Hey readers,
It's Dylan Scott here.
The Covid-19 pandemic revealed that, in a global health emergency, all the aspirational rhetoric about international cooperation didn't mean much. Once groundbreaking Covid-19 vaccines became available a year into the pandemic, rich countries looked out for themselves and poorer countries were largely left behind.
That brought recriminations, but also a pledge from the world's nations to learn from those mistakes and create a better playbook for when a future pathogen inevitably threatens the world.
So at the end of 2021, the World Health Organization (WHO) announced that the global community would negotiate a pandemic treaty to set the rules for international cooperation in future public health crises. Those efforts were supposed to reach a triumphant conclusion this May, at the World Health Assembly in Geneva, where the final product of treaty negotiations would be reviewed and ratified by the world's nations.
But the last few months of negotiations have instead been tumultuous. The same divisions between rich and poor countries that emerged during Covid are now threatening to derail what was meant to be a landmark achievement in protecting the world from catastrophic pandemics.
The fundamental problem is that, much as they were in the thick of the pandemic, wealthy nations remain largely allied with Big Pharma against the Global South's interests.
The stalemate over sharing information about emerging diseases
One major sticking point in the pandemic treaty is about coming to an agreement on sharing information about dangerous new pathogens — a key component of keeping the world safe from future pandemics.
Africa in particular is the source of many emerging diseases that could pose a risk to humans. Under the system being contemplated in the pandemic treaty talks, once a potentially dangerous virus is identified, developing countries would share access to viral samples with developed countries, home to the bulk of the world's biopharmaceutical industry.
The industry would then take that information to begin developing medical countermeasures, like vaccines or new treatments. Then those new medicines would be shared equitably between the nations where they were developed and the nations that provided the raw material about the diseases.
In exchange for providing pathogen samples, African nations want pharmaceutical companies to pay an annual fee to support a centralized system for sharing pathogen information and for sharing the medical products that are ultimately developed from that information, potentially managed by a major multilateral body like the WHO. They also want pharmaceutical companies to commit to making a certain percentage of the products developed from these pathogen samples (diagnostics, vaccines, medicines) available for free or for the cost of production in a future pandemic.
But Big Pharma opposes both compensating countries for sharing pathogen information and the creation of a centralized bureaucracy to manage that process, arguing that it would slow down the development of medical breakthroughs. Drug companies have been largely supported in that position by the US and European Union.
Big Pharma's argument should be familiar to anybody who has followed the drug pricing debate in the US: Whenever a new regulation is proposed, the drug industry warns that it will stifle innovation. Research on drug development, however, suggests that may not be true.
The pharmaceutical industry says it does not have a problem with reserving some of its products for low-income countries. But its conditions for providing that conflict directly with the desires of the Global South.
Pharma companies want free, unfettered access to the pathogen information from the Global South. They also want intellectual property rights to treatments to be protected, which could make it harder for new medicines to get to developing countries by limiting the scale of production. (Relaxing IP rules, on the other hand, would make it easier for other parties to manufacture their own version of the medicines and distribute them in an emergency.)
During Covid, the vaccination initiative Covax attempted to circumvent IP rights in order to quickly produce and distribute vaccines, but those efforts were delayed and ultimately watered down, in part with the support of international actors like the EU, where many big drugmakers are based. "By organizing its multilateral effort with a commitment to saving IP rights at the same time as saving lives, [COVAX] created a terribly limited and limiting vaccine supply system for underserved and excluded populations," according to a recent analysis in the journal New Political Economy.
Private interests could derail the pandemic treaty
That is exactly the type of situation that a pandemic accord is meant to prevent. But the current stalemate suggests that the underlying dynamics that led to millions in the Global South missing out on Covid vaccines haven't changed.
Wealthy states remain too often beholden to their biopharma industries. They have established a complex web of regulations that protect the companies' IP, giving nations first access to the drugs and vaccines their drugmakers produce. That entanglement has created what the authors of the New Policy Economy paper, Matthew Sparke of the University of California Santa Cruz and Owain Williams of the University of Leeds, describe as collusion between developed nations and the drug industry.
"They serve to capture value from biomedical innovation in ways that limit global access to medicines while simultaneously entrenching the dominance of high-income countries, lead firms and the interests of investors," they wrote.
Many other questions about the pandemic treaty must still be resolved in the coming months, including the nature of the agreement itself. Should it be opt-in or opt-out? The latter would mean that it comes into force more quickly (and that some of its provisions could be watered down). But an opt-out treaty might be politically difficult in countries like the US, where broad swaths of the public are skeptical of global health authorities, and a Republican-controlled House may not ratify such an agreement.
It is too early to declare the pandemic treaty dead — negotiators are in the midst of a two-week meeting to try to resolve these issues. But the obstacles are substantial. Pharma's influence has frequently thwarted drug cost control efforts in the US and around the world. Let's hope this time policymakers can overcome it.
—Dylan Scott, senior correspondent
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