No abstract

Based on the proposal by the European Council, more than 25 heads of state and the World Health Organization (WHO) support development of an international treaty on pandemics, that planned to be negotiated under the auspices of WHO, will be presented to the World Health Assembly in May 2021. Given that the treaty alone is not enough to ensure compliance, triggers for a high-level political response is required. To this end, to inform the design of a support system, we explored institutional mechanismsi with a mandate to review compliance with key international agreements in their signatory countries and conduct independent country investigations in a manner that manages sovereign considerations. Based on our review, there is no single global mechanism that could serve as a model in its own right. There is, however, potential to combine aspects of existing mechanisms to support a strong, enforceable treaty. These aspects include: • Periodic review - based on the model of human rights treaties, with independent experts as the authorized monitoring body to ensure the independence. If made obligatory, the review could support compliance with the treaty. • On-site investigations - based on the model by the Committee on Prevention of Torture according to which visits cannot be blocked by state parties. • Non-negotiable design principles - including accountability; independence; transparency and data sharing; speed; emphasis on capabilities; and incentives. • Technical support - WHO can provide countries with technical assistance, tools, monitoring, and assessment to enhance emergency preparedness and response.

The COVID-19 pandemic has created enormous challenges for national economies, livelihoods, and public services, including health systems. In January 2021, the World Health Organization proposed an international treaty on pandemics to strengthen the political commitment towards global pandemic preparedness, control, and response. The plan is to present a draft treaty to the World Health Assembly in May 2021. To inform the design of a support system for this treaty, we explored existing mechanisms for periodic reviews conducted either by peers or an external group as well as mechanisms for in-country investigations, conducted with or without country consent. Based on our review, we summarized key design principles requisite for review and investigation mechanisms and explain how these could be applied to pandemics preparedness, control, and response in global health. While there is no single global mechanism that could serve as a model in its own right, there is potential to combine aspects of existing mechanisms. A Universal Periodic Review design based on the model of human rights treaties with independent experts as the authorized monitoring body, if made obligatory, could support compliance with a new pandemic treaty. In terms of on-site investigations, the model by the Committee on Prevention of Torture could lend itself to treaty monitoring and outbreak investigations on short notice or unannounced. These mechanisms need to be put in place in accordance with several core interlinked design principles: compliance; accountability; independence; transparency and data sharing; speed; emphasis on capabilities; and incentives. The World Health Organization can incentivize and complement these efforts. It has an essential role in providing countries with technical support and tools to strengthen emergency preparedness and response capacities, including technical support for creating surveillance structures, integrating non-traditional data sources, creating data governance and data sharing standards, and conducting regular monitoring and assessment of preparedness and response capacities.