Making laws for health

Member states of the World Health Organization (WHO) are about to meet in Geneva, and while everyone agrees that we need to be better prepared for the next pandemic, the question of exactly how remains open.

Way back in 2003, I was temporarily on assignment in Geneva, before starting there as a correspondent a year later. The story: to cover final negotiations, taking place at the annual World Health Assembly, on the Framework Convention on Tobacco Control (FCTC) – a landmark WHO treaty governing the global sale and marketing of tobacco products.

The FCTC remains the only legally binding international public health treaty in existence. Despite the health risks of tobacco consumption being known for decades, the treaty took years to negotiate, during which immense pressure was brought to bear, both by the tobacco industry itself, and by countries which host the industry.

But finally, on May 21, 2003 – my birthday in fact, so my own celebrations had to wait – member states of the World Health Organization adopted the treaty. At a hastily organised press conference the then head of the WHO, Gro Harlem Brundtland, beaming, was certainly celebrating – this was a day she had worked incredibly hard for, and on which she had staked her reputation.

Now, as member states gather again, for the first proper World Health Assembly since 2019, there’s talk of a new legally binding treaty, this one on pandemic preparedness. After the trauma, tragedy, and utter disruption to all our lives, many are convinced we need laws to help us prevent something like this ever happening again.

Lessons learned?

But what lessons do we need to learn from the pandemic, and what exactly should be in such a treaty? That’s the topic of our Inside Geneva podcast this week, and as we find out, views vary. Everyone agrees we must do better next time (and there will be a next time) but what are the key things we should do to ensure better pandemic preparedness?

Inside Geneva’s guests include Suerie Moon, of Geneva Graduate Institute’s Global Health Centre, Nicoletta Dentico, head of the global health justice programme at the Society for International Development, and Thomas Cueni, director of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Dentico is keen to go straight to the root of the problem: zoonotic illnesses. We know Covid-19 originated in bats and then passed, almost certainly via another animal, to humans. So although the exact origins of the virus remain somewhat unclear, and China has, some suggest, been less than helpful towards those researching the origins, we know that animals are hosts to viruses which could be very dangerous to humans, and that these viruses can make the leap to a new species (us) in certain conditions – usually ones of unsafe, unhygienic farm and food production.

‘‘We should look at why zoonotic events do happen, and maybe start banning wildlife trading. A new pandemic treaty should address the way we grow food and breed animals,” Dentico told Inside Geneva.

Binding global rules

But even if we do clean up food production systems, a new virus could still emerge. So how do we prepare better, how do we avoid being forced into rigid lockdowns, and how do we ensure vaccines and treatments are fairly distributed?

Everyone on Inside Geneva agreed that all these areas need improvement, but when it comes to exactly how, things get tricky. Suerie Moon is convinced we need a treaty that is legally binding – promises and kind words won’t do it.

“Charity is not going to be good enough, calls for solidarity are not going to be good enough,” she told Inside Geneva. “Calls to listen to science and do the right thing are not going to be good enough. We have to have many more binding rules that governments really follow because they think it’s in their own best interests to do it.”

This question, legally binding or not, is the key area where member states may find it difficult to agree. As Thomas Cueni points out, the United States has a history of avoiding legally binding treaties, and may prefer a nicely worded voluntary option.

At the same time, anything that legally binds pharmaceutical companies to waive their intellectual properties rights over lifesaving vaccines will be resisted by the industry. Cueni believes it would send the “wrong signal” to the industry and points out that lengthy discussions at the World Trade Organization over an IP waiver (or TRIPS waiver) for Covid-19 vaccines has got nowhere. Meanwhile the pandemic appears to be waning, and there is currently an overcapacity of vaccines.

“That the TRIPS waiver discussion on vaccines is still ongoing, I personally consider as a mix of mind-boggling and insane,” he said.

Slow process

What we can be sure of is that the road to a treaty, even a non-binding one, will be long. International treaties typically take years to negotiate; the target date for some indication of what a draft pandemic treaty might look like is 2024. Anyone hoping for clear progress at this World Health Assembly will be disappointed.

But since there is no disagreement that we all need to do better on pandemic preparedness, let’s hope the next pandemic doesn’t arrive before the treaty does.