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to Public Health On Call, a podcast

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from the Johns Hopkins Bloomberg School

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of Public Health, where we bring

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to publichealthquestion at jhu .edu. That's

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publichealthquestion at

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jhu .edu. for future

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podcast episodes. It's

0:32

Lindsay Smith -Rodgers and today some good

0:34

news for global health. Since 2021,

0:36

countries have been drafting a

0:38

pandemic treaty aimed at ensuring there's

0:41

a better global response to the

0:43

next pandemic. On April

0:45

16th, the WHO announced that an

0:47

accord was reached in the

0:49

world's first global pandemic treaty. Dr.

0:52

Alexandra Phelan, an expert in global health

0:54

law with the Johns Hopkins Center for

0:56

Health Security, returns to talk with

0:58

me about the treaty, some

1:00

exciting inclusions, next steps, and

1:03

what it means that the US was

1:05

not at the table. Let's

1:07

listen. Alexandra Phelan, thank you so

1:09

much for joining us today on Public Health on

1:11

Call. So you're back on

1:13

the podcast to talk about an

1:15

update to a really exciting topic, the

1:17

pandemic treaty. Can you give us

1:19

a quick background on the pandemic treaty and how

1:21

we got to where we are now? Yeah,

1:24

absolutely. Thanks for having me. It is an

1:26

exciting moment to be back, but it

1:28

has all just happened. So about

1:30

three years ago, in the wake of

1:32

the peak of the COVID -19 pandemic, WHO,

1:35

World Health Organization, member states,

1:37

decided that they wanted to review

1:39

the international system. And as

1:41

part of that process was they

1:43

wanted to look at creating

1:45

a new international legal instrument to

1:48

address many of the gaps

1:50

that was seen during COVID -19,

1:52

particularly around international inequities in vaccines,

1:54

diagnostics and therapeutics, but also

1:56

some of the gaps that had

1:58

been recognized in previous outbreaks

2:00

like Ebola and Zika.

2:04

And so they started this process

2:06

of negotiations and launched in

2:08

Feb 2022, was when they kicked

2:10

off. It wasn't for another

2:12

year and a half though, before

2:14

they got to an actual negotiating

2:16

text and Treaties typically, the negotiation

2:18

process, take a decade. They are

2:20

not short processes, but they

2:22

had a really ambitious schedule. In

2:25

May 2024, they met for

2:27

the World Health Assembly and hadn't

2:29

been able to reach agreements, so they extended

2:31

for another year. And so

2:33

after three years, a year and a half

2:35

of text, on Saturday morning

2:37

at 9 a .m. Cutters worked through the

2:39

night and came to very close to consensus.

2:42

and adjourned came back together and

2:44

just yesterday the early hours in

2:46

Geneva managed to have a complete

2:48

consensus draft text. They're all in

2:51

agreement on the terms and the

2:53

language and a process going forward. So

2:55

the next step will be

2:58

the World Health Assembly next month

3:00

in Geneva where they hope

3:02

to adopt the draft text. And

3:05

we can talk about what the next

3:07

steps look like, but that'll be a

3:09

pretty monumental event, assuming that all goes

3:11

through, and it likely will. And

3:13

I think we should talk about those next

3:15

steps. And first, just to date our

3:17

conversation, we're talking on Thursday, April 17th. This

3:19

episode will likely run next week. So

3:21

just to give our listeners a time frame

3:23

of what we're talking about here, but

3:26

tell us what's happening next. Yes.

3:28

Once the draft text is

3:30

adopted, It will launch

3:32

a sort of a process

3:34

to negotiate one of the really

3:36

tricky issues that came up

3:38

during negotiations. And the

3:41

idea is to craft a new

3:43

annex that will become part of

3:45

the agreement. But countries knew that

3:47

they needed a little bit more

3:49

time to work out the details,

3:51

including technical inputs. So that is

3:53

called the Pathogen Access and Benefit

3:55

Sharing Annex. And the treaty itself,

3:57

the text contains provisions about establishing

3:59

a pathogen access and benefit

4:01

sharing system, which is essentially

4:03

a system for the sharing

4:05

of pathogen samples and their

4:07

genetic sequences. And then

4:09

the equitable sharing of benefits that arise

4:11

from the use of those samples and

4:14

sequences. So things like vaccines and diagnostics

4:16

and therapeutics, they rely on those sequences

4:18

and samples to be created and tested.

4:21

And that equitable sharing really goes to

4:23

the heart of many the issues

4:25

seen during the COVID -19 pandemic. So

4:28

countries will negotiate that likely

4:30

over the next year or

4:32

so in an intergovernmental working

4:34

group, but potentially sooner, potentially

4:36

longer. And once that

4:38

is adopted by a future

4:40

World Health Assembly, then

4:43

the treaty can be open

4:45

to signature. And when the

4:47

treaty is open to signature countries can then

4:49

sign it and ratify it and then they

4:51

become parties to the treaty. Once

4:53

there are 60 parties to the treaty,

4:55

add 30 days, and that's when the

4:57

treaty becomes into illegal effect and becomes

4:59

legally binding. So it

5:01

is a bit of an

5:04

uncertain timeline going forward, but

5:06

given we've seen the negotiations

5:08

go so fast, consensus reached

5:10

in many long hours, but

5:12

in a relatively short time

5:14

frame, I think the hope is

5:16

that these next steps will happen relatively

5:18

quickly and we can move to an

5:21

international agreement that sets the standards. of

5:23

pandemic prevention preparedness and response. What

5:25

are some other aspects of the treaty

5:27

that you're particularly excited about? Yeah,

5:29

so I mentioned this PABS,

5:31

Pathogen Access Benefit Sharing Eye. That's

5:33

been a particular focus of

5:35

mine for nearly 10 years. And

5:37

so I think seeing that

5:39

come together is really exciting and

5:42

I think is at its

5:44

core about rectifying injustices in science

5:46

as well as access to

5:48

countermeasures. So I

5:50

think that's really exciting. There's

5:52

some other tricky issues that were

5:54

big. The first is prevention. So how

5:57

do we prevent pandemics? Thinking about

5:59

the upstream drivers, which include things like

6:01

climate change and biodiversity loss, as

6:03

well as spillover of zoonotic pathogens.

6:05

Pathogens move from animals to humans

6:07

and from humans to animals and

6:10

sometimes back again. And

6:12

similar to that, there's also prevention specifically on

6:14

the concept of one health, which is

6:16

this idea of taking measures at

6:18

that interface between animals, humans and

6:20

the environment. Technology transfer

6:22

was a big issue, particularly

6:24

last week. It really became

6:27

a focus on how do

6:29

we incentivize and engage with

6:31

industry in this process of

6:33

building global capacities to produce

6:35

vaccines, therapeutics and diagnostics. And

6:38

so there's language, there's provisions

6:40

in there around technology transfer

6:42

that really try and balance

6:44

the perspectives of countries and

6:46

different views about intellectual property.

6:49

I think there's some of the key issues, but

6:51

some of the parts that I'm excited about that

6:53

haven't gotten much attention. There are

6:56

articles on healthcare workforce,

6:58

on protecting and retaining strong

7:00

healthcare workforce, so doctors,

7:02

nurses, and other allied health

7:04

professionals. There are provisions

7:06

about building and strengthening health

7:08

systems with a goal towards universal

7:10

health care. You know, these

7:12

are the things that are often

7:14

forgotten. These are the big systemic changes

7:16

that really address inequities. And I

7:18

think they shouldn't be discounted. The final

7:20

thing that I'm really excited about

7:22

is the governance arrangements. And that's, you

7:25

know, that's the international law in

7:27

me. But I think we often see

7:29

treaties as the text and nothing

7:31

else. For me, I see the process

7:33

of negotiations and then the structures

7:35

and institutions that the treaty creates going

7:37

forward as just so important. That's

7:39

what builds trust. That's what repairs

7:41

the fractures that we've seen over

7:43

the last five years. And in

7:45

a particularly difficult geopolitical environment, that's

7:47

so valuable and important. And

7:49

so the treaty establishes a conference

7:52

of parties that will meet and

7:54

come together to interpret and build

7:56

guidelines and further steps and details

7:58

to implement the treaty. And

8:00

I think those sorts of structures

8:03

are actually really important because they put

8:05

pandemic prevention preparedness and response onto

8:07

the table of leaders at the top

8:09

levels of government so that this

8:11

is a continuous conversation and not just

8:13

written and forgotten. When we

8:15

talked previously, the summer of

8:17

2024, it was because they had actually

8:19

missed a deadline that they had set up

8:22

to sign this treaty. Was

8:24

there anything between then and now that

8:26

maybe didn't make it in that you were

8:28

disappointed to see was left on the

8:30

cutting room floor? You know,

8:32

I think what was surprising is,

8:34

I guess, so much did

8:36

make it in in the end,

8:38

but The process of compromise

8:40

and negotiation did mean that some

8:42

of the more binding, really

8:44

clear, direct obligations kind of got

8:46

watered down or got limited

8:48

in some way. subject

8:51

to the availability of national resources

8:53

or national laws. And so, you

8:55

know, I think that's kind of

8:57

one of the bargains that gets

8:59

made in the negotiation process is

9:01

if you want a legally binding

9:03

treaty, how willing a country is

9:05

to sign up to something that,

9:07

you know, it's going to cost

9:09

them money, attention, time, you

9:11

know, technical capacity. And so that's a

9:14

careful balance. So I think it's understandable.

9:16

But I think, you know, There's

9:18

always a desire to have as

9:20

strong language as possible. I

9:22

really like that this treaty does capture

9:24

expressly the right to health. I

9:26

think it would have been great to have

9:29

more human rights language in there. Right now,

9:31

the treaty does include the principle of respecting

9:33

human rights and the right to health. There

9:35

are other aspects to human rights,

9:37

like protecting human rights and fulfilling human

9:40

rights by protecting them from third

9:42

parties and not just governments. other

9:45

actors. And I think that sort of

9:47

language would have been really beneficial. But

9:50

I hope that this foundation at least

9:52

gives the opportunity to build on that

9:54

through the COP process going forward. There's

9:56

one noticeable thing here that was not

9:58

there before, and that is the US

10:00

was not part of this negotiation and

10:03

is now not part of this treaty.

10:05

Yeah, absolutely. I think, you know,

10:07

when the United States announced its

10:10

intention to withdraw from the WHO,

10:12

which is scheduled to go into

10:14

effect in January 2026, they

10:16

also withdrew from the negotiations

10:18

process. And, you know,

10:20

I think it's probably not common

10:22

knowledge, but In this process in

10:24

particular, but this does

10:26

happen around other negotiations, but the

10:29

US played a really critical,

10:31

moderating role. The negotiators

10:33

were deeply engaged on

10:35

the issues. They tried

10:37

to foster good faith discussions. And

10:40

in many respects, I think other countries often

10:42

rely on the US being in the room

10:44

so that they don't necessarily have to take

10:46

certain positions quite strongly. When the

10:48

US withdrew, I think that was a real loss

10:50

to the process. I think it

10:52

did force countries into perhaps more adversarial positions

10:55

than they are normally used to playing in

10:57

this sort of environment, or at least not

10:59

having to take on themselves. And

11:01

I think that did affect the last

11:03

week and a half or so of

11:05

negotiations in particular. And

11:08

I think it's a loss because

11:10

the US's input I think is

11:12

vital to this sort of international

11:14

agreement. I think there is still

11:16

scope for either the US or

11:18

potentially US pharmaceutical companies or others

11:21

involved in pandemic prevention preparedness and

11:23

response to be involved in some

11:25

way in the process, particularly the

11:27

PABS annex, the system as it

11:29

comes into play. But it

11:31

is a loss and it's a lost

11:33

opportunity, not just for the United States,

11:35

but also the world. He's

11:38

hoping that in time, there's opportunities

11:40

for the US to be reengaged in

11:42

the process. Yeah, and I

11:44

think especially it's on everyone's minds as we're

11:46

looking at things like H5N1 and M -Parks.

11:48

All these things are really top of mind. Anything

11:51

else you want to add about this? I

11:53

think that there is going to be a lot

11:55

of very valid sort of picking a part

11:57

of the text. But I think

11:59

it's easy to forget just how intensely

12:01

countries have worked and how this has

12:03

been prioritized, how much time and energy

12:05

countries have put into this. And nothing

12:07

is in there without very careful thought. quite

12:11

literally were hours of discussions

12:13

around single words or commas.

12:15

This is the treaty that

12:17

I think reflects a really

12:19

great achievement, especially in the

12:21

current. environment we are, I

12:23

think it is a reaffirmation

12:25

of multilateralism as a process

12:27

for solving problems and working

12:29

together internationally. And I

12:32

think that as we have hopefully adoption

12:34

in May 2025 at the World

12:36

Health Assembly and then the future that

12:38

we spoke about before about entry

12:40

into force, I think recognizing that

12:42

these are the foundations for making a

12:44

safer, more equitable world. Well, it's really nice

12:46

to talk about something that's a big

12:49

win for global health these days. Alexandra Phelan,

12:51

thank you so much for joining us.

12:53

Thank you so much for having me. and

13:16

Philip Porter, with support from

13:18

Chip Hickey. Distribution by Nick

13:20

Moran. Production Coordination by

13:22

Catherine Ricardo. Social

13:24

Media, run by Grace Fernandez

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Elisa Rosen. If you

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have questions or ideas for

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Thank you for listening.