No one is safe until everyone is safe: An open letter on the proposed pandemic preparedness treaty

This open letter has been developed by Frontline AIDS, Aidsfonds, AVAC, the Global Fund Advocates Network (GFAN) and STOPAIDS in response to the decision by the World Health assembly to set up an intergovernmental negotiating body responsible for drafting and negotiating a treaty, agreement or other international instrument under the Constitution of the World Health Organization to strengthen pandemic prevention, preparedness and response.

We see this announcement as an important first step towards strengthening the global response to pandemics, and we would urge member states to engage in this process to ensure a fairer and more equitable response to future pandemics.

However, we also note with concern the proposed schedule for the negotiating body, which will not submit its outcome for consideration until 2024. As organisations working with some of the most marginalized communities worldwide, we know that this time-frame does not in any way reflect the urgency and pressing need to strengthen the pandemic response. With the emergence of the Omicron variant, as borders are again closing and economies are further impacted, we can see that urgent and dramatic changes to the way we are responding to pandemics are needed. Large parts of the world cannot continue to be left behind on access to treatment and vaccines for years. The human cost will be too great.

We are writing to urge governments to respond with all speed to this ongoing crisis, and to ask for your support behind four key actions to ensure a pandemic preparedness and response framework, as well as global funding and implementation mechanisms that truly work for all.

Take forward existing pandemics’ health and community systems infrastructures, and lessons learned

Efforts to tackle COVID-19 and prepare for future pandemics should harness the substantial expertise and experience that already exist in the responses to HIV/AIDS and tuberculosis. Scale up and investment must build on the considerable health and community service infrastructures, and access-enabling policies created through efforts to tackle existing pandemics.

We urge all parties who will engage with the intergovernmental negotiating body to recognize existing pandemics’ health and community infrastructures as the strongest base from which to build future pandemic preparedness and response efforts, and mobilise resources to sufficiently fund health systems, community responses for health and community systems strengthening. 

Address systemic challenges which hold back progress by supporting equitable technology transfer and ensuring human rights are at the centRE

We have observed with concern the uneven distribution of the COVID-19 vaccine. As we saw with HIV treatments, pharmaceutical companies will prioritise profits over human lives, even if it means denying lifesaving products to people in low- and middle-income countries and increasing the risk that new variants of viruses will emerge.

It is vital that the pandemic preparedness regulatory framework, and the mechanisms for its implementation and accountability address, rather than exacerbate, systemic challenges which hold back progress. Bold commitments and action to enable open science and open licensing and effective technology transfer to address inequalities, build strong health and community systems, and respect human rights are essential. This is the only way to develop and then make preventative and diagnostic tools, vaccines and treatments for current and future pandemics, including HIV and tuberculosis, available and affordable for everyone.

It is crucial that the global regulatory framework as well as future pandemic preparedness and response implementation mechanisms such as ‘a new Financial Intermediary Fund’ and ‘end-to-end development, procurement and access to medical countermeasures for health emergencies’ build on principles of equity, equal access to technology, strong health and community systems, and human rights. 

Engage civil society and communities in the governance mechanisms and key decision-making processes 

Under the decision adopted, there is a call for public hearings to be held: in addition to our previous suggestion to move the timetable up significantly, it is critical that the intergovernmental negotiating body plan, in partnership with civil society and community representative bodies, multiple full and meaningful global consultations with civil society and communities to inform the content of the pandemic treaty. One of the key learnings from the HIV/AIDS response over the last four decades is that the vital leadership brought by communities is critical for addressing pandemics effectively, including reaching people who would otherwise be left behind and developing truly person-centered care models.

Community and civil society leadership has also been a pivotal component of the response to COVID-19, particularly in sustaining health services during lockdowns and other restrictions. For future pandemic responses to be effective, similar principles must be adopted and further strengthened. It is crucial to involve community and civil society representatives in key decision-making processes and governance structures for pandemic preparedness. 

This right to participation must include permanent seats for civil society and communities in any governance structures, with equal voting and financial support to enable civil society and community representatives to convene and consult with those they represent.

Civil society and communities should be explicitly recognized as equal partners at every stage from conceptualization and design to implementation and governance of key pandemic preparedness and response decision-making mechanisms, including in COVID-19 national coordination councils. 

Prioritise community responses for health as essential elements of health systems 

Community responses for health are the combination of actions taken by, in, and with communities to prevent and address health problems, and to ensure people’s wellbeing. They are an integral part of health systems. However, they are often not recognized as such.

Efforts to prepare for future pandemics create an opportunity for a fundamental reimagining of systems for health, so that they truly work for and with people, and explicitly acknowledge and engage communities as essential partners for health across all health systems building blocks.

We urge that the critical role of community responses for health and community systems strengthening are recognized as core components of an effective global pandemic preparedness and response framework and the mechanisms for its funding, implementation and accountability. The same recommendation holds for global pandemic preparedness funding and implementation mechanisms. 

To truly be effective on a global scale, the global pandemic preparedness and response treaty, funding, and implementing mechanism must serve the whole world.

SIGNATORIES

To sign your organisation on to this open letter, please email sfinlayson@frontlineaids.org 

• Aidsfonds
• AIDS Vaccine Advocacy Coalition (AVAC)
• Frontline AIDS
• Global Fund Advocates Network (GFAN)
• STOPAIDS