Prevention Obligations in a Pandemic Agreement: Emphasizing Intent & Examining Scope [GUEST ESSAYS]
Newsletter Edition #118 [Treaty Talks]
Hi,
Today WHO member states are meeting to resume negotiations towards a new Pandemic Agreement, albeit under a significantly altered geopolitical frame.
Time is limited ahead of the May 2025 deadline to conclude these talks, and so is opportunity. The coming days will be crucial in determining not just the direction and the outcome of these treaty discussions, but will prove to be a true test for multilateralism in global health, many are of the view.
Committing to prevention obligations, and what they can look like, has divided countries for most of the last three years of this negotiating process. See our update from November 2024 during the previous rounds of negotiations: Rancor Over Disagreement On Prevention Obligations in Pandemic Agreement Talks, Withholds Progress in Key Areas.
In this edition, we bring you two differing views on the ways to approach obligations on prevention. Four Paws and Third World Network have been influential civil society actors in these negotiations that have worked with countries on these provisions on prevention. We present views from experts affiliated with these groups.
Watch out for our updates from these negotiations this week.
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Until later!
Priti
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GUEST ESSAYS
Prevention Obligations in a Pandemic Agreement: Emphasizing Intent & Examining Scope
I. VIEW FROM FOUR PAWS
The One Health Approach: A Cornerstone of the Pandemic Agreement for Global Pandemic Prevention
By Josef Pfabigan
Pfabigan is President and CEO of FOUR PAWS International. On Pandemic and Animal Welfare affairs, contact: paw@four-paws.org
As the world grapples with the lessons of the COVID-19 pandemic, one fact stands out – preventing future pandemics requires a proactive, comprehensive strategy.
The One Health approach, which integrates human, animal, plant, and environmental health, must be a fundamental pillar of the Pandemic Agreement. By addressing the root causes of disease emergence and fostering equity and collaboration across sectors, One Health offers a blueprint for safeguarding global health and preventing local outbreaks from developing in animals, spilling over to humans and escalating into full-blown pandemics.
The Urgent Need for Prevention via a One Health Framework
Human health is deeply intertwined with the health of animals and the environment. Over 70% of emerging infectious diseases in humans originate from animals, underscoring the necessity of a unified health governance approach. Factory farming, fur farming and wildlife trade, private keeping of wild animals and habitat loss, have long been identified as major drivers by creating the perfect hotbeds for pandemics. Phasing out such cruel practices, would protect animals and human health.
Traditional, siloed responses to health crises, that focus on symptom control only, are insufficient – pandemic prevention demands a multidisciplinary effort involving human and animal health experts, environmental scientists, policymakers, communities and civil society.
The COVID-19 pandemic exposed the vulnerabilities of fragmented health systems. As global societies rebuild, there is an urgent need to embrace prevention via the One Health approach. This holistic approach follows a root-cause strategy. It ensures that protecting human health does not begin after animal and environmental health are compromised but that action is taken, so that their health and well-being is also considered and protected. This holistic perspective acknowledges that ecological imbalances – driven by deforestation, unsustainable industrial agriculture, and wildlife trade – fuel the emergence and spread of diseases. Without systemic changes, the world remains at risk of recurrent pandemics.
Prevention: Tackling Root Causes to Stop Outbreaks Before They Start
Surveillance and response strategies are crucial but insufficient on their own. The key to effective pandemic prevention lies in addressing the root causes of disease spillovers. Activities such as deforestation, land-use change, intensive and industrial animal farming, and wildlife trade increase human-animal interactions, creating pathways for zoonotic diseases to jump to humans.
The One Health approach prioritises upstream prevention by:
● Bringing together all sectors and involving the communities at the frontline of outbreaks so that effective and holistic prevention mechanisms are developed and owned by the communities that implement them.
● Tackling the root causes and drivers of diseases that can emerge in animals and spread to humans. Priority measures will vary from country to country and could include regulating wildlife trade to reduce exposure to zoonotic pathogens, reducing deforestation and promoting sustainable land-use practices, improving animal welfare standards in farming and food systems to minimise disease risks, and enhancing surveillance not only of diseases but their drivers, so risk factors are identified and addressed in national strategies. The steps taken by each country, depending on the risk factors they identify and prioritize, will not only enhance animal welfare and protect communities, who come into daily contact with animals but also reduce financial burden and trade restrictions tied to disease incidence and outbreaks in animals.
By integrating these measures into global health governance, One Health ensures a long-term strategy for pandemic prevention rather than reactive crisis management.
Equity: Ensuring Global Resilience and Health for All
Pandemics disproportionately affect vulnerable regions, particularly low-income countries with limited healthcare infrastructure. Successful One Health implementation must prioritise equity, ensuring that resources, knowledge, and technology are accessible to all nations. Capacity-building, financial support, and technology transfer are critical to empowering local communities to adopt sustainable, low-risk practices without jeopardising their livelihoods.
Empowering local communities with the tools to prevent outbreaks, at the earliest stages, before they emerge in animals and escalate is crucial. Timely, coordinated action at both the local and global levels can stop pandemics in their tracks. Countries and international organisations must work together to provide financial and technical support to high-risk regions, reinforcing global resilience against future health threats.
Institutionalising One Health in the Pandemic Agreement
● The Pandemic Agreement offers an unprecedented opportunity to embed One Health principles into global health governance. Article 5 of the Pandemic Agreement underscores the necessity of involving scientists, policymakers, and international organisations such as WHO, WOAH, FAO, and UNEP among others to support member states, if requested, in designing and implementing effective policies aimed at preventing, preparing for and responding to disease outbreaks.
A strong Pandemic Agreement should:
● integrate One Health as a core principle in pandemic prevention, preparedness and response;
● establish international commitments and evidence-based guidelines to enable governments and their communities to reduce drivers of disease spillover;
● ensure financial, technical and implementation support for vulnerable nations, so they have the needed resources to implement pandemic prevention provisions;
● promote robust national surveillance systems that do not only monitor diseases in humans, animals, and the environment, but also their drivers, so that the focus is not only on early detection, after communities are exposed to outbreaks but instead before they suffer, by integrating steps to address drivers of outbreaks in national plans.
Proven Success: Implementing One Health in Practice
Countries worldwide have successfully implemented One Health strategies, offering models for global adoption. Kenya’s holistic One Health strategy and community-led initiatives to prevent zoonotic outbreaks highlight how inter-ministerial collaboration and localised action can prevent outbreaks at the earliest stages and have a global impact. In France, national epidemiological surveillance platforms unite public and private stakeholders in animal health, plant health, and food safety, demonstrating the benefits of integrated health management.
Supporting governments with such plans, exchanging insights on best practices, scaling up these initiatives and embedding them into international policy frameworks will ensure that all countries are empowered to protect their citizens by preventing future outbreaks. The One Health approach enables effective and cost-effective strategies and has transformative potential, becoming a cornerstone of pandemic prevention worldwide.
A Call for Action: One Health as the Future of Global Health Governance
A focus on prevention and tackling the root causes of diseases, before humans, animals and the environment suffer, must define a new era of global health governance. The world cannot afford to repeat past mistakes – reacting only after an outbreak that has spiraled into a pandemic. The Pandemic Agreement must therefore enshrine One Health as a guiding principle and operational approach, ensuring that prevention takes center stage alongside preparedness and response.
By recognising the interconnectedness of human, animal, and environmental health, we can build a resilient global health system that prioritises equity, sustainability, and long-term pandemic prevention. The time to act is now – to protect future generations. We must institutionalise One Health as an essential pillar of global health security. We are counting on WHO member states to successfully conclude the Pandemic Agreement, so that efforts to achieve Health for All are mainstreamed and implemented.
II. VIEW FROM THIRD WORLD NETWORK
Pandemic Agreement: An Attempt to Institutionalize Data Extraction?
By K M Gopakumar and Nithin Ramakrishnan
K M Gopakumar & Nithin Ramakrishnan are legal experts affiliated with Third World Network. Contact: kmgkumar@gmail.com
The preamble of the decision of the Special Session of the World Health Assembly [SSA 2(5)], which adopts the decision to establish an intergovernmental Negotiating Body (INB) to negotiate the legally binding Pandemic Instrument (instrument) acknowledges the need to address existing gaps in the prevention and preparedness and response to health emergencies including “development and distribution of, and unhindered, timely and equitable access to, medical countermeasures such as vaccines, therapeutics and diagnostics, as well as strengthening health systems and their resilience with a view to achieving universal health coverage; emphasizing the need for a comprehensive and coherent approach to strengthen the global health architecture, and recognising the commitment of Member States to develop a new instrument for pandemic prevention, preparedness and response with a whole-of-government and whole-of-society approach..”
The instrument is expected to frame “ frame practical actions to deal with both causes and consequences of pandemics and other health emergencies”. However, the draft negotiating text for the 13th meeting of INB gives a different picture i.e. the proposals are far away from the goals mentioned in the preamble and move to a direction wherein the global public health concern is placed below the economic and strategic interest of developed countries.
One of the important criticisms of the global health emergency regime, including the International Health Regulations (IHR), is that it obligates Parties to share information without any corresponding obligations to share the benefits with countries who provide the information, although parties utilize the information.
The recent amendments to IHR offers some changes. However, the negotiating text for the 13th INB meeting makes a clear departure from the IHR, and proposes an obligation which would institutionalise the data extraction from the Global South without any corresponding obligation to the Global North to share the benefit from the utilisation of data.
Articles 4 and 5
These Articles set out the obligations of parties in the area of surveillance and health. Though Article 4 is titled Prevention and Surveillance, concrete obligations are only in the area of surveillance. Para 1 already enjoys consensus, and states the general obligation of strengthening the preventive and surveillance capacities consistent with the IHR 2005 through individual and international collaboration, in bilateral, regional and multilateral settings.
Para 2, then proposes prevention and coordinated multi-sectoral surveillance in 10 areas.
These 10 areas are:
· Prevention of the emergence and re-emergence of infectious diseases
· Coordinated multi-sectoral surveillance to detect and conduct risk assessment
· Early detection and control measures, including at the community level
· Strengthening efforts to ensure access to safe water, sanitation and hygiene
· Measures to strengthen routine immunisation
· Infection prevention and control
· Prevention of infectious disease transmission between animals and humans, including zoonotic disease spillover
· Surveillance, risk assessments and prevention of vector-borne disease
· Laboratory biological risk management
· Measures to address pandemic-related risks associated with the emergence and spread of pathogens that are resistant to antimicrobial agents
Fulfillment of these obligations requires the deployment of a robust surveillance system and the generation of data. It is understood that developing countries would be forced to share the data generated through surveillance in different ways, such as data sharing, a condition to receive technical and financial assistance to meet the surveillance obligations
However, the proposal under Para 2 (b) obligates the sharing of data with WHO and other relevant organisations. It reads: “coordinated multi-sectoral surveillance to detect and conduct a risk assessment of emerging or re-emerging pathogens, including pathogens in animal populations that may present significant risks of zoonotic spillover, as well as sharing of the outputs of relevant surveillance and risk assessments within their territories with WHO and other relevant agencies to enhance early detection”.
It is also important to note the wide scope of surveillance proposed under Para 2 (b). The scope of surveillance covers both detecting and conducting risk assessment of emerging or re-emerging pathogens as well as pathogens in animal populations that may present significant risks of zoonotic spillover.
This means the surveillance needs to cover not only pathogens that could trigger a disease that have pandemic potential, but also pathogens that pose a mere risk of spillover, those that may not necessarily trigger disease.
Similarly, surveillance requirements are mentioned explicitly for vector-borne diseases. However, it is clear that without surveillance, one cannot take measures to address antimicrobial resistance, prevention of infectious disease transmission between animals and humans, including zoonotic disease spill-over, early detection and control measures at the community level, etc.
Article 4.2 proposes obligations to establish a comprehensive surveillance infrastructure without any resource or technology commitments from developed countries.
Goes beyond the IHR
These surveillance requirements are different from the IHR (2005) amended in 2024.
Under IHR, the surveillance obligations focus on events, which means the manifestation of disease or an occurrence that creates a potential for disease. Thus, the surveillance is restricted to events. The proposal in Article 4 goes beyond the requirements under IHR and obligates parties to establish around-the-clock surveillance of pathogens rather than diseases.
Further, the obligation under IHR is to share the information from surveillance only those “public health information, of all events which may constitute a public health emergency of international concern within its territory”. Contrary to IHR Article 4 obligates parties to submit all information obtained from the surveillance.
Para 2(b) uses the word outputs of relevant surveillance and risk assessments. In the absence of a definition, the scope could be subject to interpretation. It is also important to note that Article 6.2 of IHR does not make it obligatory to share the genetic sequence data of pathogens.
Further, there is no provision in Article 4 to regulate the use /dissemination of information obtained by WHO. Article 11 of IHR 2005 regulates the information flow from WHO.
WHO can disseminate the information to other state parties only when :
(a) the event is determined to constitute a public health emergency of international concern, including a pandemic emergency, in accordance with Article 12; or
(b) information evidencing the international spread of the infection or contamination has been confirmed by WHO in accordance with established epidemiological principles; or
(c) there is evidence that: (i) control measures against the international spread are unlikely to succeed because of the nature of the contamination, disease agent, vector or reservoir; or (ii) the State Party lacks sufficient operational capacity to carry out necessary measures to prevent further spread of disease; or
(d) the nature and scope of the international movement of travellers, baggage, cargo, containers, conveyances, goods or postal parcels that may be affected by the infection or contamination requires the immediate application of international control measures.
In the absence of such any disciplining on WHO on the sharing of data obtained through surveillance, could bear the danger of unintended use.
Data Extraction
In the name prevention, Article 4 proposes a range of data to be collected, and its unrestricted transfer to various agencies, including WHO, without disciplining the use of data. This wide range of data has multiple uses beyond public health objectives and can be used for strategic and economic objectives.
A group of researchers have warned:
“It seems plausible that these technologies might mostly benefit from the research effort and data sharing occurring in tropical countries, where zoonotic viral diversity is believed to be highest . However, their development might mostly further the careers of researchers in high-income countries in North America and Europe, particularly if developed by experts who are unattuned to power dynamics in global health. Equally concerning, we identify a possibility that these tools will largely be developed as proprietary ‘risk assessment algorithms' by corporate ‘data science for impact’ programmes, for-profit global health firms and non-profit organizations, just as they have been for the development of pandemic insurance programmes or similar analytics. In these circumstances, and without appropriate governance, the countries with the highest burden of zoonotic emergence might find their own data (repackaged in an analytic format) sold back to them at a premium by scientists and corporations from high-income countries.”
It is important to note that there is no proposal to facilitate access to health products required for effectively carrying out obligations under article 4 such as routine immunization, new antibiotics or other tools to address AMR or products required for effective vector control.
Further, there is no provision in the agreement to share the benefits from the use of a wide range of data generated as currently proposed in the obligations under Article 4. The only text on sharing benefits is under Article 12.7 in the draft agreement, which offers 20 % of production to WHO (10% of their real-time production free of charge and remaining at an affordable price). There are no concrete commitments to facilitate access to health products during a PHEIC or an outbreak having the potential to become a PHEIC or pandemic.
In its current form, Article 4 could institutionalize the data extraction from developing countries and would reinforce the inequity, defying the rationale for the pandemic instrument stated in SSA 2 (5).
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