The COVID-19 pandemic has examined international well being governance and worldwide legislation in unprecedented methods, revealing weaknesses and gaps within the present international well being safety structure and fueling debate over tips on how to strengthen international governance of illness. In December of 2021, the World Well being Meeting (WHA) agreed to launch a course of to develop a brand new worldwide settlement on pandemic prevention, preparedness and response, with at the least an preliminary consequence anticipated in 2024. So far, there was no detailed examination of present international well being treaties, commitments, partnerships, organizations, and different international well being agreements (hereafter known as “agreements”) to establish gaps and potential areas of collaboration transferring ahead. To assist inform these discussions, we reviewed present agreements to evaluate their potential function in pandemic preparedness and response efforts, and whether or not they have been used to reply to COVID-19. Key findings are as follows:
- 71 agreements have been recognized as having a job in international well being. These agreements, a few of that are greater than 100 years outdated and others that have been established solely not too long ago, handle a variety of areas together with ailments (HIV, malaria, tuberculosis, and so on.), susceptible populations (youngsters, ladies, refugees, and so on.), the surroundings, and commerce/mental property, amongst others.
- Practically half (34) of those agreements are binding below worldwide legislation. Legally binding agreements are these supposed to create enforceable authorized obligations within the worldwide area on their events. The 34 binding agreements embrace treaties, protocols (that are related to present treaties), and the phrases of memberships in some United Nations (UN) entities such because the World Well being Group (WHO). The remaining 37 agreements, whereas not legally binding, might confer obligations and commitments upon collaborating international locations.
- Lower than one-third (21 or 30%) of the agreements have pandemic preparedness and response (PPR) as a part of their unique mandate. Of those 21 agreements, 9 are legally binding below worldwide legislation.
- Nonetheless, most (50 or 70%) of those agreements participated within the COVID-19 response. They have been both concerned immediately (25), through actions particularly geared toward addressing the pandemic, not directly (8), by means of actions that addressed the impacts of the pandemic on different well being areas, or some mixture of each (17). Thirty-six didn’t have PPR of their unique mandate however both tailored present efforts or began new actions to deal with the pandemic.
- The 71 agreements recognized on this overview might play a key function within the subsequent part of pandemic preparedness and response, together with many who didn’t have PPR of their unique mandate. As the worldwide neighborhood considers a brand new worldwide instrument to assist put together for and reply to future pandemics, our evaluation finds that lots of the present agreements have been mobilized to deal with COVID-19 and others have PPR as a part of their unique mandate. The extent to which these present agreements may very well be a part of future preparedness efforts stays to be seen however additional analysis might assist to focus on whether or not extra strengthening or additional adaptation is required, in addition to spotlight gaps that will persist.
The COVID-19 pandemic examined international well being governance and worldwide legislation in unprecedented methods, revealing weaknesses and gaps within the present international well being safety structure and fueling debate over tips on how to strengthen international governance of illness. Beginning in late 2020, nations and skilled teams started discussing the potential want for a brand new worldwide settlement addressing pandemic preparedness and response (PPR). In December 2021, the World Well being Meeting (WHA) agreed to launch a course of to develop such an settlement. As a part of this course of, the WHA has established an Intergovernmental Negotiating Physique (INB) “to draft and negotiate a WHO conference, settlement or different worldwide settlement on pandemic prevention, preparedness and response” with an consequence for consideration anticipated in 2024. At its assembly held in July 2022, INB members agreed that at the least some parts of the brand new worldwide pandemic settlement must be legally-binding, though this choice will not be but ultimate. The INB not too long ago launched a draft of the settlement which lays out a proposed governance construction for the brand new settlement in addition to the PPR actions events could also be anticipated to undertake, equivalent to bettering provide chains and logistics networks, supporting data sharing and expertise switch, growing analysis and growth capabilities, and strengthening well being programs and workforce. Nonetheless, ultimate textual content will not be anticipated till 2024.
To assist inform the present dialog, we reviewed present worldwide international well being agreements (e.g. Worldwide Well being Rules), organizational charters (e.g., World Well being Group; International Fund to Battle AIDS, Tuberculosis and Malaria; and so on.), and establishments which have issued declarations addressing international well being points (e.g., World Financial institution, G7, G20, and so on.) to evaluate their function in pandemic preparedness and response efforts, together with whether or not they have performed a job within the COVID-19 response, to assist establish present gaps and potential areas of collaboration with different organizations within the PPR house. This evaluation builds on work researchers at KFF and Georgetown College performed greater than a decade in the past exploring U.S. involvement in worldwide well being treaties and different international well being organizations. For this evaluation, we confirmed whether or not the agreements included in our unique evaluation have been nonetheless lively and recognized extra agreements that must be included (e.g., those who have taken on a better function in well being or have been created for the reason that unique paper was revealed). We assessed the extent to which every settlement has been concerned within the COVID-19 response (both immediately or not directly) and/or possessed pandemic preparedness and response capacities. We thought-about agreements to be “immediately” concerned within the COVID-19 response in the event that they addressed the impacts of COVID itself (e.g., supplied medical countermeasures or different COVID-specific assist). Agreements thought-about to be “not directly” concerned have been those who sought to deal with the impacts of COVID on different well being areas (e.g., supplied assist to keep up or scale back the impact of COVID on the response to a different communicable illness). We outlined agreements broadly to incorporate each those who have been legally-binding in addition to non-binding agreements, partnerships, and the charters establishing United Nations entities and formally established international establishments (see Methodology for extra element).
Total, we recognized 71 international well being agreements, together with 46 that have been included in our unique evaluation. An extra 13 have been already established however had not been initially included (that they had taken on a better function in well being) and 12 have been extra not too long ago created. The earliest settlement was established in 1902 (the Pan American Well being Group, initially the Pan-American Sanitary Bureau) and the latest in 2021 (The Treaty of the African Medicines Company). They span a variety of focus areas, together with ailments (HIV, malaria, tuberculosis, and so on.), susceptible populations (youngsters, ladies, refugees, and so on.), the surroundings, and commerce/mental property, amongst others, and have various ranges of enforcement energy and power. Although a minority of the agreements reviewed had PPR of their unique mandate, most have been utilized within the COVID-19 response indirectly, with many organizations taking over new roles to take action. Our particular findings are as follows:
- Practically half (34) of the 71 agreements reviewed are legally-binding below worldwide legislation (see Determine 1). These embrace 24 treaties, 6 protocols (that are related to present treaties), 3 United Nations organizations, funds, or specialised companies (WHO, WTO, and WIPO), and one different worldwide settlement (OECD) (see Desk 1). Treaties embrace trade-related agreements below the World Commerce Group (WTO), that are binding below worldwide legislation for WTO member international locations, membership in worldwide well being organizations such because the World Well being Group (WHO) and the Pan American Well being Group (PAHO), and different legally binding agreements such because the Worldwide Well being Rules (2005). Protocols embrace lots of the agreements centered on environmental points such because the Kyoto and Nagoya protocols.
- The remaining 37 agreements should not legally-binding below worldwide legislation, however embrace agreements that confer obligations on members, together with participation in organizations with international well being mandates. Most of those (23) are “worldwide partnerships”, which embrace initiatives such because the Sustainable Improvement Objectives (SDGs) and Common Well being Protection (UHC) 2030, in addition to formal institutional preparations of regional member states, such because the Africa Centres for Illness Management and Prevention (CDC), and broader alliances such because the Group of Seven (G7), Group of Twenty (G20), and North American Leaders’ Summit (NALS). “United Nations organizations, funds, or companies” made up the rest (14) and embrace entities such because the United Nations Environmental Programme (UNEP), United Nations Youngsters’s Fund (UNICEF), and United Nations Inhabitants Fund (UNFPA).
PPR in Unique Mandate
- Of the 71 agreements examined, 21 (30%) included PPR, in some capability, as a part of their unique mandate (see Determine 2). For instance, the Worldwide Well being Rules (IHR) (2005) require international locations to own sure capacities round PPR, together with detecting, assessing, reporting, and responding to public well being emergencies. The Africa CDC’s settlement obligates the physique to work with member international locations to construct illness surveillance programs able to figuring out well being threats and to supply response assist throughout well being emergencies. Equally, the European Centre for Illness Management and Prevention’s founding paperwork define a surveillance and response technique for rising well being threats. The Settlement on Commerce Associated Facets of Mental Property Rights (TRIPS) and the accompanying Doha Declaration on the TRIPS Settlement and Public Well being acknowledge the gravity of public well being emergencies and converse to the potential for mental property rights flexibilities within the context of those public well being emergencies.
- 9 of those 21 are legally-binding. These are: The Settlement on the Utility of Sanitary and Phytosanitary Measures (SPS Settlement), Organic and Toxin Weapons Conference (BWC); The IHR (2005); The Nagoya Protocol on Entry and Profit-Sharing; The Pan-American Sanitary Code; The Protocol on Water and Well being; The TRIPS Settlement; the Treaty of the African Medicines Company, and the World Well being Group.
- Most (50 or 70%) of the agreements reviewed have been utilized to reply to the COVID-19 pandemic both immediately (25), through actions particularly geared toward addressing the pandemic, not directly (8), by means of actions that addressed the impacts of the pandemic on different well being areas, or some mixture of each (17) (see Determine 3). Twenty-one of those agreements are legally-binding (see Desk 2).
- The 25 agreements that solely supported the direct impacts of COVID-19 undertook a variety of actions, equivalent to provisioning medical countermeasures, coaching well being care staff, shoring up laboratories and different well being programs, and creating new governance mechanisms to coordinate the response. For instance, the Entry to COVID-19 Instruments Accelerator (ACT-A) supported a variety of actions centered on addressing the COVID-19 pandemic, together with supporting the procurement of diagnostic instruments, therapeutics, vaccines, and private protecting gear, the World Organisation for Animal Well being created a number of skilled teams to develop tips associated to animal well being and COVID-19, and the International Polio Eradication Initiative shifted its efforts to help within the COVID-19 response by coaching laboratory staff to detect the virus.
- Eight addressed solely the oblique impacts of COVID-19 on different areas that aligned with their mandates. For instance, the Cease TB Partnership issued steerage to assist excessive TB burden international locations combine their TB and COVID-19 testing programs, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) supplied steerage on sustaining progress on HIV prevention within the context of the COVID-19 pandemic.
- Seventeen engaged in each direct and oblique COVID-19 responses. For instance, the International Fund to Battle AIDS, Tuberculosis and Malaria procured COVID-19 diagnostics, therapies, and oxygen for the international locations by which it really works and arrange the COVID-19 Response Mechanism (C19RM) to fund international locations’ efforts to mitigate the impacts of COVID-19 on HIV, TB, and malaria; the United Nations World Meals Programme supported each the supply of COVID-19 provides, equivalent to private protecting gear (PPE), in addition to meals help to deal with meals insecurity ensuing from the pandemic; and the Pan American Well being Group (PAHO) assisted international locations within the procurement and supply of vaccines, in addition to supplied steerage on sustaining important well being providers within the context of COVID-19.
- Many of the agreements concerned in responding to COVID-19 (36 of fifty) didn’t have PPR of their unique mandate however tailored to deal with the pandemic (see Determine 4). These embrace the International Fund, which established the COVID-19 Response Mechanism (C19RM) to supply grants to low- and middle-income international locations for the acquisition of check, therapies, and private protecting gear (PPEs), and the World Financial institution, which established the COVID-19 Quick Monitor Facility and supplied assist for vaccine rollout.
- A subset of agreements that weren’t concerned within the COVID-19 pandemic response (7) include PPR capacities of their unique mandate. In some circumstances, this can be as a result of COVID-19 fell outdoors their organizational scope (for instance, water-borne ailments) or as a result of these agreements have been created very not too long ago (for instance, the Treaty of the African Medicines Company).
The COVID-19 pandemic has highlighted main gaps in international pandemic preparedness and response capabilities. This evaluation outlines the worldwide agreements already concerned in pandemic preparedness and response to tell the event of a brand new pandemic settlement designed to deal with these gaps. Total, we discover that a lot of the agreements reviewed (50 of 71) have been concerned in addressing the COVID-19 pandemic, both immediately or not directly. Most of those shouldn’t have PPR of their unique mandate however, slightly tailored to deal with the pandemic. As well as, half of the 71 agreements (34) are legally-binding, together with 20 that responded to COVID. This implies that there are already capacities to deal with PPR inside present agreements that would doubtlessly be coordinated with a brand new framework. Importantly, although, this evaluation doesn’t try and assess the effectiveness of an settlement’s response to COVID-19 or its PPR capabilities extra broadly, and future analysis might search to take action. As well as, whereas a lot of the agreements responding to COVID-19 did so by adapting their work, we didn’t assess what was required to make such variations (e.g., whether or not new authorizations or mandates have been wanted). As international leaders proceed to pursue the event of a brand new pandemic instrument, this overview might assist to establish agreements with present PPR capabilities, together with whether or not they want strengthening or additional adaptation, in addition to spotlight gaps that will persist.
We sought to establish multilateral worldwide treaties, commitments, partnerships, organizations, and different agreements (“agreements”) that have been health-specific or had a big well being part.
We began with the checklist of agreements compiled and standards used for our earlier evaluation, “U.S. Participation in Worldwide Well being Treaties, Commitments, Partnerships, and Different Agreements”. Because the unique report was accomplished over a decade in the past, we revisited and reviewed the preliminary checklist to substantiate whether or not every settlement was nonetheless lively. We additionally revisited the sources (listed under) to find out if extra agreements warranted inclusion on this evaluation (for instance, if that they had taken on a better function in well being or have been created after the preliminary evaluation). Every settlement was reviewed by a number of members of the group to make sure the accuracy of categorizations.
We analyzed each legally binding and nonbinding agreements and categorized every by kind of settlement, and whether or not parts of PPR have been current within the settlement’s founding paperwork. Legally binding agreements have been compiled based mostly on a overview of the Division of State’s required annual report back to Congress on all Treaties in Pressure, the United Nations Treaty Assortment, the Library of Congress reference assortment on Treaties, the Congressional Analysis Service, and different reference paperwork. Nonbinding agreements have been compiled based mostly on a desktop overview and embrace multilateral organizations, partnerships, consortia, and different preparations. As such, the nonbinding checklist of agreements is complete to the very best of our data however is probably not exhaustive.
We then assessed every settlement to find out if it was concerned in responding to COVID-19 both immediately (by means of actions or the availability of providers geared toward addressing the COVID-19 pandemic) or not directly, to deal with the secondary results of the pandemic (e.g., actions or the availability of providers geared toward addressing different health-related actions, equivalent to meals help, which were immediately affected by the pandemic). If an settlement was deemed to be “immediately” concerned within the COVID-19 response, it was robotically included below the PPR categorization. Agreements addressing the “secondary results” of the COVID-19 response won’t essentially imply they might be concerned in PPR actions. As such, there have been a number of that weren’t concerned within the COVID-19 response that have been included below the PPR categorization. If an settlement was not deemed to be concerned within the COVID-19 response or PPR, it was listed as “Different”. A number of agreements resulted from or are immediately associated to beforehand established agreements (e.g., the Nagoya Protocol was established following the Conference on Organic Variety) or are below the auspices of one other entity (e.g., WHO manages the implementation of the Worldwide Well being Rules). In these cases, the father or mother settlement is assessed as having the identical function within the COVID-19 response because the sub-agreements.
|Direct||Helps efforts aimed immediately at responding to and mitigating the impacts of the COVID-19 pandemic.|
|Secondary Results||Helps mitigating the potential results on different well being actions ensuing from the COVID-19 pandemic.|
|Pandemic Preparedness & Response (PPR)||Manages, directs, or helps efforts to arrange and reply to potential illness outbreaks. If an settlement is categorized as contributing to the COVID-19 response (both direct or secondary results), it’s deemed to additionally assist PPR, however not vice versa.|
|Different||Goals to forestall or scale back the chance of virus rising that would end in a pandemic or aids within the strengthening of nation well being programs.|
Anna Rouw, Adam Wexler and Jen Kates are with KFF.
Kate Toole, Anjali Britto, and Rebecca Katz are with Georgetown College.