UNGA's PPPR Zero Draft Defers to WHO; Pandemic Accord Talks: Countries to Decide Next Week Whether to Talk Tough Now or Pick "Low-Hanging Fruits" First?
UNGA's PPPR Zero Draft Defers to WHO; Pandemic Accord Talks: Countries to Decide Next Week Whether to Talk Tough Now or Pick "Low-Hanging Fruits" First?
Newsletter Edition #28 [Treaty Talks]
Hi,
One of the tenets of writing well, is to avoid clichés. But if you indulge me just this one time. There seems to be a “war of words” across column inches among select global health governance experts.
The debate is whether to have a high-level heads of state council on preparing and responding to health emergencies, affiliated to the UN General Assembly. This has divided a few influential voices in global health. DG Tedros has already made his views known emphasizing the importance of anchoring any new council in the realm of the WHO constitution.
And the release of a Zero Draft this week, for the high-level meeting in New York in September has some early indications on how these discussions could go. In less than three months, a Political Declaration will be adopted by countries. To the extent possible, we will keep an eye on these developments given their implications for Geneva. We hope you find this edition on Trans-Atlantic global health governance discussions useful.
We have another story for you this week.
As summer definitively settles over Lac Léman, WHO member states have the herculean task of grappling with text presented by the Bureau of the Intergovernmental Negotiating Body. A drafting group meeting starting next week will set the direction of these negotiations over the coming months.
I also want to say how privileged we feel to be able to bring glimpses of these discussions to our readers in near-real-time, thanks to the generous time and trust of our sources.
If you find our work valuable, support us! Tracking closed-door negotiations is tough and expensive. Help us in raising important questions, and keep an ear to the ground. Readers paying for our work helps us meet our costs.
Until next week!
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
STORIES OF THE WEEK
I. UNGA's PPPR Zero Draft Defers to WHO
The Zero draft on the Political Declaration on Pandemic Prevention, Preparedness and Response, for the United Nations General Assembly High-level Meeting in September 2023 reflects many of the themes being discussed in the context of the pandemic accord and the amendments to the IHR, including financing of research and development, sustainability of supply chains, referring to the importance of local manufacturing, among other key areas.
The 14-page document is now being considered by countries and they have until next week to provide comments. A final text is expected to be ready by July 26th after at least two rounds of revision according to a preliminary plan. The declaration is scheduled to be adopted by September 20th at the High-Level Meeting in New York.
This story presents key excerpts from the draft, with opinions from experts who seem divided on the approach to governance and accountability issues stemming from this political declaration.
THE ZERO DRAFT
The document has 29 preambular paragraphs, and 17 operational paras dedicated to equity issues, with five on governance and a dozen spelling out leadership and accountability mattes, and the rest of related health matters and financing issues. There are also a set of proposed follow-up actions including a call to convene a high-level meeting on pandemic prevention, preparedness and response in 2026 in New York.
Excerpts:
Preambular paras:
“…PP7: Express concern that there remains a fundamental mismatch between the scale and speed at which funds are required to finance large-scale operations and ensure equitable and timely access to pandemic-related products during global and regional health emergencies (WHA A76/10, PP22)
PP13. Recognize further that, through the adoption of the Addis Ababa Action Agenda of the Third International Conference on Financing for Development, we supported research and development of vaccines and medicines, as well as preventive measures and treatments for communicable and non-communicable diseases, in particular those that disproportionately impact developing countries; (A/RES/77/275, Verbatim PP3)
PP14. Note that the local production of medicines and other health technologies is a critical development to provide for greater sustainability of supply chains, especially in public health emergencies; (WHA 74.6, Verbatim PP16)
PP15. Recognize the need to support developing countries in building expertise and in developing local and regional manufacturing capacities for tools, including by building on efforts under the COVID-19 Vaccine Global Access (COVAX) Facility, with a view to developing improved global, regional and local manufacturing, handling and distribution capacities while further enabling the increased use of health technologies and the digital transformation of health systems; (A/RES/76/257, Verbatim PP17)
ON EQUITY
The language on equity refers to a range of issues including concerns around healthcare workers; mental health implications; vulnerable groups; apart from specific language on access to medical products.
The set of operational paras under equity also make references to flexibilities in the WTO TRIPS agreement, and also mention “waivers” in the context of removing trade barriers during emergencies.
“OP1. Strengthen international collaboration and coordination at the highest political levels with the determination to reduce inequities and increase the fair, equitable and timely access to, and strengthening of capacities for pandemic prevention, preparedness and response; (New language)
OP2. Ensure the timely, sustainable and equitable access to pandemic -related products, including vaccines, diagnostics, therapeutics and call on the World Health Organization to coordinate this with relevant partners, ensuring coherence with the ongoing discussions of the Intergovernmental Negotiating Body and the Working Group on Amendments to the International Health Regulations (2005) in Geneva; (New language)
…OP11.Promote equitable distribution of and increased access to quality, safe, effective, affordable and essential medicines, including generics, vaccines, diagnostics and health technologies, to ensure affordable quality health services and their timely delivery; (A/RES/74/2, Verbatim OP49)
OP12.Promote increased access to affordable, safe, effective and quality medicines, including generics, vaccines, diagnostics and health technologies, reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) as amended, and also reaffirming the 2001 World Trade Organization Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products; (A/RES/74/2, Verbatim OP51)
OP13.Reaffirm the right to use, to the fullest extent, the provisions contained in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), which provides flexibilities for the protection of public health and promotes access to medicines for all, in particular for developing countries, and the World Trade Organization Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property protection is important for the development of new medicines and also recognizes the concerns about its effects on prices, while noting the discussions in the World Trade Organization and other relevant international organizations, including on innovative options to enhance the global effort towards the production and timely and equitable distribution of COVID-19 vaccines, therapeutics, diagnostics and other health technologies, including through local production; (A/RES/76/257, Verbatim PP20)
OP14.Explore, encourage and promote a range of innovative incentives and financing mechanisms for health research and development, including a stronger and transparent partnership between the public and the private sectors as well as academia, acknowledging the important role played by the private sector in research and development of innovative medicines, while recognizing the need for increasing public health-driven research and development that is needs-driven and evidence-based, guided by the core principles of safety, affordability, effectiveness, efficiency, equity and considered as a shared responsibility, as well as appropriate incentives in the development of new health products and technologies; (Based on A/RES/74/2, OP52 and OP53)
OP15.Promote the transfer of technology and know-how and, encourage research, innovation and commitments to voluntary licensing, where possible, in agreements where public funding has been invested in research and development for pandemic prevention, preparedness and response, to strengthen local and regional capacities for the manufacturing, regulation and procurement of needed tools for equitable and effective access to vaccines, therapeutics, diagnostics and essential supplies, as well as for clinical trials, and to increase global supply through facilitating transfer of technology within the framework of relevant multilateral agreements; (A/RES/76/257, Verbatim OP11)
OP16.Address the need for removing trade barriers, strengthening supply chains, and facilitating the movement of medical and public health goods, especially during pandemics and health emergencies among and within countries, including through appropriate waivers; (New language)
OP17.Call to improve timely and equitable access to quality, safe, effective and affordable vaccines, therapeutics, diagnostics and other health technologies, inter alia, through building capacity for local and regional production, especially in low- and middle-income countries, technology transfer on mutually agreed terms, cooperation with, support to and the development of voluntary patent pools and other voluntary initiatives, such as the World Health Organization COVID-19 Technology Access Pool and the Medicines Patent Pool, and promoting generic competition in line with the World Health Organization road map for access to medicines, vaccines and other health products, 2019–2023; (A/RES/76/257, Verbatim PP21)”
GLOBAL GOVERNANCE
The following set of operational paras under governance recognize the leadership of WHO.
Interestingly there is also language on sharing pathogens and the resulting access to benefits – one of the most contentious topics in the current negotiations in Geneva. The language also refers to One Health.
“…OP18.Strengthen international collaboration and coordination for pandemic prevention, preparedness and response at the highest political level to accelerate efforts to ensure international, national, regional and local readiness for future pandemics and health emergencies; (New language)
OP19.Commit to promote the full potential of the multilateral system and call upon the relevant entities of the United Nations development system, within their respective mandates, primarily the World Health Organization, as the directing and coordinating authority on international health work in accordance with its Constitution, as well as the reinvigorated resident coordinators and the United Nations country teams, within their respective mandates, as well as other relevant global development and health actors, including civil society, the private sector and academia, to assist and support countries in their efforts to achieve pandemic prevention, preparedness and response at the national level, in accordance with their respective national contexts, priorities and competences; (Based on A/RES/74/2, OP80 and A/RES/69/132, PP26)
OP20.Call for the integration of a multisectoral approach towards pandemic prevention, preparedness and response, given the multifaceted consequences of pandemics; (Based on A/RES/77/275, OP2)
OP21.Commit to a fully supported World Health Organization with the authority, independence and funding required to support countries to minimize the risks of health emergencies, and to mitigate their consequences and recognize the leadership and centrality of the World Health Organization on global health matters within the broader United Nations response;(New language)”
ON ACCESS TO PATHOGENS AND TIMELY SHARING OF BENEFITS
“..OP27.Encourage fair, equitable and timely sharing of benefits of pathogens with pandemic potential, including genomic sequences and information, through a multilateral system, and the sharing of benefits arising from their use, including data, knowledge, innovations and tools and taking into account relevant national and international laws, regulations, obligations and frameworks, including the International Health Regulations, the Convention on Biological Diversity and its Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization, and the Pandemic Influenza Preparedness Framework, and also mindful of the work being undertaken in other relevant areas and by other United Nations and multilateral organizations or agencies, particularly the ongoing work of the International Negotiating Body and Working Group on Amendments to the International Health Regulations (2005) in Geneva; (New language)
ONE HEALTH
“…OP35.Call for international cooperation and coordination, to ensure support in building national and community level One Health capacities, enable rapid diagnostics of drivers of outbreaks in animals of zoonotic potential, support communities in transitioning away from high-risk practices and towards other sources of livelihood to support in preventing and mitigating any outbreaks in animals, the environment and humans during both inter[1]pandemic and pandemic times; (New language)
FINANCING
For a political declaration at the UNGA, the zero draft reflects a fair amount of detail including on financing issues for WHO, suggesting how critical WHO’s financial health is in the context of leading on the governance of health emergencies.
The draft also contains language to encourage partnerships with private sector and other stakeholders – deepening the trend towards the financialization of health emergencies governance.
“…OP39.Mobilize domestic public resources as the main source of financing for pandemic prevention preparedness and response, through political leadership, consistent with national capacities, and expand pooling of resources allocated to health, identify new sources of revenue and improve the efficiency of public financial management; (Based on WHO EB152(5) OP1 (5) and A/RES/74/2 Paragraph 41)
OP41.Ensure timely, adequate, predictable, evidence-based and sustainable financing for infrastructure and capacities, while improving their effectiveness to support national efforts in strengthening pandemic prevention, preparedness and response, in accordance with national contexts and priorities, through domestic, bilateral, regional and multilateral channels, including international cooperation, financial and technical assistance, considering the use of traditional and innovative financing mechanisms, as well as partnerships with the private sector and other relevant stakeholders; (New language)
OP42.Commit to leveraging existing financing tools and to explore potential options to mobilize additional timely, reliable, equitable, predictable and sustainable funding for pandemic prevention, preparedness and response, as well as funding for rapid surge financing response in the event of a public health emergency of international concern, and to consider strengthening global health financing mechanisms, as well as their roles and responsibilities; (Based on A/RES/76/257, OP10)
OP43.Commit further to sustainable financing that provides adequate and predictable funding to the World Health Organization, which enables it to have the resources needed to fulfil its core functions as defined in its Constitution, noting the importance of transformation, increased transparency, accountability and efficiency gains in the World Health Organization and stressing the relevance and importance of adequate funding of the World Health Organization Contingency Fund for Emergencies for its rapid response to health emergencies (A/RES/76/257, Verbatim OP9)”
WHAT THE DRAFT CALLS FOR:
In a set of proposed actions, the draft calls for the conclusion “in 2024” the negotiations for the Pandemic Accord and the amendments to the IHR.
“…OP45.Request the Secretary-General to provide, in consultation with the World Health Organization and other relevant agencies, a report including recommendations on the implementation of the present declaration towards strengthening pandemic prevention, preparedness and response during the seventy-ninth session of the General Assembly, which will serve to inform a high-level meeting to be convened in 2026; (New language)”
It also calls for a high-level meeting on PPPR in 2026 in New York, “aimed to undertake a comprehensive review of the implementation of the present declaration to strengthen pandemic prevention, preparedness and response, the scope and modalities of which shall be decided no later than the seventy-ninth session of the General Assembly, taking into consideration the outcomes of other ongoing related processes to strengthen pandemic prevention, preparedness and response. (New language)”
RESPONSE TO THE ZERO DRAFT:
The response to the draft has been mixed.
“We presently have too many processes which provide too many opportunities for regime shifting. The text shows this clearly. The priority process should be the “treaty”. The draft does address that responsibly,” Ilona Kickbusch, an influential global health governance expert told us this week.
(See also by Kickbusch: The World Won’t Be Safer With a Fragmented Global Health System)
In an opinion piece this week, IPPPR panel members who first suggested a Global Health Threats Council, said: “The council’s purpose would essentially be to maintain political commitment and accountability for pandemic preparedness and response.”
Excerpts from Leadership Is Essential to End the Pandemic Panic: The mission of a Global Health Threats Council extends beyond health: Think Global Health by Mauricio Cárdenas, Helen Clark, Joanne Liu, Michel Kazatchkine, David Miliband, Ellen Johnson Sirleaf.
“For a time, the United Nations system was overwhelmed, having no playbook on how to collectively mobilize. Neither the General Assembly (UNGA) nor the Security Council met to coordinate policies and actions. World Health Organization (WHO) staff were working hard but not even the WHO’s Executive Board convened. No senior diplomatic channels were in place to help unblock problems. Lower-income countries couldn’t access World Bank emergency funding at the speed and scale required to protect their people and economies. People in humanitarian crises were left out.
“…We recommend that the council be formed by a UN General Assembly resolution and comprise heads of state and government, with leaders from each of the UN’s regional groupings. We underscore the importance of the council for helping raise and oversee allocation of funds, and emphasize that it be a lean and effective operation with a secretariat of capable professionals, possibly based in Geneva, rather than a large new bureaucracy.
…Rather than “fragment the health system,” such a council would help connect health to the broader arena of global concerns beyond the control of the WHO and national health ministries. In practice, it would be an independent ally to the WHO in working toward the common goal of no more pandemics.
The WHO argues that any such council should be created under its Constitution, but pandemic readiness extends beyond health, and heads of state and government have no tradition of traveling to Geneva to report to the WHO Executive Board or World Health Assembly (WHA). An effective council with adequate participation should not be solely under the mandate of the WHO; instead, it needs to operate with a strong General Assembly mandate and independence from the WHO.”
TAILPIECE:
Governance and accountability issues are one of the key areas where WHO member states have to come together to define what the post-COVID-19 health emergencies governance will look like. For now, there is no real indication at this point on member states’ preferences on what a new structure should look like even within the WHO processes, let alone a body at the UN.
The wider question is whether technical (and political) matters like health be solely determined by technocrats and health ministers, or should high-level political forces (sometimes unpredictable) be relied upon during emergencies that have implications well beyond health? The pie is big and interests are many.
See our previous stories on this:
Countries Assert Their Role In Defining Health Emergencies Architecture: WHA76 Wrap
Need for Accountability, Equity & Cooperation Dominate UNGA hearings on Pandemic Prevention, Preparedness, and Response: By Shoa Moosavi
II. Pandemic Accord Talks: Countries to Decide Next Week Whether to Talk Tough Now or Pick "Low-Hanging Fruits" First?
The Bureau of the Intergovernmental Negotiating Body set up to establish a Pandemic Accord, held an information session for member states and non-state actors earlier this week to discuss the upcoming drafting group meeting during 12-16 June.
At the meeting, Co-Chairs, South Africa’s Precious Matsoso and Roland Driece from the Netherlands presented the way in which the recently released Bureau’s text was crafted building from the overall compilation text (that reflects all country positions with proposals made across the Zero Draft of the Pandemic Accord - more than 200 pages in length).
In a presentation made at the meeting, seen by Geneva Health Files, the Bureau said that they had received 30 individual country submissions, 1 regional submission and submissions from 3 groups of countries to the Zero Draft.
Explaining the methodology to arrive at the Bureau’s text, the co-chairs said, that they used the compilation text as the basis, with the overarching aims of providing text that can bring Parties closer, ensuring text is future proof and ensuring the preservation of sovereignty.
While the Zero draft contains 49 preambular paras, 8 chapters, 18 guiding principles & rights, with 38 articles, the Bureau’s text does not yet have preambular paras, has 3 chapters, 12 general principles & approaches and 41 articles.
See below slides presented at the meeting that capture the choices the Bureau has had to make to streamline the text:
THE BASIS OF NEGOTIATION?
So, while the Bureau has taken pains to crunch essentially months of discussion into a 43-page text, it is not clear whether this document will form the basis of negotiations next week.
In fact, it is not fully certain that countries will “negotiate” or draft language next week. Several diplomatic sources indicated that countries will offer comments on the Bureau’s text, but that it may not result in negotiations per se. Much will depend on whether there is consensus on what to tackle first.
Although according to the document on the meeting, “the INB, through the drafting group, will be invited to discuss and consider the Bureau’s text as a basis for negotiation.” The Bureau is also expected to present a proposal on the way forward.
EASY FIRST, DIFFICULT LATER?
Sources who attended the meeting said that some member states volunteered suggestions on the way forward for the meeting next week.
Developed countries including the US, the UK and Canada, appear to prefer focusing on a small set of issues and tackling difficult issues later.
Suggestions were also made to address difficult issues in informal consultations. There was also a suggestion that proponents of difficult issues could take volunteer to facilitate and present their ideas to countries
Bangladesh reportedly suggested that difficult issues must be addressed first.
“What is the point of discussing easy issues first? It will be a waste of time to discuss something we all agree on,” a developing country diplomat told us this week.
In INB parlance, difficult issues are mostly understood that those concerning intellectual property, access to pathogens and the sharing of benefits among other areas of contention.
“There is no escaping talking about difficult issues. And we are not going to agree to any deals at this stage on picking which issues to discuss. That is not happening”, a diplomat from a large developing country told us.
This week, member states also met for a closed-door meeting between the WG-IHR and INB bureaus.
(See this post from KEI on upcoming meetings in the context of these negotiations: June 2023 – July 2023: WHO intensifies negotiations on the pandemic treaty and the amendments to the International Health Regulations)
Separately, the EU engaged with non-state actors in Geneva this week, on the discussions towards a pandemic accord.
See ours from last week:
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