Fractured world unites for a pandemic treaty

Hindustan Times

28-04-2025

On April 16, a new global public health treaty emerged after prolonged multilateral negotiations, among the member-States of the World Health Organization (WHO). The Pandemic Treaty is the second global public health treaty steered by WHO. The first was the Framework Convention on Tobacco Control (FCTC), adopted in 2003. I was a member of the Indian delegation that won global acclaim for ensuring a strong FCTC, despite opposition from the US, Japan and Argentina, alongside hesitancy from some members of the European Union. It was clear then that economic interests around the tobacco trade often prevailed over widely proclaimed commitments to public health.
Similar prioritisation of national trade interests marred negotiations on the Pandemic Treaty, which had been debating contested text over the past four years. The world recognised serious failures in the global response to the Covid-19 pandemic. A strong global treaty was envisaged, to carry global cooperation to firmer ground than slushy affirmations of solidarity during a crisis. The treaty was meant to be adopted in 2024 but negotiations extended till 2025 because countries disagreed on the text in vital areas.
Two contentious areas related to: (a) assurances of equitable global access to vaccines, drugs and technologies, and (b) pathogen sharing by countries that first discover dangerous microbes or their variants (for enabling other countries to produce tests, vaccines and drugs directed at them). High income countries (HICs) wished to protect the patents and profits of their pharmaceutical industries. Low- and middle-income countries (LMICs) wanted to ensure that they had affordable access to vaccines and drugs produced against pathogens shared by them or validated through clinical trials conducted in their populations. As the negotiations stipulated that 'nothing is agreed till everything is agreed', negotiations were protracted, drawing on till all the words were fine-tuned.
The absurdity of haggling by rich countries, which were stridently protectionist of their pharma industry, was evident when they wanted to modify text on technology sharing between countries — from 'on the basis of mutual agreement' to 'voluntary mutual agreement'. This was to ensure that the treaty would not bind countries to measures that were deemed vital for pandemic prevention, preparedness, and effective responses to a dangerous new pathogen. Global solidarity would then remain a pious platitude and insincere commitment. Memories of vaccine hoarding by rich countries during the Covid-19 pandemic are only too fresh. It is also worth remembering that virus variants emerging from unprotected populations circulated around the world to haunt the rich countries that behaved like Ebenezer Scrooge.
Such posturing by some rich countries hid the fact that their own laws permitted their governments to exercise of powers to impose involuntary actions on domestic industries, under exceptional circumstances. The US has a Defense Production Act that confers such powers. Germany, in 2020, enacted legislation to 'protect the population in case of an epidemic situation of national significance'.
It is reassuring that 193 countries waded through these conflicting viewpoints to achieve convergence on several key provisions that include: rapid and timely sharing of information during a pandemic; commitment by manufacturers to supply at least 20% of available vaccines, drugs, and diagnostics to WHO for global distribution during a pandemic; sharing of technology to enhance scale and speed of production needed to combat a pandemic. For the first time, WHO will have an overview of the global supply chains of personal protection equipment (like masks and medical gowns).
The treaty also stresses pandemic prevention, advocating a One Health approach, building geographically diverse research and development capacities, enabling pathogen access for research, facilitating transfer of technology to enable production of pandemic-related health products, mobilising a skilled, multidisciplinary national and global health emergency workforce, setting up a coordinating financial mechanism, adoption of measures to strengthen health system resilience, and establishment of a global supply chain and logistics network.
The treaty upholds the sovereign rights of countries to address public health matters within their borders, and states that nothing in the agreement shall be interpreted as providing WHO any authority to direct, order, alter or prescribe national laws or policies, or mandate countries to take specific actions, such as to ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns.
Many global health experts such as Lawrence Gostin, the eminent American lawyer with expertise in public health law, view this treaty as a major achievement that 'sets important norms for global health'. Others hail it as an assertion of public interest over commercial greed. Coupled with the recent revision of the International Health Regulations (IHR), again under the auspices of WHO, global health systems will now be stronger in alerting attention to, and ensuring prompt action on, new microbial threats around the world.
There have been critics too. During the Biden administration, Republican politicians and Right-wing media commentators criticised US participation in the negotiations, denouncing the draft treaty as a power grab by WHO and an infringement on the sovereign rights of nations. The process by which WHO decides on declaring a pandemic was criticised. The impact on trade and travel concerned many. Critics claimed that WHO was trying to transition from a multilateral body to a supra-national world government.
It was no surprise that the Trump administration withdrew from WHO and exited the treaty negotiations. Perhaps that helped to create a cordial and accommodative environment for the negotiations to proceed to fruition. However, the absence of the US among the ratifying countries will create major gaps in global pathogen surveillance and technology-sharing arrangements. The world will have to find new mechanisms for national capacity building and regional cooperation, even as it tries to infuse intent and content into global solidarity. A global threat needs a global thrust to counter it. The Pandemic Treaty provides that propulsion.
K Srinath Reddy is distinguished professor at PHFI and ISPP. The views expressed are personal