Precious Matsoso, the director-general of the Department of Health between 2010 and 2019, has been appointed as the co-chair of a globally important Intergovernmental Negotiating Body (INB) tasked by the World Health Assembly (WHA) with drawing up a draft Pandemic Preparedness Treaty. The WHA is the annual meeting of members of the World Health Organization (WHO) that sets its priorities and debates on key policy areas.

Matsoso was proposed by South Africa’s minister of health and, with the endorsement of African ambassadors to the WHA, she represents the Africa region on a six person bureau, made up of Brazil, Egypt, the Netherlands, Japan and Thailand. Roland Driece, her co-chair, is director of international affairs of the Dutch ministry of health.

The bureau, which has its first meeting in February 2022, has its work cut out. It must develop a working draft, in consultation with member states and civil society stakeholders, by August. In his address to the bureau, WHO Director-General Tedros Ghebreyesus described it as “a momentous undertaking, and a necessary one. Because the Covid-19 pandemic has shown that the status quo is not good enough to protect our communities, our societies, and our economies.”

In blow to Ramaphosa, fraud-accused Zandile Gumede prevails in ANC’s eThekwini conference vote

Global discussion

A global discussion has now commenced to consider what issues must be covered by such an instrument. WHO member states, civil society and other stakeholders are being asked what issues they consider critical — and why. The International Health Regulations, for example, are supposed to be legally binding on states, but were often ignored during the Covid pandemic. They need to be shored up with a new treaty.

To this end, the WHO is beginning public hearings this week in “every corner of the world”, asking, “What substantive elements … should be included in a new international instrument on pandemic preparedness and response?” The discussions are meant to be accompanied by country-level consultations.

According to Matsoso, the WHO is also planning to set up working groups for a deep dive into the issues that are identified. This will prepare the foundation for later negotiations and regional meetings between August and October 2022 to engage member states and stakeholders. The ultimate aim is for a new treaty to be adopted in 2024. 

Pandemic conventions

Covid-19 and the chaotic, uncoordinated and inequitable response of states has shown the devastation that pandemics can wreak. A study published in The Lancet estimates that up to 18 million people had died of SARS-CoV-2 by the end of 2021.

The death toll in Africa is much higher than was at first estimated. Recorded excess deaths in South Africa had reached more than 303,000 by the beginning of April 2022. But, in addition, there have been uncounted deaths because of the neglect of other diseases during Covid and the social and economic consequences of the way states have responded. This toll is only just beginning to be counted.

In this context, the proposal for a pandemic treaty was first made by the Independent Panel for Pandemic Preparedness and Response (IPPPR), set up by the WHO DG’s office, which issued its report COVID-19: Make it the Last Pandemic in May 2021. Specifically, the panel recommended “that countries rapidly agree on a new pandemic framework convention, using the powers of Article 19 of the WHO Constitution. This convention or treaty would address gaps in the current legal framework, endorse principles for effective pandemic preparedness and response, establish norms and obligations of countries, and clarify the responsibilities between states and international organisations.

“The convention would be complementary to the International Health Regulations and help ensure that these legally binding international instruments facilitate a pro-active and rapid response to outbreaks with pandemic potential.”

The report and its recommendations were discussed by the WHA in May 2021 and again at a special session of the WHA held in November 2021 —only the second special session in the WHO’s history. It was here that it was resolved to “come up with a legally binding instrument within two years” and to create the INB and bureau to advance the process. The proposed treaty will focus on pandemic threats, rather than the panoply of threats to human health. 

In an interview with Maverick Citizen, Matsoso said that the “epidemic forces us to reconfigure the global health architecture”. She said that a working group on strengthening WHO preparedness and responses to health emergencies had made 133 recommendations and “found gaps” in the International Health Regulations, citing in particular the issue of what the consequences are for countries that didn’t comply with the regulations during Covid-19 and other epidemics.

The bureau’s, and later the INB’s, task is to consolidate and prioritise these recommendations. 

AU response driven from SA Presidency

Recognition of South Africa’s leadership is not only at a global level. Parallel to the Global Treaty, an African Union (AU) process is also under way that is aiming to develop a pandemic treaty for the continent. This follows a meeting of the Assembly of the African Union Summit in February 2022, which adopted a proposal to explore developing an African Pandemic Preparedness and Response Authority (APPRA) under the Africa Centres for Disease Control and Prevention (CDC).

The AU’s resolution recognised that “disease threats require a multi-agency response through strong continental institutions including the Africa CDC and the Africa Medicines Agency” and acknowledged that “Africa’s response from the pandemic depends on the continent’s ability to turn the current challenges into viable opportunities, including through increasing the capacities and capabilities of the health workforce; initiating and expanding local manufacturing enterprises for all commodities required in pandemic response and particularly vaccines; and mobilising appropriate technical and financial resources…”

It is thought that this may require the development of a new continental treaty. President Cyril Ramaphosa leads this initiative in his capacity as the designated AU Champion for Covid-19. To assist this work, the President has established a Covid-19 Commission, located in the Presidency but drawing on multidisciplinary expertise from across Africa. Its secretariat is led by Dr Lwazi Manzi.

Last week, Manzi said the AU takes the recommendations of the International Panel on Pandemic Preparedness and Response“extremely seriously” and that the AU’s process aimed to be complementary to and strengthen the global process. She added that “APPRA will interface with the global treaty … but the continent needs its own capabilities should multilateral arrangements fail us again.”

Manzi points out that other regions, including the EU, are taking a similar approach. Although overshadowed by geopolitics and the war in Ukraine, “all continents and regions are either building something new or strengthening whatever they have already” to prepare for future pandemics, she said. DM/MC

Read our previous reports on the International Panel on Pandemic Preparedness and Response:

Act urgently or pay with our lives: Report reveals a disparate world unprepared for future pandemics and health crises

Global treaty on Covid-19 has to be located in human rights, panel told