Devastated by covid-19, the world is braced for future pandemics. If we are to avoid this fate, then bolder global solutions will be required. On 30 March 2021, twenty eight world leaders called for an international pandemic treaty to be adopted. [1]  They underline the necessity to approach our future pandemic response and pandemic preparedness with an all of government and all of society response. World leaders’ willingness to act provides a historic window of opportunity for global health diplomacy to create a new rulebook for collective action. Speed is of the essence.

We reviewed the rational and options for such a treaty earlier this year. [2] Now as political support is growing, clarity must be gained on three issues: the scope of such a treaty, the type of treaty to pursue, and the process for its adoption. 

As world leaders have indicated, a pandemic treaty must be cross-cutting in its scope if it is to meet the challenges posed by the pandemic. It will be important—but not sufficient—to address some of the key gaps and ambiguities of the current International Health Regulations (IHR 2005). A treaty must complement and empower the more technical agreements of the IHR such as on matters of compliance, investigations, and on-site verifications. The issue of additional health measures, as well as criteria for and legal implications of a public health emergency of international concern, must be clarified. 

Four further clusters of health issues need to be considered: the approval, production, and supply of—and access to—relevant medical equipment, vaccines, diagnostics, and medicines; the capacity of healthcare sectors in pandemics, including international support when critically needed; cooperation on research and technology sharing; and the intersection of pathogens, pandemics, and “one health” as strongly flagged in the leaders’ statement. The latter would also open opportunities for a much-needed legal response to the closely related challenge of antimicrobial resistance.  

The treaty must also look beyond health—and already some of the health-related issues mentioned above cannot be resolved without multisectoral action, for example, take production or supply chains. The social and economic disruptions caused by pandemics are enormous; the future treaty cannot fulfil expectations without addressing a range of issues such as international movements and transport, fiscal measures, international trade, social protection, jobs and education. The Sendai Framework provides a valuable example of addressing protection of health, lives, assets, and livelihoods in a single international instrument—but it is not binding. [3] When applied to a pandemic treaty, such an approach would both catalyse an intersectoral response to the global challenge, and also position the health sector’s stewardship within it. 

A treaty needs to be clear on governance processes. While it needs to strengthen existing institutions such as the World Health Organization (WHO) and provide it with more authority, it must also clarify in what way the implementation of the treaty would be ensured by intergovernmental and interagency cooperation. The treaty must plan for the financing of countries’ preparedness and response, as well as ensure the full financing of the treaty secretariat, and processes and bodies that treaty might call for—for example regular country reviews or a compliance fund. It might also link compliance to treaty privileges, trade, or monetary measures. 

The leaders state that they see the negotiations taking place under the Constitution of WHO. This would mean that the pandemic treaty would be potentially WHO’s second treaty after the Framework Convention on Tobacco Control (FCTC) adopted in 2003. The process for the new treaty would then likely kick-off at the World Health Assembly (WHA) in May 2021 with pressure to complete the process with high speed. This is a notable difference from the WHO’s first treaty-making experience. The idea of a tobacco treaty was brought up and advocated in expert and civil society circles long before reaching the WHO’s political floor, while this time around a pandemic treaty is called for by influential political leaders. It can therefore be expected that the upcoming WHA would formally launch a preparatory process for a treaty and indicate that formal negotiations should begin rapidly. 

This means that the usual approach to the preparatory work—based on experiences in the UN system—which comprises both expert and intergovernmental components, would be compressed. In the case of the FCTC expert consultations led by WHO (themselves preceded by informal expert input) were held for a period of two years before an intergovernmental preparatory working group could be established to take the process further. [4] In the case of a pandemic treaty, the urgency of the task and the broad political support already in place would justify—indeed necessitate—compressing the two components in a single and much shorter process. The WHA could, for example, mandate an intergovernmental working group to prepare draft elements of the proposed treaty to serve as the basis of future negotiations, based on technical input from WHO. 

Even if the treaty is to be rooted in the WHO’s Constitution, support from the UN system and other relevant international organizations will be indispensable due to the multisectoral landscape of issues to be addressed. Going back to the experience of the FCTC, a UN ad-hoc interagency task force on tobacco control was established in the same year as the WHO’s process for the framework convention was launched. [4] In addition, an influential report by the World Bank made an important contribution to negotiations by providing compelling economic arguments for tobacco control. In a later experience, the UN Office on Drugs and Crime and the World Customs Organization were invited and made important contributions to the negotiations of the FCTC’s Protocol to Eliminate Illicit Trade in Tobacco Products. In the case of a pandemic treaty, in our view, the World Bank, the International Monetary Fund, World Trade Organization and the International Labour Organization must be invited (in addition to “health” partners such as the Global Fund and GAVI). Intense dialogue is necessary with political bodies such as the G7 and the G20 and the increasingly important regional bodies such as the African Union, ASEAN and others. The treaty cannot be seen to be an instrument promoted predominantly by high income countries—that is why the broad scope of the leaders signing the call is so important. Early outreach is required towards parliamentarians, as the treaty will need to be ratified “back home.”

The issue of a framework convention vs a “regular” convention will likely be debated. A framework convention approach would create more space for consensus and compromise, but it would also create a legitimate expectation towards further protocols and similar instruments to provide the often-critical details. Protocols, meanwhile, take considerable time to negotiate and bring into force. The FCTC’s first protocol, on illicit trade, was adopted and entered into force respectively seven and thirteen years after the mother convention came into force.* The first protocols to the UN Framework Convention on Climate Change and the UN Convention on Biological Diversity required, respectively, three and seven years to adopt and 10-11 years to enter into force once the mother conventions were in force.  As we underscored earlier, a framework convention approach could be a viable one if countries could agree on short definite timelines for negotiating further protocols and similar instruments. [2] If this is not deemed feasible, then negotiating a “regular” convention, with all critical details immediately in place, should be the approach to take. 

The design of a pandemic treaty and the speed of the process will be critical. This makes Geneva—where the missions have capacity and experience in the issues at stake, and important political meetings on the treaty process are already taking place—the right place to move forward. There is a tension as to the breath of issues the treaty should cover and the need to act. This is perhaps where the recent call for “a new dynamic  multilateralism” can be essential. [5] As the Director-General of WHO recently noted, “the world cannot afford to wait until the pandemic is over to start planning for the next one.” [6]

Haik Nikogosian, senior fellow, Global Health Centre at the Graduate Institute of International and Development Studies, Geneva, Switzerland

Ilona Kickbusch, founder, Global Health Centre at the Graduate Institute of International and Development Studies, Geneva, Switzerland

Competing interests: none declared. 

References:

1. COVID-19 shows why united action is needed for more robust international health architecture. https://www.who.int/news-room/commentaries/detail/op-ed—covid-19-shows-why-united-action-is-needed-for-more-robust-international-health-architecture.
2. Nikogosian H., Kickbusch I. The case for an international pandemic treaty. BMJ 2021; 372.      doi: https://doi.org/10.1136/bmj.n527 (Published 25 February 2021)
3. Sendai framework for disaster risk reduction 2015-2030.   https://www.undrr.org/publication/sendai-framework-disaster-risk-reduction-2015-2030.
4. History of the WHO Framework Convention on Tobacco Control (2009).    https://apps.who.int/iris/bitstream/handle/10665/44244/9789241563925_eng.pdf;jsessionid=25058BAE71C0311897B27BB11EFC47D4?sequence=1
5. Gayle H., LaForge G., Slaughter AM. America can – and should – vaccinate the world. Foreign Affairs, March 19, 2021.  https://www.foreignaffairs.com/articles/united-states/2021-03-19/america-can-and-should-vaccinate-world
6. WHO Director-General’s remarks at the press-conference with President of the European Council to discuss the proposal for an international pandemic treaty. https://www.who.int/director-general/speeches/detail/who-director-general-s-remarks-at-the-press-conference-with-president-of-the-european-council-to-discuss-the-proposal-for-an-international-pandemic-treaty

 *The Kyoto Protocol and the Cartagena Protocol, respectively