After 29 million deaths, it seems the world has learned nothing

The director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has earned a reputation for being a disciplined representative of the United Nations, restrained in both his manner and language. That is why it attracted so much attention when, a few days ago, he described the negotiations for the new multilateral pandemic agreement as “a torrent of fake news, lies, and conspiracy theories.” A potential failure for which future generations “may not forgive us.” After 29 million deaths, generational trauma and a billion-dollar debt we’ll be paying off for decades, according to the planet’s foremost health authority, the international community appears to have learned nothing.

Any serious analysis of the negotiations justifies Ghebreyesus’s alarm. With less than 16 weeks to go before the World Health Assembly, which needs to approve an agreement that until recently seemed like a done deal, differences between rich and poor countries, the distortion of geopolitical context and greed drive interference of private interests threaten to pulverize two years of negotiations, and leave the multilateral system defenseless in the face of the next pandemic.

A quick glance at the ProMED alert chart should be sufficient to remind us of what’s at stake. The International Society for Infectious Diseases’ program has been working since 1994 to gauge and tackle the risk of emerging pathogens and infectious vectors that could give rise to much larger problems. If you look at the landing page of ProMED’s website, you will see a world map full of red and orange indicators, suggesting that health risks from viruses and bacteria are as real a threat as they were in February 2020, even if we hardly mention them. One of the best indicators of the transience of political priorities is that ProMED itself is struggling to stay afloat financially.

“If the international community is unable to understand why we need a good epidemiological surveillance system in the throes of pandemic, how can we expect it to prepare for other health risks?”

If the international community is unable to understand why we need a good epidemiological surveillance system in the throes of pandemic, how can we expect it to prepare for other health risks? After all, infectious diseases are not our only concern. Extreme natural events — like wildfires, droughts and floods stemming from climate change — armed conflicts or biochemical and radioactive accidents can put even the most sophisticated health systems at risk. Nuclear episodes, for example, were the stuff of movie dystopias before the wars in Ukraine and the Middle East, but today they are a real scenario for which we are obliged to prepare in much the same way as we would for other health emergencies.

In this context, the multilateral pandemic agreement carries with it a symbolic and political weight that multiplies the value of its content. The text that is being negotiated covers an ample spectrum of preparedness and response systems: from epidemiological surveillance and information-sharing models to the resilience of health systems, also including access to biotechnological development, coordination between public-private actors and public communication. All of these are complex territories in which the international community has demonstrated that it has a lot of room for improvement.

The main challenges for the agreement are concentrated in two minefields of global health: control of knowledge and sharing of resources. For the Global South, it will only be possible to correct the profound inequities and inefficiencies of the Covid-19 response if the North facilitates the distribution of diagnostics, treatments and vaccines. This improvement also depends on response financing based on the principle of differentiated common responsibilities that have already been applied in other negotiations, such as those on climate. From the perspective of the North — and its influential pharmaceutical sector — reconsideration of intellectual property rules seems as anathema as the introduction of binding financial commitments.

“In 17 OECD countries, the budget for health programs fell in 2022 to levels similar to or below that of mandatory financial commitments in 2019″

The elite’s disinterest in the multilateral agreement reflects deeper problems. As experts churn out reports that warn of the possibility of new health cataclysms, governments’ commitment to preparedness and response systems appears to be fading. In 17 OECD countries, the budget for health programs fell in 2022 to levels similar to or below that of mandatory financial commitments in 2019. The new WHO/World Bank Pandemic Fund — one of the few tangible outcomes of the Covid-19 catastrophe — has only received $1.6 billion of the $10 billion that has been requested from donors for a first attempt at preparedness and response effort in low- and middle-income countries.

We are running the risk of establishing a dangerous precedent. The most worrisome part of Covid-19 response evaluations in many countries is not the circus of lies, abuse and incompetency that have been uncovered, but rather a surprising disinterest in learning from our mistakes. And in this, Spain is no exception. Although the State Public Health Agency — meant to organize preparedness and response actions, among other functions — will soon be rolled out, the government has so far failed to approve a Global Health Strategy to determine our priorities in this essential debate, as the EU and several neighboring countries have done. In Spain’s Parliament, the issue seems to have lost all electoral sex appeal: of the 459 health-related initiatives in 2023, less than a dozen made direct reference to preparedness for future health risks. Meanwhile, the evaluation of the country’s National Health System’s pandemic response by independent experts, which was commissioned in 2021, took a year and a half to arrive and wound up being shelved for eight months, only to be published in December 2022, to no apparent impact on public debate.

Ignoring the recommendations of this report would be as serious a mistake as trying to impose speicial interests on the negotiations of a multilateral pandemic agreement. Both emphasize the fundamental role of health systems, starting with primary care and public health services, and the need to correct serious shortcomings in administrative coordination, the flow of information and institutional and legal framework. Multinational mechanisms, such as the Pandemic Fund and, in the case of Europe, the new Health Emergency Preparedness and Response Authority (HERA), are of urgent need. The necessity of fairer and smarter mechanisms in developing, producing and distributing vaccines and other essential products is apparent. A piecemeal approach that ignores the deep interconnections between the health of people, the planet and the other beings that inhabit it would be disastrous.

This is no leaden debate about an obscure international agreement. Nor can it be a bargaining chip in the geopolitical poker game. Negotiations to regulate the global response to pandemic should be fueled by the memory of those we watched suffer and die. That is the standard that citizens must set for their representatives. As the authors of a letter signed by some 50 scientific, political and social leaders alarmed by the state of these negotiations point out, “A new pandemic threat is inevitable. A new pandemic is not – if we act now.”

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