Digging into the hardware of the Zero Draft

Public Statement on Zero Draft of Pandemic Treaty

While the entire global health community is examining the zero draft of the WHO CA+ text, developed for the consideration of the Intergovernmental Negotiating Body at its fourth meeting in February 2023, we wish to raise concerns about the fact that, yet again, the currently available text overlooks elements that are foundational for the success of a multilateral accord that will have operational, systemic, and multigenerational implications on how the international community tackles future pandemics.

Several civil society actors working in public interest have deeply examined the text and responded with a diverse set of critical, topical comments on the zero draft, producing crucial analytical work. At this early stage of the process, we prefer to garner a holistic structural view of its political and epistemological undercurrents, so as to inform the overarching debate on the WHO INB negotiation before sharing specific inputs on the draft.

Of course, the INB Bureau is confronted with a daunting task in having to canvass an overwhelming flow of political pressures coming from Member States and relevant stakeholders, with their diverse and diverging interests in dealing with pandemics. We are aware that this challenge will continue to stay with us and shape the intergovernmental negotiation, in a scenario of unregulated power asymmetries among governments and stakeholders. But against this background, key core issues must be addressed in the current zero draft, to make the whole WHO CA+ discourse stand. These are the following:

1. The zero draft is limited in scope. The COVID-19 pandemic has been the most acute reminder of how urgent the integration of environmental justice in public health debate has become. Instead, the zero draft neglects the indispensable focus on the prevention measures to tackle the root causes of pathogen spillover at the animal-human interface, and overlooks the range of pre-outbreak measures that are necessary to this end, for public health. Counterintuitively, the text is radically imbalanced towards the biomedical approach, as if a pandemics were a destiny that cannot be avoided. Member states at the WHO must fulfill this prevention role, after the COVID-19 lessons, at the intersectionality of public health, structural inequalities, biodiversity, climate crisis, food systems, neoliberal mechanics, gender and race issues. The biomedical vision as the primer serves the private corporate sector well, but it hardly corresponds to the need for an ambitious approach grounded on One Health and interventions on the drivers of spillover events and of other health emergencies like Antimicrobial Resistance (AMR).

Thus, taking judicious cognizance of how massive public health upheavals are either engendered or exacerbated by the structural violence on the planet becomes imperative in the development of any guidance that aims to prepare global, geopolitical, and public health systems for future pandemics. The first weeks of 2023 have been marked by news of highly pathogenic avian influenza spreading among mammals in Latin America and Europe, and an epidemic of Marburg virus in Africa: working on promoting the Western medical remedies to the symptoms isn’t enough! Unless there is a constructive and deliberate interconnection established between the right to health and the right to healthy environment (now explicitly adopted as one human right by the United Nations), as well as between the right to health and the rights of nature to exist and thrive, the coordination for future pandemic remains an aspiration based on a limited anthropocentric understanding of how such zoonotic and other events manifest.

2. The zero draft’s implicit belief ‘in good faith’ arrangements. The binding nature of the text is considerably weak, when not altogether missing. The vulnerability in the current treaty draft lies mostly on its reliance on voluntary recommendations. Which sections of the treaty are compulsory and which are not is challenging to decipher, but the diplomatic register must be unambiguous. Clear and unequivocal language that articulates the binding nature of the agreement is an indispensable condition to pursue the original purpose of the new WHO CA+. It is also a condition to measure progress of compliance mechanisms and impact of such an accord going forward, in a regime of complementarity with the binding arrangements of the International Health Regulations (IHR), now under review. None of the commitments made by member states in the WHO treaty will yield the fruits of change required, in the absence of a robust and reliable mechanism to hold governments accountable.

3. Safeguards missing in action. One additional layer of concern derives from the zero draft’s failure to provide safeguards that are key to setting its accountability standards and monitoring tools vis-à-vis the role of the corporate sector. The negotiation on this accord follows a dangerous but unfettered evolution of multistakeholderism’s ‘whole of society’ strategic push by the United Nations leadership. For the purpose of the CA+, the attempt to invite the private sector at the table for helping the world prevent, prepare for, and respond to future pandemic is intentional yet counterintuitive, once again, considering how the COVID-19 crisis has been used by corporate players to hold people’s health rights on ransom to expand profits, hoard intellectual properties, and monopolize markets. The pandemic preparation, prevention, and response must remain wholly in the scope of public health, public governance, public systems, and public funds. The private sector is an entity that must be strictly regulated. Alternatively, the enforcement of conditions to public funding of research and development (R&D) for medical products, and the requirements of transparency of prices and purchasing contracts remain purely illusionary, as we have already seen in the past with WHA61.21 and the then heralded “milestone resolution” WHA 72.8.

The version of multistakeholderism under which the entire process of the accord is being promulgated must be either redesigned, or at least substantially repaired. Not only does the accord need to propound a comprehensive legal accountability framework that authorizes monitoring, evaluation, and regulation of the role of private sector in the public health discourse, but also it needs to proscribe the introduction or influence of the private sector in the policy-making spaces, including through the agents of philanthrocapitalism. Demands for such a mechanism are neither novel, nor quixotic, they have been advanced in climate multilateralism, in the current treaty negotiation on business and human rights. Moreover, they have already been adopted in the tobacco control binding policy infrastructure that the WHO introduced less than two decades ago.

4. Financial justice for pandemic prevention preparedness and response. In the advancement of geopolitical power hegemonies – the unfortunate legacy of COVID-19 – the financing approach of the zero draft blatantly ignores the multiple dependencies of the global financial system that have historically prevented low- and middle-income countries from investing in health as needed, even during peak of the COVID-19 pandemic crisis. The zero draft acknowledges the need for investing in strong health systems and progressively realizing Universal Health Coverage (UHC), and proposes sustained budget allocation to pandemic prevention, preparedness, and response and health systems recovery (PPR & HSR). Yet, no reference appears regarding the structural financial hurdles that make increased domestic fiscal space impossible. These include austerity measures, debt payment, illicit financial flows, among others.

According to the International Monetary Fund (IMF), the decade before the arrival of the new coronavirus had witnessed the largest, fastest, and most broad-based increase in debt in low and middle income countries’ economies in the past 50 years. Since 2010, their total debt rose by 60% of GDP to a historic peak of more than 170% of GDP in 2019, and more countries have emerged from the pandemic with higher and more unsustainable debts still. In low-income countries, debt has increased from 58% to 65% between 2019 and 2021. Thirty nations in sub-Saharan Africa have seen a debt-to-GDP ratio exceeding 50% in 2021 and alarm bells are starting to go off for the international financial institutions. The treaty negotiation cannot shy away from these challenges. Without remedies to the global financial architecture that enable countries to gain sovereignty on their public budgets, no fiscal space will exist for maintaining – let alone substantially increasing – their resources for health. If financial injustice remains untouched, countries’ ability to effectively prevent, prepare for and respond to pandemics will be significantly hampered. A reality that has a lot to do with the potential spreading of pathogens. Private resources on the other hand cannot fill the public funding gap. The notion that – once again – collaboration with the private sector plays a role in increasing domestic funding other than through the private sector paying their fair share of taxes must be rejected. Delegates need to be prepared to acknowledge and challenge this status quo, including actors and institutions that maintain the current system of financial entanglement.

There are no easy shortcuts to the crafting of a decent WHO CA+ text. For this to stand, the fault lines in the ground on which the whole initiative stands will have to be recognized, addressed, and remedied. Public health requires seeing things and populations in their reality from the ground, rather than through the eyes of corporate investors and vested policy-making.

Authors: Ashka Naik, Corporate Accountability
and Nicoletta Dentico, Society for International Development

Full version with footnotes and updated list of endorsements: here

The publication and dissemination of this statement addressed to the members of the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (INB) has been facilitated by the Geneva Global Health Hub (G2H2), as a service to the members involved in this initiative, with Corporate Accountability and Society for International Development in the lead. Contact for enquiries: G2H2 Secretariat.

Related opinion piece: Pandemic Accord Text Falls Short of Expectations
By Ashka Naik and Nicoletta Dentico, IPS, 13 March 2023

Illustration taken from: “The politics of a WHO pandemic treaty in a disenchanted world”, G2H2 report, November 2021