Why a pandemic treaty might empower poor countries in times of global health crisis

There is a lot of debate on why there is a need for a separate treaty for pandemics when the International Health Regulations by the World Health Organisation is already in place.
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The world has not been the same since December 2019. The coronavirus pandemic that has, to date, infected more than 246.8 million people worldwide and killed over five million people has changed the way we look at the world. From critically impacting economies and changing working styles to starting conversations on the need for international cooperation and relaxing intellectual property rights, the pandemic has been transformational. It has also shed light on the existing inequalities between countries in aspects like access to vaccines and economic stability. These inequalities, and the general lack of preparedness, that was evident when SARS-CoV-19 wreaked havoc across the globe is perhaps the reason behind countries rallying for a new pandemic treaty (Treaty for Pandemic Preparedness and Response), helmed by the World Health Organisation (WHO). 

A pandemic treaty, which has been in the works at the WHO for months now, is expected to promote equity in access to medicines and vaccines during a pandemic, to address issues around the search for the origin of pandemics and the related sharing of information between countries. 

A treaty is not a new concept when it comes to global health. The Framework Convention on Tobacco Control (FCTC) was the first treaty adopted by the WHO. Since its adoption in 2003, the FCTC has had 168 signatories and 182 parties come onboard and effectively covers more than 90% of the world population. It is among the world’s most accepted treaties when it comes to public health. With this as a precedent, 28 world leaders proposed the adoption of a pandemic treaty under the auspices of the WHO, in March 2021, after the President of the European Union suggested the idea in December 2020. The main goal of this treaty would be to “foster an all-of-government and all-of-society approach, strengthening national, regional and global capacities and resilience to future pandemics.”

However, many countries like the USA questioned the need for a separate treaty when the International Health Regulations (IHR) is in place. The IHR is an international law instrument that defines countries' rights and obligations in handling public health events and emergencies that have the potential to cause trans-national damage, as per the WHO. IHR is legally binding in 196 countries in the world. However, according to experts, the IHR’s scope is limited as it falls under Article 21 of the WHO’s Constitution (WHOC). Article 21 restricts IHR to public health concerns and related areas. It does not empower IHR to make rules on the wider aspects of global health like intellectual property rights, trade, socio-economic aspects, etc. The pandemic treaty is proposed under Article 19 of the WHOC, which gives more powers to expand the content of the treaty. A new treaty for pandemic preparedness hopes to address the gaps in IHR and ensure more cooperation globally in a pandemic situation, especially around human rights.

A pandemic treaty would help Low and Middle Income Countries (LMICs) strengthen their voice in global health because the treaty would be legally binding in countries that opt to be part of it. In my opinion, a pandemic treaty would help empower LMICs with more bargaining power and create a legal obligation for richer countries to mobilise the required resources to aid poorer countries. Access to vaccines and medicines is an important part of the pandemic response that will improve with such a treaty in place. 

As evident during the COVID-19 pandemic, while wealthier countries engaged in vaccine nationalism and used their money power to purchase or reserve vaccines under development for their population, the LMICs were helpless spectators. There were also instances when wealthier countries hoarded vaccines beyond their requirement thus obstructing availability to LMICs. 

As of March 2021, rich countries with around 14% of the world’s population had procured around 53% of the vaccines. As of June 2021, only 13% of the Indian population had received a vaccine shot while the numbers were more dismal in African countries at a paltry 2%. All this while wealthy countries had vaccines enough to inoculate their population over three times. The most shocking issue is that most of these extra doses of vaccines hoarded by rich countries in the EU will be wasted, while it could have been given to LMICs early on to help in their vaccination programme. 

It is against this backdrop that India and South Africa with the support of the USA proposed temporary patent waivers for vaccines so that they can manufacture and administer them to their population and to the people in other LMICs. This has been under discussion at the World Trade Organisation (WTO) since October 2020 and countries like the UK, Switzerland, and the European Union have blocked the waiver proposal, thus maintaining the lack of access to vaccines. Though organisations like Medecins Sans Frontieres (MSF) and the Biden administration are constantly calling for a temporary suspension of TRIPS waivers, the issue is nowhere close to being resolved. This increases the gap in vaccination coverage between LMICs and the wealthier countries.

The IHR is not empowered to direct countries on these aspects, since it involves issues beyond the mandate of Article 21 of the WHOC. A pandemic treaty, meanwhile, could potentially offer clear directions on issues that combine trade, commerce, patent rights and human rights. Preventing vaccine apartheid is just one aspect of pandemic response. Issues like lack of sharing when it comes to genetic information of pathogens, diagnostics and medical equipment; and the pandemic being used as an excuse to commit human rights abuse are matters of grave concern in LMICs, which could be addressed if there was a pandemic treaty in place.

At times of a global health emergency like COVID-19, it is crucial to put humanity over greed and business needs. Extending all possible help and cooperation to LMICs that, due to lack of adequate resources, may not be able to protect themselves from a raging virus, reflects the idea behind the setting up of the WHO. A pandemic treaty will help put a new world order in place, where there is extended and mutual cooperation between countries. 

Megha Kaveri (she/her) is a journalist and a postgraduate student at the Graduate Institute (IHEID), Geneva. She is specialising in issues around migration and global health in her postgraduate programme.

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