Towards Meaningful Country-Level Engagement on the Pandemic Treaty: A Canadian Perspective [Guest Essay]
Newsletter Edition #180 [The Curated Primer]
In today’s curated edition, we have scholars from Canada, writing for you on the importance of effective country-level engagement to feed into the Pandemic Accord discussions in Geneva.
It is difficult to understand how these processes are unfolding in capitals. We are grateful for this perspective and we wish to bring more views from countries into Geneva. Do feel free to get in touch with us during these crucial negotiations, it will help us shed light on country-level experiences.
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Watch out for our analysis later this week, on the key issues at the on-going fifth meeting of the Intergovernmental Negotiating Body discussing the Pandemic Accord.
On another note, I am delighted to have participated in this podcast on global health conversations in the audio medium! See below.
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I. GUEST ESSAY
Achieving Meaningful Canadian Engagement on the Pandemic Treaty
By Kelley Lee, Cécile Bensimon, Mark Brender, Roojin Habibi, Kim L. Lavoie, Joanne Liu, Srinivas Murthy, Katrina Plamondon, Leah Shipton, Veena Sriram, Brian Li Han Wong
Around 100 representatives of Canadian provinces and territories, Indigenous peoples, youth, civil society, private sector, and academia gathered in Ottawa in March 2023 for a government-hosted consultation on the draft World Health Organization (WHO) legal instrument on pandemic prevention, preparedness, and response (known colloquially as the pandemic accord). Another 100 or so participants joined this Pandemic Instrument Partner and Stakeholder Engagement Forum virtually from across the country.
This event came between sessions of the intergovernmental negotiating body (INB) tasked with moving from a draft to a final instrument that WHO Member States are expected to sign in May 2024. With adoption targeted for the World Health Assembly in May next year, the world is now entering the critical stage of negotiations.
Negotiations will determine whether or not the proposed accord will promote more effective and equitable global action during future pandemics. The stated purpose of the engagement forum was to “help inform the development of Canada’s priorities and objectives in the creation of a pandemic instrument.” This includes the opportunity to align the rhetoric of solidarity, frequently used by the Canadian government during the COVID-19 pandemic, with action. 
So far, few if any governments have held similar consultations. For this, the Canadian government should be commended. The need for broad consultation is clear. The pandemic has profoundly impacted the lives of individuals and communities worldwide, albeit inequitably.
In many societies, this has led to social divisions that, in turn, have fed public suspicions about strengthening the roles of public health officials, governments, and WHO. Understanding the diverse individual and shared experiences of the pandemic will be crucial to Canada’s positioning on the draft treaty. Successful negotiations will also depend on the degree to which Canadians embrace the need for improved international cooperation to navigate future pandemic events.
Much planning and resources went into this engagement forum. The meeting was opened and closed by top-level officials from Health Canada, the Public Health Agency of Canada (PHAC), and Global Affairs Canada. The word “meaningful” was frequently used during the two-day event, with organizers formally asking participants, “What would ‘meaningful’ representation, engagement, and participation in decision-making processes look like to you?”.
This effort suggests the event was not merely “window dressing” but a genuine intent to listen. Given that further Canadian consultations may take place as treaty negotiations unfold, and recognizing opportunities for collective learning by other countries wishing to do the same, we offer the following observations to support meaningful engagement based on our experiences as in-person and virtual attendees.
LESSONS FOR OTHER COUNTRIES
First, who does and does not participate determines the quality of engagement. While participants cannot be fully representative of Canada’s diversity, transparency in the choices made about participation is needed. This allows any important gaps to be identified and filled, and helps locate the perspectives that are expressed.
Over the past year, the PHAC Pandemic Instrument Team have provided email updates on the INB process. Was this opt-in email list the basis of invitations to attend the Ottawa engagement forum? This seems a sensible starting point. However, were invitations driven by the seven “stakeholder and partner” groups formed or did these groups emerge from those who came forward? On the balance of representation, did organizers seek to keep the groups roughly similar in size (implying their moral equivalence) or was there weighted representation? For example, with 20% of Canada’s population under 30 years of age, was 10-15 youth representatives sufficient?
Was there a cap on participant numbers overall and per group? What thought was given to representativeness within each group? The private sector, for example, seemed largely composed of pharmaceutical industry representatives. Importantly, who was missing? Unfortunately, answers to many of these questions are not possible because organizers declined to circulate a list of participants prior to or during the event, citing privacy protections (although may now do so post-event after requests by attendees).
Second, what process is applied to gather perspectives determines the meaningfulness of engagement. The process in Ottawa largely consisted of plenary presentations and breakout groups. The latter were six one-hour sessions with each focused on a selected topic: Leadership and Governance; Enhancing Capacities to Detect, Understand and Act on Public Health Emergencies; Health Systems Strengthening; One Health; Equitable Access to Pandemic Response Products; and Health Equity and Gender Equality. Briefing papers for each topic set out a brief overview, context, zero draft considerations, and discussion prompts although a succinct summary of Canada’s current positioning on these issues was missing.
Participants, organized into four breakout groups of around 50 participants each, were divided into tables of 5-6 people from a mix of the seven partner and stakeholder groups. Each table was then tasked with the ”discussion prompts”, with key points written down and submitted on a form by a group member. Professional facilitators kept in-person proceedings moving at a brisk pace, with 1-2 minutes of feedback solicited per question per table. On-line groups facilitated themselves with no interaction with other groups.
While this format was perhaps necessitated by the breadth of the 32-page zero draft of the pandemic accord, relationships of trust and shared understandings are central to conducting meaningful exchange. A list of participants would have also provided some contextual understanding of the perspectives represented around each table. Instead, participants were given five minutes to introduce themselves before engaging in rapid-fire discussions that went to the heart of pandemic prevention, preparedness and response. This tight timeframe made it difficult to integrate insights from participants with varied levels of content expertise on specific topics.
The scope of the questions was too broad and complex for a meaningful ten-minute discussion. On health systems strengthening, for example, one set question was “Given the diversity of health systems globally, are there any particular health systems building blocks that should be prioritized for collective action within the pandemic instrument? Which ones and why?” As one participant put it, “one question potentially contained multiple doctoral dissertations.”
Moreover, the exclusive focus on discussing these preset questions strictly bounded what could be discussed. One participant described this as eliciting what the government wanted to hear rather than what needed to be said. Further concerns were raised by how the views expressed and notes taken in the breakout groups were not contextualized by the positioning of the speakers, especially given the strong presence of the pharmaceutical industry.
How the Canadian government will draw meaning from or weigh the validity of different statements put forth by participants, and notably vested interests, is not clear. The opportunity to comment chapter-by-chapter on the zero draft through an on-line system (described by organizers as “passive engagement”) was likely to be more useful to government by generating article-specific insights for negotiators. Overall, providing a better briefing for participants on attendees and the engagement process, offering summaries of available evidence to inform discussions, allowing more focused and longer conversations guided by content experts would have yielded deeper insights.
We recognize that practicing inclusive governance takes time and effort at the best of times. Emerging from a prolonged pandemic, which has opened fissures across Canadian society and globally, the task is now even more challenging. Yet the Canadian and other governments must persist in these laudable efforts. Meaningful engagement gathers insights towards nuanced, responsive, and productive solutions to complex problems.
For those of us participating in the pandemic accord proceedings, hearing from diverse voices, advancing deeper understanding, and building relationships of trust are key ingredients to moving global pandemic governance forward.
In addition to informing government positioning on forthcoming treaty negotiations, meaningful engagement will help renew faith, eroded during the pandemic, in democratic processes at all levels of governance. This rebuilding of trust in government and public health systems will be essential for underpinning public support of a pandemic instrument.
A meaningful process of Canadian consultation will, in turn, encourage similar efforts in other countries where vested interests, rather than the voice of the many, continue to dominate. Ultimately, meaningful engagement improves the chances of adopting a pandemic accord that effectively serves needs across the whole-of-society. We therefore urge the Canadian government to continue its engagement efforts as these historic pandemic accord negotiations advance. Doing so is not only in the best interests of Canadians but a timely opportunity for Canada to model participatory democratic processes on the global stage.
Kelley Lee (corresponding author)
Scientific Director, Pacific Institute on Pathogens, Pandemics and Society
Tier 1 Canada Research Chair in Global Health Governance
Professor, Faculty of Health Sciences, Simon Fraser University
Chair of the Research Ethics Board (REB), Children's Hospital of Eastern Ontario (CHEO)
Governor for Canada, Board of Governors, World Association for Medical Law
National Director, Partners in Health Canada
Research Fellow, Global Strategy Lab, York University
PhD Candidate, Osgood Hall Law School, York University
Kim L. Lavoie
Tier 1 Canada Research Chair in Behavioural Medicine
Professor, University of Quebec at Montreal (UQAM)
Co-Director, Montreal Behavioural Medicine Centre (MBMC)
Professor, School of Population & Global Health, McGill University
Director, Pandemics and Health Emergencies Readiness Lab (PERL)
Health Research Foundation of Innovative Medicines Canada Chair in Pandemic Preparedness Research
Clinical Associate Professor, Faculty of Medicine, University of British Columbia
Michael Smith Health Research BC Scholar
Assistant Professor, School of Nursing, University of British Columbia Okanagan
PhD Candidate, Department of Political Science, University of British Columbia
Assistant Professor, School of Population and Public Health, University of British Columbia
Brian Li Han Wong (Youth Delegate)
Member, Steering Committee, WHO Youth Council
PhD Candidate, Care and Public Health Research Institute (CAPRI), Faculty of Health, Medicine and Life Sciences, Maastricht University
 Christine Harmston, “Message from the Director General of the Office of International Affairs for the Health Portfolio,” Pandemic Instrument Partner and Stakeholder Engagement Forum, Ottawa, 21-22 March 2023.
 Houston AR, Murthy S. Canada is no global health leader on COVID-19 vaccine equity. Lancet 2021; 397(10287): 1803.
 Labonté R, Johri M, Plamondon K, Murthy S. Canada, global vaccine supply, and the TRIPS waiver: Le Canada, l’offre mondiale de vaccins et l’exemption ADPIC. Canadian Journal of Public Health 2021; 112(4): 543-547.
 Yee B. Elon Musk Tweets ‘Countries Should Not Cede Authority To WHO,’ Here’s Why That’s Not Happening. Forbes, 24 March 2023. https://www.forbes.com/sites/brucelee/2023/03/24/will-elon-musks-tweet-further-misconceptions-about-the-who-pandemic-accord/?sh=1ad20a247b23
 WHO. Voice, agency, empowerment - handbook on social participation for universal health coverage. Geneva, 2021. https://www.who.int/publications/i/item/9789240027794
II. PODCAST CORNER
The growing popularity of podcasts as an innovative platform for sharing experiences and views on a wide range of topics was one of the inspirations for starting Global Health Matters. This bonus episode shares some highlights from the Twitter Space moderated by host Garry Aslanyan, covering topics such as the unique advantages of podcasts compared with other communication tools, the accessibility of podcasts, and how they are used by educators in the classroom.
Host Garry Aslanyan speaks with the following guests:
Emmanuella Amoako: Co-host of Global Health Unfiltered podcast
Leshawn Benedict: Host of Public Health Insight podcast
Gordon Than: Host of Public Health Insight podcast
Mark Goldberg: Host of Global Dispatches podcast
Priti Patnaik: Founding Editor of Geneva Health Files
Garry Aslanyan is the host and moderator of the Global Health Matters podcast. You can contact him at: firstname.lastname@example.org
This podcast promotion is sponsored by the Global Health Matters podcast.
If you wish to promote relevant information for readers of Geneva Health Files, for a modest fee, get in touch with us at email@example.com.
IV. WHAT WE ARE READING
Why Ebola sex abuse victims may never find justice: The New Humanitarian
In WHO’s Internal Justice System, All Roads Lead to Director General: Health Policy Watch
IMF ‘Falling Short’ in Climate Crisis: Health Policy Watch
The four horsemen of the apocalypse at the WTO: Peterson Institute for International Economics
Commercial determinants of health: The Lancet
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