The initial COVID-19 outbreak and subsequent variant emergence has proven that the world’s ability to detect and respond to outbreaks is only as strong as its weakest link, and any gap in a country or the larger international system is a risk to people everywhere. Since the beginning of the pandemic, we have seen this narrative play out – from the “lost month” of February 2020 where multiple countries were slow to report information and respond, to today’s vaccine nationalism, which has left over 80% of the population across Africa unprotected against the virus.
The most consequential gap in our current global health architecture is the lack of accountability and compliance to ensure all countries prepare for outbreaks, act in concert if one spreads and distribute life-saving resources equitably. In the last two years, many countries took a piecemeal approach, defied what few regulations were in place and ignored sound public health recommendations from the World Health Organization (WHO). We cannot afford another piecemeal approach. We need a global system that holds all countries to account and ensure assistance for those that need it.
Countries have recognized the cracks in our system and are taking action to fill them. Late last year, they began the process of crafting a new international treaty, convention or instrument for pandemic preparedness and response. An Intergovernmental Negotiating Body (INB) is taking this forward, with a two-year mandate to negotiate and deliver a plan for consideration to the World Health Assembly in May 2024. This plan should address existing gaps and build an accountable international architecture that enables countries at every income level to detect, alert and respond to health threats.
Now is the moment for all those involved to take advantage of this historic opportunity to build a healthier and safer world, learn from the last two years and implement evidence-based solutions. There is a case for a positively incentivised system where compliance with agreed preparedness standards, alert protocols and response efforts is overseen by an independent monitoring and assessment body. Unlike the status quo, such a system would need to be coherently governed by an overarching body overseen at the heads of state level to ensure equity and inclusion, coordination, trust between all parties and accountability.
While setting agreed standards for preparedness is essential, those standards are no good if we don’t ensure all countries are financially capable of meeting them. For many low- and middle-income countries – and even some richer middle-income countries, like Malaysia, insufficient resources over the last decade meant that health systems and economies were ill-equipped to monitor outbreaks, deal with the tsunami of knock-on effects caused by COVID-19 and source the necessary “countermeasures” to respond like PPE, tests and vaccines.
In many cases, COVID-19 funds that were distributed were imbalanced and resulted in further debt. In the first six months of the pandemic, almost all funds committed to low- and middle-income countries by multilateral agencies was debt. It is in all countries’ self-interest to ensure this doesn’t happen again. A new multilateral financing facility to ensure all countries can access predictable and sustainable funding without incurring catastrophic debt will be a necessary step in a new Pandemic Treaty.
While predictability during a crisis is hard to come by, we must do our best to set up a system that instills as much mutual assurance as possible. That means determining who is required to take what action and when must be negotiated and agreed ahead of time to ensure that countries and agencies are ready to go the moment a signal is heard. This includes accountability for preparation; incentives for transparent and real-time reporting of health threats; assured implementation of evidence-based public health measures; timely information sharing, including of genetic sequences, specimens and samples; and equitable distribution of pandemic goods like treatments and vaccines. Moreover, the treaty must not ignore pandemic prevention through the adoption of the planetary health approach – simply put, tackling the upstream environmental drivers of zoonotic spillovers such as climate change and biodiversity loss.
In conclusion, a Pandemic Treaty must be rooted in solidarity, transparency, accountability and equity. The world must wake up and realize that pandemic preparedness and response is not charity, but rather a global good, and demands countries work in solidarity and take responsibility. When countries succeed in reducing greenhouse gas emissions, we do not see this as charity, rather, an obligation on all countries to safeguard life as we know it. Building an international system to save lives and livelihoods against the next health threat is no different. A new Pandemic Treaty must not leave this to chance.
By Professor Tan Sri Dr Jemilah Mahmood, Executive Director, Sunway Centre for Planetary Health at Sunway University and Member, Panel for a Global Public Health Convention
Professor Dr Elil Renganathan, Professor of Public Health and Policy at Sunway University, and Special Advisor, Panel for a Global Public Health Convention
