Over the course of the COVID-19 pandemic, there has been significant discussions on the need to ‘build back better’ and to avoid the same mistakes seen in the global COVID-19 response. The most glaring of these mistakes being that of vaccine inequity, a problem that continues to persist. Other issues in the COVID-19 response have included unequal distribution and access to PPE, diagnostics, ventilators, and medicines distribution; unnecessary and unsafe exposure of healthcare workers to the virus; and weak health systems unable to provide necessary care to their patients. 

Keeping in mind the hugely inadequate response of the global health community to the COVID-19 pandemic and the large-scale health inequity (largely due to lack of cooperation among states) witnessed during the pandemic, a need was felt for an agreement among nations on directives and measures to effectively avoid and address any future health emergencies. As a result, at a special session of the World Health Assembly, held in November 2021 member states of the World Health Organisation (WHO) agreed to proceed with a new international instrument towards this. The instrument, informally known as the Pandemic Treaty, will set voluntary as well as legally binding norms and standards aimed at strengthening pandemic prevention, preparedness, and response. It will be drafted through formal negotiations through the Intergovernmental Negotiating Body (INB). The final instrument is expected to be adopted in 2024 at the 77th World Health Assembly (WHA). 

This instrument is important as it can shape the ways in which health systems globally not only respond during a pandemic, but also ways for countries to address existing health inequities. 

This means that the treaty should ideally include clauses that secure and protect the interests of the health and care workforce of countries. We know that health systems are strong and resilient only when workers' interests are secured.

It is thus important that during the negotiations member states push for provisions that will ensure future cooperation and democratic processes that can strengthen health systems, ensure decent work conditions, and build resilience within the global health governance to respond to shocks such as a pandemic.

Decisions made at the World Health Assembly are achieved through consensus between governments. In some rare cases decisions are made by vote if the topic is particularly sensitive and there’s lots of disagreement (for example on the health situation in Ukraine). All member states of the WHO can define the focus and text of the new pandemic agreement through the INB which is open for all governments to take part in.   

The INB consists of:

Co-Chairs: from South Africa and the Netherlands

Vice Chairs: from Thailand, Japan, Egypt, and Brazil

In addition to member states, United Nations and intergovernmental organizations, official observers and nongovernmental organisations in official relations with the WHO are also invited to attend and speak at INB meetings, workgroup meetings and contribute via an online platform. This engagement is extended to a further list of organisations selected by the INB. However, they only have a consultative role and are not part of the negotiations. 

PSI as a non-state actor in official relations with the WHO has been part of the process of the development of the treaty. Negotiations on the text of this instrument are currently underway. So far, the member states have agreed the new instrument will be legally binding but may also contain non-binding provisions.   

Upholding the Decent Work Agenda for all health and care workers across workplaces is vital for quality public services and strong healthcare systems. Article 12, in the Zero Draft on "strengthening and sustaining a skilled and competent health workforce" remains grossly inadequate in addressing the rights of workers. It fails to recognise the essential role of health and care workers who despite the lack of Personal Protective Equipment (PPE) early in the pandemic risked their lives to ensure that elderly and disabled people were taken care of and reached out to vulnerable communities.   

Because of lack of secure employment and decent working conditions there is a drain of health and care workers from low-and-middle income countries to high-income countries. In most cases the mobile population of workers are not protected by any laws in the destination countries. During the pandemic this phenomenon was exacerbated due to the stressful conditions face by the health workforce. However, the current draft fails to address this phenomenon. It is imperative in the context of strengthening global health systems and regional cooperation for preparing for future pandemics, that the treaty addresses issues faced by both the migrant health workforce as well as the sending countries whose health systems are already overburdened and weak and face acute shortage of workforce. 

The following are the specific inclusions that PSI calls for in the Pandemic Treaty:

• Labour and union rights for health and care workers both inter- and in pandemic times, to be explicitly included;  

• The application of the precautionary principle in policies affecting health and care workers' exposure to risk, as an additional principle   

• The inclusion of meaningful participation of unions and organisations of health and care workers in decision making in long term health and care policy as well as in crisis planning during a pandemic; 

• An additional article in Chapter IV (ideally before the current Article 12) providing for measures to ensure decent work for health and care workers, with the explicit inclusion of improved working conditions, adequate health and care worker to patient ratios and the labour rights provided for in ILO recommendations and instruments, such as the 2017 ILO Tripartite Meeting on Improving Employment and Working Conditions in Health Services,  the 2016 Report of the Expert Group to the High level Commission on Health Employment and Economics and the Convention 149 on nursing personnel; 

• The new instrument should explicitly include protective measures that secure rights of migrant health and care workers in destination countries. As well as adequate measures to ensure that sending nations do not face health workforce shortages. 

The Zero Draft includes clauses on compulsory obligation for manufacturers that receive public funding for R&D in pandemic countermeasures to disclose prices and contractual terms for public procurement in times of pandemic. This is included in Article 9 on "increasing research and development capacities” (Article 9.3.b). This inclusion is a valuable gain.  

However, to truly realise a robust global health systems architecture we believe that we must understand all health technologies as public goods. Governments must commit to invest in their development and distribution. 

It is therefore important that the instrument includes policies that guarantee that all health products, technologies, know-how, etc, that originate from public-funded research programs be kept in the public domain.

The TRIPS Waiver campaign for a suspension of intellectual property rights (IPR) on vaccines, therapeutic products and diagnostics as demanded by more than 100 countries at the World Trade Organisation (WTO) highlighted the restrictive role of trade rules in addressing people’s health concerns. 

Because of the international pressure created by the TRIPS Waiver campaign as well as continued discussions around the world on big pharma greed and its profiteering over the lives of people, the current pandemic treat text has included a provision for a time-bound waiver of intellectual property rights to accelerate and scale-up manufacturing of pandemic products.

However, this article needs to be strengthened in order for it to be effective. PSI therefore calls for the time-bound waiver to be automatically triggered with the announcement of a PHIEC, ie a public health emergency of international concern. A PHIEC is a WHO defined situation of emergency and covers a wider range of critical health emergencies, including a pandemic. 

Further, it should be specified that this waiver would apply to all parties willing to use it and not be left for each country to take measures within their borders unilaterally. The existing caveats in the TRIPS agreement of the WTO already enable countries to take such unilateral initiatives, which has proven to be a sub-optimal mechanism.