Lesson not learned
David Dodwell says a strong draft of WHO treaty aimed at preventing a repeat of the failures of the Covid-19 pandemic has been crippled by nationalism
With missiles whistling around Ukraine and the Middle East, you could be forgiven for not noticing the ninth – and what was supposed to be the final – set of World Health Organization (WHO) negotiations on an urgent and essential global pandemic agreement.
Created in December 2021, and tasked to draft an agreement that ensured we learned the grim lessons of the Covid-19 pandemic – about 20 million deaths and economic costs estimated by the International Monetary Fund at more than US$12 trillion – the Intergovernmental Negotiating Body has toiled for more than two years. After its ninth round of meetings in March, it is now set to present a final draft agreement to the World Health Assembly in Geneva at the end of next month.
However, the desperately sad reality is that negotiators remain light-years away from any agreement. As a form of global amnesia descends on the traumatic pandemic years, it seems the imperative to learn lessons that might protect us from similar future tragedies is also set to evaporate into the ether. The depressing conclusion of Richard Horton, editor-in-chief of the Lancet journal, is simple: “If a pandemic were to strike again, the same failures – vaccine nationalism – would be repeated.”
An initial “zero draft” that circulated more than a year ago now appears to have been diluted, or as the Lancet medical journal notes, “filled with platitudes, caveats and the term ‘where appropriate’”.
In early 2023, the “zero draft” contained details on building an equitable global health security ecosystem. It included recommendations on supply chain resilience for products needed to ensure health security.
The draft focused on improved pandemic surveillance, early warning systems and rapid information-sharing on new pathogens. It emphasised the need for equitable access to technology, clinical trial networks, regionally distributed manufacturing capacity for things like vaccines, and arrangements to ensure equitable distribution. It called for simulations, training for health workers and vulnerability mapping.
Courageously, it focused on rules that would relax intellectual property protections to enable fast technology transfer worldwide. Perhaps inevitably, the draft also called for more powers for the WHO.
But now, with the World Health Assembly meeting just weeks away, differences between the rich Western countries and the developing world seem wider than ever. When the latest round of negotiations ended inconclusively on March 28, the Fox News channel in the United States went on the attack with a story highlighting critics who say the Biden administration was selling out US sovereignty.
An examination of the latest treaty draft by the conservative Heritage Foundation in the US called on US negotiators to withdraw. The think tank complained of “many provisions harmful to US national interests”, too much attention paid to resource transfers, a weakening of intellectual property rights and too much focus on “rewarding China”.
The foundation insists the agreement should be rejected in its current draft form, and that even an “improved” draft would need to be submitted to the US Senate for “advice and consent”.
In the US Congress, Brad Wenstrup, the Republican chair of the US House Select Subcommittee on the Coronavirus Pandemic, insisted the treaty “must not violate international sovereignty or infringe upon the rights of the American people or the intellectual property of the US”.
Voicing the concerns of the global science community, a Lancet editorial retorted that such approaches were “shameful, unjust and inequitable”, saying that there is a “need for high-income countries and private companies to behave fairly, [and] that they do not stockpile millions of doses of vaccines or refuse to share life-saving knowledge and products”.
The editorial complained that, under the current draft treaty, the WHO would only have access to 20 per cent of the pandemic-related products for distribution based on public health risks and needs, leaving 80 per cent of medicines and vaccines “prey to the international scramble that in Covid-19 saw vital health technologies sold to the highest bidder”.
Ensuring equitable access “is not an act of kindness or charity”, it insisted: “It is an act of science, an act of security and an act of self-interest … Ultimately it is the politicians of G7 countries who must put aside vested industry interests and finally understand that in a pandemic it is not possible to protect only your own citizens.”
It feels surreal that there is such reluctance to forge an agreement that captures the lessons we need to protect us from a dreadful repeat when the inevitable next pandemic sweeps across our hyper-connected world.
It is of course possible that, by some miracle of pragmatism, a meaningful pandemic treaty will emerge from next month’s World Health Assembly, just as it is possible for China to open its doors to further investigations into the origins of Covid-19, or for the United States government to face down pharmaceutical giants keeping a firm grip on intellectual property rights.
The realist in me says we are likely to emerge with few meaningful protections. As Horton noted a year ago: “Delivering a global agreement on pandemic preparedness and response would be challenging even in the best of circumstances. And today’s fractured and hostile world does not present the best of circumstances.”
Failure to secure an agreement would be a tragedy for which we would pay a terrible price, perhaps dangerously soon.