The Cardinal Points of a Pandemic Accord: Prevention, Equity, Financing & Acting Now

This week marks the start of the final round of negotiations of the Intergovernmental Negotiating Body responsible for preparing an international instrument on pandemic prevention, preparedness, and response (INB). The process to prepare a “Pandemic Agreement” has been running for two years under the leadership of World Health Organization (WHO) Member States, with guidance and input from other relevant actors, including global health initiatives such as Gavi, the Vaccine Alliance. 

The effects of the COVID-19 pandemic across the globe are widely known: close to 15 million lives lost as a direct result of COVID-19 or from the pandemic’s impact on health systems and society, unprecedented impacts to health systems during the pandemic, and unprecedented disruption in essential services such as backsliding in immunisation coverage with 25 million children missing at least one essential vaccine in 2021 alone. 

We know from recent research that the chance of a pandemic, with a similar impact to COVID-19, is about 1 in 50 in any year. The year of 2024 alone has seen important health emergencies, such as dengue outbreaks in Bangladesh and Brazil, measles spreading in Uganda and the Democratic Republic of the Congo, and several cholera outbreaks.  

With less than 70 days until the potential adoption of the final Pandemic Agreement at the World Health Assembly in May, the final negotiations happening in Geneva between this week and the next represent a critical juncture.

Below are the cardinal points of the negotiating text that will be critical for the world to better prevent, prepare for, and respond to major health emergencies in the future.  

Prevention and preparedness to reduce risk of pandemics is essential 

Immunisation programmes have a proven track record in preventing the spread of infectious diseases, and they are the first line of defense against pandemics. They also play a role in preparing health systems for outbreaks by increasing surveillance and detection capacity, reaching marginalized populations, and training community health workers who can scale up services when emergencies arrive. 

Recognizing the role of immunisation and health system capacity strengthening will not only help mitigate the impact of pandemics, but also build resilience against routine outbreaks, and should remain a key focus for Member States. There has been significant progress in integrating routine immunisation and routine health services into the draft document, with the Revised Draft Negotiating Text, released ten days ago, taking these programmes into account for pandemic preparedness. 

However, there remains a significant gap for immunisation and vaccination in the prevention components of the Agreement, especially in Article 4 of the current draft. To neglect the role of immunisation and vaccines in preventing pandemics is a significant oversight that should be rectified in this final round of negotiations. 

Greater steps towards ensuring vaccine equity still needed 

The aim of the Pandemic Agreement was always to address equity gaps in the responses seen around the world so we could do better in the future, with a significant concern being the equitable sharing of vaccines and other pandemic-related products. It is broadly understood that fair sharing of ‘benefits’ derived from pathogen information and genetic sequencing data would be a significant factor in enabling equitable responses. 

The pathogen access and benefit sharing system proposed in the document – understood to be the biggest sticking point in the negotiations at this stage – has recently reinstated language committing to equitably sharing in real-time “contributions of relevant diagnostics, therapeutics or vaccines produced by [manufacturers], 10% free of charge and 10% at not-for-profit prices during public health emergencies of international concern or pandemics”. 

This would seem like an absolute bare minimum figure to address some of the equity gaps identified during the COVID-19 response. While the 10+10% percentage mentioned above should be seen as a minimum, it is a promising development to translate the principle of equity into concrete actions. 

Financing for future pandemics needs involvement of existing partners 

Member States made important progress in the last negotiating round with respect to the development of a financing mechanism for the Pandemic Agreement, especially through the introduction of a proposed Coordinating Financial Mechanism aimed at increasing the effectiveness and efficiency of existing and future financial mechanisms. 

Under this coordination format, other agencies such as the Pandemic Fund, the The Global Fund or Gavi, the Vaccine Alliance would be able to coordinate extensively with the Pandemic Agreement’s financing mechanism, sharing information and participating in relevant discussions for alignment. 

This focus, which will ultimately give this new mechanism a coordinating role, must be maintained as it can ensure availability of funding across the entire spectrum of prevention, preparedness, and response, with the latter being available at-risk from day zero for rapid responses. Let's avoid creating another standalone fund which could duplicate functions already implemented by existing agencies. 

Now is the time to make an impact for the future 

With outbreaks and pandemics, achieving equitable access is critical: not only for moral reasons, but because it is the only way to limit the duration and impact of the emergency, for all countries and individuals. Rapidly and equitably reaching billions of people with vaccines in countries across the world at the same time requires incredible real-time planning and coordination across all stakeholders, and it is essential that Member States keep this in mind in the final days of negotiations. 

In the special session establishing the INB in December 2021, Member States noted “the need to address gaps in preventing, preparing for, and responding to health emergencies, including in development and distribution of, and unhindered, timely and equitable access to, medical countermeasures such as vaccines, therapeutics and diagnostics, as well as strengthening health systems”. There has been progress made to find compromise and consensus on these points throughout this process and we must carry this momentum forward.

Now is the time for countries, specialized agencies, experts, and civil society to come together and ensure the Pandemic Agreement meets our collective needs, builds on lessons learned from COVID-19, and serves as a blueprint for better and stronger prevention, preparedness and response efforts in the future.