The starting draft of the pandemic treaty (known as the Zero Draft) for member states to negotiate was published on 1 February 2023. Government delegations have initiated negotiations in Geneva from 27 February to 3 March 2023 as the International Negotiating Body (INB) meets for the fourth time (INB4). This will be followed by another round of negotiations from 3 to 6 April (INB5).

The Zero Draft fails to properly recognise the essential role of care workers and the impact the pandemic had on systems of care. This is unacceptable for the millions of care workers who risked their lives to ensure that the most vulnerable people within our societies were well cared for and no amount of applauding will ever measure up to guaranteeing their safety and dignity at work. Care is a fundamental human right. Well-funded, comprehensive and accessible systems for the vulnerable are essential for an equitable and just society.

The Zero Draft ignores not only that safe workers save lives, but also that the best prevention for pandemics are resilient health and care systems, of which decent work for all health and care workers is a cornerstone. Upholding the Decent Work Agenda for all care workers across workplaces is vital for quality public services and strong care systems.

It is important that unions bring attention to the voice of labour at the start of the negotiations on the Zero Draft and keep the momentum as negotiations take place. Ahead of the second round of negotiations in April, we must ensure that the concerns of care workers are represented within the treaty process. Working with our affiliates, we will push for the inclusion of the following priorities in the text of the Treaty:

1. Access to Decent Work

Globally, care workers lack access to decent working conditions. The predominately female, and often immigrant, care workforce are some of the lowest-paid and most precarious workers in our societies. When care workers are undervalued, underpaid, and working in precarious conditions they cannot provide adequate care. Care workers around the world lack access to freedom of association, sectoral collective bargaining, pay progression and career support.

The Treaty must ensure that workers have equal pay for work of equal value, training opportunities, equity and non-discrimination in recruitment and retention policies. That the rights to freedom of association and to collective bargaining are respected for all workers in the health and care sectors, whether in the formal or informal economy, as well as their representation in the decision-making process. Fund universal, gender-responsive social protection accessible by all workers regardless of employment status or migrant status, racial or ethnic background, disability, gender, sexual orientation, and inclusive of workers in the informal economy.

Decent work and employment conditions play a key role in pandemic prevention and preparedness and embed resilience into care systems. Ensuring full access to labour rights for all care workers is a vital factor in preventing outbreaks in workplaces during future pandemics.

2. Occupational Health and Safety

Care workers face a range of occupational risks associated with infections, unsafe patient handling, hazardous chemicals, radiation, heat and noise, psychosocial hazards, violence and harassment, injuries, and inadequate provision of safe water, sanitation and hygiene. Care workers globally wereleft exposed to the pandemic without access to quality Personal Protective Equipment (PPE). Many were forced to design their own PPE, using refuse bags or other unsterile materials. Too often we have heard of workers who were left with infected or potentially infected service users with little guidance and training on how to prevent the spread of infection.

A lack of robust occupational health policies or a lack of enforcement by employers is putting care workers at risk. It is important that workplaces are pleasant places where the freedom and dignity of residents are respected, and where everyone’s health and safety are robustly and effectively managed. By safeguarding the health, safety and well-being of care workers, we can prevent diseases and injuries caused by work, while improving the quality and safety of care, human resources for health and environmental sustainability in the health sector. The Pandemic Treaty must have an explicit reference to strengthening the occupational health and safety of care workers such as including an obligation to hold minimum stockpiles of PPE and/or to support local, in-country production to create more resilient supply chains.

3. Safe Levels of Staffing

There is a staffing crisis within care services; many care systems around the world are not staffed adequately and vaccines are outstripping the supply of care workers. Workers weary of exploitation and poor pay are leaving the sector in record numbers. Those who remain are left with little time and resources to fulfil their increasing workloads. As societies expand and people live longer care needs will only continue to grow; governments around the world need to ensure that care workers have the right skills, training, and support to fulfil their roles. Without mandated staffing levels or a regular assessment of future workforce needs, governments are unable to plan or train the staff needed to ensure the safe delivery of care services and this must be clearly reflected within the Treaty text.

4. Protection from Violence and Harassment

As we saw the world over, health and care workers were forced into the spotlight. Violence against health and care workers strongly increased during the COVID-19 pandemic and this trend only seems to continue. The attacks have exacerbated occupational stress and the physical and mental health risks of individual care workers. International assessments suggest that up to 38% of health and care workers experience physical violence in the workplace at some point in their careers. The Treaty needs to explicitly call for governments to ratify C190 and enact policies that tackle violence and harassment in care settings, such as preventing staff from working alone, minimising service waiting times, and providing counselling support and training to care workers on conflict resolution.

5. Fully funded and well-integrated health and care systems

The pandemic exposed the weaknesses embedded within care systems. Many countries with privatised care services saw worse outcomes for service users and workers during the pandemic. The commercialisation of care has put extracting profits ahead of our care needs. It treats vulnerable users not as people but as centres of revenue and profit. It treats workers not as essential providers of quality care but as costs to be minimised by cutting wages, training and staffing levels. Privatised care undermines our public health systems and incentivizes poor health outcomes. Health problems that could be prevented by investing in quality care are instead shifted to the health system once they become acute. Worse still, privatised care has incentives to avoid accountability and treats workers, and their unions, as forces opposed to profit maximisation.

Caring for vulnerable people requires a well-funded, holistic approach. Quality care systems must be integrated into our health systems. Successful integration of the planning, commissioning, and delivery of coordinated, joined-up, and seamless services to support people to live healthy, independent and dignified lives, improving outcomes for the population as a whole. Everyone should have access to quality and affordable care when they need it most. The Treaty must include a reference to the public provision of quality affordable care.

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