🚨 The working draft for the pandemic instrument being negotiated at WHO has just been released.
The breadth of issues covered shows cognizance of the scale of the challenge (the "what") but there is little detail on actions (the "how").
Summary in this 🧵
The draft was informed by input from the Member States, invited stakeholders and the public, and will form the basis for negotiations next week.
New terminology includes "WHO CAII".
This is shorthand for “WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response”.
In other words, there is no indication yet on whether the CAII will be legally binding.
The preamble reaffirms the principle of Member State sovereignty and emphasizes equity.
It also mentions the broad effects of pandemics, the importance of cross-sectoral action and the tension in IP rules for promoting access (to medicines, diagnostics and vaccines).
The vision focuses on protection from the effects of pandemics and affirms that this must be done with an equity, human rights and solidarity focus.
It also notes the centrality of universal health coverage to ensure the highest attainable level of health for all.
The draft outlines the general expectations for countries including:
✔️establish national pandemic strategies
✔️engage with communities and non-state actors
✔️cooperate with other member states
✔️mobilize financial resources to WHO for pandemic preparedness and response.
The "specific provisions" outline what the WHO CAII would aim to address.
It is extremely broad.
Issues include achieving equity, local production, One Health, global supply chains, national and global governance, research and development and financing, to name just a few.
Proposed governance rests with WHO.
Oversight mechanisms will only be considered in the future and may include incentives, cooperation procedures and some form of compliance mechanisms.
The draft recognized the breadth of the challenge in line with past reviews.
But the detail is lacking and the legal option for the instrument has not been chosen.
Public hearings (originally scheduled for June) will take place in September instead.
It's a long road ahead.
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🔙#PandemicAccord negotiators were back at it in Geneva Monday to iron out sticking points in the draft text.
🔎 Today’s opening (and open) sessions centered on the pact’s legal architecture and its complementarity and coherence with the IHR.
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⌛️All parties pointed to the urgency of the talks given the rise of Mpox, making clear the importance of covering the full PPR cycle.
⏰To have a deal by the end of the year, chairs noted Nov 12 was the deadline to call a WHA special session in 2024.
📜The legal architecture question remains: should the pact be adopted under Art 19 or 21 of WHO Constitution?
👐The negotiations are being held on the basis of Art 19, giving it greater authority. But it also has a higher bar for ratification & potentially less universality.
💥It has no provision for monitoring compliance or details on state reporting requirements other than “periodically.”
🛑This leaves Member States with no accountability for any of their treaty commitments (weak or strong).
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A positive? The Proposal articulates some ambitious intentions (e.g. tech transfer, pathogen sharing).
However, there is a lot of hedging language (e.g “take steps,” “consider supporting,” & “according to national law”)
Details on key issues (e.g. PABS, OneHealth) remain TBC.
An accompanying draft resolution for the World Health Assembly proposes creating working groups on “sticky issues” (PABS, OneHealth, Coordinating financing).
Notably missing is a working group for accountability or any type of Compliance Committee.
📊 In the first 3 months of rollout, when vaccines were in limited supply, low-income areas with high proportions of older people had lower coverage rates than wealthier areas.
They also had higher mortality over the year.
@CutlandClare @WitsUniversity When vaccines were no longer in short supply, uptake for ALL income groups 65+ rose above 80%.
Bottom line: Scarce doses were misallocated to younger people from wealthier income areas.
🚨 The "Zero Draft" political declaration for the UN General Assembly High-Level Meeting on Pandemic Preparedness and Response is out.
There is little new. Most content reiterates ongoing discussions.
At 14 pages, it is not the "short" document many had called for.
Quick 🧵
The draft lacks any language on independent monitoring or compliance and is nearly silent on accountability for pandemic PPR commitments.
It lists 29 principles, highlighting the impacts of the COVID-19 pandemic, including inequity and disruption to health and other systems.
The draft includes concerns about inadequate financing for pandemic response and points to the need to align with WHO processes to negotiate a pandemic treaty and amend the IHR while linking health to other sustainable development dimensions (economic, social, & environmental).
The Working Group on Amendments to the International Health Regulations (made up of member states) just wrapped up its third meeting in Geneva.
Progress is being made, but political tensions persist.
More in this 🧵 from the closing (as negotiations are behind closed doors)
Member states discussed proposed amendments related to compliance, implementation, and public health response.
Inter-sessional work ahead of WGIHR4 includes a discussion of amendments, informal consultations and informational briefings.
African Member States, negotiating through the African Group provided a revised proposal on the “Implementation Committee” and emphasized universal membership and support to countries.
Confidence in vaccines has dropped in 52 of 55 countries (for which data are available), according to Unicef's just published State of the World's Children.
Overall, the statistics on childhood immunization are grim.
A few highlights (or lowlights) in this 🧵
Over the past decade, despite growing efforts to expand immunization, there has been a backsliding in the number of zero-dose children (children who have not received any vaccines).
1 in 5 children remain un or under-immunized.
Backsliding in vaccination coverage during the pandemic resulted in the loss of hard-won growth.
(In much of public health, reaching the last 20 % can be much harder than reaching the first 20%)