As the final stage of negotiations of the World Health Organization (WHO) Pandemic Agreement nears conclusion, the AIDS Healthcare Foundation voices major concerns about the latest Proposal for the Agreement.

Much has changed since March 30, 2021, when during the COVID-19 pandemic, leaders from Europe and other developed countries held hands while touting commitments for an agreement guided by “solidarity, fairness, transparency, inclusivity, and equity.” The mood has since soured, with many of the world’s leading economies now siding to protect the greedy corporate interests of pharmaceutical companies.

Equity, which was once described as the heart of the proposed agreement, runs the risk of becoming nothing more than a cliché, or worse still – a punchline. Despite the agreement’s stated objective of preventing, preparing, and responding to pandemics while being guided by equity, at least some countries don’t seem to be serious about turning this into a reality. Neither promises, charity, nor voluntary obligations were sufficient to prevent or address the human misery caused by global health inequity during COVID-19 and other global health emergencies, and we don’t expect them to start working miracles now.

This is why the signing of any pandemic agreement must be grounded in clear commitments and binding obligations to operationalize equity. The Pandemic Access and Benefit Sharing System (PABS), under Article 12 of the pandemic agreement, is a major way of addressing global health inequity. During the pandemic, low and middle income countries (LMICs) were "forced to be part of an unequal fight with major powers," wherein competition for vital pandemic-related health products, including protective equipment, reagents, diagnostics, life-saving treatment, and even oxygen, exacerbated global health inequities and hindered an effective global response to the crisis.

“At all stages of the COVID-19 pandemic, developing countries struggled to obtain equitable access to all kinds of pandemic-related health products. First there were shortages of masks, diagnostics, ventilators, and oxygen, then vaccines, and later, to effective therapeutics,” said Dr. Jorge Saavedra, Executive Director of the AHF Global Public Health Institute. “All the meanwhile, high-income countries were able to acquire and retain much of the world’s supply, while the majority of the world waited in the back of the line.”

Under PABS, parties are required to rapidly share biological materials and genetic sequence data, which are critical for the timely development of diagnostics, vaccines, and therapeutics. Participation in this system requires that participants agree to share a certain percentage of pandemic-related health products to ensure they are equitably distributed, addressing the urgent needs of all nations and safeguarding global health security.

Currently, fierce debate between high-income countries and the rest of the world over Article 12 provisions has resulted in an “amalgamation of text and brackets within brackets,” which has only worsened as negotiations near completion. The current best-case scenario in the most recent text will require that 20% (10% as a donation and 10% at non-profit prices) of pandemic-related health products be “made available for use on the basis of public health risk and need. This is grossly insufficient because it leaves 80% of critical vaccines, treatments, and diagnostics inaccessible to LMICs which comprise approximately 85% of the world’s population. The world-leading scientific journal, The Lancet, has described this proposal as “shameful, unjust and inequitable.”

While we are encouraged by recent proposals in Article 12, which would allow for the advanced release of pandemic-related health products before a Public Health Emergency of International Concern (PHEIC) is declared, and provisions on the promotion of specific benefit sharing modalities to address prevention and preparedness in addition to emergencies, we have serious doubts whether these measures will ever be voted on in light of high-income countries’ competing interests.

“AHF was among the first organizations to promote and publish a proposal for a new global public health convention, but the current proposal for the pandemic agreement could do more harm than good by enshrining inequity. As such, we consider that instrument as immoral, and we call on member states to reject this agreement unless meaningful binding provisions are added to guarantee equity,” said AHF President Michael Weinstein.

AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to over 2 million clients in 46 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare and Instagram: @aidshealthcare

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