Despite missed deadline, hope for global treaty rises
The 2024 World Health Assembly met in Geneva, Switzerland, on the final wording of the COVID-19 pandemic agreement and treaty extension
Although the decision-making body of the World Health Organization (WHO) failed to agree on the final wording for a pandemic treaty on 27 May, I am hopeful that differences between countries can soon be overcome. This would avoid repeating the issues associated with the COVID-19 pandemic, such as when wealthy nations prioritized their own access to vaccines at the expense of people in low- and middle-income countries (LMICs).
The agreement and treaty extension were both announced on 1 June, the final day of the 2024 World Health Assembly, the WHO’s annual decision-making meeting in Geneva, Switzerland.
“There was a great weariness setting in Geneva,” says Lawrence Gostin, a specialist in health law and policy at Georgetown University in Washington DC, who closely followed the negotiations. The new deadline was a good one. It showed that there is still political will to get this done and not give up.
The Third World Network is a research and advocacy organization that focuses on development of low income countries in Penang, Malaysia. He says that rushing the discussions to meet the original deadline could have compromised the legitimacy of the process and even reinforced inequities.
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The inequity will be corrected by a treaty. It proposes that the WHO gets access to 20% of the H1N1 tests and treatments as it sees fit. If it received any royalties it would use them to improve access worldwide. A funding mechanism would also be set up to support pandemic preparedness and response efforts, foster international collaboration and establish ways to settle disputes. Research and development would be expanded, as would the transfer of knowledge and technologies to LMICs.
Several delegates speaking at the assembly said that the adoption of the amendments would re-energize the efforts to forge a pandemic treaty. Mekdes Daba, Ethiopia’s minister of health, said that this will create a pivotal moment to accelerate the discussions in the pandemic agreement and complete our unfinished work.
But not all observers are optimistic about the treaty’s future. “They could eventually approve some sort of agreement,” says Nina Schwalbe, a public-health researcher and founder of the public-health think-tank Spark Street Advisors, in New York City. The question is whether or not this will be a real step change for equity or just another excuse to shirk accountability.
I have seen many countries conclude ambitious treaty negotiations, only to fail to comply with the obligations. For example, with regard to free trade, some nations that have promised to avoid subsidies still offer tax breaks to domestic companies; others take advantage of exemptions by delaying renegotiations.
That’s a lot to ask. How can countries be made to comply? Unlike domestic laws, international treaties have no mechanisms to enforce them. There are no penalties for breaching these laws.
Incentives have been included in other treaties. For example, an independent committee could be established to monitor compliance as was the case with nuclear or chemical weapons. The clause is not part of the current draft, but could be added in the future.
Sharing information about compliance increases the likelihood that a nation will follow the law. Other treaties require member states to notify each other when enacting or amending domestic laws that are relevant to the treaty. The draft of the pandemic treaty includes a requirement for reporting and sharing information, with the frequency and content to be determined later. It remains to be seen whether this will be enough.
Treaty compliance cannot be guaranteed by adding all these mechanisms. Most of the time, breeches happen for mundane reasons.
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Different ministries in the same government often struggle to collaborate. It is not the top of every ministry’s agenda to have Pandemic Preparedness. Capacity building in LMICs, or hiring extra health-care personnel if there is a future outbreak of the H1N1 bird flu, might not be something the treasury wants to spend money on.
ministries supporting businesses and industry may find it hard to convince private firms to comply with the treaty if it involves the loss of royalties. Ministries of justice might be reluctant to provide reviews to health ministers after domestic laws are changed.
The WHO’s decision-making body, the World Health Assembly, has failed to agree on the final wording of a COVID-19 pandemic treaty at its annual meeting in Geneva. The draft treaty will require member countries to notify each other when enacting or amending domestic laws that are relevant to the treaty. It will also require reporting and sharing information.