Africa CDC's wishlist for the pandemic treaty

Countries are currently hammering out the details of a pandemic accord — an international agreement aimed at ensuring the world works with more cohesion in better preventing, preparing for, and responding to future pandemics. The text of this agreement has been in negotiation since February 2023. The African continent has a lot at stake in getting this text right. During the COVID-19 pandemic, its populations were left stranded without key countermeasures such as vaccines to fight the virus, due to hoarding by high-income nations, inadequate sharing of intellectual property, and export restrictions. The lofty ambition behind creating a global pandemic accord is to ensure these dynamics don’t play out again during the next pandemic — as the status quo led to countless and needless deaths. Negotiators are debating the provisions in Geneva, with a deadline of the World Health Assembly in May. But because some points are under contention, it’s unclear whether this deadline will be met. And there is a notion that the African continent is blocking this agreement, said Dr. Fifa Rahman, pandemic negotiations consultant for the Africa Centres for Disease Control and Prevention, or Africa CDC, during a recent webinar. “It really isn’t,” she said. “Equity takes time to negotiate — and rushing to conclusions isn’t necessarily within Africa’s interest.” “The devil is in the details.” --— Fifa Rahman, pandemic negotiations consultant, Africa CDC Africa CDC isn’t negotiating directly on the accord but serves as an adviser to the African group of negotiators — a Pan-African group working to ensure that the continent’s perspectives are properly represented in the negotiations. At the African Union summit in February, African leaders approved a common position for negotiators to use — but the document is confidential. Sharing pathogen data The issue of sharing pathogen data is “at the heart of the political bargain” for the pandemic accord, Rahman said. Africa CDC wants to ensure that when a virus spreads, anyone who shares genetic sequence data on these pathogens — for example, laboratories in African nations — should also be privy to the benefits when that data is then integrated into the development of products, such as vaccines. This could be through technology transfer — when an international pharmaceutical company shares the technical know-how on how to create a product with a local African manufacturer — or a donation of their products to the World Health Organization, or a commitment to selling the products at an affordable price, she said. However, text that related to the benefits countries might receive from sharing pathogen data released last week didn’t align with these ideals. “It was — for lack of a better word — just simply not what we wanted. It incorporated many positions from the [European Union] and we felt wouldn’t be able to deliver something that is equitable for Africa,” Rahman said. This text, which was rejected by the group of African negotiators, had strong language around the sharing of data on pathogens — stating it was more or less obligatory — and softer language on the benefits countries might receive. “There needs to be a changing of the asymmetry in the language at this stage,” Rahman said. Either sharing and benefiting from the pathogen data must both become equally obligatory, she said, or countries should be given the right to choose whether or not to share the data with global databases. “If we don’t have a resolution on this, I don’t know, really, what’s going to happen in May,” she said. Cumbersome obligations Rahman said there is also a notion that African nations aren’t interested in ramping up efforts on One Health — a field that works to strengthen the collaborations between the sectors of human, animal, and environmental health. Because viruses often spill over from animals to humans, there is a need for heightened surveillance, for example, to ensure that when an outbreak results from a zoonotic source, it is squashed before it rapidly begins to cross borders. African nations do prioritize One Health, Rahman said. Africa CDC has a department devoted to this issue, and countries have their own initiatives to create smoother collaborations between sectors such as human health and veterinary science. But the text of the accord is currently too vague on this issue, and obligations could wind up being overly burdensome. “The devil is in the details,” she said. The current pandemic accord text has strong language around enhanced collaborative and integrated surveillance, as well as the need to develop, strengthen, and maintain pandemic prevention capacities. But these specific capabilities aren’t outlined in detail. This raises concerns that African countries would be committing to increasing their in-country capacities on preventing pandemics in unknown ways — when they are also bound by adhering to commitments under the International Health Regulations. It’s crucial, she said, that more details are brought into the text and that there is a clear understanding around the legal framework of these obligations. This can be burdensome not just for small countries with limited resources, she said, but also for larger and wealthier countries. These obligations would likely include reporting on an annual or biannual basis — to demonstrate what countries have achieved, she said. A new fund The World Bank hosts the Pandemic Fund — a multilateral financing mechanism to provide multiyear grants to low- and middle-income countries to better prepare for future pandemics — with WHO as its technical lead. It was established in 2022 and its first round of $338 million in awards was granted in July 2023. And the second round will be made for $500 million. But the way it’s been rolled out has received criticism from some on the African continent. For example, Africa CDC, while it serves as an observer on the board of the pandemic fund, has previously not been able to serve as an implementing entity of the fund — meaning it could not apply to implement multicountry grants. It has recently applied for this role. However, not everyone sees the Pandemic Fund as adequate for providing surge capacity in a rapid response to an emerging threat. The Geneva negotiations on the accord have included discussions around setting up a new financing mechanism to help countries strengthen capacities around pandemic prevention, preparedness, and response, which could help in surge response during a pandemic. But Rahman said it’s unclear whether there’s an appetite for a new fund. “What we’re hearing is that there are some parties that consider the pandemic fund to be sufficient to respond to surge capacities and to be used for the increase of competencies related to the [International Health Regulations] and related to pandemics,” she said. But from Africa CDC’s perspective, a new fund of pooled finances could have benefits if its governance is more inclusive, in a way where the interests of the African continent are better represented than they are in existing structures. She said this is also key because the pandemic accord could include more cumbersome requirements of African nations, which require adequate levels of financing flowing to African countries. “It will be a challenge for wealthier countries so you can also imagine how difficult it would be for say, a Madagascar or another country at the lower-income levels. The financing is incredibly important,” she said. Africa CDC, separately and through the African Union, is working to set up the Africa Epidemics Fund, but details around how this fund will operate are still being hammered out.