Pathogen benefit-sharing pact thwarted again

When you watch international organisations thrash out a major new agreement, it’s a lesson in how geopolitics and rich-country heft plays out, even when it relates to something as fundamental as public health. Inevitably, developed countries manage to get their way and seal the highly unequal and iniquitous terms reached by “consensus” in multilateral fora into binding agreements. We have seen this time and again at the World Trade Organization (WTO). If, however, the developing world digs its heel in, the negotiations are given a fresh lease of life, quite often for an undetermined number of years till a “consensus” more favourable to the developed world is eventually reached. This time, it was the World Health Assembly (WHA) that saw another round of protracted negotiations without concluding a treaty on an improved global strategy to fight future pandemics.

The memory of COVID-19 that devastated countries and communities and killed several million people worldwide just a short while ago appeared to have faded as the 194 member-states of the World Health Organization (WHO) failed to reach an agreement as mandated in the last week of May. The UN agency has been given another two years to conclude the pandemic treaty. The deep differences between the developed nations and poor countries on critical measures like pathogen and vaccine-sharing, which have marked negotiations in the UN agency for two years, were on full display once again. For one, it was a world more polarised than ever before that was meeting in Geneva in May, sharply divided over the savage war unleashed by Israel in Gaza. This ongoing war, which has resulted in the biggest humanitarian crisis in modern times, has also blurred the lines between rich and poor nations and seen dramatic changes in strategic alliances over the genocidal Israeli assault on the Palestinian people.

The war on Palestine overshadowed the 77th WHA negotiations, with several rounds of voting on a resolution moved by a large group of countries (32) trying to focus more attention on the catastrophic conditions in Gaza. India was not among the sponsors of this resolution that sought WHO’s assessment of “the impact of barriers to health access in the occupied Palestinian territory including East Jerusalem, as a result of the longstanding occupation and the ongoing war”. The discussions were marked by bitter debates and accusations of politicisation of the issue by Israel which, just elected to the executive board, managed an unexpected amendment to the resolution by adding a paragraph on release of hostages by Hamas. This resulted in a denunciation of the politicised nature of the Israeli amendment, which seeks to “justify targeting health facilities and putting the lives of citizens in danger”. As a riposte, three additional amendments were suggested by sponsors of the original resolution condemning the “indiscriminate attacks on medical and humanitarian facilities used exclusively for humanitarian purposes”, and referred to two provisional measures ordered by the International Court of Justice, according to a report by the independent news website Geneva Health Files.

A report by Health Policy Watch, which tracks major global health policy challenges, says delegates spent over 10 hours in diplomatic manoeuvres and debates before finally approving the resolution. In contrast, a resolution on humanitarian assistance to Ukraine took just two hours to be passed.

Since last year, WHO, as per its mandate, has been calling for “the unimpeded passage of humanitarian relief, including the access of medical personnel, the entry of humanitarian equipment, transport and supplies in the occupied Palestinian territory, in particular the Gaza Strip”. It had expressed grave concern over the “catastrophic humanitarian situation” and the magnitude of the intense damage to the public health sector, the hospitals bombed, the health personnel killed and the death of thousands of civilians, the majority of them children, women and elderly. The report, prepared by WHO Director-General Tedros Adhanom Ghebreyesus, and its recommendations were also approved. Among other immediate measures, it calls upon the international community to secure enough funds to rebuild the Palestinian health system (wrecked by the Israeli bombings) in full cooperation with WHO and relevant UN agencies.

If this was the big drama, what exactly did WHA achieve? As usual, at the end of such concaves, organisations lay claim “historical” achievements or developments. WHO settled for the latter, a claim based on the agreement reached on a package of amendments to the 2005 International Health Regulations (IHR), and to the fact that commitments have been made to complete negotiations on a global pandemic treaty within a year. 

The historic achievements, according to a WHO statement celebrating the conclusion of WHA, singled out first the introduction of a definition of a pandemic emergency to trigger more effective international collaboration, and second a commitment to solidarity and equity on strengthening access to medical products and financing. But of the critical pathogen access and benefit sharing (PABS) issue, there was no mention at all. This is one of the biggest sticking points in the proposed pandemic treaty, requiring member-countries to quickly share genetic sequences and samples of emerging pathogens. This information is vital for the rapid development of diagnostic tests, therapies and vaccines to fight new pathogen. Rich countries, however, are reluctant to agree to such data sharing because they are expected to provide in return for the genetic sequences vaccines and other products developed from such sequences to poor countries at low cost (see ‘Grab the pathogens but don’t share the drugs’, Down To Earth, 16-31 March, 2024).

Among the proposals on the table is the setting up of a WHO-coordinated laboratory network, PABS database and legal devices like Standard Material Transfer Agreements. African members are determined for a multilateral PABS with clearly defined rules on governance and accountability. Another proposal, already dropped because rich countries and the drug giants have rejected it as unworkable, is for manufacturers to set aside 10 per cent of vaccines for donation and another 10 per cent to be provided at cost to WHO for distribution to low-income nations.

The experience of the SARS-COV-2 pandemic has deepened mistrust. At the end of 2021, more than 90 per cent of the people in richer countries had received two doses of the COVID vaccines, whereas less than 2 per cent of the population in poor countries had got it. It’s telling that while WHO is hopeful of concluding a pandemic treaty by 2025, it has been more flexible with the date for finalising a PABS agreement. The target date is May 2026.