Read, Refresh, Recuperate: Two Dozen Stories [Sep-Dec 2023]
Read, Refresh, Recuperate: Two Dozen Stories [Sep-Dec 2023]
The Four-Month Roundup from Geneva Health Files in 2023
Dear Readers,
Presenting to you a wrap of the last four months of the many exclusives, analyses, interviews, podcasts and guest essays from Geneva Health Files.
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Priti Patnaik & Sana Ali
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Highlights: Sep-Dec 2023:
Compiled by Sana Ali
News flash
Delegations of a group of developing countries were taken by utter surprise last week, when it became known that one of their top negotiators from the influential Africa Group, has been abruptly asked to pack up and head home in the midst of crucial negotiations in global health.
Treaty talks
In a distinct shift from his position on using existing flexibilities in the intellectual property system to respond effectively to COVID-19, WHO DG Tedros Adhanom Ghebreyesus last week rung a note of caution against undermining IP, and being measured while dealing with such rules, when asked about extending certain agreed rules at the WTO to boost access to tests and treatments.
WHO member states met in Geneva during December 7-8 to make headway in the negotiations to amend the International Health Regulations. Countries met under the aegis of the Working Group to set up to amend these legally binding technical regulations applicable to 196 States Parties and WHO on public health events with risk of international spread.
Divergences on key issues continued to make it difficult to bridge the gap in positions among countries at WHO this week at the Intergovernmental Negotiating Body set up to establish a new Pandemic Agreement. Countries consulted among each other on some of these issues this week including on sustainable production, tech transfer, pathogen access and the sharing of benefits, and financing to ensure implementation of potential new obligations, among many other areas
WHO member states struggled to understand and define the process of conducting negotiations during the first segment of the seventh meeting on the Intergovernmental Negotiating Body this week. This is even as they made slow and laborious progress in trying to improve a proposal for the negotiating text of a draft Pandemic Agreement, with their own proposals. This meeting will resume to conclude in early December and informal consultations will be conducted in the interim period.
We present to you a few excerpts from verbatim statements made by some countries at the seventh meeting of the Intergovernmental Negotiating Body at WHO this week. These statements reflect views on process, substantive elements in discussions towards a new Pandemic Agreement and the prevailing geopolitics.
The initial assumptions on the apparently narrow and technical nature of the IHR are now being tested, with realpolitik inevitably now shaping these negotiations. As WHO member states get deeper into discussing and negotiating the proposed amendments to the IHR, it is becoming obvious that several difficult choices will need to be made in order to make this instrument better fit for purpose.
[September 22] Message from New York to Geneva: Equity Front and Centre in PPR Negotiations
Though fast disappearing from public and political consciousness, COVID-19 continued to cast a long shadow in the discussions on Pandemic Prevention, Preparedness and Response at the UN High Level Meetings in New York this week where a declaration was accepted. In Geneva, diplomats met for a resumed session of the intergovernmental negotiating body for a stocktaking session at the conclusion of informal consultations on certain provisions. In this story we bring you a quick wrap of key statements from countries and other actors.
[September 8] Some Countries May Push For More Time To Conclude Negotiations For The Pandemic Accord; First Draft Likely By Mid-October
It is becoming increasingly clear that WHO member states may push for more time in order to conclude the negotiations towards a new Pandemic Accord. While this has not been formally discussed or decided yet, a number of diplomats in Geneva indicated this week that an extension will be inevitable in order to come up with a meaningful instrument.
The coming months will see WHO member states under intense pressure: first, to begin discussions on the basis of a text that will form the basis for negotiations towards a Pandemic Accord, and second, to conclude it within the stated deadline of May 2024. This pressure could mean making compromises by countries, forcing them to move from their long-held positions on contentious issues including on intellectual property, in a bid to achieve more defining goals in a Pandemic Accord such as on Access and Benefits Sharing, a few diplomatic sources have indicated.
The files-in depth
[Dec 13] WHO's Resolution by Consensus on Health and Humanitarian Access in the Palestinian Territories
In a rare special session of the WHO Executive Board, the first such session on an active conflict, member states on December 10th, adopted a politically significant resolution on Health conditions in the occupied Palestinian territory, including east Jerusalem. It was initially proposed by Afghanistan, Morocco, Qatar and Yemen.
[Nov 29] A Wait In Vain? The USITC Report on the WTO TRIPS Extension Decision For COVID-19 Tests & Treatments
On October 17, 2023, the United States International Trade Commission (USITC) released its highly anticipated report, “COVID-19 Diagnostics and Therapeutics, Supply, Demand and TRIPS Agreement Flexibilities”. The anticipation may have been in vain, considering the lack of a clear message in the report from US authorities on the extension decision and its failure to revive the moribund discussions on this agenda.
[Nov 27] Blindspots on the Climate Crisis in Global Health Governance
A pertinent analysis that maps together the evolution of the climate crisis as a challenge that has upended how we think about addressing global health issues. We republish this piece with the permission of the Observe Research Foundation. The conversation around climate change is now several decades old, and numerous international norms have recognised the health impacts of the climate crisis. Despite the ubiquitous nature of climate change impacts, however, there are few legal commitments, if at all, to address the health dimensions of the climate crisis.
[Nov 22] Want to Boost Regional Vaccine Manufacturing? Let Countries Prioritize, Ensure Tech Transfer
Building robust regional vaccine manufacturing capacity has been one of the many tough lessons in the aftermath of the COVID-19 pandemic. It was demonstrated particularly devastatingly in the case of Africa, which had some of the world’s lowest vaccination rates during the pandemic as vaccine producing countries focused inwards first.
Industry pans it, developing countries say draft “unbalanced” with a one-sided focus on prevention, falling short on obligations on response. After more than two years of discussions on what countries would like to see in a Pandemic Accord, the Negotiating Text from the Bureau of the Intergovernmental Negotiating Body set up to broker this new instrument, has sought to strike a balance to in order to first draw countries into negotiations – but is being perceived as unbalanced and one-sided with a focus on prevention relative to obligations on response, diplomats said.
Close to four years – when the WHO was first notified of a cluster of unexplained pneumonia cases in Wuhan in December 2019 – the question about the origins of coronavirus remains controversial. Over these pandemic years, millions have lost their lives, billions have been affected, and profound disruption was caused to the world’s social, economic and health fabric.
[Sep 29] Dissecting South Africa’s COVID-19 Vaccine Procurement Contracts & their Global Implications
Efforts by the Cape Town-based public health law group, Health Justice Initiative to push for transparency in the COVID-19 vaccine contracts through a case brought and won against the South African government not only reveals the terms of vaccine procurement contracts and the concerning practices, but also casts a light on the nature and extent of private power in these vastly unequal negotiations at a time of a grave public health emergency. This comprehensive story delves into the discrepancies in pricing, stringent confidentiality clauses, constraints on vaccine distribution, and the notable imbalance of liability and sovereignty, brought to light as a result of this milestone judgement.
WTO members were presented with an evidence-gathering exercise last week, to inform their on-going deliberations, to extend clarifications of existing IP rules as applicable to the production of COVID-19 vaccines, to also tests and treatments. This story looks at key elements and arguments made by the different categories of speakers who analysed the merits and demerits of such an extension.
The Files Interview
GHF bring you a comprehensive interview with Fatima Hassan, a South African activist and lawyer, whose efforts have forced greater transparency around procurement practices and contracts of COVID-19 vaccines. This expansive and timely interview, will hopefully illustrate the consistency of efforts by civil society actors fighting for accountability in global health, and the sheer power imbalances that underpin this ecosystem.
Guest Essays
In recent weeks, much has been published on access and benefit sharing and its role in promoting equity in the context of ongoing negotiations at the World Health Organization (WHO). Critics argue that ABS "cannot deliver equity," but this article aims to address and debunk some of their key arguments.
[Nov 17] Not Finished Yet: Now is the Time to End Childhood TB By David Ruiz Villafranca, Public Policy & Advocacy Advisor, Elizabeth Glaser Pediatric AIDS Foundation
Despite being a preventable, treatable, and curable disease, tuberculosis (TB) is second to COVID-19 as the leading cause of death by a single infectious disease. TB remains a major contributor to childhood morbidity and mortality, but the response to end the disease in children has been poorly addressed by the global public health community.
[Nov 15] A Little Fairer is Not Good Enough: Why ABS Will NOT Ensure Equity
By Michelle Rourke, Law Futures Centre, Griffith University, Brisbane, Australia; Abbie-Rose Hampton, King's College London, London, UK; Mark Eccleston-Turner, King's College London, London, UK; Stephanie Switzer, University of Strathclyde, Glasgow, UK.
Access and benefit-sharing (ABS) has been a mainstay of international law for more than 30 years, but it is hard to find concrete examples of it resulting in fair and equitable outcomes. More specifically, its use in global health via the World Health Organisation’s Pandemic Influenza Preparedness (PIP)
By Simon Reid-Henry, Public Interest and Peace Research Institute Oslo; Koen Scholten (Global Health Advocate), Wemos; Khalil Elouardighi (Director, Think Equal), Equal International
Global health governance confronts two long-term problems. One of them is a growing fragmentation and misalignment of agendas and initiatives. The other is a problem of power, encompassing accountability, transparency, and meaningful voice. Inevitably the two problems are linked, and nowhere more so than when it comes to the financing of global health agendas.
[Nov 1] Squaring The Circle On Equity in a Pathogen Access And Benefit Sharing System By Jayashree Watal and Lawrence O. Gostin
Research and development (R&D) needed to manufacture and deliver key pandemic response products (PRPs) such as diagnostics, vaccines, and therapeutics requires access to novel pathogen samples and their genomic sequencing data (GSD). Yet, many low and middle-income countries (LMICs) understandably do not want to share pathogens and GSD unless they can ensure that the benefits of R&D will be equitably distributed.
By Christophe Perrin, TB Advocacy Pharmacist; Shailly Gupta, Communications Advisor; Roshan Joseph, Trade and Intellectual Property Analyst, Médecins Sans Frontières Access Campaign
In August 2023, Johnson & Johnson (J&J) reduced the price of the lifesaving tuberculosis (TB) medicine, Bedaquiline, from US$272 to $130 per treatment course of six months for many low- and middle-income countries (LMICs). This price reduction was the result of a competitive tender by the Stop TB Partnership’s Global Drug Facility (GDF), an international pooled procurement mechanism for procurement of TB health products, and represents a watershed moment in the decade-long struggle for expanding access to Bedaquiline.
[Sep 27] Decolonizing Global Health Law By Drawing on Lessons from International Environmental Law
By Matiangai Sirleaf & Alexandra L. Phelan
Global health law for pandemics currently lacks legal obligations to ensure distributional and reparative justice in critical areas, such as equitable access to vaccines, diagnostics, and therapeutics, and compensatory financing to strengthen health systems. This column explores the appropriateness of these international environmental law mechanisms, encouraging countries to consider integrating them in global health law reform processes.
[Sep 20] To Break Impasse In Pandemic Accord Negotiations, Bring Neutral Countries To Forge Compromise
By Dame Barbara Stocking, Chair, Panel for a Global Public Health Convention
We are all aware that negotiations, particularly of the WHO CA+, but also to some extent the WG-IHR, are in a difficult place. The central issues of concern are of how low and middle income countries can access epidemic and pandemic countermeasures equitably, and also the nature of any pathogens access and benefits system. There are many issues within these two areas, including distributed production of countermeasures across the world, the technology transfer, TRIPS matters and the balance between equity and the need to ensure that research and innovation continues in the pharmaceutical industries.
For months, we have watched as Member States have tried to negotiate a UN Political Declaration on Pandemic Prevention, Preparedness, and Response (PPPR) ahead of the UN High Level Meeting in September. With groups of Member States at odds on equity issues, these negotiations have gone severely off track. This is the time to deliver a Political Declaration that is ambitious, timely, and in pursuit of a level of equity that has yet to be achieved in global health.
This post has been co-authored by Amref, Gavi – the Vaccine Alliance, NCD Alliance, Save the Children, Sightsavers, Women in Global Health, and the UHC2030 Civil Society Engagement Mechanism, to inform the Intergovernmental Negotiating Body’s negotiations on the WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response.
GHF Podcasts
[Dec 15] Listen Now: The Geneva Health Files Interview with Fatima Hassan
[Nov 24] The Geneva Health Files Interview with Peter Sands, The Global Fund
[Sep 15] Global Health Negotiations in Geneva: What, Why, Who and How [An Explanatory Podcast]
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