We welcome the opportunity to submit our written comments, in the wake of our interventions at the second resumed session of the first meeting of the INB, in June 2022. We equally appreciate the work put into White paper. The following are our comments please:

• We urge the INB to pursue the drafting and negotiation of a binding treaty, in line with the provisions of Article 19 of the WHO constitution. We are of the view that this will go a long way in ensuring that far-reaching steps are taken to ensure pandemic prevention, preparedness, and response.

•  We call for the envisaged instrument to include explicit means of promoting compliance and accountability. Provisions to this extent, we suggest, should be introduced in Part 1, Section 2, and reinforced in Part XI.

• We notice that there is the White paper does not spell out any distinction between developing and developed countries. For equity, and international solidarity, we call for the inclusion of common but differentiated responsibilities (CBDR) in the principles of the intended document, as is the case with under the Declaration of Alma Ata and the International Health Regulations (2005), for example.

• Despite the frontline roles played by health and care workers in the current pandemic, which has been variously celebrated, the White paper does not, in our view, adequately capture needed substantive elements to safeguard the health and wellbeing of health and care workers and ensure safe and effective staffing for health needed for pandemic prevention, preparedness and response. We thus propose as follows:

  • Inclusion in Part 1, Section 4 (Principles):

    • decent work (as stipulated by the ILO) for health and care workers, including adequate staffing levels, renumeration, workplace safety and autonomy.

  • Inclusion in Part 1, Section 5 (General obligations):

    • Commit to addressing the health and care workforce shortages, and skills anticipation to ensure universal access to health workers with interoperability of skills for health emergencies.

• In the “Transfer of technology and know-how” sub-sections of the Equity sections of Part IV (Measures relating to preparedness) and Part V (Measures relating to response), the White paper explicitly makes an a priori case against the imposition of “legal or financial obligations, including time-bound waivers of intellectual property.” We find this shocking, in the light of the COVID-19 experience.

  • Over 100 countries, mostly from the Global South, have called for time-bound waivers of intellectual property rights, to enable universal access to pandemic products and technologies. Hundreds of experts and other world leaders, including the Director General of the World Health Organization also added their weight to this stand, with the believe that such suspension would have resulted in more lives being saved. In the light of this, we are strongly of the view that, instead of ruling out “legal or financial obligations” for the promoting access to technology and know-how, the international agreement should include a mechanism for the automatic trigger of temporary suspension of IPR for relevant pandemic products and technologies on the declaration of a Public Health Emergency of International Concern (PHIEC), as we proposed to the INB in April.

• We have earlier highlighted the primacy of strengthened universal public health systems as bedrock for pandemic prevention, preparedness, and response. We are of the view that this need is not adequately reflected in the White paper. We would propose the amendment of “resilient health systems for universal health coverage and health security” to read “strengthening universal public health systems towards the full realization of the right to health”, in the sub-sections on “capacities and systems strengthening”.

• The need for an “all of society” approach to ensuring pandemic prevention, preparedness and response has been stressed by world leaders, in arriving at the need for an international agreement. Regarding the crucial issue of financing, this means that we need much more than “enhanced collaboration between health and finance sectors” or strengthening of national financial capacity “including through enhanced domestic resources”. Debt relief, and cancellation as well as restructuring of the global financial and tax architecture would be essential as possible mechanisms for sustainable financing, particularly for developing countries.