The final draft of the Political Declaration on Pandemic Prevention, Preparedness and Response (PPPR) was sent to United Nations members last week, but, writes Kerry Cullinan for Health Policy Watch, it has several weaknesses in its failure to address major problems linked to the world’s pandemic preparedness.
Armenia and Rwanda, the co-facilitators of the declaration negotiations, put the “final” text of the declaration for the High-Level Meeting (HLM) on PPPR in September under the silence procedure on 28 July.
The silence procedure means member states have a certain period during which to object – or break the silence – otherwise the text is regarded as agreed on, despite any weaknesses.
For example, the text identifies climate change as one of the issues straining developing countries’ pandemic prevention, preparedness and response. But at the HLM on Road Safety last month, the US was the lone vote against that – in part because it mentioned climate change.
The PPPR declaration also recognises that women and girls are among the groups disproportionately affected by pandemics, and calls for “gender equality” to be mainstreamed “into all policies and programmes”, and urging “universal access to sexual and reproductive healthcare services” by 2030, and the reaffirmation of “commitments to ensure universal access to sexual and reproductive health and rights (SRHR) in accordance with the Programme of Action of the International Conference on Population and Development (ICPD) and the Beijing Platform for Action”.
The ICPD, adopted by 179 member states in 1994, calls for universal access to a full range of reproductive health services, including family planning.
Meanwhile, the Beijing Platform, adopted a year later by 189 member states, establishes that all people have “the right to attain the highest standard of sexual and reproductive health” and that their right to make reproduction decisions should be “free of discrimination, coercion and violence”.
However, SRHR has become contested in the UN, with several countries claiming that, by linking sexual and reproductive health to rights, the UN and the WHO are trying to promote universal access to abortion.
Positive points
According to a group called The Friends of the HLM on PPPR, the final draft contains positive language on foundational elements that could lead to a stronger pandemic readiness system.
This group’s co-convenors are The Elders, FOUR PAWS, The Independent Panel for Pandemic Preparedness and Response and Resilience Action Network International (rani).
The Friends add that positive aspects include that the text welcomes the adoption of the Pandemic Agreement and amendments to the International Health Regulations (2005) and calls for the timely conclusion of the pathogen access and benefit-sharing (PABS) negotiations. It also promotes geographically diversified research, development and manufacturing of health tools, and calls for “the need for financing preparedness”.
The group also approves of “recognising a One Health approach to prevent spillover of pathogens from animals to humans” and “the importance of data, tools and assessments that facilitate action-oriented plans, and science and evidence-based monitoring”.
And the real problems…
But Helen Clark, co-chair of The Independent Panel and a member of The Elders, and on behalf of The Friends’ co-convenors, notes: “At a time when the Ebola Bundibugyo emergency is now the second largest Ebola outbreak in history, we need measurable commitments which put effective multi-sectoral plans into action, serious money on the table, and ensure real accountability.
“The ultimate test of this declaration is simple: will its implementation make the world measurably safer?”
The Friends identify four key gaps in the draft.
The first is the lack of concrete commitments or timelines to fill the financing gap, including the $15bn needed annually to prepare for pandemics.
Weakness Two is the failure to “strengthen the capacities of veterinary, animal, and environmental health services” given that more than 70% of emerging infectious diseases in humans are zoonotic.
The third weakness is its failure to recognise current gaps in monitoring, “including of equitable access to medical countermeasures, operational readiness, financing, and the social dimensions of resilience”.
Finally, The Friends highlight that the Secretary General gets almost five years to report back on the implementation of the political declaration, “too late to follow up on commitments … and which will take momentum from an already neglected agenda”. They propose three years instead.
The HLM is set for 25 September.
Meanwhile, a recent study in The New England Journal of Medicine warns that the “dominant model of pandemic preparedness has focused on technical capacities: stronger laboratories and surveillance, more effective vaccines and medicines, faster emergency response”.
Yet, argue the authors, including Nobel Prize-winning economist Joseph Stiglitz, some of the most” prepared” countries have mounted the most ineffectual responses in real time.
“Among the officials and experts charged with stopping pandemics, the current understanding of what drives pandemic risk for the world is proving to be insufficient. The missing element…is inequality,” say Stiglitz and co-authors Matthew Kavanagh, Monica Geingos, Winnie Byanyima and Michael Marmot, for the Global Council on Inequality, Aids, and Pandemics.
They propose four approaches.
The first involves addressing the social determinants that drive outbreaks to become pandemics, for example, ensuring social protection including expanded unemployment insurance and paid sick leave “so people can follow public health guidance without impossible trade-offs”.
The second involves “strengthening visibility, governance, and trust” by establishing multisectoral governance bodies that include government officials, community organisations, and scientific leadership.
The third involves reforming the international financial architecture to enable “sovereign debt-suspension mechanism for distressed nations during pandemic emergencies”, International Monetary Fund special drawing rights during pandemics and expanded pandemic lending facilities.
The fourth measure involves equitable access to pandemic science and technologies, including “open licensing for publicly funded biomedical research with pandemic relevance” and expanded regional manufacturing capacity for cutting-edge medicines and vaccines.
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WHO pandemic agreement finally adopted
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