Opinion: Imagine a health COP getting as much attention as climate COPs

At the World Economic Forum annual meeting last month, Bill Gates suggested a Conference of the Parties for global health, just like the COP for climate, which would ensure that health stays near the top of the global agenda. That is exactly what the world’s efforts for pandemic preparedness and response, or PPR, need. The 194 World Health Organization member states are currently in intense negotiations to finalize a new international PPR agreement proposed at a special session of the World Health Assembly to work toward WHO’s objective: “the attainment by all peoples the highest possible level of health.” In March 2021, 25 heads of government and international agencies issued an extraordinary joint call for a pandemic treaty. Since that time, WHO has waffled at what exactly is being negotiated, using a series of word salads: from a ““convention,” “agreement,” “instrument,” or “CA+,” to a “pandemic accord” and more recently to a “pandemic agreement.” We understand why WHO would use elastic language amid delicate treaty negotiations. But even for sophisticated international lawyers, such fluidity in language is disorienting. Much of the global health community is confused about what is being negotiated and its legal standing. Let’s be clear. The world needs a binding treaty — a Framework Convention on Pandemic Prevention, Preparedness, and Response, with an empowered COP. The logistics of a PPR agreement First, let’s talk about timing. WHO Director-General Tedros Adhanom Ghebreyesus has warned that the May 2024 deadline is at risk. Tedros is right that a delay would be politically disastrous, especially with high-stakes elections in over 50 countries, with populist leaders surging. If the WHA doesn’t act now, this historic opportunity may not occur again in generations. The pandemic agreement could take one of three forms under the WHO Constitution: (1) A recommendation (Article 23), which is essentially voluntary. (2) A regulation (Article 21) like the International Health Regulations, but those already exist, and are currently being fundamentally revised. (3) A framework convention under WHO’s treaty-making authority (Article 19), akin to the Framework Convention on Tobacco Control, or FCTC. As it currently stands, the Intergovernmental Negotiating Body has divided the draft text into subgroups because the positions of various coalitions of states are so far apart on virtually every major aspect of the agreement. Yet there appears little promise that this process-oriented change will bridge outstanding divides. It would not be a silver bullet but a framework convention could break the impasse while setting the stage for an historic binding treaty. Here are four compelling reasons why a framework convention-protocol approach is vital. 1. A framework convention strategy to unblock political resistance The unique advantage of a framework convention over other forms of international legal instruments is its capacity for evolution over a long period of time, similar to the UN Framework Convention on Climate Change. A framework convention would enable states parties to agree to core values such as access and benefit sharing, financing, and accountability while charging an empowered COP to negotiate binding duties in future protocols. There would thus be less political tension in adopting the initial framework convention, as parties could approach negotiations and discussion on the most contentious portions incrementally. A framework convention would provide clarity on priorities, obligations, and expectations while providing states more time to agree on specific standards and how they will be operationalized. The core treaty should still have strong principles for security and equity, but the detailed binding duties could be negotiated over time via a powerful COP. 2. An empowered COP with robust civil society and stakeholder engagement The FCTC and UNFCCC have strong COPs that have led the way to adopt essential national policies through sharing ideas and practices; developing subsequent implementing treaties often called “protocols,”; and guidelines that are advisory but capture evidence and best practices. The Convention on Biological Diversity also is governed by a strong COP informed by civil society, which has overseen the development of guidelines and two protocols aimed at biosafety and access-and-benefit sharing. COPs may also integrate civil society organizations and other nonstate actors, e.g., foundations, which contribute to these efforts both in-country and on a global scale. In fact in his COP 27 closing address, U.N. Climate Change Executive Secretary Simon Stiell cited civil society organizations as “critical” to the progress achieved so far. And the Framework Convention Alliance, now the Global Alliance for Tobacco Control, has been transformative in the FCTC. Civil society organizations often provide the engine for mobilizing political will to identify priorities and solutions, as well as to mobilize funding. Models such as the Global Fund to Fight AIDS, Tuberculosis and Malaria show that civil society can be incorporated into agenda-setting and empowerment of communities. A COP could also include channels for participation by major donors and private sector players that are now codified in provisions having to do with technology transfer and supply chain management that are causing much disagreement. “It is now essential to establish a global health mechanism that sets bold standards and assesses progress made by nations, NGOs, and philanthropists against their commitments.” --— 3. Coordinating action and setting priorities In global health, the current mechanisms for priority setting, including donor preferences or national foreign policies, have been criticized repeatedly, including more recently by advocates calling for the decolonization of global health. The practice of allocating resources based on funders’ interests rather than in-country and global priorities, and prioritizing activities and solutions that do not reflect the burden of diseases is the norm rather than the exception in global health. The lack of leadership and clarity in agenda setting may also be traced to significant changes to the global health governance structure marked by the emergence of a maze of old and new players that have contributed to the growing compartmentalization of the field. Thus, an alternative governance arrangement that can effectively convene stakeholders to agree to priorities and make commitments will disrupt the status quo. Framework agreements such as the FCTC and UNFCCC have recorded significant success in this regard, including but not limited to facilitating the implementation of tobacco control policies around the world, fostering international cooperation for addressing tobacco use as a threat to public health, negotiating subsequent international agreements, “protocols,” and the carbon emission reduction targets that countries set for themselves, all informed by agreed global targets. A framework convention, accompanied by frequent high-profile COPs, similar to the FCTC and UNFCCC, will go a long way in advancing priorities concerning pandemic preparedness and response for countries, and fostering collaboration for the coordination of activities, funding, and technical assistance. 4. A strong COP would evaluate progress and ensure promises are kept In a previous paper, one of us proposed a Framework Convention on Global Health, arguing that there’s a lack of a robust and reliable framework to assess international obligations to global health. It is now essential to establish a global health mechanism that sets bold standards and assesses progress made by nations, NGOs, and philanthropists against their commitments. Implementing compliance models informed by experiences with UNFCCC and FCTC would allow COP to enforce accountability among parties by setting standards and guidelines, monitoring progress, and serving as a mediator for dispute resolution. We would all prefer to see a binding treaty adopted in May filled with bold and binding standards — with scientific sharing, equity, financing, and accountability. But that won’t happen. With the WHA less than four months away, the time to finalize the text of the pandemic agreement grows ever shorter. Choosing the framework convention model would be instrumental in getting WHO over the finish line, enabling WHO member states to achieve their self-imposed deadline — and reach an agreement before the traumas of the COVID-19 pandemic further fade from our collective memory, and political will completely collapse. Once adopted, the framework convention-protocol approach would help ensure continued high-level attention to pandemic preparedness and response, avoiding the complacency that is typical between pandemics. The choice should be clear: A framework convention is vital to the future of pandemic preparedness, response, and robust equity. A Pandemic Treaty has the potential to be global health’s watershed moment. No more talk of CA+, accords, or agreements. We need a binding treaty with an empowered COP.