It shouldn’t be a Christmas tree full of wishes, the International Pandemic Agreement. When the President of the European Council, Charles Michel, brought up the idea in November 2020, he was looking for a lean solution. The world was deep in the corona crisis. There should be a set of rules for future pandemics, focused on the most important points. Michel urged that the world must be better prepared next time. That she needs to act in a more coordinated manner. Or wouldn’t end up in a situation like that again. It was a political moment of great consequence – and a proposal that made sense to many. But after more than three years, the world is still struggling with the agreement. Health negotiations have a tendency to “become like Christmas trees,” says global health expert Ilona Kickbusch. “Each country wants to bring in its own concerns and hang them like baubles on the Christmas tree.”
Over time, Michel’s idea turned into an extensive paper full of vague declarations of intent and also controversial points. Whether this will result in an agreement will be decided this week.
Ilona Kickbusch worked for the WHO herself for many years. Today she heads the global health program at the University Institute for International Studies and Development in Geneva. She is observing the process from close quarters and has good connections with the negotiating committee. The so-called Intergovernmental Negotiating Body has been meeting in Geneva for days, once again. The committee, founded at the end of 2021, is made up of delegates from WHO members: 194 countries need to be united. Will they be able to agree on a pandemic agreement? They still have until Friday to do this. The pressure is high because the 77th World Health Assembly, at which the agreement is to be decided, begins at the end of May.
Why an international pandemic agreement?
Roughly speaking, it is about preventing future pandemics, recognizing them more quickly and fighting them together. The countries would commit to better coordination in the future in order to act in a more coordinated manner. Better early warning systems should be created for this. They should take into account how closely the health of humans, animals and the environment are connected – that is, that disease outbreaks in animals represent a danger, especially where people live closely with them or penetrate ever deeper into their habitat. Countries should ensure stable public health systems and staff that are adequately trained to recognize and respond to health emergencies. Above all, data and samples from new pathogens should be shared quickly globally. There is also talk of more research capacity, more stable supply chains and fairer medical care.
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On the surface, all of this sounds obvious. But it’s not the details. Does fair access to vaccines mean that manufacturers should forego patents and royalties? That they should share important technologies and know-how more generously with countries in the Global South so that vaccines can also be produced in Africa? Wouldn’t that be appropriate, especially if the technologies were created with the help of public money? It is questions like these that come up again and again and also divide the negotiating parties in Geneva. “Never before has there been as much mistrust in a WHO negotiation as it is now,” says Ilona Kickbusch. Because trust was lost in the corona pandemic.
Key point of contention: How do you ensure justice?
Many people remember only too well what happened when countries around the world competed for scarce goods such as masks, gloves, oxygen and, above all, vaccines. Instead of coordinating internationally, countries fell into egotism. Protecting their own people first became the goal of many governments. “Rich countries have snatched the vaccines from others on the market and hoarded them. They have sometimes played off each other and concluded unilateral contracts with pharmaceutical companies,” says global health researcher Till Bärnighausen from Heidelberg University Hospital. This meant that African countries in particular were only able to vaccinate their populations much later. “The way the pandemic goods were distributed globally was certainly poorly coordinated and unfair,” says Bärnighausen, who himself does a lot of research in African countries.
Transparent data versus fair distribution of goods?
To ensure that such fights and the shameful imbalance do not happen again, the negotiations surrounding the pandemic agreement increasingly revolved around the question of justice. In some cases they were overshadowed by a North-South conflict. The countries of the Global North in particular are insisting on unhindered access to data and information about new pathogens. If a dangerous new virus emerges somewhere in the world, other countries should be able to quickly access samples of this pathogen and genome sequence data. So that it quickly becomes clear what you are dealing with. So that diagnostic tools, medicines or vaccinations can be developed.
But the countries of the Global South want security in return for this information. You don’t want to run the risk of sharing data generously, but in the end being the last to receive the vaccinations or other goods that were created on the basis of this information. Especially since transparency can also come at a price. “When my colleagues in Botswana and South Africa discovered the Omicron variant in November 2021 and made it public, many countries blocked flights from there,” says Till Bärnighausen. This caused considerable economic damage, so honesty was punished.
Article 12 of the current draft (PDF) is intended to resolve the dilemma, at least in part. He describes Pathogen Access and Benefit Sharing, or PABS for short. This system is intended to ensure both – on the one hand, that data and samples of pathogens are exchanged worldwide and, on the other hand, that fair access to the resulting “pandemic-related products” such as vaccines is ensured. There have been many discussions in the past few weeks about what this system should look like in detail, what percentage of their production manufacturing companies would give to a collective WHO pot in order to create more justice. “We have come closer on these points,” says Ilona Kickbusch. But will that be enough to reach a good overall agreement?
Wars and changes in government make unification more difficult
The fact that the negotiations are “under a black star,” as Kickbusch says, is not just due to the unfair Corona years. Geopolitics has also overshadowed the conversations. “Who stands with whom on Ukraine, who stands with whom regarding Gaza? All of these things are now influencing the pandemic agreement,” says Kickbusch. Global health used to be a field that united the global community. Even if she was otherwise conflicted. Whether in the fight against smallpox or polio: When it comes to health issues, the world has often stuck together at crucial moments, says Kickbusch. “But now it’s the case that health no longer brings the world together, but divides it.”
Maybe after all this time, the political moment that EU Council President Michel seized in 2020 has simply passed. Not all governments are committed to the plan anymore. “You can see the influence of the many changes of government, also in Europe – as a result we have more right-center governments,” says Kickbusch. They tend to have less interest in international treaties and, in extreme cases, would even see their national sovereignty at risk as a result. The AfD has also submitted a motion in the Bundestag to reject the international pandemic agreement.
Is there a threat of a WHO dictatorship?
But would the pandemic agreement actually encroach on the sovereignty of the countries? The idea is definitely to create an agreement with clear rules that is binding under international law. It would be comparable to the Framework Convention on Tobacco Control, which was negotiated under the leadership of the WHO and came into force in 2005. At that time, 168 countries committed to protecting people more consistently from the dangers of smoking. For example, the convention calls on them to enact comprehensive bans on tobacco advertising, to protect non-smokers from secondhand smoke in public places and to have warnings printed on cigarette packs.
The Tobacco Control Convention is legally binding. However, it gives the signatory countries leeway to implement the requirements within the scope of their own possibilities. And it has to be said: not everyone consistently follows the rules. Germany, for example, introduced the advertising ban too late and has not implemented it 100% to this day. The German Cancer Research Center judged in a report (PDF) that it is also not doing enough to protect health policy decisions from the influence of the tobacco industry. However, this has no consequences because the WHO has no sanctioning power. Nevertheless, the Tobacco Control Convention is considered a success; it is a valuable instrument that continually reminds countries of what the goal is. Your goal. Because they signed the contract voluntarily.
What if the negotiations fail – and Trump becomes US President again?
Whether this will happen with the pandemic contract will become clear in the next few hours. In a press conference last Friday, the chairmen of the negotiating committee were optimistic that a solution could still be found. Some insiders were already afraid that the whole venture could fail, as the negotiations seemed to be going sour.
An extension would be possible; theoretically, such an agreement could also be passed at the World Health Assembly in 2025. But it won’t get any easier. The upcoming election in the USA alone is making many people nervous, says Kickbusch. What if Donald Trump ends up in the White House again? Trump already had his country withdraw from the WHO in 2020. “And of course many fear that he will dig up the letter again as soon as he is in office,” says Kickbusch. More countries might then come up with the idea of withdrawing from the WHO.
H5N1: outbreak in the USA
Bird flu: “It’s the first time we’ve seen an outbreak in cows”
Bird flu: Will the next pandemic start in the udder of cows?
It can now be observed that the USA itself still has a need to learn how to prevent pandemics. Since bird flu broke out in several US dairy farms, meaning the pathogen infected cows for the first time and traces of it were even found in supermarket milk, experts around the world have been worried. The pathogen still lacks critical mutations to be able to transmit from person to person. But if the outbreak is not contained, there is at least an increased risk that H5N1 could change in this direction and ultimately trigger a pandemic at some point.
It is all the more worrying that the outbreak has apparently been going on since the end of 2023, but remained undetected for months. Even after the cases became known, the reaction of the US authorities seemed slow. So far they have been able to say little about the outbreaks. In addition, they shared the genetic data of infected animals far too slowly and in a bulky format, which frustrated researchers immensely. The transparency and speed that people demand from other countries apparently only work to a limited extent in their own country.