The Pandemic Treaty, the Pandemic Fund, and the Global Commons: our scepticism

Abstract

The call to strengthen global health governance against future outbreaks through a binding treaty on pandemics has attracted global attention and opinion. Yet, few of these perspectives have reflected the voices from early career global health professionals in Africa. We share our perspectives on the Pandemic Treaty, and specifically our scepticism on the limitations of the current top-down approach of the treaty, and the need for the treaty to centre equity, transparency and fairness to ensure equitable and effective cooperation in response to global health emergencies. We also highlight the challenges intergovernmental organisations for health faced in coordinating nation states during the COVID-19 crisis and how a Pandemic Treaty would address these challenges. We argue that lessons from the COVID-19 pandemic provide a critical opportunity to strengthen regional institutions in Africa—particularly in a multipolar world with huge disparities in power and resources. However, addressing these challenges and achieving this transformation may not be easy. Fiscal space in many countries remains constrained now more than ever. New tools such as the Pandemic Fund should be designed in ways that consider the specific needs and capacities of countries. Therefore, strengthening countries’ capacities overall requires an increase in domestic investment. This paper calls for wider structural reforms such as debt restructuring among other tools to strengthen countries’ capacities.

The WHO pandemic treaty: where are we on our scepticism?

“…In our earlier analysis published in this journal, we shared our scepticism 5 on the pandemic treaty, pandemic fund and the need to uphold equity and foster regional resilience. This commentary is a follow-up, and we expound further by discussing some of the substantive provisions for equitable access to MCMs embedded in the pandemic treaty zero-draft text and their key tensions.…”

“…While there are calls for an independent body to monitor the alignment of countries’ commitments with their pandemic preparedness plans, such actions would benefit risk assessment activities including surveillance. 9 15 However, as we queried in our earlier analysis, 5 it is still vague what incentives the pandemic treaty could offer political leaders that would make them behave differently during another outbreak, and choose not to restrict export or hoard vaccines and instead prioritise populations who are at risk thousands of miles away. Or how pharmaceutical companies who have refused to share technologies and are well suited in protecting their shareholders’ dividends would balance their corporate social responsibility with profit generation when supplying the non-donated 10% stipulated in the zero-draft text.…”

How the World Bank's Pandemic Fund can address health inequities

“…It is imperative, however, to recognize that marginalized groups -such as ethnic minorities, the economically disadvantaged, people with disabilities and residents of remote areas -often suffer disproportionately during health crises. In the wake of health emergencies like COVID-19, the pronounced health disparities and the severe implications for these vulnerable populations became glaringly evident [3,4]. These groups encountered a myriad of challenges, from higher infection and mortality rates to limited healthcare access, all of which magnified existing socio-economic inequalities [5].…”

“…Emphasizing sustainability in the Pandemic Fund's strategies is also essential. Fostering resilience, strengthening health infrastructures and endorsing self-sufficiency within LMICs provide a long-term vision for combating future health crises [4]. Equally crucial is the implementation of a rigorous evaluation framework for the initiatives funded by the Pandemic Fund.…”

Beyond rhetoric in the pandemic treaty: Prioritizing equity and inclusion for marginalized populations

“…In Africa, the COVID-19 pandemic has exacerbated existing inequities experienced by marginalized groups in under-resourced areas, compounded by poor housing, limited healthcare access and inadequate water and sanitary facilities [3]. A critical step towards addressing these disparities is to protect these communities from further marginalization in global health initiatives [10]. One such way is through resource allocation towards research that collaborates with these communities, a step crucial not only in addressing the current pandemic but also in building a more robust and equitable global health infrastructure for future pandemics.…”