How to save the pandemic treaty

Recent drafts of a global pandemic treaty have been widely criticised as “shameful and unjust.” When the latest round of negotiations opened on March 18, it was clear that a key lesson of the Covid-19 pandemic was being ignored: public health and the health of the economy are interdependent.

Achieving both requires rewriting the rules of how health and well-being are valued, produced, and distributed — and how economies are governed. The treaty’s success will depend on member states’ willingness to hardwire equity into its terms. And that, in turn, will require a new economic paradigm. If the treaty is whittled down to become as inoffensive as possible, it will fail.

The World Health Organization Council on the Economics of Health for All, which I chaired, has already issued recommendations for how to proceed. For starters, negotiators from all countries must remain focused on the overarching goal of preventing future health threats from becoming catastrophic. That means designing the terms of the treaty – including those related to innovation, intellectual property (IP), public-private collaboration, and funding – to be mission-oriented. Equity must be the top priority, because everyone – and every economy – ultimately suffers in a pandemic if tests, vaccines, and lifesaving therapeutics are not accessible to all.

Moreover, how innovation and knowledge are governed is as critical as the innovation itself. Governments have powerful levers for determining who benefits from innovation. They are major funders of everything from early-stage research and development to product development and manufacturing. The mRNA Covid-19 vaccines, for example, benefited from about $31.9 billion in US public investment. Stronger conditions on private-sector access to public funding would help to ensure equitable and affordable access to the resulting products, as well as facilitating profit sharing and reinvestment in productive activities (like R&D) rather than unproductive ones (like shareholder buybacks).

The point, in each case, is to establish a more symbiotic relationship with the private sector – one based on shared goals, and on shared risks and rewards. As we saw with the repeated spread of new Covid-19 variants, a vaccine that only some can afford will not stop a pandemic. Any pandemic treaty should unapologetically commit to this shift and avoid clauses designed to serve private rent-seeking interests.

A key part of getting public-private collaboration right is to establish an approach to knowledge governance and IP rights that serves the common good, rather than protecting monopoly profits. This issue has become a major flashpoint in the treaty negotiations. Lower-income countries are being asked to share pathogen data (which aids the development of new tests, vaccines, and treatments) without any guarantee that they will have access to the resulting products.

While the current draft alludes to the importance of IP rules that do not limit affordability and access, it merely “encourages,” rather than requires, measures aimed at knowledge sharing and limiting royalties. Even weak language asking governments to “consider supporting” patent waivers has become a sticking point.

This suggests that a misplaced drive to preserve current IP rules is complicating the negotiations. To incentivize innovation and deliver broadly shared societal benefits, patents must be narrower; they must encourage productive follow-on innovation and collective intelligence; and they must be accompanied by commitments to transfer the knowledge and technology required for production.