The need for change
For decades, the world has been unprepared to stop infectious disease outbreaks and address the consequences of a global pandemic. COVID-19 exposed cracks in the existing international system and the catastrophic societal and economic repercussions of inaction. Countries were not sufficiently prepared; opportunity to mitigate impact was missed; countries did not comply with the International Health Regulations; and there were major inequities in access to tests, vaccines, drugs and other measures. There is now a historic opportunity to create a new global architecture for pandemic preparedness and response (PPR) to ensure no outbreak becomes a global pandemic again.
A Pandemic Accord for a safer, equitable world
The purpose of a pandemic accord is essentially to stop outbreaks becoming epidemics or pandemics, and to manage them better if they do become pandemics. In December 2021, WHO’s 194 Member States agreed to negotiate a new convention, agreement, or other international instrument on pandemic preparedness and response (referred to as WHO CA+, or, the Pandemic Accord). An Intergovernmental Negotiating Body (INB) was established with a two-year mandate to deliver an Accord for consideration by the World Health Assembly (WHA) in 2024.
The accord’s potential
A Pandemic Accord could create stronger national, regional and global systems to help contain future outbreaks and ensure an equitable, coordinated response. Countries have agreed to pursue a legally binding Pandemic Accord, potentially giving the Accord the authority needed to hold countries accountable to prepare and respond to future health threats. The new accord would represent a global commitment to work together to prevent a future pandemic.
KEY ISSUES FOR NEGOTIATION IN THE PANDEMIC ACCORD
Prevention
Whole-of-society and -government approaches to prevent pathogens that jump from animals to humans (zoonotic outbreaks) as well as pathogens resistant to antimicrobial medicines.
Preparedness
Enhanced financial and technical support, particularly to developing countries, to strengthen health emergency prevention and preparedness. Frequent assessment of countries’ readiness to respond to health threats and to identify potential gaps in cross-sector responses, including in logistics and supply chain management. Peer review and/or independent mechanisms to assess national, regional and global preparedness capacities.
Response
Timely and transparent information sharing and reporting. WHO rapid access to outbreak areas to assess and support the response to emerging outbreaks. Effective whole-of-society and -government response in decision-making, implementation, monitoring, and evaluation.
Equity
Systems and platforms to ensure that the global supply of lifesaving tools, like vaccines, therapeutics, and diagnostics, are predictably and equitably shared during a crisis. ‘Common but differentiated responsibilities’ to prepare and respond to health threats based on countries’ income levels.
Funding
Sustained, predictable funding for health emergency preparedness and response, including from domestic budgets to support preparedness measures. Financial assistance to ensure all countries can meet their obligations under the Pandemic Accord.
Travel and trade
How to avoid unnecessary interference with international traffic and trade while ensuring a comprehensive and coordinated public health response.
Accountability and Incentives / Disincentives
How countries can be held to account, including incentives and disincentives to prepare for and respond to outbreaks.
Governance
How the Accord will be governed and its relationship to WHO defined. It is expected that there will be a Conference of Parties (COP) as part of the governance.
AN ACCORD AND IHR IN PRACTICE
How does this fit with the existing global order?
The International Health Regulations (IHR) are the only existing global framework for preparing and responding to health emergencies. As a legally binding agreement, it requires countries to report outbreaks with risk of international spread to WHO and respond to national health threats. The COVID-19 pandemic exposed IHR’s limits, and as such, a Working Group on Amendments to the IHR (WGIHR) is negotiating over 300 amendments put forward by countries and other stakeholders. This process is separate from, but complementary to, the INB negotiations on the Pandemic Accord. The concurrent negotiations in the INB and the WGIHR pose a challenge, and it is critical that there is alignment and coherence between these two ongoing processes.
What is the legal status of a Pandemic Accord?
In July 2022, Member States agreed to adopt the Pandemic Accord under Article 19 of the WHO Constitution. According to WHO, “Article 19 gives the 194 Member States forming the Health Assembly the authority to adopt conventions or agreements on any matter within WHO’s competence.” Only one other agreement has been established under Article 19 to date, the WHO Framework Convention on Tobacco Control, which has made a substantial contribution to saving lives. Like the FCTC, the Pandemic accord is an ‘opt-in’ arrangement which means that countries will have the choice to join the accord, usually after they ratify the accord at national level. It will be legally binding for the countries opting to join the accord.
What is the legal status of the IHR?
The IHR is a legally binding international instrument adopted under the WHO Constitution Article 21. Unlike Article 19, article 21 is an ‘opt-out’ arrangement. Thus, when the amendments to IHR are adopted through a resolution at the World Health Assembly, every WHO Member State is party to the IHR unless they actively request to opt out of it.
How would an accord and IHR come into force?
If an Accord is not adopted by consensus, Article 19 requires a two-thirds vote of the WHA. Then, countries would need to ratify the Accord at the national level for it to be legally binding. For the IHR under Article 21, a simple majority vote is needed for adoption.
How will the Pandemic Accord and IHR fit together?
Both instruments are expected to play central roles in pandemic prevention, preparedness, and response. It is likely the Accord would set out the principles for Preparedness and Response with the revised IHR setting out the technical requirements.
PROCESS
What are the next steps for the Pandemic Accord?
The INB presented a progress report to the 76th World Health Assembly in May 2023. The negotiations will continue until a final proposal for an Accord is ready to be presented to the 77th World Health Assembly in May 2024.
What is the process for the IHR?
Made up of WHO Member States, the Working Group on Amendments to the IHR (WGIHR) (2005) is responsible for considering proposed amendments to the existing IHR. At the second meeting of the WGIHR in February 2023, the group considered over 300 proposed amendments to the IHR. The WGIHR will hold sessions in July, October, and December to continue discussing amendments to finalize an updated IHR by the WHA in May 2024.
With thanks to: Briefing note prepared with inputs from Panel for a Global Public Health Convention, Pandemic Action Network and UNITE.
