“You have a great responsibility on your shoulders…”

Open civil society letter on key issues to be addressed in the INB process

Ms Precious Matsoso (South Africa)
Mr Roland Driece (the Netherlands)
Ambassador Tovar da Silva Nunes (Brazil)
Mr Ahmed Salama Soliman (Egypt)
Mr Kazuho Taguchi (Japan)
Dr Viroj Tangcharoensathien (Thailand)
cc.: WHO Secretariat


Rome/Boston/Geneva, 12 March 2022


Dear members of the INB Bureau, 

As you start your mandate as leaders of the newly constituted Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (INB), allow us to submit for your attention a set of critical issues that, in our sense, deserve to be taken into serious consideration at this early stage of the INB process.  

We represent a broad constituency of civil society organizations that have a long history of engagement in the WHO global health agenda. Some of us have been and still are very active in treaty-making processes, including significant efforts in the past towards including foundational accountability and transparency principles and requisite provisions in the Framework Convention on Tobacco Control (FCTC) proceedings at the WHO. We share the conviction that pursuing health rights is an essential condition for human dignity and societal security, in the face of mounting challenges on a global scale.

For this reason, we ask for your attention on the following issues:  

COVID-19 has kept the world in a pandemic grip since early 2020 and has patently shown the malaise of health governance, at the intersection of global crises that have converged in 2020: the mounting inequalities, the doom of climate change and more elements of what has been diagnosed as the “structural pathogenesis of globalization” (1).  The pandemic continues to engulf lives and livelihoods after more than two years from the day the WHO declared the public health emergency of international concern, while large parts of the world tackle an unprecedented debt crisis. COVID-19 and the planet’s health emergency are two faces of the same crisis. The international community will not succeed in preventing, preparing and responding to new similar health threats unless it is ready to address the multiple determinants of potential future pandemics, paying strategic attention to the inherent injustice and structural inequities exacerbated by such crises. 

COVID-19 is not the only pandemic raging the world. Pandemics are not exclusively triggered by zoonotic events. They are, rather, a health emergency condition of current patterns of unsustainable food production and livestock breeding, wildlife trading, resource intensive lifestyles and consumption systems, with the resulting destruction of ecosystems. Reference needs to be made to the Antimicrobial Resistance crisis and to the soaring figures of the multiple forms of cancer prospected in the next 20 years (WHO/IARC), some of which are aggravated by COVID-19, for example due to alcohol consumption, smoking, and obesity. So how to define a pandemic? After two years of COVID-19, it is paramount that such interconnected dynamics are no longer ignored, and a relevant vision in policymaking is opted for.

On the other hand, as the INB process negotiation starts on pandemic prevention, preparedness and response, it is all the more crucial that the state of universal public health systems and their workforce are prioritized as a pillar of any strategies for the future. Health personnel working in the public health system shape nations’ health in a myriad of ways. The COVID-19 pandemic has placed this critical workforce in the spotlight now more than ever. The focus on pathogen sharing, though important, remains largely insufficient in the absence of a serious understanding about the basic epidemiology of how the virus spread. The biomedical approach enshrined in the very narrative of the pandemic treaty so far, and inspired by a reinforced health security agenda that needs decolonizing (2), appears unlikely to provide the most appropriate and realistic response. COVID-19 has invariably demonstrated that pharmacological strategies, as crucial as they are in facing the contagion, represent but one of the indispensable approaches required to tackle a zoonotic event on a global scale. 

Pandemics are not a destiny, nor a natural phenomenon. As the May 2021 WHO Independent Panel on Pandemic Preparedness and Response report argues, they are the unfortunate and undesirable outcome of incoherent policymaking by Member States and lack of international cooperation. This governance failure needs to be addressed. The UN Committee on Economic, Social and Cultural Rights has emphasized that international cooperation and assistance is a global duty, and “the fact that the current crisis is a pandemic reinforces this obligation of States” (3). While this is not limited to finally ensuring universal equitable access to vaccines wherever needed, it is clear that tangible progress on global vaccination would foster the indispensable trust for engaging in credible international cooperation, starting from the condition of a waiver on IP rights given that vaccines therapeutics and diagnostics are developed with substantive government funding, so as to avoid the private appropriation of public goods (4). 

The WHO Director-General has repeatedly referred to a negotiation inspired by a “whole-of-society” approach, but it is not easy to comprehend what this soothing locution really means. For several years now the WHO has opened its doors to philanthropic organizations, transnational corporations and their proxies, and has invited them into policy spaces under the guise of “stakeholders”. This trend, which affects pathologically the whole of the UN system, has been dramatically accelerated in the two years of the COVID-19 due to the creation of “super public-private partnerships” (5) to tackle the pandemic. In doing so, the international community and the WHO have embarked on a disconcerting route, allowing corporate interests to drive decision-making in the context of the health emergency. 

During these pandemic years, the pharmaceutical industry has legitimately been accused of adding billions to its profits, with hardly any concessions to the public interest globally (6). In fact, we are witnessing to concerning trends, such as the ownership by tobacco corporations of pharmaceutical companies to develop and distribute COVID-19 vaccines, which provides the tobacco industry a new disguised entree into global health decision-making spaces (7) so as to exert new undue influence behind the excuse of a global health crisis. It would therefore be a very dangerous temptation now to consider involving giant economic and related financial conglomerates in multilateral diplomatic initiatives for the purpose of the pandemic treaty negotiations. If such were the imagined scenario, it would happen at the detriment of Member States responsibility at the WHO, and at the detriment of the public interest as represented by frontline communities and civil society at large. In this regard, the limited transparency on the INB process so far is a reason for serious concern. Calls for more inclusive engagement in the treaty making process need to be very carefully balanced with the need for ensuring the Member State-driven nature of the delicate diplomatic process, while granting its protection from the undue influence of the private sector and its powerful lobbyists.

This is our preliminary analysis at the starting point of an expectedly long process. It is the harvest of direct treaty-making experience and direct engagement in examining the COVID-19 pandemic management in countries. We wish you all the best for your work, which we will continue to closely monitor. You have a great responsibility on your shoulders, there is much at stake in this negotiation process. 

With assurances of our highest consideration,

Nicoletta Dentico, Society for International Development, Co-President G2H2
Ashka Naik and Daniel Dorado, Corporate Accountability
…and over 120 civil society co-signatories: see the list below

Versión en español
Traducción informal: aquí (PDF)

Related media release
by G2H2 and Corportate Accountability
13 April 2022: here


  1. Sell, S. and Williams. O., (2019), Health under capitalism: a global political economy of structural pathogenesis. Review of International Political Economy (here). 
    See also: Geneva Global Health Hub (2021), The politics of a WHO pandemic treaty in a disenchanted world (here
  2. Fukuda-Parr S., Buss P. et al, Pandemic treaty needs to start rethinking the paradigm of global health security. BMJ Global Health, Volume 6 Issue 6, 2021 (here)
  3. Statement on universal and equitable access to vaccines for the coronavirus disease (COVID-19) : statement by the Committee on Economic, Social and Cultural Rights. 2020 (here)
  4. Pagano, U (2018), Finance, Intangibles and the Privatization of Knowledge (here)
  5. Storeng, K. T., de Bengy Puyvallée, A., & Stein, F. (2021). COVAX and the rise of the ‘super public private partnership’ for global health. Global Public Health, 1-17. (here)
  6. Kollewe, J. (2022), Pfizer accused of pandemic profiteering as profits double. The Guardian (here
  7. Organizational sign on letter: Urge Canadian government to terminate conflictual agreement with Medicago. Corporate Accountability (here)    

Initial co-signatories (126) and further endorsements (72) 

  1. Abdilah Manafi Lugome, Executive Secretary, Tunaweza Organisation
  2. Adriana Rodriguez, Socuedad Uruguaya de Tabacologia
  3. Adriano Cattaneo, Ibfan Italy
  4. Agnoletto Vittoiro, University of Milan
  5. Ajeng Larasati, Human Rights Lead, Harm Reduction International
  6. Akaninyene Obot, Focal Person, Ukana West 2 Community Based Health Initiative
  7. Akinbode Oluwafemi, Executive Director, Corporate Accountability and Public Participation Africa (CAPPA)
  8. Akweteireho Amiri, Executive Director, Kapotec Foundation Uganda
  9. Alastair Iles (Dr), Professor, University of California-Berkeley, USA
  10. Alejandra Karina Garron Monje , Executive Director, International Heart Federation, Bolivia, Directora FIC BOLIVIA, coordinadora de la Alianza por la Salud
  11. Alison Blay-Palmer, UNESCO Chair Food Biodiversity and Sustainability Studies, Wilfrid Laurier University
  12. Ambrose Oduch, Chief Representative, Child Way Uganda
  13. Ana Maria Suarez Franco, Permanent Representative in Geneva, FIAN International
  14. Ana Vračar, Delegate, People’s Health Movement at G2H2
  15. Anand Grover, Lawyers Collective, former UN Rapporteur to the Right to Health
  16. Andreas Wulf (Dr), Global Health Advocate, medico international, Germany
  17. Anicet LOSSA LONDJIRINGA, Directeur Exécutif
  18. Anna Shevel, Director, Good Food Network
  19. Anne Bellows, Professor, Syracuse University
  20. Annelize van Elk, Former director, IBFAN-ICDC
  21. Aung Than Oo (Dr), Universal Peace Federation
  22. Balqiaz Khan, President, RIHRDO NGO, Pakistan
  23. Barrie Margetts, Professor, University of Southampton
  24. Beatriz Champagne, Executive Director, CLAS Coalition for Americas’ Health
  25. Beatriz Goja , Past President, Sociedad Uruguaya de Tabacologia
  26. Belinda Gillett, The 1970 Trust
  27. Belinda Phipps, Baby Milk Action supporter
  28. Bill Jeffery, Executive Director and General Counsel, Centre for Health Science and Law
  29. Blanca Llorente, Research Director, Fundacion Anáas
  30. Bobby Ramakant, Citizen News Service (CNS)
  31. Bonaventure Yameogo, Engenderhealth
  32. Brenda Chitindi, Ex. Director Tobacco Free Association of Zambia, Nat. Focal Point Zambia NCD Alliance
  33. Brett Sander, VC Saoso
  34. Brid Brennan, Coordinator, Corporate Power Programme, Transnational Institute
  35. Carlos Mediano, President, Medicus Mundi International – Network Health for All
  36. Carole Dobrich, Director and professional development educator, International Institute of Human Lactation Inc.
  37. Carsten Krueger (PD Dr MIH, FRCPCH), Honorary chairman, German Society of Tropical Paediatrics and International Child Health (GTP)
  38. Catherine Sophie Dimitroulias, Présidente, Association des Femmes de l’Europe Meridionale
  39. Cedric Nininahadzwe, Global Advocacy Manager, Global Network of People Living With HIV (GNP+)
  40. Celestina Andoh, Executive Secretary, Indigenous Women Empowerment Network, Ghana
  41. Cfine Ezeanochie Okorochukwu, CEO, Centre for Public Health
  42. Charles Ashie, CEO, Christ Soldiers Foundation
  43. Christian Monje, Fundación Bolivia Saludable FBS
  44. Christopher Kwizera, National Program Manager, UNCDA
  45. Claudio Schuftan, Member advisory council, People’s Health Movement PHM
  46. Cornel Radu-Loghin, Secretary General, ENSP – European Network for Smoking and Tobacco Prevention
  47. Dagmar Schneidrová, Assoc. Prof., MD, PhD, teacher, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
  48. Danny Devito Gotto, Executive Director, Innovations for Development
  49. Denis Joseph Bukenya , Executive Director, Human Rights research Documentation Center (HURIC)
  50. Diana Esperanza Rivera Rodríguez, Directora Ejecutiva
  51. Diego Estol, Medical Director, Doctari
  52. Diego Rodriguez Sendoya , Sociólogo, CIET Uruguay
  53. Dirk-Jan Verdonk, Country Director, World Animal Protection Netherlands
  54. Douglas Onyango Otieno, Executive Director, Tinada Youth Organization
  55. Eduardo Del Castillo Valadez , Director de Códice ONG
  56. Eduardo Missoni , Professor, Global Health and Development
  57. Elia Badjo (Dr), Coordonnateur Exécutif, Conseil sur la Santé et l’Académie de Médecine “COSAMED”
  58. Elisabetta Recine, Brazilian Alliance for Adequate and Healthy Food Representative
  59. Els Torreele, Visiting Fellow, Institute for Innovation and Public Purpose, University College London
  60. Emilia Reyes, Program Director, Equidad de Género: Ciudadania, Trabajo y Familia
  61. Emmanuel Kwashie Fugah, Executive Director; Community Youth Development Foundation
  62. Emmanuel Nembundah Tangumonkem, Executive President, ACADI Cameroon/ PHM Cameroon
  63. Emmanuelle Beguinot, Directrice, Comité National Contre le Tabagisme
  64. Enow Awah Georges Stevens, Executive Director, Organisation For Health in Sustainable Development (OHISD)
  65. Erick Antonio Ochoa , Director of Salud Justa MX
  66. Erik Millstone, Emeritus Professor of Science Policy, University of Sussex
  67. Estefanía Carrera , Nutrióloga
  68. Fanny Polet, Director, Viva Salud
  69. Felix Richard Abraham, Sanctuary of Hope Charity Foundation
  70. Fiona Dove, Director, Transnational Institute
  71. Flavia Radovic Ragonesi, Presidenta, Comisión Nacional Permanente de Lucha Antitabáquica – COLAT Perú
  72. Ford Bosco, Executive Director
  73. Gianna Gayle Amul, Secretary, Asia Pacific Alcohol Policy Alliance
  74. Giulia Grillo, Former Minister of Health, Italy
  75. Hernando Salcedo Fidalgo (MD, MSc.), Researcher and director of Quale Vita
  76. Ibrahim M. Donzo, Chief Executive Officer, Aalem for Orphan and Vulnerable Children Inc.
  77. Ida Oleanna Hagen, Secretary General, FORUT
  78. Iris Martine Blom, Liaison Officer to the World Health Organization at the International Federation of Medical Students’ Associations
  79. Ivan Fredrick Kasonko, Executive Director, Key Populations Uganda
  80. Jai K Das, Assistant Director, IGHD, Aga Khan University
  81. James Ngun Hre, Director, KMSS
  82. Janine Giuberti Coutinho, Healthy and Sustainable Food Programme Coordinator of the Brazilian Institute for Consumer Protection-IDEC
  83. Jean Pierre Bianga , Health Advocacy Advisor
  84. Jeremie Kasongo Kasongo, Volunteer, Youth army malaria champion
  85. Jonathan Grigg (Prof.), Chair of the Tobacco Control Committee, European Respiratory Society
  86. Joseph Gimba Ph.D, CEO, Center for Peace Education and Community Development.
  87. Joseph Kwashie, Executive Director, Community And Family Aid Foundation
  88. Josephine Grey, Human Rights Defender, LIFT Toronto
  89. Juan Núñez Guadarrama, Coordinator, Coalición México Salud-Hable
  90. Judith Helga Philipona, Member, IBFAN/GIFA
  91. Kabine Doumbia, Coordinator, NGO ASRAD Mali
  92. Kabineh Moses Bengeh, Chief Executive Officer
  93. Kakha Nadiradze (Dr), President, AFRD Georgia
  94. Kareem Karassery, Gen. convenor, Blood Patients Protection Council Kerala
  95. Katherine Pettus, Senior Advocacy and Partnerships Director, IAHPC
  96. Kathleen Parry, Project Director, Maternal & Child Health
  97. Kelsey Romeo-Stuppy, Managing Attorney, ASH
  98. Kenneth Nana Amoateng , CEO, AbibiNsroma Foundation
  99. Kristina Sperkova, International President, Movendi International
  100. Kurt Aigner (M.D., FCCP em.), Austrian Council on Smoking and Health, president
  101. Labram M. Musah , Executive Director of Programs, Vision for Alternative Development
  102. Leonida Odongo, Co-Founder , Haki Nawiri Afrika
  103. Leslie Solomonian (ND, MPH), Doctor of Naturopathic Medicine, chair, Naturopathic Doctors for Environmental and Social Trust
  104. Lindokuhle Sibiya, Patient advocate and Youth Mentor, Action against NCDs in Eswatini
  105. Lizzy Igbine, NIWAAFA (Nigerian Women Agro Allied Farmers Association)
  106. Loïc Josseran (Prof.), Chair, ACT – Alliance Contre le Tabac
  107. Lorenzo De Min, Medical doctor, Saluteglobale.it
  108. Luciano Ruggia, Director, Swiss Association for Tobacco Control
  109. Luis Eugenio Souza, Steering Committee Member, Sustainable Health Equity Movement
  110. Luis Renato Vedovato, Professor – Laboratory of Public Policy and Educational Planning – UNICAMP
  111. Luke Kapchanga , Director
  112. Lutgard Kokulinda Kagaruki, Executive Director, Tanzania Tobacco Control Forum (TTCF)
  113. Manfred Neuberger (Prof., M.D.), Co-chair, www.aerzteinitiative.at
  114. Mange Ram Adhana, Association for Promotion Sustainable development
  115. Marara Alexandre, Program Manager
  116. Marc Humbert (Prof.), President, European Respiratory Society
  117. Marcos Arana, IBFAN/ CCESC
  118. Mariam Mayet, Executive Director, African Centre for Biodiversity
  119. Marianne Haslegrave, Director, on behalf of Commonwealth Medical Trust
  120. Mariska Meurs, Global Health Advocate, Wemos
  121. Marita Pizarro, Executive codirector. Interamerican Heart Foundation Argentina
  122. Marta Trejos, IBFAN LAC Regional Policy Council
  123. Martin Drewry, CEO, Health Poverty Action
  124. Mary Ger, Director, Mumbo International
  125. Massimo Brenna, Medical Doctor, associated to Cuamm Medici con L’Africa Como onluss
  126. Maywa Montenegro de Wit, Co-founder/Co-organizerAgroecology Research-Action Collective ARC, Assistant Professor at University of California Santa Cruz
  127. Mercy Annapoorani , Director – Blossom trust
  128. Meri Koivusalo, Professor, Tampere University
  129. Michael Krawinkel , Prof.em., Justus-Liebig-University Giessen, Germany
  130. Micheline Beaudry, Professor (retired), Université Laval, Québec, Canada
  131. Mira Shiva (Dr), Coordinator Initiative for Health & Equity in Society, and All India Drug Action Network
  132. Miriam Ramirez López, General Director, Asociación de Desórdenes del Ciclo de la Urea y Metabólicas (Adcum)
  133. Mohsin Ali, Executive Director, WAVE Foundation
  134. Molly Anderson, William R. Kenan Jr Professor of Food Studies, Middlebury College
  135. Mónica Torres , IBFAN Ecuador
  136. Nanda Nobile, ICW-CIF Representative to FAO
  137. Nandu Murari Meshram, Society for Oral Cancer and Health
  138. Nathanael Buka Mupungu, Président National, Confédération Paysanne du Congo COPACOPRP
  139. Nelson Otwoma, Director, NEPHAK
  140. Nicholas Heinamann, Director, Afristar
  141. Nurul Alam Masud, Chief Executive, Participatory Research & Action Network PRAAN
  142. Nydia Amador, Presidenta Red Nacional Antitabaco ( RENATA ) Costa Rica
  143. Ofra Balaban, Chair, CHEN patient fertility association
  144. Ouedraogo Edmond, President, AFAD
  145. Owain Williams, Associate Professor of Global Political Economy and Health, University of Leeds
  146. Øystein Bakke, Secretary, Global Alcohol Policy Alliance
  147. Patrick Yowasi Kadama (Dr), Director Policy and Strategy, ACHEST
  148. Patti Rundall, Baby Milk Action, IBFAN Global Council
  149. Pauline Denise O’Brien, Parent
  150. Paulo Buss, President, Latin-American Alliance of Globsl Health
  151. Philomena Anyanwu, President, EL-AGED CARE LTD /GTE, Nigeria
  152. Priti Sridhar, CEO, Mariwala Health Initiative
  153. Raffaella Ravinetto, Senior researcher, Institute of Tropical Medicine Antwerp
  154. Raphael Godlove Ahenu , Global Media Foundation, Ghana
  155. Raymond Saner, Director, CSEND, Geneva
  156. Remco van de Pas, Senior research fellow, ITM Antwerp
  157. Richard Daynard, President, Public Health Advocacy Institute
  158. Robert Peck, President, IBFAN-GIFA
  159. Roman Vega, Global Coordinator, People’s Health Movement PHM
  160. Ronald Labonte, Professor and Distinguished Research Chair, University of Ottawa
  161. Rosa Pavanelli, General Secretary, Public Services Inetrnational
  162. Rose Wanjiku, Policy and advoacy officer, African Sex Workers Alliance
  163. Rose Williams, Director, Biowatch South Africa
  164. Ruth Kopelke, Pharmacist, 1st chairman, God Bless the Child e.V.
  165. Saeed Baloch , General Secretary, Pakistan Fisherfolk Forum
  166. Sakiko Fukuda-Parr, Professor, The New School
  167. Samuel Jasper Ochieng, Chief Executive Officer, Consumer Information Network (CIN) Kenya
  168. Samuel Koranteng, Abibinsroma foundation
  169. Sandeep Pandey (Dr), national General Secretary, Socialist Party (India)
  170. Sandra Beuving , on behalf of the 17 organizations of the Dierencoalitie
  171. Sani Lake, Director, JPIC Kalimantan
  172. Sara (Meg) Davis, Digital Health and Rights Project, Graduate Institute Geneva
  173. Sebastián Tobar, Researcher, FIOCRUZ Center of Global Health
  174. Seorais Graham, Border Crossing
  175. Severin Sindizera, Global Coordinator, Indigenous Peoples Global Forum for Sustainable Development, IPGFforSD
  176. Shobha Shukla, Citizen News Service (CNS)
  177. Sida Lweendo, Chairman, Zambia Heart and Stroke Foundation
  178. Silvia Barigazzi, Global Health professional
  179. Stefano Prato, Executive Director, Society for International Development (SID)
  180. Steve McIvor, CEO, World Animal Protection
  181. Surendra Kumar Mishra (Prof. Dr), Director, Vikash Samukhya
  182. Susan Sell, Professor, Australian National University
  183. Sylvanus Murray, Co-Founder & President, Advocacy Initiative for Development (AID)
  184. Tammi Jonas, President, Australian Food Sovereignty Alliance
  185. Thomas Schwarz, Executive Secretary, Medicus Mundi International – Network Health for All
  186. Tim Reed, Executive Director, Health Action International (HAI)
  187. Timothy Barley Muwanga, Executive Director, Most at Risk Populations’ Society in Uganda
  188. Tom Rogers Muyunga-Mukasa, Co-CEO and Co-Founder, The Advocacy Network Africa (AdNetA)
  189. Ugo Pagano, Emeritus Professor of Economic Policy, University of Siena
  190. Ulysses Dorotheo (Dr), Executive Director, Southeast Asia Tobacco Control Alliance
  191. Unni Karunakara , Senior Fellow, Global Health Justice Partnership, Yale University
  192. Uzodinma Adirieje (Dr), CEO, Afri-health Optonet Association (AHOA) – CSOs Network
  193. Verónica Villalta, CENCASS
  194. Vivian Wauters, postdoctoral scholar, UC Davis
  195. Wan Manan, Chairperson, HADAM – Rights to Food Malaysia
  196. Wenzhen (Jen) Zuo (Dr), Family Physician – Hospitalist
  197. Yassen Tcholakov, Assistant Professor, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
  198. Yves Martinet, President, Comité National Contre le Tabagisme
  199. Zahedul Islam, Director, Treatment Alliance for Public Health

The letter was open for endorsements from 11 to 15 March 2022
Thanks to all who co-signed!

The drafting, publication and dissemination of this open letter to the Bureau 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 its members involved in this process. Contact for enquiries: G2H2 Secretariat.

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