Pandemic treaty comes as welcome sign of multilateralism

Dolores Reyes Fernández, 61, hugs her father, José Reyes Lozano, 87, for the first time in nearly four months as visits resume at a nursing home in Barcelona in June 2020. Ap2020

The new pandemic treaty is set to be adopted at the World Health Assembly, which starts in Geneva on Monday. Hailed as a historic achievement, it comes as the United States has withdrawn from the WHO.

At the end of May, the World Health Assembly (WHA), the decision-making body of the World Health Organization (WHO), is expected to adopt the new pandemic agreement aimed at better preparing for future pandemics.

In the words of Tedros Adhanom Ghebreyesus, Director-General of the WHO, this is a “historic” moment. It will make the world safer, he said when the negotiations by WHO members ended in April.

The treaty took three years to finalise – quick for an international agreement – amid resistance from some developed countries about sharing technology with developing countries in case of a pandemic.

It comes as US President Donald Trump has challenged the UN-based multilateral system. One of his first executive orders was to pull the US out of the WHO. The US is the WHO’s biggest donor, donating $1.284 billion (CHF1 billion) during the two years 2022–2023. The US withdrew from the final negotiations. 

The agreement was prompted by the Covid-19 pandemic, which killed an estimated 15 million people. The pandemic also brought to light extreme disparities in vaccine access: with rich countries hoarding vaccines while countries mainly in the Global South had to wait months before accessing doses. 

Delegates at the opening day of the 77th World Health Assembly in Geneva on May 27, 2024. The WHO chief urged countries to nail down a landmark global agreement on handling future pandemics after they missed a hard deadline. Afp Or Licensors

Health experts hope the treaty can regulate future pandemics and better coordinate multilateral response. It was welcomed by global health experts and NGOs.

“The agreement is a strong sign of solidarity,” Melissa Scharwey, humanitarian advocacy officer for global health and access to medicines at MSF, told SWI swissinfo.ch.

The treaty is actually three agreements in one, said Ricardo Matute, policy advisor at the Global Health Centre of the Graduate Institute in Geneva. It includes provisions for the prevention of pandemics, for preparedness and for responding to a pandemic.

It was surprising that it could be finalised in just over three years given the current geopolitical context, Matute said. “It’s a historic agreement for multilateralism, a sign that we must solve problems together.”

Can the treaty function without the US?

Experts SWI swissinfo.ch spoke to say the withdrawal of the US from the WHO gave member states an extra push to finalise the treaty ahead of the WHA.

“It was no longer just about the WHO, but also about reaffirming multilateralism,” Matute said. “The system of regulations in the pandemic treaty would not fail even without the US. Over 190 countries are involved.”

The US’s withdrawal from the WHO will not come into force until January 2026. Until then the US remains a member of the WHO and as such could still participate in the upcoming WHA.

The US could decide to join the agreement at a later date. Prior to their withdrawal, the US had “actively participated in the negotiations in the first three years”, Matute said.

The absence of the US does pose certain challenges though. Experts say the withdrawal will have financial implications for the WHO, for public health and for the implementation of the agreement.

It remains to be seen whether the US, for example, will collect pathogens and make them available to the WHO, said Scharwey of MSF. They are in no obligation to do so.

“If the US decides not to do so, there could be gaps in the fight against future pandemics,” Sangeeta Shashikant, legal expert at Third World Network (TWN), told SWI swissinfo.ch. Shashikant attended the negotiations in Geneva as an observer.

‘A step forward’

Most notable advancements include provisions for supply chain and logistics for delivery, says Matute.

Another important provision of the treaty is that governments can impose conditions when companies use public funds for the development of medicines. Prior to the treaty governments often had no legal means of accessing products of private companies or ensuring their distribution.

The aim of the treaty is now to enable the distribution of vaccines and medical supplies in line with health needs and to avoid mass hoarding of medical products.

Fourth booster dose of Covid-19 vaccines for health workers in Indonesia in August 2022. EPA/Bagus Indahono

One of the aims of the treaty is to convince developed countries to share knowledge and production facilities to help developing countries produce pandemic-related vaccines, treatments and diagnostics locally. Transfer of technology between developed and developing countries was one of the touchpoints of the negotiations.

The treaty now states that the parties are legally bound to promote technology transfer. The process is mutually agreed upon between the countries and willingly undertaken, according to the treaty.

Further negotiations needed

But it will take several years for the treaty to come into force. The agreement includes an annex that has yet to be negotiated and is to be adopted at the WHA in 2026. Only then will both documents be opened for signature and ratification.

They can enter into force only once 60 countries have ratified them.

The annex concerns pathogens of potential pandemics, their genetic sequences and the sharing of financial benefits of any medical products the companies manufacture with the pathogens.

Currently, countries send their pathogens to WHO-coordinated laboratories. Pharmaceutical companies then use these pathogens to manufacture medical products, creating a system with inequitable access to treatments.

Companies using the mechanism have to give the WHO 10% of their products for free and 10% at affordable prices in the event of a pandemic.

However, this is not enough, according to Shashikant. She added that equitable access to medical products to contain outbreaks and prevent pandemic should also be included in the treaty.

In case of a pandemic, production must be expanded quickly, she said. “Licences are therefore needed so that more manufacturers in developing countries can participate in production.”

Other open questions include the lack of a control mechanism and sustainable financing.

Until the treaty comes into force, MSF is calling on governments to start implementing measures at a national level. According to observers present at the negotiations, civil society will play an important role in holding governments accountable, as there is no control mechanism planned in the treaty.

Edited by Virginie Mangin/ts