🔙#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.

🧵 ⌛️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 proposed WHO #PandemicAccord is released.

💥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).

🧵 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.

🚨New York’s COVID-19 vaccine strategy failed to prevent deaths among the most vulnerable.

💰Despite shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas.

📈Our latest in the Journal of Urban Health



🧵 bit.ly/COVIDZIP
📊 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.

🚨 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 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.

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.

Tuberculosis and COVID-12 both hit hardest people who are marginalized or in poor health.

There are strong synergies in actions required to prevent, prepare for and respond to both.

That's why we need high-level political UN commitments in September.

Sceptical? Read this 🧵 Both TB and pandemic prevention, preparedness and response (PPR) require:

🕳 Closing the gap in prevention, treatment and access to care.

📚 Implementing evidence-based solutions

🚆 Accelerating research, development, rollout and access to medical countermeasures

🚨 The Intergovernmental Negotiating Body (INB) published the "zero draft" of the #pandemictreaty last week and briefed Member States about it this week.

The draft will be discussed in Geneva from 27 Feb to 3 March.

Summary of the process & highlights on the new text in this 🧵 During the briefing, Member States expressed concern:

⏰ too little time between now and the next meeting
⌛️ too little time dedicated to complex issues.

Suggestions included postponing discussions on denser issues or inter-sessional work (which may disadvantage smaller states)

💥Deadly #cholera outbreak continues in Malawi.

According to WHO, there have been nearly 37,000 cases and over 1200 associated deaths.

Every distinct is affected.

In the face of the deadliest cholera outbreak in the country’s history, vaccines are in (too) short supply.

🧵 Prompted by a severe vaccine shortage, in Oct 2022, the International Coordinating Group on Vaccine Provision (ICG), which allocates cholera vaccines to affected countries, announced that it would provide a single-dose regimen instead of two.

This week, in preparation for its meeting on 20 February, the Working Group on Amendments to the IHR (WGIHR) published the Technical Review Committee's (TRC) report on proposed amendments.

The TRC report is intended to help inform negotiations.

Update in this 🧵 The Director-General appointed the TRC to assess amendments proposed by member states for appropriateness, clarity, consistency, and feasibility.

The TRC also identified "shared values" including advancing equity, solidarity, cooperation, trust, transparency, and sovereignty.

🔥 The "draft zero" of the #pandemictreaty is out.

There is no plan for an independent accountability mechanism (or any accountability mechanism).

As we explain in @TheLancet and 🧵, this is a serious oversight.

bit.ly/lancettreaty We reviewed the evidence and interviewed experts from around the world.

Independent accountability is key for compliance with any international agreement.

bit.ly/monitoraccord

💥Today the WHO Executive Board discussed the report by the Secretariat on governance for health emergency preparedness and response.

Brief summary of what happened in this 🧵 Dr Mike Ryan explained that the proposals intended to align with, not circumvent, Member State processes.

He emphasized that countries should be at the centre of emergency response and that international instruments must enable countries to implement national plans.

💥 This week holds promise for progress on the #PandemicTreaty.

The WHO Intergovernmental Negotiating Body (INB) will publish a “draft zero”.

In @TheLancet, we explain why there must be explicit provisions for independent monitoring of compliance. 🧵

bit.ly/lancettreaty Why this matters?

Treaties are only effective if implemented.

And yet the first draft of the #PandemicTreaty lacked ANY reference to independent accountability, punting the issue until after adoption.

🗞 UPDATE: The WHO Executive Board (EB) is meeting this week and next.

The 34 members are discussing (among other issues related to WHO's work):

🦠 governance of global health emergencies
💶 WHO's financing

Quick re-cap of the first two days 🧵 This included a discussion on Tedros' 10 proposals for PPR.

Several states emphasized the WHO Secretariat should not get ahead of Member State negotiations.

Others expressed concern about a proposed high-level Global Health Emergency Council.

https://twitter.com/nschwalbe/status/1612893515687825408?s=20&t=yGIoPs4iN19NvAT7TJKZgA

💥NEW by Spark Street Advisors in @TheLancet!

🎯 Independent monitoring for the pandemic accord: a non-negotiable provision

📬 In this correspondence, we outline a proposal to promote #PandemicTreaty compliance.

bit.ly/lancettreaty We propose an independent committee to monitor states' compliance with and reporting on the proposed #PandemicTreaty.

bit.ly/monitoraccord

As soon as COVID-19 vaccines were made available, authorities tried many ways to get people vaccinated.

One of them was giving 💵 or even a 🐄

How useful are incentives in increasing adult vaccination coverage?

We reviewed the evidence and here’s what we found 🧵 A range of incentives were offered for COVID-19 vaccines.

💵 cash
🎟 lottery tickets
🍩 donuts
🐄 cows
🗽 a trip to the Statue of Liberty

And even marijuana...

🚨 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.