The Pandemic Treaty. Can we have high hopes?
You have probably noticed how these days there is a lot of talking around the new Pandemic Treaty, a.k.a. international treaty on pandemic prevention and preparedness. The World Health Assembly established in December 2021 the intergovernmental negotiating body (INB) with the aim of delivering the final draft of the Pandemic Treaty by May 2024. This treaty is strongly supported by the EU, in fact already in November 2020 at the Paris Peace Forum, it was Charles Michel, President of the European Council, to first announce the treaty.
The final aim of the Pandemic Treaty is to be better prepared to the next pandemic in terms of early detection and prevention, response, and resilience. Countries working in synergy, coordinating efforts, are safer than countries working alone, it goes without saying, and it is also clear that the One Health approach will have an important part in the treaty.
Looks great, but there is one problem: international treaties do not work unless enforced, so negotiations will have to agree on what will be made legally binding and what not.
Hoffman and colleagues have recently published a wonderful article on PNAS exactly about how international treaties do not have an effect unless they are enforced. The most striking example is the Paris agreement, which is binding only in theory. And we know how that is going. In the words of the authors “When analyzed by policy domain, only trade/finance treaties produced their intended effects. Human rights and environment treaties have not been shown to consistently improve state practices and sometimes may have caused harm.”
Reaching the same conclusion from another starting point also Toolan and colleague, in a great piece of research published almost at the same time in PLOS ONE. Starting from analysing the role of public health in climate litigations, the authors conclude that “The evidential failure of implied protection of planetary health, stability of the climate and human health through existing laws provides a powerful argument that such protections must be made explicit and legally binding”.
The good news is that apparently the Pandemic Treaty is going to be legally binding (at least in part). This is the first time it happens since the Framework Convention on Tobacco Control, so expectations are high. Until now the negotiations of the INB went well – even too well – to the point that some commentators are talking about “honeymoon negotiations” (meetings are shorter than scheduled, what about that!), but now it is time to decide which provisions will be legally binding and which not. It is also not yet clear what will be the enforcing mechanisms (how will countries be made accountable? will there be punishment for infractions or rather incentive for good compliance?).
Anyway, considering the number of international public health mechanisms in place, impact is to be expected only if all these policies work in synergy, to complement each other, and do not overlap. Notably, the Pandemic Treaty should complement the IHR2005 (or the amended IHR that we will hopefully see in the near future), and, from the EU point of view, the new EU Global Health Policy (please excuse my European chauvinism).
Authors more authoritative than myself are advocating for elements to be added in the Pandemic Treaty. One paper that I found of particular interest has been published on Science by Phelan and Carlson. The authors highlight not just the importance of One Health solutions to reduce spillover risks, but also of considering social aspects. “One unsatisfying solution would be to relegate the pandemic treaty solely to matters of human health as much as possible. […] Pandemics connect to every aspect of society, both driven by and spilling over into politics, the environment, economics, and systematic inequalities and injustices”. The authors bring also forward an additional great opportunity of the treaty “The treaty is an opportunity to dismantle intellectual property law barriers to equitable access in a forum that is more democratically representative of the Global South than the World Trade Organization”. That is a wonderful proposal, as it highlights two crucial aspects: 1) most of the spillovers take place in low and middle income countries, so those countries should have a central role in the negotiations (although Europe was recently highlighted as a possible hotspot for future cross-species transmission, check this Nature paper here authored also by Colin Carlson); and 2) we can aim to equitable access to medicines only if market is regulated, and you know how I feel about leaving the entire drug producing capacity in the hands of private companies.
I would like to end with a quote from a recent editorial of The Lancet Global Health, which is about the IHR, not the Pandemic Treaty, but the message is very much fitting to all the global health initiatives (yes, I am also looking at new EU Global Health Policy!)
“an emphasis on equity may be the only way towards trust and collaboration”