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Pandemic preparedness on all fronts

Originally published: The Lancet Planetary Health on VOLUME 7, ISSUE 3, E184 March 2023 by The Lancet Planetary Health Editors (more by The Lancet Planetary Health) (Posted Mar 09, 2023)

The COVID-19 pandemic was a wake-up call to the international health community and world governments. Recognizing what it called “… the catastrophic failure of the international community in showing solidarity and equity…” during the pandemic, in Dec 2021 the WHO World Health Assembly established an International Negotiating Board (INB) to reach a global cooperative agreement on future pandemic preparedness by 2024. The mandate for this so-called Pandemic Treaty is necessarily wide-ranging and ambitious, covering intersecting issues such as antibiotic resistance, universal health coverage, intellectual property laws on medicines, cooperation on disease surveillance, and not least importantly, the human-environment interactions that contribute to pandemic risk. The Pandemic Treaty therefore represents an important opportunity to take an integrated whole-environment approach to strengthening global health.

The INB has published its initial draft of the pandemic accord for consultation ahead of further negotiations in February to April 2023. While much of the draft focusses on matters like improved infectious disease monitoring, information sharing, strengthening healthcare systems, and equitable access to medical pandemic countermeasures (all of which are important), it is also highly encouraging that there is a section dedicated to One Health. The draft wording recommends that national pandemic preparedness plans include addressing the drivers of zoonotic disease emergence, including climate change, land use change, wildlife trade, and antimicrobial resistance in domesticated animals. The INB also aspire to work with other UN bodies, that lead on the food system, animal health, and the natural environment, to develop a systems-level approach to pandemic preparedness. The holistic scope of the Pandemic Treaty at this stage is laudable, but there is much room for improvement in the detail.

Most of the specific One Health recommendations focus on disease monitoring. Future iterations of the agreemeAnt would benefit from a much stronger emphasis on the prevention of disease spillover and policies to understand, monitor, and address the drivers of spillover risk. It will be vitally important that the treaty takes One Health, at an operational level, to mean more than surveillance, if it is to meaningfully help prevent future pandemics.

The draft treaty calls for the international community to ensure equity in future pandemic prevention and response efforts. However, at present much of the language on commitments in the treaty is vague and could leave too many decisions down to voluntary agreement by individual nations. There is a similar danger that necessary steps like preserving biodiversity and intact natural ecosystems will be derogated to lower income countries. A mechanism for binding commitments is needed. There should also be provision for the governments of high income countries and for private organizations to account for the global ecological impacts of their consumption.

Realising the kind of universal and equitable approach to pandemic preparedness envisioned in the treaty will need financing commitments from higher income countries to lower income countries. The current treaty draft emphasises the importance of investing in research development and collaboration into pandemic response, but it should be equally important that scientific investment go into better understanding the biological and sociocultural mechanisms which contribute to zoonotic disease spillover risk from wildlife trade, encroachment into nature, domesticated animals, and antimicrobial resistance.

An effective international system to reduce the risk of future pandemics must include a strong delivery orientated component on tackling the upstream causes of novel infectious disease outbreaks. Prevention strategies could also produce better ecological and more economical and just outcomes–but achieving this requires that research and governance systems take a genuinely integrated approach that embraces the many relevant fields of knowledge and practice. Such a commitment is easy to make, but challenging in practice, and so this should be an explicit goal that is measured and evaluated through the treaty development and negotiation process.

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