What You Need to Know About the WHO Pandemic Treaty With Georgetown Law Professor Lawrence Gostin
Professor Gostin, who has been involved in the negotiations, shares his insights.
The COVID-19 pandemic blazed an unforgiving and destructive path through public health systems the world over. With SARS-COV-2 still circulating, the international community has been scrambling to fill the gaps exposed by the virus, applying the lessons of the current crisis to prepare for the next.
At the World Health Organization, one of those efforts has faltered. Last month, the members of the WHO assembly shelved a pandemic preparedness treaty that had been in the works for over two years. The treaty would have provided a framework for the international community to more effectively respond to a global public health crisis, but the members could not reach an agreement over certain provisions related to information sharing about pandemic viruses and medical technology.
The pharmaceutical industry has been leveraging its political influence in countries like the United States to weaken any language that threatens its intellectual property—even for vital, life-saving medicines. Meanwhile, the treaty has also faced opposition from right-wing dark money groups like the Heritage Foundation and the Brownstone Institute, a far-right outfit founded to oppose COVID-19 mitigation measures. Brownstone and several other similar groups and anti-vaxxers protested against the treaty last month.
Now, the effort to create a framework to address future pandemics faces an uncertain future. For the latest developments, Important Context interviewed renowned global health law professor Lawrence Gostin, director of Georgetown University’s WHO Collaborating Center on National and Global Health Law. Professor Gostin has been involved in the negotiations process.
Our full interview is below. Our questions are in bold.
The World Health Assembly members recently failed to reach agreement on a pandemic preparedness treaty that has been in the works for two years. Can you explain for our readers, in broad strokes, what that treaty proposed to do and what the failure to finalize it means for humanity today as we continue to face COVID-19 and the inevitability of future pandemics?
Broadly, the treaty was intended to prevent pandemics by preventing dangerous pathogens from "jumping" from animals to humans. So-called zoonotic spillovers cause more than 65% of all novel infectious diseases, including SARA, MERS, Ebola, Avian influenza, and most probably COVID-19. The treaty also intends to increase countries' preparedness and response to epidemics, seeking to prevent outbreaks from international spread. This includes health system strengthening, surveillance, and early reporting of outbreaks. But perhaps the single most important reason for the treaty was to make the world fairer and more equitable, especially in the allocation of vaccines and treatments. The gross inequities during COVID-19 galvanized political will for a treaty.
Why was it so critical to finalize this treaty now, in May?
The concern was that political will was waning as much of the world put COVID in the rear view mirror. Also, 60 percent of the world's population are having elections in 2024 and it could change the political dynamics. There is little doubt, for example, that Donald Trump would torpedo the treaty if he were elected as President.
What were the major areas of disagreement between the WHO members? Can you discuss the competing factions?
Broadly, rich countries like the U.S. and in Europe wanted free and open sharing of scientific information, while low- and middle-income countries especially in Africa wanted guarantees that lifesaving medical products would be allocated fairly. The European Union wants a One Health approach, which are rules to ensure the interconnections between animal health, human health, and the environment. But the Africa group sees this as an unfunded mandate unless there is a funding mechanism. There were also deep disagreement between the Global North and South on intellectual property rights.
Throughout these negotiations, equity has been a major focus for African countries and lower-middle income countries. Why is that? Can you talk a little bit about how the experiences of these nations throughout the COVID-19 pandemic have informed their demands related to the WHO treaty and what those demands are for proposals like the Pathogen Access and Benefits System?
During the COVID-19 pandemic LMICs were last in line for lifesaving products like vaccines and therapeutics. Rich countries in North America and Europe hoarded vaccines. They pre-purchased virtually all of the global supplies, making vaccines scarce and expensive. As a result, millions probably died unnecessarily. Unconscionable inequities have been a fact of life for most global health emergencies, which has caused understandable anger in Africa and other lower income countries.
Why do you think the U.S. and European Union are so protective of pharmaceutical intellectual property protections even now after all we have seen from COVID?
Partly it is because they genuinely feel that they don't want to create disincentives for pharmaceutical companies to invest in products and to innovate. But beyond that is the fact that they are very protective of industries which are located in their territories. Pharma has also lobbied hard against any diminution of IP rights.
What would this pandemic preparedness treaty really have meant for U.S. pharmaceutical companies and intellectual property protections?
Most companies are already highly profitable. I don't think a pandemic treaty would have harmed them much. More important, if Pharma behaved as if health and equity mattered to them, they would gain public trust and respect. That trust is eroding rapidly.
The WHO treaty is just the latest effort to establish a framework for balancing intellectual property rights with the need for essential medicines in times of global public health crisis. In 2020, South Africa and India put forward a proposal ant the World Trade Organization under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement to waive IP protections for COVID tools, including vaccines. How was that fight related to the negotiations at the WHO?
The big fight at WHO was whether WHO itself could regulate IP rights or whether that was principally the role of WTO. TRIPS flexibilities are important but they haven't worked well in practice. The Pandemic Treaty would urge LMICs to seek compulsory licenses in public health emergencies. And more importantly urged high income countries to respect those licenses. In the past, rich countries have placed enormous and unfair pressures on LMICs.
Can you explain how the Trump and Biden administrations approached the TRIPS waiver and what the WTO ultimately ended up doing on the issue of IP?
The Biden administration is still protective of Pharma but is willing to listen to concerns from LMICs. He has a better track record on IP waivers than Trump, but still has not diverged that much from what Pharma wants. The big push back against IP waivers has come from Europe.
What were some of the weaknesses of the pandemic preparedness treaty—for example, the lack of a One Health approach?
It is too early to say as negotiations are ongoing. But the key weaknesses were the lack of financing and the lack of compliance and accountability. Beyond that, PABS and One Health were hotly contested.
We cover misinformation and disinformation at Important Context. The treaty called on parties to collaborate and work against misinformation. Can you talk a little bit about what that could have looked like and explain the enforcement mechanisms?
WHO got a lot of push back from language in the Pandemic Treaty about disinformation with false claims that they interfered with the freedom of expression. The Treaty would urge more work at ensuring more accurate information but in the end it didn't do much to prevent and correct a worldwide disinformation campaign.
Author’s note: For a more in-depth answer to this question, Professor Gostin provided links to his writing on this topic. You can read those pieces here and here.
Right-wing groups came out against this treaty, claiming it put too much power in the hands of international bodies in terms of enforcement and threatened innovation. How do you respond to such assertions?
The answer is that the treaty would not interfere with national sovereignty. Also, WHO would not have the power to order mask or vaccine mandates or order lockdowns as right-wing media has claimed.