The Covid-19 pandemic revealed deep flaws in global governance structures favouring those with power and wealth and causing avoidable harm to vulnerable populations. Calls for reform of this system have been under way as early as October 2020 when South Africa and India tabled the Trade Related Aspects of Intellectual Property Rights (TRIPS) Waiver Proposal at the World Trade Organization.

That proposal requested a temporary suspension of protection and enforcement of intellectual property rights on Covid-19 diagnostics, therapeutics and vaccines. In response, influential governments in the Global North argued that the request was misguided. They said TRIPS was not the only or even the main driver of unequal access to pandemic products and that much bigger structural barriers needed to be addressed. Based on this, the European Union called for a global agreement on pandemics to be negotiated under the authority of the World Health Organization (WHO). 

Twenty-seven heads of state, including President Cyril Ramaphosa, and the WHO director-general backed the call. It stated: “We are, therefore, committed to ensuring universal and equitable access to safe, efficacious and affordable vaccines, medicines and diagnostics for this and future pandemics. Immunisation is a global public good and we will need to be able to develop, manufacture and deploy vaccines as quickly as possible.”

The above efforts culminated in a special session of the World Health Assembly in 2021, resulting in a decision to start negotiations on a new legal instrument to address pandemic prevention, preparedness and response. The decision was named “The World Together” and it called for “prioritising the need for equity” and “stress[ed] that member states should guide their efforts to develop such an instrument by the principle of solidarity with all people and countries, that should frame practical actions to deal with both causes and consequences of pandemics and other health emergencies”. Currently, WHO member states are meeting in Geneva with the objective to conclude the negotiations and table a final text at the 77th World Health Assembly next month. 

Unfortunately, there is very little in the draft negotiating text to translate equity and solidarity into legally binding practical actions. With only a handful of official negotiating days left, the current situation is disturbing: developed countries continue to say “no” to including proposals tabled by the Africa Group and the Group for Equity that aim to operationalise equity.

Countries of the Global South will remain dependent on buying pandemic products from manufacturers in the north and will never become self-sufficient.

For example, developed countries have said “no” to legally binding obligations to ensure technology transfer to developing countries. The current text contains no legally binding mechanism for effective technology transfer coordinated by the WHO that would facilitate the sharing of technology and know-how to a geographically diversified production network. It contains no obligation on member states to transfer publicly funded pandemic-related product technology to such a technology transfer mechanism. Developed states have also pushed back against incorporating text that would affirm their unequivocal recognition of countries’ rights, already recognised by the Doha Declaration, to temporarily suspend protection and enforcement of intellectual property rights to facilitate local production and expedite the supply of pandemic-related health goods.

This means countries of the Global South will remain dependent on buying pandemic products from manufacturers in the north and will never become self-sufficient. It also means we don’t enlarge the total pool of manufacturers of pandemic products, and production sites remain concentrated in the Global North. Therefore, supply chains will be vulnerable to the same disruptions we saw during Covid-19, and fewer producers means fewer pandemic products for everyone. In this scenario, everyone loses – but Global South countries that don’t have the resources to procure huge volumes of pandemic products from this artificially limited supply pool will once again be the biggest losers – at enormous human and economic costs.

Another example: the current draft text asks states to establish extensive surveillance infrastructure to identify pathogens with pandemic potential. This is very expensive, especially when one has to focus not just on pathogens that have actually caused disease outbreaks, but on ALL pathogens with pandemic potential. However, no new financing mechanisms have been proposed to support this work in Global South countries. Without new financing, Global South countries may have to take money from their limited budgets for surveillance, thereby weakening fragile health systems more in order to service a global pathogen sharing mechanism which will primarily benefit northern countries. 

In South Africa, for example, the state has been saying for decades that it does not have the resources to honour community health workers’ (CHWs) demands to be employed as public sector workers with decent working conditions and salaries. Nevertheless, it depended on CHWs to be the “footsoldiers” of its Covid-19 response efforts. If a new treaty compels the government to spend already limited public resources on establishing new surveillance capacities, CHWs’ demands for decent work risk being kicked even further down the line. Shockingly, the current text does not even include legally binding obligations to facilitate access of health workers to pandemic-related products on a priority basis.

The lack of binding equity commitments… seems to suggest that the only lesson to be learnt is that some lives are considered less worthy of protection than others.

Additionally, the current negotiating text does not guarantee that countries that share pathogens will have access to either monetary benefits or to drugs developed as a result of pathogen sharing. It also does not guarantee that countries that share new pathogens won’t experience blowback for doing so. For example, in November 2021, South African scientists shared details of the new Omicron variant. Instead of receiving praise for promoting an open and transparent approach to science or being given access to vaccines modified to offer better protection against Omicron, South Africa was one of several southern African countries subjected to irrational travel bans. 

During the pandemic we saw Global North countries buying more vaccines than they would need to vaccinate their populations, while highly vulnerable populations in the Global South, such as health workers and the elderly, had almost no access to vaccines. The current text of the pandemic treaty contains no binding provisions that would prevent this from happening again. It contains no mechanisms to prevent the kind of vaccine hoarding we saw during the Covid-19 pandemic – especially during the early days of a pandemic before manufacturing of pandemic products can be ramped up to meet global demand.

We are at a point where Global South countries’ trust in multilateral processes is battered. The world’s promises to learn from the HIV/Aids epidemic, to learn from the 2014 Ebola outbreak, and to learn from the Covid-19 pandemic are beginning to seem like empty promises. The lack of binding equity commitments in the Pandemic Accord text seems to suggest that the only lesson to be learnt is that some lives are considered less worthy of protection than others. 

Read more in Daily Maverick: Covid Archives

Some are calling for the negotiation process to produce a framework agreement by May 2024 that allows countries to agree on the “low-hanging fruit”, while leaving more controversial issues to future rounds of negotiations. However, it is unclear whether a minimalist agreement of this sort will ever deliver on the demands of the Global South. Other international processes that have deferred negotiations about structural reforms aimed at promoting equity have delivered many disappointments. For example, the Doha Development Agenda of the World Trade Organization has still not been concluded, 23 years after it started. In the area of climate justice, the struggle for climate reparations is ongoing. Another round of deferred discussions and reliance on voluntary measures is unlikely to deliver equitable outcomes during pandemics. Indeed, it is likely to cement, if not aggravate, the current inequitable governance arrangements for access to health products needed to address pandemics. 

The South African government should not agree to a pandemic treaty which fails to deliver on predictable access to pandemic health products, technology and finance. WHO member states, especially Global South countries, should resist the pressure to adopt an instrument that is full of paper promises and no legal obligations. Doing so is not obstructionist, it is instead consistent with the mandate given to them by the World Health Assembly: to ensure “universal and equitable access to safe, efficacious and affordable vaccines, medicines and diagnostics for this and future pandemics”. DM 

The People’s Health Movement – South Africa (PHM-SA) is one of 160 signatories to an Open Letter to the director-general of the World Health Organization that raises concerns about the fairness of the treaty negotiating process and calls for the DG to take measures to ensure member states are not pressured into endorsing a treaty containing no binding legal commitments to equity.