Can a Changing World Agree on the WHO Pandemic Treaty?

LISBON, Portugal — “Work together and mobilize our forces” around the Pandemic Treaty, said experts at the 17th European Public Health Conference (EPH) 2024. The agreement is being designed to promote equity in allocating vaccines, therapeutics, and diagnostics for international health security in preparation for future pandemics.

But time is running out.

A key opportunity has been missed to ensure the accord is put to a vote at a special session of the World Health Assembly (WHA) in December. The reason: A lack of consensus on certain key provisions at the most recent meeting of the Intergovernmental Negotiating Body (INB) from November 4 to 15.

Elena Petelos, PhD, president of the European Public Health Association (EUPHA) global health initiative, chaired a session at the EPH on the topic. She is also involved in the treaty negotiations. She told Medscape Medical News that the World Health Organization (WHO) member states have had the opportunity to reach consensus on fundamental provisions through agreement of key points, with a view to tackling further amendments later.

But in the past few days, the INB announced that more time is needed for negotiation. “Given recent political shifts across the Atlantic, and the view of US President-Elect Donald Trump, the US is likely to withdraw support, critically jeopardizing any likelihood of concluding the agreement for the next WHA scheduled in May 2025,” she said.

Despite substantial progress on all key elements, Petelos said “there’s still work to do in coming weeks, and negotiations will continue into 2025 to conclude for the WHA. Time is of the essence, and the negotiations are now on precarious ground.”

“This should be a wake-up call-for-action across public health communities, everyone involved in care provision, global health, and health-related policymaking,” she added, noting the urgency for strong engagement from member states given how critical the accord is.

Tit Albreht, MD, associate professor of public health at the University of Ljubljana, Ljubljana, Slovenia, who took up the role of EUPHA president on the final day of the conference, told Medscape Medical News, “We definitely need this treaty, and we need to agree upon it at least in general terms.”

He pointed out the “stark contrast” between the Global North and Global South, where the South has been left to its own ingenuity. “In order to work together and mobilize our forces, we need a joint approach, and the Pandemic Treaty definitely represents such a step. We need a workable document soon, even if not drawn to perfection, but we need this to be the basis of future work.”

Doesn’t Need to Be All or Nothing

Ricardo Mexia, MD, public health physician and epidemiologist and EPH conference chair, recognizes that a finalized agreement by the May 2025 WHA is now in the balance. “Even if it’s not the perfect treaty, it is beneficial to make some progress towards a form of the treaty and let it evolve from there later on. It shouldn’t be all or nothing,” he told Medscape Medical News.

“This is a very important issue,” he added. “We seem to alternate between panic in the crisis, and then soon after we seem to forget this important issue, and consequently, we delay sorting out the problems we know exist.”

“We need to fight the sinking feeling that we can’t do this because with this frame of mind, we won’t be able to reach a consensus. We need to make people realize that if we don’t do it now, it will be much harder when we have a future pandemic.”

He explained that the importance of the treaty is that there was “a lot of egocentricity among countries during the pandemic. Countries were closing themselves in with no clear plan on how to disseminate protective equipment, vaccines, and treatments across the world.”

More Work on Fine Details Needed

Petelos highlighted some of the practical considerations to the treaty, along with revisiting the definition of a public health good.

“Equitable access to vaccines and financing for surveillance systems have been some of the more difficult points to negotiate, especially with the proposed 20% for WHO distribution [to the Global South] almost being halved, although negotiations continue.”

Speaker Marta Caminiti, president of the European Network of Medical Residents in Public Health, and medical resident in hygiene and preventive medicine at the University of Perugia, Perugia, Italy, turned to the topic of equity and the lack of agreement over the pathogen access and benefit sharing system, a key component of the WHO Pandemic Treaty. “During the pandemic, the Global South shared pathogen information with the world but then had less access to vaccines, so inequities were evident. Equity must be central to the treaty. It’s non-negotiable because in pandemics, diseases transcend borders and affect everyone.”

Caminiti also highlighted the need for clarification around the language used. She cited the example of a proposed article within the treaty that says strengthening of technology transfer between countries “should be done as appropriate.”

“It’s conditional and not binding,” said Caminiti. “The meaning of the word ‘appropriate’ is currently left open to interpretation.”

Reasons for the delay in reaching consensus are multiple and not unexpected, given the treaty’s global nature and sheer number of countries involved.

In his call for a pragmatic approach, Mexia noted some of the inherent but not insurmountable challenges. “The agreement requires different countries to surrender part of their sovereignty. Each country has its own set of laws and regulations, and this is very difficult to address,” he said. The decisions will have much impact politically, he explained. “This is a key limitation. It is still very unclear what type of tools we will be able to implement.”

Europe Needs to Take Back Control

Professor of EPH, Martin McKee, PhD, from the London School of Hygiene & Tropical Medicine, London, England, commented during the session on the present and future status of the Pandemic Treaty. “There’s an elephant in this room that hasn’t been mentioned,” referring to the recent election of Donald Trump in the United States.

He added, “With due respect, I feel we are living in cloud cuckoo-land at the minute because I fear he [Trump] is determined to disrupt every rule that exists. He will almost certainly withdraw the US from the World Health Organization yet again,” he said, raising the question of what Europe should do in response to this. “We have 4 years of interlude in which the rest of the world can take back control. Let’s look at what we can do in Europe and other regions. What can we do proactively to fill the gap that the American withdrawal will leave.”

“But our global health strategy in the EU is not fit for purpose, frankly,” he added. “The list of things we might be doing is disconnected, so I say can we mobilize together? We need to continue to make the world a better place and we need to confront this reality.”

Petelos, McKee, and Mexia disclosed no relevant financial relationships.