Following the release of the Zero Draft of the pandemic accord (WHO CA+) by the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) on Feb. 1, AIDS Healthcare Foundation (AHF) urges the establishment of an independent body, outside and above the WHO’s governance structure, to prevent another public health catastrophe like the COVID-19 pandemic. The INB’s WHO CA+ will be up for consideration at its fourth meeting on February 27 through March 3.

The Lancet article A Global Public Health Convention for the 21st Century details the reforms needed for a new global health architecture, which are covered in a range of important topics, including equity, governance, global coordination, and global health financing. While the Zero Draft includes several of the recommendations in the article, the WHO CA+ lacks an adequate proposal for an effective governing body with appropriate mechanisms to promote compliance.

Prior to the publication of the Zero Draft, global public health experts called for the creation of an independent body that sits above or outside of the governance structure of the WHO. The need for such a body to be established by the UN General Assembly and comprised of heads of state and governments has also been echoed in the G20 High-Level Independent Panel report, published in June of 2021.

“It was clear before and during the peaks of the pandemic that the WHO was not enough—not strong enough nor trusted enough—to enforce or convince all countries to follow the International Health Regulations [IHR-2005]. Too many countries went their own way and ignored WHO recommendations,” said Dr. Jorge Saavedra, Executive Director of the AHF Global Public Health Institute. “COVID-19 touched and impacted everything, from health and the economy to politics and communities. The WHO wasn’t sufficient, and thus we need a more effective body to deal with pandemics.”

This needed independent body would address the shortcomings observed during the COVID-19 pandemic response, including geopolitical division and logjams at the WHO and the need to maintain high-level political commitments and monitor progress toward pandemic goals and targets set by the WHO. It should also guide the allocation of resources in global health financing and hold actors accountable. While the Zero Draft contains provisions for establishing a Governing Body of the WHO CA+ (Article 20), it is essential for it to be made independent and at arms-length from the WHO.

“The WHO also failed to obtain all the epidemiological and initial genomic sequencing information from China, which would have allowed scientists to discern the origins of SARS-CoV-2,” added AHF President Michael Weinstein. “The Wuhan lab leak theory is still a big question mark, and a lack of transparency on U.S. oversight on its grantees research has been called into question – another sign that WHO cannot even enforce epidemiological transparency – a weakness it’s had since its founding.”

The Zero Draft does not relegate the establishment of compliance mechanisms to the Governing Body or COP of the WHO CA+ (Article 22). Accountability mechanisms, as well as incentives and disincentives for compliance, must be written into the agreement rather than negotiated after it comes into force. These mechanisms need to be clearly delineated in the WHO CA+ to ensure that they are legally binding, whereas decisions made after the fact by the COP may not be legally binding.

Lastly, the lack of representation by non-state actors (non-governmental organizations/civil society) in the governance structure outlined in the proposed agreement is disappointing. Throughout assessing the necessary reforms and proposing changes, non-state actors have been an integral component of the global health ecosystem. Therefore, civil society and other non-state actors must be given an adequate voice in the WHO CA+ process and structure moving forward.

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