Hi,
I have reported on global health long enough to turn grey. But luckily one of the perks of journalism is, how your day job continues to surprise you and informs you, no matter how much time has passed.
So I was happy to be at the World Health Summit in Berlin this week – a really interesting conference that not only showcases global health, but also reveals the nature of this industrial complex. Such an event presents the latest trends, but is also to an extent, a veritable barometer for the field. It attracts the political leaders, philanthropists, corporate types, lobbyists, but also students, committed activists, patient groups and some media folks. What this looks like is a zillion, simultaneous, intersecting conversations. (“Wait, are we talking about global health or climate change? Oh, but that is where the funding is going.”)
The WHS does hold up a mirror to the goings-on in global health - the power play orchestrated by pledged dollars. It is an indicator for rising private power (Big Tech is Big in global health), shifting government priorities, latest preferred flavors from the funders, and the politics. It also shows what goes unsaid!
While geopolitics and deep distrust have splintered the ground we stand on, dialogue and a curiosity to engage is the only way forward. Such spaces are important, for they convey engagement and an appetite to listen to all voices. I found resonance on this, also among other experts in global health who find value around this event. (In the interest of transparency, I have to disclose that I was invited by the German government to participate in a closed door session.)
I spoke and participated at two sessions – both of which were closed doors conducted under Chatham House rules. (There were countless candid, humorous, and serious anecdotes, the kind of stuff reporters dream about!) So while I am not going to report on them, below I present my interventions on some of these issues. These insights have already been expressed through our newsletters previously.
We are sharing this, also in light of upcoming negotiations over the Pandemic Agreement in early November 2024.
And may I also add, how absolutely lovely it was to meet the readers of the Files in person. This community runs on the basis of the trust and authentic engagement of its readers. Thank you for reading!
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Until later!
Priti
Feel free to write to us: patnaik.reporting@gmail.com, Follow us on X: @filesgeneva
I. EDITORIAL
The Pandemic Treaty May Have Begun As A Political Project, Doesn’t Have To End As One
At a closed door session on October 13, 2024, (Pandemic Agreement Negotiations: Key Insights Gained: A Critical Review of Multilateral Negotiations in Global Health), I was asked to share my perspectives on some of these questions and themes. The following is based on my prepared remarks, most of these messages were conveyed during the session.
It has been a great responsibility and a humbling experience to share our insights based on what we gather while reporting for the Geneva Health Files.
Whether the discussions and negotiations on the pandemic treaty are going in the right direction? Key challenges:
It depends on whether one sees the glass half full or half empty. Progress has been made undoubtedly, but important and tough issues remain to be resolved.
THE POLITICS
Surely the worsening geopolitical climate is adding to an already complex negotiation.
So let’s say in five years from now, we are looking back, assuming countries do reach consensus, they would pride themselves in pulling a victory from the jaws of defeat as it were.
I always like to remind people, that when the negotiations towards a pandemic agreement were launched in late 2021 by way of a special session, Russia had not invaded Ukraine, and the Middle East had not ruptured. So to conduct these technical discussions in global health in an era of eroding trust, and what has been an absolute disaster for geopolitics, is a formidable task. But we also have concurrent and urgent health crises, so these negotiations assume even greater importance.
In addition to geopolitics, there is also the changing nature of political realities across swathes of countries. In general there is a retreat from globalism – in country after country. Authoritarian leaders often play to the domestic constituency using international forums such as the WHO to serve their narratives.
THE RISK OF THE LACK OF AMBITION
In my personal opinion, the biggest challenge is the risk that countries would lack adequate ambition, and settle for the lowest common denominator on what such a treaty can achieve. So I feel that political expediency to rush through and finish off this process is a big challenge.
The reality is that there will always be limited time, resources and political momentum – for anything as difficult as crafting obligations at an international level. This is being touted as “a generational opportunity”. So if countries settle for something that is marginally better than the status quo, or even worse than what exists now, it will actually be a lost opportunity for a long time to come.
We are also told that there is a “rush to green”. This cannot be a tick box exercise if you are calling it a generational opportunity. All of WHO member states, 194 countries have invested time in the process for the last 3-4 years. So it has to be taken to a logical and meaningful conclusion. It is incredible to hear how this is sometimes being seen as a vanity project in Geneva, far away from what it could mean for people on the ground.
The pandemic treaty may have begun as a political project but does not have to end as one.
DISINFORMATION
The other challenge, that I observe as a journalist, is of course disinformation. I also see governments being on the back foot when it comes to taking bold measures on disinformation – also in relation to the pandemic treaty. Governments are beginning to sound apologetic – in the sense that – “we cannot be too bold because we will invite the ire of the right wing on the pandemic treaty.” I don’t fully understand these concerns.
Governments are in the driving seat when it comes to dealing with disinformation. I think there should be no need for self-censorship, or being apologetic for taking science-based decisions. Governments should not be making the threats of disinformation bigger than they are. It seems they may be according a certain level of importance to these forces, placing it higher than the potential for substantive obligations in a Pandemic Agreement.
THE LACK OF TRUST
Finally, the lack of trust is a big problem. The anger about vaccine inequities during COVID-19 is very real. Experts have said that there is an under-appreciation of the “depth of the distrust and anger.”
In addition, talking down to the other side will not fly, from what we understand from negotiators in various countries. So for this stuff to work, it cannot be an ego battle between countries.
THE DISTRIBUTION OF POWER
There is a failure to recognize that there has been a material change on the ground. So by this I mean that while power remains with the powerful, but the power is no longer uncontested. Recently one negotiator asked me if I thought the power had shifted. The metrics of how power is distributed might have changed more than we acknowledge. So there needs to be a recognition of this shift.
There is a structural deadlock, there was an expectation that the global south would capitulate – that has not happened so far. It is not ruled out. There is a greater articulation of aspirations. Genie is out of the bottle.
It is clear that the reason these negotiations have been difficult is partly because political expectations of diverse countries cannot be forced and straitjacketed into a pre-cooked model of what an Pandemic Agreement needs to look like.
As a reminder, the Pathogen Access Benefits Sharing System, first came as a proposal from the poorest countries. Later, everyone else have rallied around it of course. The other example is, when countries submitted 300 proposals for amendments to the International Health Regulations. When the US first spoke about strengthening the IHR in 2021, no one expected that more than 40 countries to come back with detailed proposals on the way they saw these amendments.
What are the potential structural and procedural changes to improve the INB negotiations?
FAIRNESS IN THE PROCESS
First and foremost, the process must be perceived as being fair. This has not been the case based on what we hear from countries. We should acknowledge that international diplomacy is not a level playing field. Therefore, for a multilateral negotiation to succeed it needs to have a semblance of fairness.
ON IMPROVEMENT
On improving processes, what we have gathered is the following: one is on the role of the bureau, and the second is the structure of the negotiations, namely formal vs informal consultations.
THE IHR STYLE
On the first one we can look at what happened in the IHR – with the caveat that the IHR track was easier than the treaty track for reasons we know – amending an existing instrument, as opposed to starting with carte blanche.
The perception was the IHR negotiations were member-state led, that the Bureau did not lead on the process, but allowed the process to be informed by what countries wanted. This included members of the bureau coming up with bridging language on the spot, that was supported by home work done prior to the formal meetings, a lot of work in the back channels, better overall preparedness of the bureau. The IHR Bureau also got brownie points for explaining a clear and comprehensive rationale for the textual changes they suggested. Sources have also pointed to a natural cohesion within the IHR bureau members, among other reasons.
Ensuring transparency and fairness in the conduct of these negotiations will inject greater faith and engagement in the process.
It is a fantasy to think that there will not be political or commercial interests snapping at the heels of these processes, but the expectation from stakeholders is that every effort should be made to at least attempt to insulate treaty making from such influences.
FORMAL VS INFORMAL SESSIONS
The other issue is what processes can be altered to achieve consensus. There has been a push for informals, and to let countries make deals themselves. But I was recently educated by a negotiator, that you cannot make deals if delegations are not even talking to each other. And why is that? Deep distrust among and between delegations.
Also deals happen when there is a lot more to play with. So at the WTO, one would see deals across trade disciplines, but to an extent what negotiators at WHO have is limited.
And just having informals, may not guarantee success. The trickiest provisions in the draft Pandemic Agreement (9, 11, 12, or 4 & 5), have had scores of informals over three years.
Also, the IHR process did not see as many informals. To be sure, the sheer breadth of the pandemic treaty means you need informals to clarify positions, before countries engage in line by line text-based negotiations. You have entire provisions that read like mini-agreements, whether it is 11 on tech transfer, or 12 on PABS.
There are examples in other forums where informals have contributed to consensus-making – and I am told much depends on the chair of the informals, whoever it may be, in playing fair and in bridging compromise.
We understand the Bureau also has a role to play in facilitating such an environment.
Leadership in structuring these negotiations going forward, in creating spaces and opportunities to bring countries together to make compromises, is going to be critical in contributing towards a consensus, diplomats believe.
But ultimately the outcome and the process will have to be determined, and owned by the member states: you get what you ask for.
Access to stakeholders has materially changed these discussions in the last few weeks alone. I should add here is that the press is an irrelevant stakeholder - we don’t get any regular and structured briefings on the treaty negotiations, more than three years into this process.
Extension of the negotiations beyond December 2024 is all but inevitable. These are complex provisions and more time will be needed even to arrive at a streamlined framework convention. (The November formal meeting is already being given a pass by some stakeholders, on account of American elections.)
These negotiations are not only about pandemics – it has the potential to reset the power dynamics between the state and private parties, and could potentially shape the commercial linkages in global health, and is therefore contentious.
How Do We Assess Our Role In The Process.
Media is not a non-state actor. We do not get structured formal briefings that NSAs get. (This is deeply frustrating and tiresome.)
As a journalist reporting on these negotiations, our responsibility has been to provide information in a timely and accurate manner. And even more so, if it has a material impact on the discussions. (This means working the phones on weekends, and writing on Sunday nights!)
Fact-based information is vital in an era of disinformation. So it is important that the press is briefed regularly – which we are not.
At Geneva Health Files we take our role seriously. There is a certain responsibility and an exercise of both caution, and editorial judgement.
Our ultimate service is to our readers - 80% of whom are outside Geneva, across more than 130 countries.
We are also acutely aware that we operate in a sensitive diplomatic space. So we want to soothe not flare to the extent possible. However, if we see blood on the floor we have to report about it. We cannot paper over it, we cannot gloss over it.
Shooting the messenger or accusing us that we are pouring oil on fire is not going to be helpful. Dismissing journalism as fake news is not helpful. Sometimes, we have spent precious time standing behind what we publish, instead of doing the actual journalism in the course of these fast-moving negotiations.
Also we are not advocates, we are not here to make people happy. We are documenting what is happening – even if it is behind closed doors. We are piecing together the picture by talking to a range of voices, while being mindful of narratives and motivations of those who speak to us.
We try to provide neutral coverage, we often publish country statements, as a record for posterity.
We recently published a book on the TRIPS waiver negotiations that we reported from October 2020 to February 2024. We are told that it would have been impossible to reconstruct what happened in these discussions from WTO records alone.
No one else is doing it the way we are, so we are very committed to our job and I hope our kind of journalism gets more support.
People need to speak with reporters – you have to trust that the press is on the side of the larger public interest. We are just doing our job. We have upset many quarters, and that tells me we must be doing something right.
Is there a risk of losing political momentum? How can it be ensured that the commitment for the negotiations remains high?
I do not see a big risk in the potential loss of political momentum given the deep commercial interests in the outcomes of these negotiations.
To be sure, there is a lot of posturing on all sides, to walk away from these discussions. There is a perception that the amended IHR have been for the rich countries, and the pandemic treaty is what developing countries need. But this does not capture the importance of such an agreement for all countries involved.
We are told that at least one former health minister has turned anti-vaxxer. There is money in disinformation as The Washington Post reported recently.
In addition, a number of countries have voted in new governments over the summer that could have an impact on the brief given to negotiators.
Finally these negotiations are not happening in a vacuum. Prevailing health emergencies and political crises will, both have an impact in the coming weeks and months, sometimes in complex and opposite ways.
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