[COLUMNIST] Urgency in reaching global consensus on pandemic agreement

According to the World Health Organization (WHO), there have been over 7 million deaths directly related to COVID-19 as of May 12, 2024. Some estimate the number to be much higher if we consider all the deaths indirectly caused by the pandemic, as it put a massive strain on healthcare systems across the globe, including in Malaysia.

Seeing how much damage the preventable pandemic has done in a short span of time due to various factors, leaders from different countries, including the Director General (DG) of WHO, Dr Tedros Adhanom Ghebreyesus, have banded together and proposed the idea of a WHO Pandemic Agreement in 2021. The aim is to ensure the world is better prepared for the next pandemic by enhancing global cooperation so we can avoid a similar tragedy in the future.

Fast forward to 2024, the WHO Pandemic Agreement, despite having gone through several rounds of negotiations by the Intergovernmental Negotiating Body (INB) since 2023, have yet to be finalised. The improvements in the latest draft as of April 22, 2024, failed to convince member states to come to a consensus, and the talks ended without agreement on May 24, 2024.

One key part of the argument was the mandatory Pathogen Access and Benefit-Sharing system (PABS) (Article 12). In short, the developing countries that allow access to pathogen samples should be guaranteed access to any products produced by manufacturers using the data, including vaccines and diagnostics equipment.

Other than the PABS, Articles 10 and 11 of the agreement are under intense scrutiny as well. The articles propose that member states with the ability to manufacture health products diversify local production by expanding production lines into developing countries (Article 10) and facilitate the transfer of technology, regardless of government ownership, to developing countries via measures such as licensing agreements (Article 11).

It is more than sufficient to say that the above articles stem from the recent events of how the world has combated COVID-19.

The world has seen unprecedented speed in vaccine development, as multiple nations and research facilities successfully developed several vaccines within a year. However, the distribution of the vaccines is concerning, with high-income countries having the advantage of getting more and earlier access.

According to So and Woo (2020), high-income countries, which comprise only 13.7% of the world’s population, have reserved around 3.85 billion doses of vaccines, accounting for 51% of the stocks at the time.

Malaysia was fortunate to secure some vaccines supplies and rolled out the vaccination programme in late February 2021. In contrast, low-income countries, specifically in the continent of Africa, had only received 37 million doses of vaccines, of which 18 million were administered, accounting for less than 2% of all doses inoculated globally as of April of 2021 (Loembé & Nkengasong, 2021).

Thus, the inclusion of articles ensuring equity in delivery of health products in the WHO Pandemic Agreement is laudable. With Articles 10 and 11, the production of necessary health products can be accelerated, ensuring that the world has enough stock to combat pandemic effectively.

Furthermore, under PABS, in the event that the WHO declares Public Health Emergency of International Concern (PHEIC), manufacturers should provide the WHO with access to 20% of necessary health products for distribution purposes. This would guarantee that low-income countries, which do not have the financial power to secure vaccine supplies, can have their populations immunised, fully committing to the narrative that “no one is safe until everyone is.”

However, the high-income countries have argued that the sharing of technology regarding intellectual properties (IP) should be voluntarily and not mandatory. Stakeholders in the United States (US) have opposed the agreement on the ground of sharing IP would deny companies the opportunity to profit from their investment in the IP itself, which would discourage further research within the industry (The Heritage Foundation, 2023).

Besides US stakeholders, other high-income countries and regions, such as the European Union (EU), United Kingdom (UK) and United Arab Emirates (UAE), have also expressed dissatisfaction with these articles (POLITICO, 2024).

Another point of concern regarding the WHO Pandemic Agreement is the claim that it would give the WHO the power to override the sovereignty of nations, which is also one of the concerns of our Ministry of Health (MOH), according to Code Blue (2024).

The concern over WHO’s power is justified not only on the grounds that a nation’s sovereignty should not be impeded but also due to their actions during the early days of the outbreak, which have courted criticisms from different sectors. These actions include the delay in the declaration of PHEIC and pandemic, as well as the denial of airborne transmission of COVID-19.

These events have cast doubts over the WHO credibility and sufficient agility in a data- and science-driven approach. This is especially important given that the current proposed amendments to the International Health Regulations (IHR) include proposals to expand the scope of what constitutes a PHEIC and give the WHO and its DG the authority to issue legally binding instructions (Behrendt & Müller, 2023; WHO, 2023; WHO, 2024).

However, it should be noted that Article 24(2) of the WHO Pandemic Agreement specifically mentions that the agreement should not be interpreted as providing the WHO Secretariat or DG with the authority to mandate specific actions from member states. Additionally, the agreement would reaffirm countries’ sovereignty in addressing public health matters while ensuring effective collaboration between member states.

It is also uncertain whether the agreement will be a treaty like the Framework Convention of Tobacco Control (FCTC) or a regulation like the IHR.

Given the circumstances where the world’s ineffectiveness in combating pandemic has been exposed, it is advised that Malaysia take a positive stance on the WHO Pandemic Agreement, provided the agreement does not infringe on our sovereignty, which it explicitly reaffirms.

If the agreement concludes with a deal, it would bring many benefits to Malaysia, for we are still a developing country.

In the event of an unfortunate pandemic, we would be able to compete for and secure the right to produce essential health products, including vaccines. This would not only improve our chances of securing vaccine supplies but also provide invaluable experience in manufacturing them, which would immensely benefit our future plans to developing our own vaccines for various diseases. Additionally, ensuring greater transparency in the vaccine manufacturing process is paramount to our national security and sovereignty.

Furthermore, Article 13 of the agreement would mandate transparency in health product pricing, which in turn would enhance transparency in product procurement.

Currently, two global pandemics are considered “ongoing”: the COVID-19 pandemic, and the HIV/AIDS pandemic that began in 1981.

However, as Avian Influenza A (H5N1) gains public awareness due to its spread among cattle in the US, a recent report has mentioned a notable change in the genome of the human virus, indicating viral adaptation to mammalian hosts (Center of Disease Control and Prevention, 2024).

Although there is no yet data suggesting human-to-human transmission, people understandably worry that the next pandemic may hit shortly.

Therefore, the world needs to rekindle the negotiations on the WHO Pandemic Agreement and quickly reach a consensus to safeguarded public health.

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** Chia Chu Hang is a Research Assistant at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.