The pandemic has cost seven million lives, but there are talks to prevent a recurrence

The cost of not achieving one? Incalculable, say experts. An unknown future pathogen could have far more devastating consequences than SARS-CoV-2, which has cost approximately 7 million lives and trillions of dollars in economic losses.

But even as negotiators pack in extra hours, the goal of striking a legally binding pact next month is far from certain – despite a new draft document being submitted in recent days. The main bottleneck concerns access to vital information about new threats that may emerge – and to the vaccines and medicines that can counter that threat.

“It is the most momentous time in global health since 1948,” when the World Health Organization was founded, said Lawrence O. Gostin, director of the WHO Collaborating Center for National and Global Health Law at Georgetown University.

The background to today’s negotiations is completely different the years after World War II, when countries united around principles that guarantee universal human rights and protect public health. The unifying fear of Covid has given way to concerns about a repeat of the injustices that have tainted the response to the pandemic, widening the divide between the Global North and the Global South.

“The trauma of the Covid-19 pandemic has permeated the negotiations,” said Ellen ‘t Hoen, a lawyer and public health advocate who specializes in intellectual property policy. According to her, representatives of the 194 member states of the WHO are looking backward rather than forward.

The reasons are clear. An article published in October 2022 in the journal Nature found that nearly 50 percent of the world’s population had received two doses of coronavirus by the end of 2021 vaccine, but that there were huge disparities between high-income countries, where coverage was almost 75 percent, and many low-income countries, where less than 2 percent of the population had received two doses. At the same time, South Africa, where the omicron variant was identified, felt punished by travel bans rather than praised for the epidemiological insight and openness of its scientists.

“We felt like we were beggars when it came to the availability of vaccines,” South African President Cyril Ramaphosa recalled at a global financial summit in 2023. “We felt that life in the Northern Hemisphere is much more important than life in the Global South.”

The United States has expressed support for a legally binding agreement, including using its purchasing power to expand access to medicines around the world. But the United States, like many other countries of the European Union, is the object of distrust because it is the seat of the powerful pharmaceutical industry, which is reluctant to relax control over production knowledge.

The main point of contention concerns access to pathogens and benefit sharing. In many ways, the story of the fraught pandemic deal negotiations is the story of Henrietta Lacks — the African American patient whose cancer cells were used in research for years without her family’s knowledge — retold on a global stage. Who can use – and benefit from – samples and scientific information, which often comes from disadvantaged groups?

High income Countries want guarantees that samples and genetic data on emerging pathogens are shared quickly to enable the development of tests, vaccines and treatments. Developing countries, where pathogens such as AIDS, Ebola and MERS have emerged in recent decades, want guarantees of benefits such as equal access to vaccines and cooperation with local scientists.

Nearly two decades ago, the Indonesian government brought these conflicting priorities to the fore by refusing to share bird flu samples. WHO member states responded by creating the Pandemic Influenza Preparedness Framework (PIP), under which major manufacturers agree to provide 10 percent of the flu vaccines they make to WHO for distribution.

No such agreement exists for other pathogens with pandemic potential.

“The PIP framework gives us good guidance on what an access and benefit sharing tool might look like, but there are areas where the pandemic agreement could improve,” said Alexandra L. Phelan, senior scholar at the Johns Hopkins Center for Health Security, which co-authored a piece in the journal Nature in February calling for a “science-for-science mechanism” to ensure vaccine equity in the next pandemic.

A new agreement, Phelan said, could include a requirement to share genetic sequence data and consider public health risks when determining how medical products are shared during an emergency. Unlike previous outbreaks, today you don’t have to wait for a pathogen sample to arrive in the mail in a test tube; work on vaccines and treatments can begin based on genetic sequencing attached to an email.

Even as negotiators grapple with these issues, the company has been plagued by disinformation on social media, including hostility toward the WHO and claims that any international agreement would threaten the sovereignty of nations – claims that WHO Director-General Tedros Adhanom Ghebreyesus has condemned it as “utterly, completely, categorically untrue.” The final agreement, Tedros said in early April, will not give the WHO the power to impose lockdowns or mask mandates in individual countries.

Underlying all this is “a lack of trust,” says ‘t Hoen, who, like Phelan, is one of the external experts approved by member states to provide input to the negotiations, even if they do not participate in the negotiations. conversations behind closed doors. Some describe hanging around the cafeteria, waiting for the opportunity to gather information or advise country representatives when they need refreshment.

“This is a pretty opaque process,” Phelan said, with “a lot of grumpy and unhappy people.”

The stymied talks prompted former British Prime Minister Gordon Brown, who serves as WHO ambassador for global health financing, to write to the 194 WHO member states in March urging them to work together for the common good. The letter was signed by many former presidents and prime ministers, along with experts in global health and finance.

But signing up is less politically palatable to today’s political leaders now that so many people have put the pandemic behind them and chosen to ignore the not-if-but-when warnings that public health officials are sending out again today, just as they did before the crisis . The new coronavirus was identified in China more than four years ago.

“Global leadership is lacking,” said Nina Schwalbe, director of global health think tank Spark Street Advisors, another expert approved to provide input into the negotiations.

And in many ways, the coronavirus has made the world more vulnerable, Schwalbe and others argue, amid increased resistance to vaccination and other preventive measures and the fatigue of public health officials. In some American states, the powers of civil servants have been limited by the legislature.

Meanwhile, climate change and increased interactions between human and animal populations increase the likelihood of spillover events that produce zoonotic diseases that are virtually impossible to control given the speed of modern travel.

Attempts to study pathogens carry their own risks, as laboratories around the world engage in medical and military research aimed at increasing the virulence of existing bacteria and viruses through gain-of-function research , which poses a threat. from accidental or intentional release.

And in March, the National Academies of Sciences, Engineering, and Medicine published a paper outlining a new danger: Advances in gene editing and synthetic biology are making it possible to revive pathogens, including the virus that causes deadly and disfiguring causes smallpox – the only human disease declared eradicated almost half a century ago after a vaccination campaign by epidemiologists.

“New technologies could allow nefarious actors to manipulate the smallpox virus from scratch or make it even deadlier,” said Gostin, chairman of the committee that authored the National Academies report. “The risk of a laboratory leak or the deliberate release of smallpox or other smallpox viruses is real.”

Nature also shows its power.

Since the beginning of 2023, the Democratic Republic of Congo has reported more than 12,000 cases of MPOX, resulting in There have been 581 deaths and more than 700 cases in the United States this year, according to the Centers for Disease Control and Prevention. Bird flu has been diagnosed in dairy cows in several US states, with one dairy worker treated for symptoms. A new JN.1 strain of the coronavirus is circulating.

When the ninth and supposedly final round of talks on the global pandemic agreement concluded without an agreement at the end of March, Tedros declared overtime and set a date at the end of April for negotiations to resume. The WHO Director-General has portrayed the pandemic deal as an urgent opportunity for generations, and only the second global health deal of this type, after the 2003 Framework Convention on Tobacco Control, which used new taxes and labeling and advertising rules to tackle smoking.

When Tedros was asked in early April whether a deal could still be made, he sounded cautious. “I believe it can happen,” he said. In mid-April, the non-profit organization Health Policy Watch published a new, bare-bones draft agreement that is being sent to member states. It maintains support for equality but leaves out key details for the next two years, by which time the leadership of many instrumental countries, including the United States, may have changed. The meetings will resume on April 29.

Some experts have speculated that the original timeline was too short to unite 194 countries around such a divisive and complex issue. They pointed out that many treaties take years to finalize and that this process is complicated by simultaneous negotiations on the International Health Rules, which aim to prevent the spread of disease. The Biden administration also just announced its own Global Health Security Strategy, aiming to combat health emergencies by using U.S. leadership to drive investments in prevention and response among partner countries.

But past crises have shown that complex global negotiations can move quickly.

“After Chernobyl, a legally binding treaty was negotiated within six months,” Schwalbe said, referring to the 1986 nuclear power plant disaster. “Covid-19 is a disaster of equal importance.”