Briefing - Pandemic Treaty Negotiations (April 2024)

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Briefing - Pandemic Treaty Negotiations (April 2024)

One last push to get our labour-related demands into the Pandemic Treaty!

One last push to get our labour-related demands into the Pandemic Treaty!

Table of contents

One last push to get our labour-related demands into the Pandemic Treaty!

Urgent Update (18 April)

On April 17th, a new negotiating text was released by the Intergovernmental Negotiating Body Bureau. The text is a huge blow both on equity (technology transfer measures, lifting of intellectual property barriers, diversifying production capacity, access to benefits deriving from sharing of pathogens) and on labour rights.

The text is a huge setback with regards to the inclusion of language and clauses to protect health and care workers. Proposals made by several countries with which PSI affiliates have worked before INB9 have not been accepted.  On top of this, important clauses that were already in the text have been removed, echoing developed country's positions, especially the US.

In terms of equity, not even one legally binding measure is seen in the latest released text. Developed countries have successfully pushed away virtually all proposals made by developing countries to include legally binding measures that ensures technology transfer, lifting of intellectual property barriers, diversifying production capacity, and, access to benefits deriving from sharing of pathogens. 

Below, see a table of what was lost in Article 7 (Health and Care Workforce) in the latest text, in comparison with the text released before INB9 (used as the negotiation basis), and the inclusion proposals from Member States:


INB 9 text (released on 8 March 2024)

After inclusion suggestions at INB 9 from Member States

INB 9 resumed session text released on 17 April 2024

Decent work

Appeared twice in text in Article 7

Appears four times  (3 in Article 7 and 1 in Preamble) 

no mention to decent work

Prevent anti-union policies

no mention

Proposed by Brazil in Article 7.1.(a)

no mention

disparities, inequalities, discrimination, stigma and bias; harassment;

the text included a provision to addressdisparities, inequalities, discrimination, stigma and bias against and within health and care workforce

improved with inclusion by Brazil, Mexico, and others

provision removed

addressing gender concerns

the text included language that spoke to addressing gender and youth concerns including existing barriers women face in the health and care workforce to reach leadership and decision-making roles

mostly supported by Member States 

provision removed

addressing violence and harassment

included provision to address violence, harassment and threats against health and care workforce

Russia and Fiji suggested deleting this

provision removed

priority access to health technologies





Reference to WHO's code, to ethical recruitment practices

inclusion by Brazil of "core labour standards" to migrant workers 

no mention

social dialogue

no mention of social dialogue - just "consultation with workers"

inclusion of social dialogue by South Africa, Brazil, Tunisia

no mention

mental health

included mental health and well-being language

no suggestions for deletion by any MS

no mention

How was the INB9

From March 18th to 28th WHO Member States gathered for the ninth round of negotiations of the Pandemic Treaty - INB9. This was supposed to be the last round of negotiations to get the text ready to be voted at the World Health Assembly (to be held on May 27th). PSI, on behalf of health and care workers around the world, was present during the whole negotiations pushing hard to include labour rights in the text of the treaty. Article 7 - Health and Care workforce - was our main priority. After this round the inclusion of new text is unlikely.

PSI and Affiliates’ Engagement on Article 7

Prior to the INB9, many affiliates from all the regions sent letters and/or had meetings with governments to share our demands. The objective was to have Member States suggesting inclusions to enhance Article 7 during the negotiations. IT WORKED! We had many countries proposing and supporting our language.

However, after two weeks of negotiations at the INB 9, Member States are still far from reaching an agreement and decided to reconvene from April 28th to May 10. During this last round of negotiations, countries will not be able to include new language. 

The new negotiating text (which will be the basis for this INB9 resumed session) is deeply unfair and unbalanced and reflects primarily the positions of the global north countries and that of the corporate lobby. Now more than ever developing countries need to stay firm on their demands and push for the reinclusion of topics that were removed from this new version!

This means that our task now is to have our governments commit to keep good inclusions and exclude the bad ones. This is the final push! We have only a few days left to make our governments side with health and care workers! Let us get them to commit to HEALTH OVER WEALTH and PEOPLE OVER PROFIT!!!

What can we do now?

Write to your government and ask for a debrief to understand the positions your country defended during the negotiations. Ask direct questions such as: "did (name of the country) defend the inclusion of decent work in Article 7?"; "did the delegation explicitly defend the inclusion of 'decent work' language?". We already have access to the "on screen" text (here). The text shows which countries are allies and which are against health and care workers rights. When the negotiations resume on April 28th, the support of each delegation to our points is fundamental! Countries need to be vocal and back the inclusion of labour rights in the final text. This is the last moment!

This month will determine whether the points that you have identified over the last year and a half in the workshops and seminars we have organized will be included in the final text of the Treaty. 

Suggested actions

  • Send the model letter asking for a meeting. In the model letter, there are two paragraphs that have options related to the position each country took. Countries notably supporting labour rights: Mexico, Brazil, Colombia, Chile, Bolivia, South Africa, and Philippines; countries notably against labour rights: USA, India, Pakistan, Bangladesh

  • In the meeting ask which positions your country have defended regarding Article 7 (and other articles, if your union is interested - check analysis here)

  • Try to obtain political commitments from the relevant ministries, explaining that the country needs to be vocal and explicitly defend health and care workers demands during the next round of negotiations. Say that it is important to transmit the information to the mission in Geneva, since many delegations were aware of our letters but claimed that they did not receive any instructions from the capital. You can mention that PSI had people on the ground, speaking with delegates and that we will have people following the INB9 resumed session.

From our demands, what was proposed by Member States at the INB9?

  • Strengthen decent work
    Many countries have defended the inclusion of language around decent work in the text of Article 7. While we also suggested that Decent Work was included as a Guiding Principle of the Treaty and that did not happen, decent work is mentioned in the Preamble and other three times in Article 7.

  • Prevent anti-union policies
    Brazil proposed the inclusion of language in Article 7.1.b, which is related to address disparities, inequalities, discrimination, stigma and bias against and within health and care workforce

  • Social Dialogue
    South Africa, backed by Brazil and Tunisia, has proposed the inclusion of a paragraph with the exact same text as the one pushed by PSI affiliates

  • Fair and Ethical migration policies
    Article 7.3 cites the WHO Global Code of Practice on the International Recruitment of Health Personnel. While some countries try to water down the article (European Union, USA, India and Bangladesh), others proposed to defend "ethical" language (Philippines), as well as "core labour standards" (Brazil) of health professionals migration during pandemics.

  • Policies to protect deceased and injured workers and their families.
    Brazil and Mexico have proposed the inclusion of a sub-paragraph with the exact same language as the proposed by PSI's affiliates.

What has not been proposed by countries

  • Precautionary principle
    No country has proposed the inclusion precautionary principle-related language. Our proposal was to include the Precautionary Principle as a Guiding principle and that was not defended by any government.

  • Staff/patient ratio
    PSI's affiliates had proposed including provisions that ensure safe staff to patient ratios as a prerequisite for strong national health systems, as well as other minimum standards referring to the  ILO Convention 149 on Nursing personnel. This was not proposed by any country.

Which countries opposed and to what?

- USA is opposing "decent work" and any language that generates compromise (wants all voluntary)

- USA is opposing to language guaranteeing priority access to health technologies to health and care workers during pandemics.

- Pakistan and India opposed "social dialogue".

- Bangladesh and India are against fair and ethical migration policies

Where is the conflict and why Member States could not reach an agreement

The negotiations show clearly a division between North and South. On one hand, developed countries are pushing to have legally binding compromises from developing countries on issues related to surveillance and access to pathogens. This puts a burden on developing countries since they would need to significantly change their actual surveillance systems.

On another hand, developing countries want measures to guarantee equity, such as legally binding measures on technological transfer, IP waivers, and access to pathogens derived from the shared pathogens. Developed countries want only voluntary measures and are blocking every measure that will go beyond the status quo on such issues.

Other articles (special attention to articles 9, 10, 11 and 12)

The last text published by the Bureau before the INB9 had around 30 pages (link below). After the INB9, and after countries included brackets with their proposals, the text has 110 pages. This shows that it will not be easy to reach a consensus. Article 11 (Transfer of technology and know-how), according to an analysis published by KEI, contains 579 country positions: 112 are more favourable to pharmaceutical corporations; and 183 are more in favour of access to medicines, vaccines.

An in-depth analysis of articles 9 (Research and development), 10 (Sustainable and geographically diversified production), 11 and 12 (Access and benefit sharing) seems impractical at this point, given the huge number of brackets in those articles. In fact, the text is unreadable. 


Read More:

PSI intervention at INB9

WHO Member States agree to resume negotiations aimed at finalizing the world’s first pandemic agreement

TWN: WHO: Member States to hold another pandemic instrument negotiations round amidst wide divergence

WHO: INB Bureau proposes another round of negotiations without “on-screen” drafting

Contact information 

●      Ananya Basu, Asia Pacific Coordinator for Health Equity (

●      Pedro Villardi, Global Coordinator of Health Equity and Regional for Interamericas (

●      Moradeke Abiodun-Badru (Abi), West Africa Project Coordinator (

●      Baba Aye, Director de Políticas del Sector de Salud y Servicios Sociales (