Global treaty on pandemic

The Covid-19 pandemic is on the decline in India, with the number of cases falling in all regions. Globally, a consistent decrease in cases was reported in January, but there has been a slight increase in the numbers this month. The number of deaths, however, has continued a decreasing trend all over. According to the WHO, over 468 million confirmed cases and over 6 million deaths have been reported globally as of March 20, 2022. Vaccination has shown a consistent rise in many countries, but the coverage remains low in some of the poorer countries in Africa and other regions. Given that the pandemic has disrupted the world in unprecedented ways and crippled livelihoods and the economies in the past two years, international bodies have been talking about ways to deal with future pandemics. Among the steps proposed is a new global treaty under the aegis of the WHO. The process to frame such a treaty has been kicked off. Like any other treaty, the success of this exercise, which is supposed to be completed in two years, would depend on several factors.

Without equity as a core principle of health, the treaty could meet the same fate as climate change.

From the very beginning of the pandemic, it became clear that cooperation among countries is necessary to address it. The WHO, being a technical and scientific agency, provided the guidance on various public health and biomedical measures needed to address the challenge. The agency is also a clearing house of global pandemic data. National governments had to take a call on various measures, such as masking, lockdowns and travel restrictions, based on technical advice and local situation. The WHO was accused of being lax when it came to investigations about the origin of the virus in China. Some administrations criticised the agency for being soft on China. The overall role of the international body in handling the crisis also came under the scanner, with calls for widespread reforms. On the other hand, as an organ of the UN, the WHO felt handicapped concerning its powers to independently investigate outbreaks in countries. The biggest hurdle is WHO’s dependence on member countries on disease-related information and data.

The present system of dealing with health emergencies of international nature is focused on a set of legally-binding rules, International Health Regulations (IHR), adopted in 2005 after the experience of SARS outbreaks in 2002-2003. China suppressed information about SARS outbreaks for months, leading to its spread to other countries. IHR rules set out obligations and responsibilities of countries in the event of ‘public health events’ of cross-border nature. They also empower the WHO to initiate health emergency measures, including travel restriction advisories. It was the IHR Emergency Committee that recommended that Covid-19 be declared a ‘public health emergency of international concern’ in its meeting on January 30, 2020. Since then, it has been meeting regularly and making recommendations about new ‘variants of concern’ and other developments. However, the experience so far shows that the IHR is a weak framework and its implementation has been lax in areas such as capacity building, monitoring, surveillance etc. In May 2020, the World Health Assembly asked the WHO to review the functioning of the IHR system and its implementation, in the wake of the pandemic. In December 2021, the health assembly approved the work on a new global treaty for pandemic preparedness.

The negotiations on the proposed treaty have just been initiated. The first question is the form it should take – a convention, legally binding instrument or something else. The WHO constitution empowers the health assembly to adopt conventions on health issues. The only available example is that of the Framework Convention on Tobacco Control which came into force in 2005. Under the convention, the Protocol to Eliminate Illicit Trade in Tobacco Products was adopted. Some countries are suggesting a similar approach for the pandemic treaty – an umbrella framework convention on health emergencies and specific protocols under it. For instance, the EU is talking about a protocol to ban trade in wild animals to prevent the spread of zoonotic diseases. There are demands for mandatory sharing of genome sequencing data on new and emerging viruses and access to diagnostics and vaccines. It is also unclear if the new instrument or treaty will replace the IHR or play a complementary role. The negotiating committee will have to grapple with all these contentious issues.

Even as the process to develop a new rule book for global health has begun, let’s not ignore the biggest lessons so far. The pandemic has only exacerbated existing inequities in health. Despite vaccines having been developed in record time, the vaccination coverage has remained low in many poor countries. People in rich countries have got booster doses and have stockpiles of vaccines. On the other hand, the vaccine pool facilitated by the WHO has failed in ensuring vaccines for the poor. Equity, affordability and access to diagnostics, vaccines and treatment remain a challenge. The pandemic has not made countries to budge from their hard positions in geopolitics as well as trade negotiations. All intellectual property barriers have remained intact. At the same time, there are attempts to undermine the WHO role and promote certain private initiatives like the Global Health Security Agenda, promoted by the US to address health emergencies. The very idea of multilateralism is under attack.

Under these circumstances, it is not prudent to pin hopes of a new health treaty capable of delivering. For decades, the world has been negotiating a climate change treaty and all that it could deliver was failed mechanisms like Kyoto Protocol and carbon credits while emissions continue to grow. The rich have consistently rejected the principle of historical emissions and ‘common but differentiated responsibility’. The promises of transfer of technology and finance for the poor countries have remained on paper. Without acknowledging access and equity as core principles of health, the pandemic treaty could also meet the same fate as climate change.