Pandemic treaty draft lacks accountability

Negotiators in Geneva are contentiously drafting a global accord on pandemic prevention, preparedness, and response — but experts are concerned about whether accountability measures will ensure it has teeth. “In the current draft, there are no accountability mechanisms,” said Lawrence Gostin, director of WHO’s Collaborating Center on Global Health, during a Devex event held on the sidelines of the United Nations General Assembly in New York City this week. Instead, negotiators are looking to “punt that off, kick the can down the road. ... That's nonsense. You can't do that,” he said. Existing international treaties notably lack compliance measures and many of them — with the exception of those involving trade under the World Trade Organization — don’t include dispute mechanisms, he said. The International Health Regulations, which is the governing instrument for reporting health emergencies of international concern, is a prime example of noncompliance. For example, in late 2021, South Africa sequenced the omicron variant of COVID-19 and reported it transparently to the world. "Rather than getting an incentive, funding — even a pat on the back, they got travel restrictions targeted to Southern Africa,” he said, which is a move that violates the IHR. The IHR currently leans heavily on peer- and self-reporting, which has limits — reports are often late, incomplete, and inaccurate, said Nina Schwalbe, principal at Spark Street Advisors, an American public health think tank. “Treaties, or whatever, they're just a piece of paper unless there's monitoring and accountability associated with it,” she said. Health experts want to ensure this same fate doesn’t befall the pandemic accord. The pandemic treaty should have a completely independent committee that examines if states are reporting against the treaty in a timely, accurate, and comprehensive way, Schwalbe said. And this committee will ensure that other credible sources of information help triangulate these reports — including from civil society. It would have on-site investigational power to enter countries to examine outbreak threats. Countries also need to be rewarded for good behavior, with incentives, and there needs to be ways to “name and shame them” for noncompliance, Schwalbe said. There are successful examples to lean on, Schwalbe said. The International Labor Organization has a mechanism for whistle-blowing, and atomic energy treaties allow for others to “march-in” to countries to examine violations. The COVID-19 pandemic led to mass inequity when it came to health care access. The pandemic treaty must have accountability measures that ensure equity and that includes commitments to diversified manufacturing of vaccines and therapeutics, Gostin said. “There is a lack of trust in Geneva now among the negotiators — [global] north and south — and this is at the heart of it,” he said. In the health space, people hold governments accountable — not the World Health Organization, The Global Fund to Fight AIDS, Tuberculosis and Malaria, nor government aid agencies, said Blessina Kumar, chief executive officer of the Global Coalition of TB Advocates. But currently, little power lies in affected communities, she said. “Empowering people is the most important thing,” she said. “The fear is that the civil society also begins to compromise — I think that's the danger. So we need to protect that voice of dissent.”