A shipment of vaccines against SARS-CoV-2 sent to Sudan. Many governments struggled to secure sufficient vaccines for their citizens during the COVID-19 pandemic.Credit: Ebrahim Hamid/AFP/Getty
The World Health Organization (WHO) last week published a draft of the first legally binding treaty intended to ensure vaccines, drugs and diagnostics are shared more equitably around the world during the next pandemic, avoiding the deep divides seen during the COVID-19 pandemic.
Researchers say that the document is an ambitious effort to address searing inequities that occurred during the pandemic, but that it doesn’t do enough to force countries to share scarce resources or punish those that don’t comply.
“It has more heart and brain than I expected,” says Kelley Lee, scientific co-director at the Pacific Institute on Pathogens, Pandemics and Society in Burnaby, Canada. “But it still has insufficient teeth and an insufficient spine to ensure that we’ll definitely have a better response next time.”
The treaty has the potential to “make a tremendous difference for the next pandemic”, says Suerie Moon, a researcher who studies global health policy at the Geneva Graduate Institute in Switzerland. “This is a once-in-a-generation chance to fix some of the big weaknesses that we saw during COVID-19.” These failures included the huge gulf in access to vaccines. Compared with high-income countries, where some 73% of people have received at least one dose of a COVID-19 vaccine, only 31% of people in low-income countries have had one or more doses.
WHO member states will now begin debating the terms of the document — known as the zero draft — at a series of meetings, the first of which will begin later this month. Researchers expect the negotiations to be contentious, and some of the language is likely to be watered down before the agreement is adopted in 2024.
It’s a tight timeline for creating a new legal instrument, but some researchers say it could still be too late for the next major outbreak. Pathogens with pandemic potential are constantly spilling over from animals to people, and researchers are anxiously tracking a fast-spreading outbreak of H5N1 influenza in birds that has jumped to a number of mammalian species. “Time is not on our side,” says Alexandra Phelan, a global-health lawyer at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
Bold proposal
A key focus of the zero draft is equity. Articles in the treaty include establishing a global network for the supply and distribution of ingredients used to produce drugs; strengthening research and the development of vaccines and therapeutics; and sharing that knowledge with the world.
The draft calls on parties to support temporary waivers on intellectual property (IP) rights to allow for the rapid manufacture of vaccines, medical equipment, masks, diagnostics and drugs when a pandemic hits. Agreeing on these terms before the next crisis occurs could help to avoid the stalemate reached during COVID-19, says Moon. In late 2020, South Africa and India proposed the introduction of a time-bound waiver on IP rights for COVID-19 vaccines, drugs and diagnostics, but the proposal, which was backed by more than 60 other countries, was largely quashed by the World Trade Organization some 18 months later.
The draft also seeks to “strike a grand bargain” in sharing data, says Moon. Rich states want countries to rapidly share data on pathogens and genomes, and low-income states want affordable access to the products created with the aid of that biological information, says Moon. The draft requires signatories to supply pathogens to a laboratory in the WHO’s network within hours of a new pathogen with pandemic potential being identified, and to upload genomic sequences to public repositories. In return, states will supply the WHO with 20% of the vaccines, diagnostics and drugs they produce — half as donations, and half at an affordable cost. But the text falls short of requiring states to share IP rights as part of such an agreement, says Moon.
Under the terms of the treaty, parties should also commit to allocating no less than 5% of their annual health budget for pandemic prevention and response. And they should earmark an as-yet-unspecified percentage of their gross domestic product, in particular to support developing countries in preparing for pandemics. If agreed, Moon says this would be the first instance she knows of in which governments commit to setting aside a specific amount of money for international aid in a treaty. “I don’t think it’s likely, but it’s a bold proposal.”
Weak rules
But researchers are concerned that even if countries do sign up, the treaty in its current form is too weak to stop signatories from ignoring the rules when the next pandemic strikes. The document is intended to be legally binding, but in some key instances, the text avoids strong language, such as ‘shall’ and ‘must’, instead using fuzzier terms such as ‘encourage’ and ‘promote’, say researchers. “It’s still quite heavily reliant on voluntary compliance,” says Lee.
Negotiations around how to ensure compliance have been pushed back, to be addressed after the treaty comes into force, which is problematic, says Layth Hanbali, a health-policy analyst at Spark Street Advisors who is based in Ramallah, in the occupied Palestinian territories. “None of the promises that states will make in the treaty document itself will have any meaning, any effect, unless there is a robust mechanism in place for holding states accountable.”
But Phelan says it is important not to underestimate the value of the treaty-building process itself. Discussions and debates over the provisions will help to build trust between governments, change behaviour and establish international norms of solidarity.