Pandemic Proof: Negotiating a Global Pandemic Agreement

PRECIOUS MATSOSO:
One country cannot be isolated. If your population is safe, your citizens are safe, it doesn't mean they'll be safe forever because these borders, they are porous, but also viruses move. So it's in our best interest to ensure that we can solve this problem collaboratively.

JAVIER GUZMAN:
You're listening to Pandemic Proof from the Center for Global Development. In this podcast, we explore policies and reforms to better prepare and respond to infectious disease threats like COVID-19, but also other nasty viruses, microbes, and fungi that can throw our health, our communities and our economies into crisis. Join us as we envision ways to better protect our world in the future. I'm your host, Javier Guzman. Let's get started. Today we're going to talk about the pandemic agreement or the pandemic accord. This is an international instrument that was envisioned to help facilitate a more equitable, robust, and cooperative pandemic preparedness, prevention, and response efforts in the future.

Of course, the intention is to avoid what we saw during the COVID-19 response, where it was clear that the world was not prepared. We had capacity gaps, we didn't collaborate, we didn't have enough international cooperation. So after more than two years of negotiations, unfortunately the WHO member states were unable to reach consensus on that instrument ahead of this year's World Health Assembly in May 2024. After that, of course, countries decided to continue with the negotiations and we have one more year. The expectation now is that we'll come back to the World Health Assembly in 2025 with an agreement. We want that negotiation to be successful. And of course, the international negotiating body is relevant, important and will begin the work in the weeks ahead. First, agreeing on a work plan but also deciding how do they go about the upcoming round of negotiations. And because of that, we thought it was very important to reflect on the past. What went well, what didn't go well, what can we learn from previous negotiations, and why we need to do this differently?

It is my pleasure, therefore, to be with Precious Matsoso today. Precious is the Director of the Health Regulatory Science Platform, a division of the Wits Health Consortium, and an honorary lecturer in the Department of Pharmacy and Pharmacology at the University of Witwatersrand, in South Africa. She has previously served several roles at the World Health Organization, as well as within the Government of South Africa, where she was the Director General of the South African National Department of Health. I met precious about 20 years ago and it is a real pleasure to have her here. Precious, thank you very much for joining us here at the CGD Pandemic Proof Podcast. Welcome.

PRECIOUS MATSOSO:
Well, thank you, Javier, for inviting me. It's a real pleasure and honor indeed to be part of these discussions.

JAVIER GUZMAN:
Thank you very much. And we want to start with a very difficult question. Is this doable? Do you think we can really reach an ambitious, yet successful and feasible pandemic agreement? We wanna hear your take on what are the key differences. Where are we in terms of the sticking points and how do we go about negotiating those?

PRECIOUS MATSOSO:
Perhaps I'll start with the first one as to whether is this doable and will we finish this work? And my answer to that is that yes, indeed we will, because we were almost done. We just needed a week. By my own calculation, we actually are 50% done in terms of the agreed texts and articles. But of course the remaining articles, they are partially agreed. So in essence, whatever is partially agreed, it can still be concluded. But for those that are partially agreed, of course they are difficult topics. And I've always said these are not just technical discussions, they are political discussions that require some nuance and that requires that we find a balance between opposing views. And for that reason, we have just recently concluded a work plan and modalities on how we can resolve these issues.

In particular, as you may know, Pathogen Access and benefit sharing is one of the most controversial issues. The second one is on One Health and the third is on technology transfer. And the old debates that we've always had for decades on TRIPS and technology transfer. And my view is that these are issues that are solvable. And in fact, the question we may ask ourselves, can we afford to? Can we really afford not to solve them, given what we've gone through? I mean, given the number of lives lost and the economic devastation we've seen in a number of countries. I don't think there's any country that was spared. So for that reason, I'm of the view that we have no option but to solve these problems. Secondly, February next year it will be exactly three years that this process has been underway, and we are hopeful that we can still do this by the end of the year. Of course, it requires political commitment. It requires a reasonable approach in the manner of some of these problems can be solved.

I don't think there's one way only to solve this. As you know, there are quite a number of difficult issues that we've resolved before, and I'm very hopeful and positive, actually, and optimistic. I've seen how the amendment to the International Health Regulations have evolved. I was not instrumental in that work. But for those who did the work towards the end, it was difficult. We were not even sure that we would finish, but we did because it took a lot of commitment. If we were confronted with outbreaks that become a pandemic today, we'll really regret why we didn't make these decisions. At least one instrument is ready for implementation. The International Health Regulations are an already existing instrument. They were being amended, but even the amendment was not just the straightforward thing countries had to negotiate, but there are still some elements in the existing instrument, the IHR, that are missing, and that complementarity between the IHR and the pandemic agreement is necessary for this to work better, and for us to have a (UNKNOWN) world and to address some of the gaps that we identified during COVID, even prior to COVID

JAVIER GUZMAN:
Thank you. You talked about three main points. And you mentioned Pathogen Access and Benefit Sharing. One Health and technology transfer. Can you go a bit deeper on each of the points and tell us what the key elements are? What the differences are and what the points of convergence are?

PRECIOUS MATSOSO:
Well, the first thing. I think the most important on Pathogen Access and Benefit Sharing is that the differing views are that the access to pathogens and benefits must be on an equal footing. And for that to happen, there are certain elements that need to be in place. For instance, the benefit must be defined. And I think this is the probably difficult part to say if we define those benefits. Some have argued that the access and benefit should not be transactional. And how do we incorporate this in detail in such a way that it can give a sense of comfort for those who'd like to share pathogen and biological material, or even information? What safeguards must be in place to ensure that the benefits should accrue, but do it in such a way that it gives others comfort that it's not transactional?

And I think that kind of balance is what we need to resolve. And secondly, the safeguards that I was referring to must be such that it gives sort of a sense of comfort that when you are hit by a pandemic, we should firstly recognise that we must minimise the risk. And in that period of sharing the pathogen, at least that process of characterizing the pathogen being able to assess what the level of risk is at the mode of transmission. I mean, that kind of technical work must be enabled so that we contain the spread. But whilst we do that, we must also look at whether are there any products that are available in the form of vaccines, therapeutics, diagnostics. If they don't exist, if it's a novel pathogen, of course, the other process must kick in. And that trigger to have the work unfold for development of diagnostics, vaccines should be enabled. But it is those details that I think are at the heart of the dispute. But what is probably important is do we need details in this instrument, or do we want other supportive legal instruments to support this.

I mean, we've seen with other international legal instruments that you don't provide details subsequent to adoption and you have a protocols developed or you come up with annexures. And I think it is those kind of legal architecture that must be resolved because it will give a sense of comfort. The second issue, which is about One Health. The issue here that has been raised is that this comes with additional obligations. And for developing countries, they are of the view that they do not want new obligations imposed for which additional resources will be needed. Some countries are currently in recovery. Their economies have been ravaged by COVID, and as part of that recovery, they would like to reinvest in their health system again. And now if you impose more obligations, it means they need to redirect resources. And the argument here is how best can we do it in such a way that the preventative measures are in place, surveillance systems work as well as they should, and we can detect early and report timeously when we are hit with an outbreak and be able to respond.

And what measures should be in place to do that? And for that reason, the debate here is whether for these kind of obligations, should we also have an instrument and what kind of instrument should it be in the form of a guideline, a protocol. And these are the details that should be resolved. And these two are being discussed together because some member states see that as a bargaining chip in both instances. Our view is that we must keep our eye on the ball to say, does this make the world safer? Yes, you may disagree, but for everything that we want to do, does it mean we'll be ready? Will we be able to respond? Will we be better prepared this time around? I think we need to keep on asking those questions as we proceed and not just focus on, you know, the give-and-take issues only. We must still go back to those original questions. The last one, of course, is whether a technology transfer, because there are arguments that there are some countries that hoarded vaccines and diagnostics.

Now, this time around, in the event that there's an outbreak, can it be such that even if some countries want to keep the supplies for their populace because it's understandable, can they also ensure that this tech transfer for others to produce? At least there are supplies. Because, you know, one country cannot be isolated. If your population is safe, your citizens are safe, it doesn't mean they'll be safe forever if others are not safe because these borders, they are porous. But also, you know, viruses move. They don't need a visa. They hit any country. So it's in our best interest to ensure that we can solve this problem collectively, collaboratively, and also that there's cooperation. And which then takes me to the last point about what the issues are about this tech transfer. The arguments are that technology transfers should not be mandatory. And others are saying, well, perhaps you don't even have to mention whether it's mandatory or not, voluntary or not, as some are arguing that it must be on mutually agreed terms.

If you look at some of the language in existing legal instruments, my opinion is that there's language that can be borrowed. You know, whether PIP Framework or the CBD Nagoya Protocol. There are some language, and perhaps if others agree, we can consider that. Some are of the view that pandemics are different, and it's better if we define this specifically for this instrument. And I think this is where we are. The IP issues of course, keep on emerging, but they are not as prominent except for the TRIPS Waiver. But there have been some other language that has been used in replacement of the language for the TRIPS Waiver, but others have argued it's good enough and can still give us the same outcome that is required. So in general, I think these are the things that, if resolved, we will be able to finish.

JAVIER GUZMAN:
Great to hear about how positive you are in terms of leveraging text that has been agreed before and of course, the relationship between obligations and money. And if we go deeper on the money angle, a big important question we are all asking is where the money should sit. Should it sit within the existing global health architecture, including the pandemic fund or should there be a new fund created elsewhere? We saw how the US announced 667 million for the pandemic fund, but we know that that's only one-third of the 2 billion that the fund wants to raise, and is far from the 10 billion figure that was estimated during the pandemic.

So I want to get your views on that point. Do you think the existing global health architecture should be where the money should sit, or should we be thinking about other funds elsewhere? We heard about the importance of making the pandemic fund a success story, but we want to hear your views.

PRECIOUS MATSOSO:
Well, I think let me start by saying that I think we've made considerable progress on the financing. I mean, relatively, if I look at other articles, the financing one, we've progressed significantly and precisely because I think there's been some recognition that having a new funding mechanism may not work because we are just building on these multiple funding mechanisms that exist. So the approach was that we needed to find a coordinating mechanism, maybe just coordinate what exists so that we can begin to understand what the flow of funds are and where they go to, because there's been some duplication in the process. And perhaps it might help us to at least leverage on what exists, that I think those are the kind of discussions that have been going on.

The second, which is your direct question about the pandemic fund has been that, yes, this pandemic fund has been created. It has been difficult to raise the 10 billion, as you said. The question is, where do you make the most investments and the best investments, because you also want domestic financing. You want countries to also invest locally and ensure that they can sustain whatever initiatives that are necessary to prevent and prepare for the next pandemic. So it's a balance between what gets done globally and what gets done domestically. And for that reason, the idea is to look at the funding mechanism, because there's also an argument that, of course, it's very difficult to write into law and specify, say, pandemic fund. Because 20 years from now, you may want to call it something else. Perhaps describe what you want, but in recognition of what exists meaning you don't discard what exists, but you also allow for future developments that may arise. In fact, the whole approach has been future-proofing this legal instrument in such a way that whatever developments occur in future, at least this will be future-proof.

And this is why we've avoided being descriptive about a particular fund. But whilst recognizing that existing funds must be considered. The last one is whether will we be able to bring not only the existing funders and start bringing for ownership bring others who are not a traditional contributors and donors and so on. And for that reason, I think there's the level of commitment that you are sensing, but also emphasis on domestic financing. So it's that a balance and tension between how you reconfigure your financing locally in such a way that you are better prepared and you can prevent whatever outbreaks, whilst ensuring that globally, there are these funding streams that are available to support initiatives and also help countries build their capacities and be ready for the next pandemic.

JAVIER GUZMAN:
Thank you. It is very important to consider the existing architecture, to avoid duplication, to fully support the existing mechanisms, and to look into the future. Very, very interesting to hear from you that you're thinking long term. Thank you very much. I've got one final question for you. What have we learned in the past three years that you will apply in this new round of negotiations? Some people have talked about the importance of improving the process, including more stakeholders or being more inclusive in the conversations, but we want to hear what your take is.

PRECIOUS MATSOSO:
Well, firstly, the first lesson is you can't negotiate in a plenary with 194 countries. It doesn't work. And I think attempts to have informals that are facilitated are good attempts. But you need the goodwill. You need commitment. And someone said to me, you know, with these negotiations that deals are normally made outside the room. The more we encourage countries to talk to each other outside the room the better because it clears the air. It allows for dialogue. It toned down tensions, but the most significant thing is to deal with two things. One is the trust deficit. When there is no trust, it doesn't matter how many meetings you convene. You know, we have to find mechanisms of building trust, building confidence, and promoting dialogue.

You know, because the level of polarization is what makes it difficult. And it might help to just find ways of encouraging countries to talk outside the room. The more they talk, the better. And the last point, what you've seen, I think, which has not happened during other negotiations of the Framework Convention on Tobacco Control, the PIP Framework, and other negotiations is that they did not happen at the time when the geopolitical landscape was as is today, because the day we started negotiations in February 2022, that's when the Ukraine issue started. And that has been carried into the discussions, because the statements that were made carried those things that were outside the pandemic treaty, they were brought into the discussions. We've seen also with the Gaza issue, those issues have been brought into the room so we can negotiate in that environment when the geopolitical landscape is changing and think we're isolated, and then the negotiations will just happen, you know, regardless.

So I think perhaps the lesson here is that even as those things happen, there must be mechanisms of organizing these informals, talking about them so that we don't have this spillover effect into the negotiations because those also have had an impact in our processes.

JAVIER GUZMAN:
Very important to hear about trust, communication, informal conversations as key elements that are part of the negotiations, especially in this difficult time when there is a lot of geopolitics and is not easy to trust for a lot of countries, the multilateral system. Before you go, we always ask the same question to all our guests, which is if you could prioritize one change in the global health architecture for pandemic preparedness and response, what would that be?

PRECIOUS MATSOSO:
Well, as you. Know, the one thing I would improve its governance. The global governance, I think, has been identified as key. And I say this with respect because we've seen how COVID brought heads of states to the table, and when pandemics hit, they affect the whole of government. And every country must ensure that heads of states at national level take interest in these matters. So governance at national level must be at the highest level and even globally. The issue here is once we have a governance arrangement, who should lead, and do health ministers have the power to coordinate other sectors, or is it the heads of states who have the power end? Regardless of whether it's there in the UN in Geneva. If we think the COP arrangements should have that element that brings the heads of states in whatever form, I think that would be a major achievement because in any event, for this pandemic agreement, the heads of states are the ones who started by writing an op-ed. Over 20 of them wrote an op-ed.

So it's their baby. It is their baby.

JAVIER GUZMAN:
This is a very good way to end this, highlighting that health is a whole of government issue, and it needs to be raised within the political agenda. It needs to go to the heads of state. We cannot see this in a siloed, health-only universe. So with that, we wish you the best in these negotiations. We hope to hear from you soon, hopefully before the World Health Assembly in 2025 with very good news to make the world safer. Thank you very much, Precious.

PRECIOUS MATSOSO:
Thank you for inviting me.

JAVIER GUZMAN:
Thanks for listening to Pandemic Proof from the Center for Global Development. Very special thanks to the CGD podcast team Sophia Greenhoe, Stephanie Donohoe and Soundeazy for making it happen. Pandemic Proof is available on the CGD podcast stream, so make sure you are subscribed to the CGD podcast on Apple, Spotify, or wherever you're listening to podcasts. And remember, you can check out all of our work on pandemic preparedness and beyond at CGDev.org.