As negotiations for an international agreement for pandemic preparedness and response continue this week, the World Health Organization (WHO) says it can reach its finish line by May, if the barriers are collectively addressed. But inequity, authoritarianism and trust deficit are not considered small barriers, according to African researchers, academics and scientists, who are closely observing the negotiations, National Daily Intelligence reveal.
Grounded in lessons from the Covid-19 pandemic, which was termed a human catastrophic crisis, world leaders, in 2021, proposed to create an international agreement with the main goal of strengthening national, regional and global capacities and resilience and to prevent future pandemics. The WHO was afterward tasked with the mandate come up with a treaty titled, a Pandemic Preparedness, Prevention and Response Accord.
In December 2021, the WHO set up a committee— the Intergovernmental Negotiating Body (INB) — to spearhead the negotiations and draft the agreement. The body is made up of the 194 WHO members states comprising 47 African countries. In paripasu, the WHO also undertook the review of the already existing International Health Regulation (IHR) of 2005— which prescribes obligations for countries on reporting public health emergencies and international travels restrictions. Over 300 amendments have been made on it. Both documents are meant to be submitted to the 77th World Health Assembly in May 2024, after which it comes into force.
However, there have been a lot of push and pull in different directions over various clauses and provisions of both the proposed treaty and the IHR. At the helms of the criticisms of the draft treaty is the group of senior African academics under the name, Pan-Africa Epidemic and Pandemic Working Group, which says that current draft reeks of health imperialism and an increasingly colonialist approach which will take Africa no further than the hardships experienced during the Covid-19 pandemic.
Issues of health sovereignty:
Speaking during an online press conference, where the group stated its position on the current treaty draft, Dr. Reginald Oduor, a member of the group and an associate professor at the department of philosophy, University of Nairobi, says what is worrisome is that the WHO, which used to be more advisory, has taken on, with these two instruments-IHR and the Treaty, a political posture.
“What we are seeing now is increasing centralization and the excuse is that we are protecting everybody. The latitude and space of African countries, is not respected for them to make decisions because they are being told to do what the WHO says.”
What worries the Group as expressed in a press statement is the use of the phrase ‘state parties undertake to follow’ WHO’s recommendation, which they say threatens nations’ health sovereignty. Contained in Article 12 of the newly amended IHR, this provision also consolidates the powers of the director-general of the WHO to determine ‘at any time’ that a disease is a public health emergency of international concern/or a pandemic, whilst also granting it the prerogative to advise mandatory vaccinations.
Uniqueness— not universalism
Professor Wellington Oyibo, a medical parasitologist at the University of Lagos, who is the Group’s Health Advisory Director, says the amendments to the international health regulations and the proposed treaty, can be described for Africa, as using a sledge hammer to kill an ant. And this, he says, will cause Africa to miss the opportunity to develop unique solutions to its unique health challenges and strengthen its own health system.
“We do not need a global lens to be able to handle some local diseases or local health challenges. For instance, in Africa, cholera still decimates lives. Likewise, we have zoonotic diseases such as ebola. People still go to the forest to get food and get into contact with bats; all out of quest for livelihoods. If these regulations are allowed to go, then people will be punished and governments too.”
Oyibo, who is also the Director, Center for Transdisciplinary Research in Malaria and Neglected Tropical Diseases adds that what is needed is not universalism but a unique approach to solving health challenges.
“On the basis of uniqueness of challenges, which is not universal, it brings to question; why the need for some universal control systems. The question we should be asking is: How do Africa strengthen their health systems to contribute to global safety, without being subsumed by international regulations as the WHO is proposing?”
Another vaccine apartheid underway?
In Article 11, Chapter 2 of the current draft lies a cauldron of disagreements, discontentment and distrust on the equity issue. The gut of this article is that pharmaceutical companies in developed countries, who have developed vaccines or who own patents to approved pandemic diagnostics or therapeutics, etc, should waive their intellectual property (IP) rights in order to allow pharmaceutical companies in developing countries, to use their patent for mass production of lifesaving vaccines. The intent is to prioritize saving lives over profiteering. But developed countries— the European Union, United Kingdom and Switzerland, who house the big pharma, have reportdely kicked against the idea, worrying that a waiver will harm research and development incentives for pharmaceutical companies
It would be recalled that during the Covid-19 pandemic, there was gross inequity in access to vaccines. According to a BioMed Central report, as at 2021 more than 76 percent of people in higher income countries had received a dose compared to low income countries which had a low uptake of 8.5 percent. This is despite the launch of COVAX, which failed to facilitate equitable access.
If according to the WHO, the idea of a new international agreement is to improve on the failures of Covid-19, is the WHO not about to make the same mistakes with the current draft?
The Article reads in part: ‘During pandemics, each Party shall: (a) commit to agree upon, within the framework of relevant institutions, time-bound waivers of intellectual property rights to accelerate or scale up the manufacturing of pandemic-related products to the extent necessary to increase the availability and adequacy of affordable pandemic-related products.’
Usually patents are protected under the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). This agreement is ratified by member countries of the World Trade Organization, (WTO) an organization which deals with the global rules of trade between nations.
An international medical charity, Medecens San Frontiers (MSF), which was an active frontline responder during the Covid-19 pandemic, reports that overcoming the intellectual property barriers was a major obstacle to equitable access, which led to loss of lives. It is reported that 3 million people died directly or indirectly of Covid-19 while several African countries were pushed into a huge debt crisis. Although in 2020, South Africa and India wrote to the World Trade Organization, to relax the TRIPS Agreement regulation. It took 20 long months of filibustering for the member states to finally agree to waive their rights partially as contained in the ministerial decision of the WTO adopted in June 2022. The civil society and health observers say it was a narrow waiver for just limited pandemic products, and which still excludes many middle-income countries.
Mausi Segun Africa director of Human Rights Watch, says that without addressing this issue, the treaty has failed from the beginning.
“Equity lies at the heart of the problem that is faced during the covid-19. Pandemic. The lack of equitable access to available technology, vaccines means fewer people in those countries had access to life saving vaccines. It is unfair.”
Odour believes that African governments can come up with their own innovations, rather than having to wait and depend on what comes from the western world.
“It is health imperialism to subjugate knowledge from other parts of the world and think medical innovations and knowledge about Covid-19 or other pandemics has to come from Geneva or the developed countries.”
He adds; “This is the very reason why we must advocate for multiple centers of knowledge and every society has a right to have its own innovations.”
WHO’s political posture
Although the WHO director-general, Tedros Gbayeresus, has refuted claims of taking over nation’s sovereignty, referring to it as ‘disinformation,’ the overreach of national governments, and the gross human right violations witnessed during the last pandemic, cast a shadow on the WHO’s intent. Secondly, is the failure of COVAX, which was set up to create equitable distribution of vaccines, therapeutics to developing countries, but was reportedly sabotaged by developed countries and the big pharma. Thirdly, is the fact that WHO is largely privately funded by the same countries who are reluctant to waive their IP rights and foster equitable access. Notably 20 percent of its funding come from assessed contributions from member states, but the remainder is from voluntary contributions. The United States was the largest funder between 2018-2019, next only to the Gates Foundation, its second largest funder. Other top funders are the United Kingdom, European Union, Australia, Switzerland.