What Pandemic Preparedness Would Look Like

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US President Barack Obama, recognizing the true nature of the threat infectious diseases might pose, even created a Global Health Security and Biodefense unit within the National Security Council. But Donald Trump, in his infinite wisdom, shut it down.

Given the strong odds that we will face another pandemic sooner or later, the international community is rightly engaged in discussions about how to do better next time. Last month, a United Nations High-Level Meeting on Pandemic Prevention, Preparedness, and Response produced a «political declaration» that was hailed as a landmark. The 14-page draft acknowledged that, as Carolyn Reynolds, co-founder of the Pandemic Action Network, has put it, PPPR «is so much more than a national health issue; it is a national and global security and economic issue. Like climate change, pandemics are a global systemic risk and existential threat to humanity, and we need to treat them as such».

But isn’t this just stating the obvious? While some have hailed the agreement as «historic», it was accompanied by no firm commitments from governments.

We already know what it will take to do better next time. After COVID-19 spread globally, millions of people in poor countries died for lack of access to medicines that were being hoarded in rich countries. We needed waivers on all intellectual property (IP) related to the pandemic pathogen – including vaccines, tests, personal protective equipment, and therapeutics – as well as commitments from everyone to share their technology and provide all the funds necessary to help poorer countries.

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Yet during the COVID-19 crisis, we saw even the most powerful advocates of international governance, namely the United States, show little compunction about breaking rules and norms that were seen to conflict with their own immediate interests. While curtailing some movement of people to contain the spread of a virus was one thing; blocking exports of essential COVID-related products was another matter entirely.

Moreover, thanks to a courageous freedom-of-information request in South Africa and other confirmed leaks, we now know that big pharmaceutical companies stooped so low as to charge some developing countries more than they charged developed countries. Some also insisted that the bulk of their products be exported to Europe from the emerging markets where they were being manufactured, even though those countries’ own citizens were desperate for medicines.

Worse, while developing-country governments were under strict contractual obligations, the companies themselves were spared from even the minimal requirement to deliver the supplies they had promised in a timely fashion. And they insisted on secrecy – for reasons that are now clear – even in cases where that meant violating a country’s transparency laws. Many developing-country governments thus were left to choose between saving their citizens’ lives and preserving democratic values. As a compromise, at least one country chose to go to Russia for the vaccines. For others, China was the only possible source. 

Any rational approach must start with the acknowledgment that controlling pandemics is in everyone’s interest. Given rich, powerful countries’ apparent inability to keep their commitments during a crisis, the reasonable solution is to ensure capacity to produce pandemic products everywhere, and to eliminate foreseeable impediments to countries doing so. That means agreeing to a strong IP waiver, and establishing stiff penalties for any drug company that wrongly interferes in another company’s use of the specified IP, including in cases where production is being exported to third countries in the developing world.

To stay ahead of future threats, some of the relevant technology should be transferred now, and governments and companies must commit to facilitate any additional transfers that future pathogens might make necessary. Governments should have the tools and legal authority to force or induce firms within their jurisdictions to share such technology, and developing countries should have the right to sue if that does not happen. That being said, global enforcement mechanisms are weak, and we saw during the COVID-19 pandemic the violation of international rules and norms by countries in the Global North – with no consequences. That is why it is so important to have production and drug development capacities in the Global South.

Nor can we trust advanced economies to provide emergency funding when the situation demands. In the current negotiations, even getting them to make pre-commitments has been like pulling teeth. Again, to stay ahead of future threats, we should mobilize the necessary funds now and establish clear rules for delivering them. Even if some governments are unlikely to furnish funds immediately – the world should expect nothing from Republicans in the US Congress – it is still possible to forge a binding agreement to deliver the money through multilateral channels such as development banks and the International Monetary Fund.

There is a quid pro quo here. Since controlling any future pathogen will require data, we need all countries to commit to data sharing. But during the COVID-19 crisis, South Africa was effectively punished when it identified a new variant of the virus: other countries responded by imposing travel restrictions against it, even though it was unclear where the variant had originated, or whether it was more prevalent elsewhere. This episode sets a potentially disastrous precedent for the next pandemic. Countries should have incentives for openness; ensuring access to technologies and emergency funding is essential to this objective.

With COVID-19, we prioritized pharmaceutical companies’ profits over the lives and well-being of people in developing countries. It was immoral, shameful, and counterproductive. As long as a pathogen is allowed to fester anywhere, there will be a risk of dangerous new mutations that threaten everyone. And with America and its European allies fighting a battle for hearts and minds across the developing world, they shot themselves in the foot and exposed the weaknesses of their own democracies. What the rest of the world sees are governments so captured by Big Pharma that they will put its interests ahead of their own security.

We must set the stage for a more just, inclusive, and rational response next time. Faced with that urgent task, last month’s UN meetings fell far short of what is needed.

© Project Syndicate 1995-2023