Why an international pandemic agreement is important

It is vital for consensus to be established between countries so the world is better prepared for the next pandemic

Read more by Dr Muiris Houston 

@muirishouston

Whatever happened to the new international treaty for preparing, preventing, and responding to pandemics?

At the height of the Covid-19 pandemic, 25 heads of government issued a call for such a treaty.

And for two years, World Health Organisation (WHO)member states have been negotiating an international agreement scheduled for adoption at the World Health Assembly this month.

However, negotiations ground to a halt as member states failed to reach consensus on critical issues. While the public mood is to quietly forget about the Covid-19 pandemic, science suggests this would be a bad move.

As I write, a new report by the Society of Actuaries in Ireland shows we experienced around 1,100 excess deaths during the pandemic years of 2020 and 2021.

The analysis reveals “broadly no excess mortality in 2020”, but significantly more during the pandemic’s second year. Among various possible reasons why there was lower excess death in 2020, the report suggests that Government-imposed restrictions stand out as one potential significant factor.

As one of the most controversial policies introduced during the pandemic, any future social restrictions on free movement and isolation of nursing home patients needs to be thoroughly addressed. Ideally, this would be achieved through a WHO-mediated international agreement.

Additional urgency for a pandemic agreement comes from the continued emergence of avian flu, aka the H5N1 virus. Since around 1996, it has led to intermittent cases of avian flu in humans. It has also steadily infected more species including, most recently, dairy cattle in the US. Between 1 January 2003 and 21 December 2023, 882 cases of human infection with the H5N1 virus were reported from 23 countries, of which 52 per cent were fatal. 

A recent editorial in The Lancet Infectious Diseases has a clear warning about the pandemic potential of bird flu: “The increasing host range of the virus, [its] potential spread among mammals and between a mammal and a human, its wide geographical spread, and the unprecedented scale of the outbreaks in birds, raise concerns about the pandemic potential (of H5N1),” it says.

And a recently published international survey of leading scientists found that some 57 per cent of disease experts now think that a strain of flu virus will be the cause of the next global outbreak to follow Covid-19. The WHO has also weighed in. The H5N1 variant has become “a global zoonotic animal pandemic”, according to the WHO’s Chief Scientist, Dr Jeremy Farrar.

According to two US experts writing in Stat online magazine, the world urgently needs global rules for reducing the risk of another pandemic, whether from H5N1 or another threat. “To prevent such a disaster, we need international law for exchanging scientific information in real time, equitably distributing drugs and vaccines, building global manufacturing capacity, and rebuilding trust between countries,” Alexandra Phelan and Lawrence Gostin said.

What specifically do the authors suggest we need to see in a new treaty?

Preventing new outbreaks is crucial to averting future crises. Since approximately up to 75 per cent of new or emerging infectious diseases originate from animals, it is imperative to address animal health threats before they cross over to humans. Ensuring quick access to pathogen samples and their genetic sequences is essential, the article states.

In the event of an outbreak, countries must share scientific data in real-time to halt the spread and expedite the development of lifesaving vaccines and treatments. All nations would benefit from robust international regulations that guarantee swift access to pathogen samples and sequences. Additionally, these regulations should include binding commitments to fairly distribute the resulting benefits, according to the article.

The Stat authors write that “if there were a single message sent by low- and middle-income countries… it is that rich countries and industry exploit pathogen samples and sequences by developing lifesaving products and then hoarding them”.

They argue: “Rebuilding trust between countries is essential to global health security. Without trust, countries won’t report outbreaks promptly, and they won’t freely exchange epidemiologic information, virus samples, and sequencing data. The pandemic agreement, like climate treaties, should create an independent ‘conference of parties’ that would monitor and facilitate compliance, hold governments to account and create new forms of regulation to fortify global health security.”

And there needs to be an improvement in the negotiating process. Spending the last two years in active negotiation behind closed doors with no agreement to show is simply not good enough. The next phase must be transparent.