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SUNDAY SCIENCE: A TREATY TO PREPARE THE WORLD FOR THE NEXT PANDEMIC
HANGS IN THE BALANCE  
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Jon Cohen
March 15, 2024
Science
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_ The COVID-19 pandemic exposed deep inequalities between rich and
poor countries. The WHO Pandemic Agreement hopes to improve global
equity and avoid mistakes made during COVID-19. _

Music fans wear masks at a concert in Barcelona, Spain, in March
2021. , Emilio Morenatti / AP

 

“Me first”—that’s how Tedros Adhanom Ghebreyesus, head of the
World Health Organization (WHO), described the wealthy world’s
response to the COVID-19 pandemic when he kicked off negotiations for
a global “pandemic treaty” in December 2021. Even before vaccines
had proved safe and effective, rich countries had purchased enough
doses to cover their entire population several times, whereas lower
and middle-income countries had little or no vaccine. The pandemic
treaty would address that searing inequity, Tedros vowed, along with
many other problems identified during the COVID-19 pandemic, leaving
the world better prepared for the next one.

That goal is now in jeopardy. After eight rounds of often contentious
negotiations in Geneva, the WHO Pandemic Agreement is nearing the
finish line. On 7 March, WHO sent member states a draft text
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will be subject to one more round of negotiations starting on 18
March. In late May, the final draft heads to the World Health
Assembly, the annual gathering of WHO member states, for approval.

But deep divisions remain around the 31-page text, and some wonder
whether there is enough time to resolve them properly. Observers from
developing nations say the agreement doesn’t give them strong enough
assurances that they will fare better during the next pandemic.
“There is a systematic marginalization of developing country
proposals on equity,” says Nithin Ramakrishnan, an India-based
lawyer with the Third World Network, one of more than 100
“stakeholders” that provided input during the negotiations. “The
process is being carefully designed to avoid any form of detailed
legal obligations.”

Failing to reach an agreement would be a serious blow, says Alexandra
Phelan, a global health specialist at the Johns Hopkins Center for
Health Security, another stakeholder. “This treaty fills a lot of
gaps and is really important because it builds trust between countries
about setting expectations and norms,” she says. “If it fails, it
says we’re going to look at COVID-19 and say that was OK.”

The spark for the treaty was a May 2021 report from an independent
panel, convened by Tedros, that issued a scathing critique
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the world’s response to the COVID-19 pandemic. Surveillance did not
keep up with the virus, responses lacked a sense of urgency, health
systems buckled, and countries hoarded masks, protective suits, and
vaccines, the panel wrote, creating “a toxic cocktail which allowed
the pandemic to turn into a catastrophic human crisis.”

To avoid a repeat, the pandemic agreement aims to bolster the
world’s defenses on many fronts. It seeks to strengthen surveillance
for pathogens with “pandemic potential” and reduce the risk they
will jump from animals to humans or leak out of a lab. Countries must
also commit to better managing antimicrobial resistance, strengthening
their health systems and sanitation, and making progress toward
universal health coverage. (Separate talks aim to amend the
International Health Regulations, which compel countries to report
health emergencies within their borders.)

The agreement’s most controversial part is a global system to share
pathogens and their genetic codes while ensuring access to
“benefits” from the research—including vaccines. Developing
countries are loath to share information about how pathogens are
spreading and evolving if they can expect little in return, as
happened during the COVID-19 pandemic. “Vaccine nationalism” may
have cost up to 1.3 million lives in low- and middle-income countries
by the end of 2021, one analysis
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The current draft of the pandemic agreement attempts a fix. It
proposes a Pathogen Access and Benefit-Sharing (PABS) System that
compels countries to share sequence information and samples with
WHO-coordinated networks and databases. In return for access to these
data, manufacturers of diagnostics, therapeutics, and vaccines will be
required to provide 10% of their products free of charge and 10% at
not-for-profit prices “during public health emergencies of
international concern or pandemics.”

A comment in the 29 February issue of Nature
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290 scientists from 36 countries, defended this plan, which, the
authors said, “could just as easily be called ‘science for
science.’” The PABS system, they argued, “will support more
pandemic science, and ensure that scientists’ contributions result
in their communities having access to lifesaving advancements.”

Pharmaceutical companies resent such restrictions, however.
“Scientists need rapid access to pathogens and data without
conditions in order to quickly develop safe and effective
countermeasures to save lives,” the International Federation of
Pharmaceutical Manufacturers and Associations said in an 11 March
statement
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At the same time, many developing countries say the draft doesn’t go
far enough, and that details are vague. “While some progress has
been made, it is still unclear what incentives the pandemic treaty
offers to political leaders that would make them behave differently
during the next public health emergency or how industry … would
prioritize populations who are thousands of miles away,” says Nelson
Aghogho Evaborhene, a vaccine specialist at the University of the
Witwatersrand. He points to passages that say states will have to
“promote” and “facilitate and incentivize” companies to share
know-how as examples of “weaker language [that] would barely alter
the status quo.”

Gian Luca Burci, an international law researcher at the Graduate
Institute of International and Development Studies in Geneva—another
stakeholder—says a “front” led by the European Union, the United
States, and Switzerland has attempted to “water down” the PABS
agreement. “These are countries with big pharmaceutical companies
that are lobbying like crazy to save the bottom line,” Burci says.
“Of course countries will not make an official statement, ‘We are
trying to kill equity.’ But listen to what they say in public
meetings and read between the diplomatic lines, as well as what the
industry is clearly saying: ‘Don’t touch patents, and please let
us have the viruses without all the strings attached.’”

Helen Clark, former prime minister of New Zealand and a co-chair of
the panel that produced the critical 2021 report, is disappointed as
well. “Member states should now be asking themselves: Are they
really working towards an agreement which would ensure that the
management of future pandemic threats is more collaborative, faster,
smoother, and more equitable—or not,” Clark says.

For the text to be adopted as a classic international treaty,
two-thirds of WHO’s member states must approve it at the World
Health Assembly. If instead it follows a pathway used for
“regulations,” the votes of only half of the member states are
needed. Even if the agreement is adopted, countries can still decide
not to join. As with other international treaties, a Conference of
Parties will be formed to hammer out further details and supervise the
treaty’s implementation.

In a talk
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13 March, Tedros urged member states to reach compromises soon. He
recalled that in 1946 the WHO Constitution was negotiated in just 6
months—long before email and Zoom calls existed. “Everyone will
have to give something, or no one will get anything,” he said.

Evaborhene agrees. “Trade-offs and compromises in the final text
must uphold principles on equity,” he says. “Otherwise, we may
continue to sow seeds of plagues and count the dead when the next
pandemic hits.”

_JON COHEN earned his B.A. in science writing from the University of
California, San Diego. He is a senior correspondent with Science and
has published widely in other magazines and
newspapers—including The New Yorker, The Atlantic, The New York
Times Magazine, Smithsonian, Technology
Review, Outside, Slate, Wired, and Surfer—as well as publishing
four nonfiction books on scientific topics. He specializes in covering
biomedicine with a focus on HIV/AIDS, other infectious diseases,
immunology, vaccines, and global health, and has reported extensively
on genetics, primate research, evolution, bioterrorism, research
funding, ethics, reproductive biology, credit battles, and the media
itself. He has appeared on several national TV and radio programs,
including the PBS NewsHour, Today, Larry King Now, and NPR’s
Fresh Air, Marketplace, and All Things Considered. Cohen has
received frequent recognition for his contributions to science
journalism, and his articles have twice been selected for The Best
American Science and Nature Writing anthology (2008 and 2011). His
books and stories have won awards from the National Association of
Science Writers, the Council for the Advancement of Science Writing,
the American Society for Microbiology, the American Society of
Tropical Medicine and Hygiene, the Global Health Council, the Pan
American Health Organization, the National Academy of Sciences, the
Treatment Action Group, and the Gaia Vaccine Foundation (photo:
Malcolm Linton)._

_The SCIENCE family of journals is published by the American
Association for the Advancement of Science (AAAS), the world’s
oldest and largest general science organization. The nonprofit AAAS
serves 10 million people through primary memberships and affiliations
with some 262 scientific societies and academies._

_A voice for science and scientists everywhere, AAAS fulfills its
mission to “advance science and serve society” by communicating
the value of science to the public, helping governments formulate
science policy, promoting advancements in science education and
diversity, and helping scientists develop their careers._

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Why Do Whales Go Through Menopause?
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Carl Zimmer
A new study argues that the change brought these females an
evolutionary advantage — and perhaps did the same for humans.
New York Times
March 13, 2024

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* Inequality
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* WHO
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* treaty
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