Letter to the Intergovernmental Negotiating Body (INB) on the Conceptual Zero Draft
Dear INB and Member States,
We, the undersigned, are individuals from NGOs, civil society organizations, community groups, academia, and independent non-state actors who wish to contribute to the future of pandemic prevention, preparedness, and response (PPPR) by supporting an international convention, agreement, or instrument.
We welcome the release of the INB Conceptual Zero Draft on 15 November 2022, because it has incorporated many of the ideas and comments we have raised in the past through different publications and consultations; however, we want to emphasize some concerns regarding the changes needed to overcome severe limitations of the current global health architecture.
We highlight that the Conceptual Zero Draft will fail to deliver if the language merely recommends, as opposed to a text that includes mandatory language with clear mechanisms, including incentives and disincentives for compliance or noncompliance to obligations. To address weak global health governance, politicization of public health, and inequity, a new global public health convention, agreement, or instrument must:
Include non-state actors in all stages. Civil society, communities, academic organizations, and other relevant non-state actors must be actively involved in all stages of the negotiation and implementation of a pandemic convention. We welcome more opportunities for structured dialogue or formal processes in the drafting and negotiation process at WHO and national levels.
Currently, the Conceptual Zero Draft emphasizes the role of multisectoral stakeholder mobilization and input at the national level. However, without the stipulation of non-state actors as decision-makers in the formulation of global health policies, there will be limits to how stakeholder processes could contribute to policy decisions. Decision-making at national and global levels should include non-state actors, in addition to governments. Since non-state actors experience great impact during outbreaks and play a significant role in PPPR, non-state actors should be: (1) More substantially involved in the negotiation process of the INB convention, and (2) seated in the body that governs the PPPR Convention.
We commend the Conceptual Zero Draft’s inclusion of relevant stakeholders in the Enlarged Conference of the Parties (E-COP), providing broad input for the decision-making processes of the Conference of the Parties (COP). We alert that the process in which organizations are selected as relevant stakeholders within the E-COP should be transparent and inclusive. Non-state members of the E-COP should be nominated by their peers, not by governments, to avoid conflicts of interest and to allow independent voices to be heard; once selected and included, non-state actors should also have the right to vote.
Ensure equitable access to pandemic response products and funding. At this time, the Conceptual Zero Draft has not established what falls into the purview of pandemic response products. The PPPR Convention must define the list of goods that should be made accessible during an emergency. Pandemic response products are public health goods that must be made universally accessible to all countries. The types of potential pandemics and corresponding products should be established and shared publicly.
For example, for an airborne respiratory pathogen like COVID-19, the list would include oxygen, ventilators, PPE, vaccines, treatments, etc. Unfortunately, high-income countries have failed to ensure the equitable distribution of essential global public health goods to the world’s citizens. COVID-19 showed us that despite platitudes of solidarity, some countries had priority access to life-saving products — while others suffered at the cost of lives lost.
The Conceptual Zero Draft references TRIPS, yet TRIPS failed to ensure access to COVID-19 vaccines. Upon a declaration of a public health emergency of international concern, technology transfers and patent waivers must be ensured, so that countries are empowered with low-cost, life-saving pandemic response products. If even one country is not equipped to prevent outbreaks, we will collectively remain vulnerable. IP waivers for new public health goods, including medicines and vaccines, need to be considered in the convention to be effective during public health emergencies of international concern, as well as rapid technology transfers for regional and/or local production of those goods to stop the spread of pathogens and save lives.
Ensure funding for PPPR. The need for sufficient funding for countries to achieve a minimum capacity for PPPR and possible avenues for that funding were listed within the Conceptual Zero Draft. However, since the exact mechanisms of funding are not present, there is no guarantee of how and to what extent the funding would be provided for all the elements included in the text. There have historically never been enough funds allocated for PPPR. The convention must make clear how adequate funding can be guaranteed.
A profound discussion of the roles that global public health financial intermediary mechanisms will play within this PPPR convention needs to be included, such as the role of the World Bank FIF, the Global Fund to Fight AIDS, TB and Malaria, and in some cases, the IMF, regional development banks, and other key multilateral global players concerned with infectious diseases, such as GAVI, UNICEF, CEPI, UNITAID, etc.
Guarantee accountability and transparency. The world’s populations must have assurance that their governments are committed to the PPPR Convention. The Conceptual Zero Draft suggests the need for oversight and accountability mechanisms to be established in the first meeting of the new COP. However, there are no mentions of specific mechanisms. We are concerned that if mechanisms assuring transparency and accountability are not included in the text of the PPPR Convention, there will be no guaranteed delivery of the Convention’s objectives (i.e., prevent and mitigate pandemics). Without a strong commitment to accountability, the PPPR Convention will be for naught.
There is a need for a clear description of the specific incentives and disincentives that will ensure accountability and transparency to the obligations of the Convention. We believe in a positively incentivized system, whereby compliance to the PPPR Convention is rewarded, and where there are disincentives for non-compliance – tailored to the resources and capacities of each country. In addition to adequate financing and resources that both incentivize and provide the means to compliance to the Convention, other incentives for compliance may include reputations for honoring commitments, priority access to limited resources, and voting rights in the COP.
In particular, the language around transparency should be more specific and be tied to mechanisms guaranteeing the transparent and timely reporting of outbreaks, epidemiological data, financing, and pricing of pandemic response products. The INB Convention should not merely “promote and encourage transparency,” it should guarantee transparency. Solidarity and financing are critical but should not be the only mechanisms utilized to promote transparent reporting.
Also, an independent monitoring, verification, and assessment body is essential to ensure accountability and transparency. We recommend an impartial technical oversight body that includes non-state actors and is independent from the WHO. If the Convention does not provide precise language for oversight mechanisms, it will not be guaranteed. It is wrong to relegate this matter for later decision by the COP after May 2024.
We urge Member States and the INB to consider and include our above recommendations in the Zero Draft and to start by immediately incorporating non-state actors as part of the discussions, negotiations, and decision-making of this PPPR Convention/Agreement.