadors too early in this process.
THE TRADE OFFS: PABS VS ONE HEALTH
Numerous interviews with diplomats from developed and developing countries over the past few days, indicate the one obvious trade off would be between PABS and One Health.
The PABS mechanism is complex in and of itself with persisting divergence on governance, benefits, terms of access, among other areas. This is one ostensible reason the INB Bureau has proposed an Intergovernmental Working Group for a later stage to negotiate the details in a future protocol.
We also learned there is renewed pressure against obliging manufacturers to share 10% of their real-time production with WHO in the framework of a PABS mechanism. (Countries will take up the PABS provision for discussion this week).
Also, given that getting developing countries to agree on One Health provisions has been difficult, the Bureau proposed an additional future line of work, to the surprise of many, including One Health proponents. It is being seen as a way to quickly make progress with bare principles of One Health, while pushing details to later. But there is little appetite for a future mechanism. It is understood that developed countries would prefer to push through some of the provisions at this current stage.
Some suggest, carving out Art 4,5 on surveillance and One Health, and to set them aside with the provision on PABS (Art 12).
“It would be ideal to finish finalising everything else, and deal with these core articles later. In the meantime, we can complete the other less contentious articles,” one developing country diplomat suggested.
But in the current scheme of things, there is hardly anything “less contentious”. Provisions on production, technology transfer, financing have all been contentious. Matters of accountability, compliance and governance also raise concerns.
THE PROCESS OF CONDUCTING THE NEGOTIATIONS
The programme of work for the current set of negotiations that lasts till May 10th has been published here.
In a communication sent to non-state actors last week, the INB Bureau said:
“The first week of the resumed session of the INB9 will focus on the finalization of the substantive negotiations on the text of the WHO Pandemic Agreement, whilst the second week will focus on any outstanding Articles in the Pandemic Agreement. A stock-take session will be held on the afternoon of 3 May in order to determine the way forward.
The latter part of the second week will consider the draft report and draft resolution for the INB to submit its outcome to the WHA77.”
The Bureau had indicated:
“The drafting group will begin with the negotiation of Chapter II Article 4 and proceed sequentially through each Article.
i. The co-chairs will provide a rational explaining changes for relevant Articles of the Pandemic Agreement.
ii. The floor will be open for discussions amongst delegations. The Bureau will aim to understand whether the INB has reached consensus on each Article, recognizing the interdependence of all the proposed Articles in the Agreement. Onscreen textual editing will be avoided building on the experience from INB9.
iii. The INB will be invited to agree text ad referendum in the drafting group.
iv. As indicated during the Briefing of Friday 19th April, the Bureau is of the opinion that the text as presented in the proposal for a WHO Pandemic Agreement is consensus ready. It was drafted on the basis of our many rounds of negotiations. The co-chairs will open the different articles and will ask the Member States if the article is ready for approval. If not, delegations will be invited to explain what their issue with the article is. Where possible the co-chairs will immediately propose a way forward. If the issue at hand is more fundamental, either a small informal meeting between a few Member States can be proposed, or - if more Member States want to be involved - a Working Group session can be proposed. In both instances, the groups will be led by a member of the Bureau and will be asked to bring a possible solution back to the drafting Group for consideration. We work on the understanding that there will not be more than two meetings running in parallel.
v. The Bureau has established flexible modalities where there is a possibility of a maximum of two parallel meetings and setting up of working groups and informals as needed, under the leadership of the Bureau members.
vi. A limited number of time-bound working groups may be established on the understanding that they would work towards consensus.”
Activists have said that they find the process deeply problematic.
In a statement, CSOs said:
“The proposed process still does not allow WHO Member States to engage in effective text-based negotiations and, instead, forces them to engage in informal negotiations, especially with the Bureau and the WHO Secretariat. Such a process has so far failed to promote consensus on any part of the text. Instead, sometimes it resulted in pro-equity proposals advanced during informal sessions being omitted from the Bureau’s text while straining the capacities of smaller delegations to keep abreast of discussions. The INB Bureau has recently conveyed that Member States’ textual/new wording proposals to the draft negotiating text will not be allowed, effectively making the Bureau’s document the default text. This leaves Member States to either take it or leave it, without any option of finding consensus among themselves. This pressurising tactic must be rejected and Member States should insist on Member State-led text-based negotiation to conclude a Pandemic Instrument that concretely addresses the status quo's lack of equity.”
Full statement here: A Pandemic Instrument that Does Not Deliver on Equity is a Failure
Experts at Third World Network point to the UN General Assembly Resolution on the Principles and Guidelines on the International Negotiations (UNGA 53/101). The following guidelines i.e. Paragraph 2 (e), (f) and (g) persist on the importance of negotiations:
“States should endeavour to maintain a constructive atmosphere during negotiations and to refrain from any conduct which might undermine the negotiations and their progress;
States should facilitate the pursuit or conclusion of negotiations by remaining focused throughout on the main objectives of the negotiations;
States should use their best endeavours to continue to work towards a mutually acceptable and just solution in the event of an impasse in negotiations.”
Also see separate letter from 160 CSOs to DG Tedros: Open Letter to the Director General of the World Health Organization
During the first day of the meeting on April 29th, countries discussed Articles 4,5,6,7, 9. In a briefing for nonstate actors, Co-Chairs discussed areas of disagreement in these articles including on issues such as data standards, inter-operability, biosafety and biosecurity risks, equitable access to R&D products, language on comparator drugs, on transparency matters, and obligations on publicly funded research. Countries also discussed references to mutually agreed terms in these set of articles.
At the close of the first day, working groups were established on articles 4 and 5. The Bureau suggested that the smaller group would bring suggestions and for the Bureau to work on a revised text that would be brought into the plenary session again for consideration by all member states. A process of iteration would follow such an approach throughout the week, sources said.
While many countries including developing ones want smaller working groups to progress through the text quickly, not everyone agrees.
“In smaller groups, the voices of developing countries are not well represented. I think discussing in the plenary makes more sense,” a diplomat from a large developing country told us this week.
WHAT TO EXPECT: DESPERATION AS AN INDICATOR
By the end of this week, it will become clear whether this process is heading in the direction that member states want. The coming days will be crucial in determining both - whether countries will reach consensus towards a bare minimum of a Pandemic Agreement ahead of the World Health Assembly, while at the same time defining the essence of what it is they will agree to.
One key indicator will be how many countries are desperate for an agreement and how much are they willing to give in, for the sake of an agreement - good, bad or ugly.
So while every country will look out for their national interest, bilateral ties and wider geopolitics will inform and swing key players who will be decisive in shaping the final outcome.
OTHER RESOURCES:
The last mile: A few suggestions for the WHO Pandemic Agreement’s last two weeks of talks: Medicines Law & Policy
The WHO Intergovernmental Negotiating Body process and the revised draft of the WHO Pandemic Agreement (A/INB/9R/3): South Centre
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