WHO: Why a pandemic agreement is important but still a long way off

There is no doubt that the corona pandemic will go down in human history as a global catastrophe: around seven million deaths have so far been laboratory-confirmed to be attributable to Sars-CoV-2, according to the World Health Organization (WHO). The actual number of victims is likely to be many times higher and ranges – depending on the statistics of “excess mortality” in the pandemic years – somewhere between 16 and 39 million. In addition, there is financial damage, which the International Monetary Fund estimates at almost 13 trillion euros.

Wouldn’t it be sensible to analyze the misjudgments and lack of preparation for such a case in detail, to learn from them and to prepare together for the next outbreak? At least that was the intention of the group of 25 states together with the EU and WHO, who called in March 2021 – in the second year of the corona pandemic – to better prepare for the future and to lay down the coordinated approach in an international treaty. But wasn’t it almost foreseeable what fate such an agreement would meet?

The “Paris Climate Agreement” of 2015 seems like a template for the very treaty that is intended to enable the world to defend itself against a new pathogen better than it did with the corona pandemic – as quickly as possible, as transparently as possible, as effectively as possible. The Paris Climate Agreement at least already exists, even if its most important goal – to keep global warming to 1.5 degrees, but in any case well below 2 degrees compared to pre-industrial temperature levels – has already been all but broken. But the pandemic treaty is already in danger of failing before it has even been fully formulated and signed.

WHO pandemic agreement: No contract, instead a multi-page hodgepodge

This was supposed to have happened at the 77th Annual Meeting of the WHO, which ended on June 1 in Geneva. There was a draft, even if it had been watered down several times during months of tough negotiations. But instead of a treaty, only a 62-page hodgepodge of proposed amendments, reservations and annexes with the abbreviation “A77/A/CONF./14” was adopted. And within another year at the most, but preferably by 2024, according to the declaration of intent, there should actually be a real treaty text – for now, of course, just another draft with an uncertain fate. Because even if the text were actually formulated and signed by the end of the year, its existence would remain highly endangered. For example, the former US President and renewed candidate for the highest office in the United States, Donald Trump, announced shortly before the WHO meeting how he intends to deal with such an international treaty should the current incumbent, Joe Biden, sign it but lose the election: On the very first day of his new term in office, Trump said, he would tear up this “monstrosity” and throw it away. But Trump is just one of many opponents of a pandemic agreement, albeit a particularly rabid one.

The problem is evident in the legal form: According to the WHO constitution, a contract is something different from a collection of regulations, which include, for example, the “International Health Regulations” in the 2005 version. It was these regulations that were applied during the corona pandemic – with the well-known result. Basically, even after the WHO Director-General declared a public health emergency of international concern on January 30, 2020, every country did what its rulers wanted. Perhaps even worse: by the end of January, the infections had already progressed so far that there was no stopping them. A Chinese scientist had indeed made the genetic code of the new virus known internationally on January 11, 2020. But that was apparently his own decision, not the policy of his government.

The virus sets the pace

Zhang Yongzhen is still suffering from the consequences of his unauthorized publication of the raw genetic data of Sars-CoV-2: at least for a while, his institute at Fudan University was closed, allegedly because of a necessary renovation. The virologist does not seem to have believed this and posted a photo showing him camping on the street in front of the institute in protest. What this bizarre incident reveals above all is that no one can hope for transparency in the future. But that is precisely what is important in the early stages of a pandemic. Because the outbreak begins a race against the virus. And it is the pathogen that sets the pace and tempo, not politics, not a paragraph of any national law or international treaty. That is why such an agreement must not only be designed to be flexible enough to be able to react as quickly as possible in an emergency. The world’s governments must also be prepared to make their information, such as the genetic data of a new pathogen, available immediately and in full. It was the release of the genetic data by Zhang Yongzhen that made it possible to have a test for the new virus available at Berlin’s Charité hospital at an early stage. It was also this data that allowed vaccine developers like those at Biontech in Mainz to get to work immediately. Transparency is essential in the fight against a new virus. But this is still lacking, as the lax and irresponsible handling of the WHO’s existing health regulations has shown.

These “health regulations” as of 2005 are also binding for the 194 member states, but can be amended or supplemented by a simple majority of the General Assembly. Treaties, on the other hand, can only be adopted with a two-thirds majority and require national ratification by the signatory states. And that can take time. The fact that a treaty is more robust than regulations is, however, not only raising concerns in the USA that their own country, their own parliaments and governments, could lose sovereignty. The – provisional – draft treaty of April 22 therefore contains, for example, this convoluted passage: “The WHO Pandemic Convention shall not be interpreted as conferring on the WHO Secretariat, including the WHO Director-General, the authority to … order, modify or otherwise prescribe or impose requirements on Parties to take specific measures, such as prohibiting or admitting travellers, imposing vaccination requirements or therapeutic or diagnostic measures, or implementing lockdowns.” It is a diplomatic egg and spoon race to negotiate such formulations and even more complicated to apply them in an emergency and to resolve the disputes that will undoubtedly arise. All of this alone would take an enormous amount of time. But time is extremely precious during an outbreak. Because viruses do not wait for political decisions. Nor do they recognize national borders.

Justice instead of “vaccine nationalism”

The problems do not end in the initial phase of an outbreak. Corona has shown that too. “Vaccine nationalism” was a term used by countries in the global south in particular to complain about the unfair distribution of vaccines. Put simply: whoever had the money got the vials. Originally, an internationally led initiative such as “COVAX” (COVID-19 Vaccines Global Access) was supposed to ensure that the vaccines, which were available unexpectedly early, could be delivered to where they were urgently needed. It is part of the nature of a pandemic that this was ultimately the whole world. But since resources were limited, at least in the first few months, it should at least be fair. How it actually went is well known. And that is why one term in particular dominates the negotiations on a pandemic agreement: “equity”.

This concerns the distribution of vaccines mentioned above. But it also concerns the know-how behind it. Countries such as South Africa have demonstrated during the corona pandemic what impressive scientific structures are already available there. It was above all the terrible experiences with HIV/AIDS that had led to this infrastructure over the decades. With their genetic analyses, the institutes there were therefore among the most important supporters in the fight against Sars-CoV-2. At the Nelson Mandela School of Medicine in Durban, South Africa, for example, the “Omicron” virus variant that still dominates today was discovered in November 2021. The world was immediately informed of this. But the thanks were devastating: In Europe and elsewhere, borders were closed and travel bans imposed. Ultimately, a country that had behaved exactly as the experts have been demanding for years and decades was isolated and punished. So how is it surprising that this behavior was perceived as racist? And how encouraged must a country in this region or anywhere else on our planet feel when another outbreak occurs in a rainforest or in a bustling market like Wuhan and it is important to share the data with the rest of the world as quickly and as completely as possible?

“Equity” has another important aspect. If, for example, samples are taken in future outbreak areas that are then genetically analyzed in the global West and used to develop vaccines and medicines, how will the countries and people share in the ownership and potential profits without which such pharmacological developments would not be possible? “Intellectual property” is therefore also an important topic in the WHO negotiations. During the Corona pandemic, rifts already opened up between those who had the knowledge and those who urgently needed it: Would it have been possible, for example, to save many lives in the South? Could a pharmaceutical infrastructure have been built up there or used to significantly increase vaccine production? Intellectual property is ultimately just another word for money. But how difficult it is for the world to distribute financial resources fairly is not only evident in times of pandemics. But even in those times it is a central issue – and accordingly difficult to anchor in an international agreement. In this specific case, fierce disputes are almost certain, and not just between “North” and “South”. The patent dispute rippling back and forth across the North Atlantic between the mRNA developers Biontech/Pfizer and Moderna, in which billions are at stake, is an example of this. But who will settle such disputes in the future? Whether in patent matters or in cases of violations of transparency or the fair distribution of vaccines or medicines? Who will bow to an international court ruling? And how long will the world have to wait for one while a virus continues its epidemic?

In any case, these are not trivial matters that still need to be clarified in detail before an international pandemic treaty that deserves the name can be reached. In January, a team of experts led by US health expert Nina Schwalbe, who is also active worldwide in the corona pandemic, published a commentary in the “Lancet”, one of the most important international medical journals. “Where there’s a will, there’s a way” was the headline at the time – a slogan that WHO Director-General Tedros Adhanom Ghebreyesus also likes to use. At the beginning of the year, there was still hope for a viable compromise. A good six months later, all that remains is the depressing realization that there is no lack of ways, but rather a lack of political will, to prepare the world for the next pandemic. In the future, the price for this recklessness, for this irresponsibility, will be paid above all by those who were not involved in the negotiations at all. Possibly with their lives.