TWN Info Service on Health Issues (Mar25/01)
7 March 2025
Third World Network

WHO: Developing Countries call for “real” pandemic prevention; rejects surveillance-centric approach

Geneva, 7 March (TWN) – During the 13th meeting of the Intergovernmental Negotiating Body (INB13), developing countries especially the Africa Group called for “real” pandemic prevention measures and rejected a “surveillance-centric” approach towards prevention contained in the draft of Article 4 of the WHO Pandemic Agreement (pandemic instrument).

Developing countries emphasised the importance of addressing social-economic and environmental determinants of health for pandemic prevention, the need for promoting equitable access to tools and resources required for preventive action, as well as safeguards to ensure preventive actions do not interfere with people’s lives or compromise national interests. They also called for better national policy space to prioritize areas of preventive action.

The INB Bureau had proposed its compromise text proposals that largely followed the European Union proposals for pandemic prevention anchored in expanded multi-sectoral surveillance.

INB13 that was held at the WHO Headquarters from 17 to 21 February 2025 discussed Article 4 at length along other important Articles 1, 3, 11, 12, 13 and Chapter III.

Prior to INB13 the Bureau circulated a text containing its proposals on various articles including Article 4 with a view to bring convergence. The Bureau proposed to add details into Article 4, as an alternative to avoid developing an additional pandemic prevention instrument as an Annex after adopting the pandemic instrument.

The upcoming 77^th session of the World Health Assembly (WHA77) in May 2025 is expected to adopt the pandemic instrument. The Bureau’s text largely focused on the text proposals previously made by the developed countries, and it ignored the text proposals made by developing countries.

The EU had proposed the idea of an annex back in April 2024, as a counter proposal to the idea of developing a full-fledged Pathogen Access and Benefit Sharing (PABS) instrument post-WHA77. However, developing countries opposed the proposal and said that it is unreasonable to call for a new instrument when there is no understanding of the scope and elementary components of such an instrument. Developing countries had several times asked the EU and other supporters of a prevention annex to list out the element of such an instrument, but there was no satisfactory response.

Unlike the proposal for the PABS instrument, the proposed prevention instrument had no clear understanding of the structure, scope and elements. Additionally, the EU and other developed countries wanted to develop a prevention instrument advocating a “One Health Approach” and “biosurveillance”, following the ideas promoted by the One Health High Level Expert Panel constituted by the quadripartite organisations pursuant to the calls made by Germany and France at the Paris Peace Forum 2020 who also provided funding.

[The quadripartite organisations are WHO, World Oganisation for Animal Health, FAO and UNEP. The Secretariats of these organisations have formed an inter-organisational arrangement which is known as the quadripartite. The One Health High Level Expert Panel (OHHLEP) is an advisory group to these organisations established with funding from Germany and France. The Panel and Quadripartite have been heavily criticized in fora like the Convention on Biological Diversity for their neglect of principles of equity and common but differentiated responsibilities and respective capabilities in their approach towards One Health.]

During INB12, developing countries made it clear that they could not undertake an obligation to develop an additional legally binding instrument, especially something based on One Health Approach - whose scope can be expanded to unimaginable levels. A One Health approach considers the health of plants, animals, humans and the environment as one and recommends taking measures at the plant-animal-human and environment interface. The concern is that there is no common understanding and proper scoping at the INB on One Health approach.

As a result of these negotiations and exchanges between the EU and developing countries, the Bureau adopted an approach initially placed by Pakistan and few other developing countries, which is to add more details into Article 4 of the pandemic instrument. The Bureau circulated its text, and said in their briefing prior to INB13, that the work programme of INB13 will focus on the substantive text of Article 4, instead of discussing whether to develop an annex or not.

Although the Bureau’s text focussed on the surveillance and information sharing aspect of pandemic prevention, developing countries and the Africa Group welcomed the Bureau’s appraoch and expressed their willingness to engage with the Bureau's text. However, they emphasised the need to improve text with a view to adopt “real” prevention measures in an equitable manner instead of surveillance-centric measures. The Africa Group emphasised “implementable” measures, while other developing countries proposed elements for a balance by incorporating “equity” considerations.

The EU hesitantly expressed agreement to go forward with the discussions on Article 4, on an understanding that if consensus was not emerging, they would reinstate the call for an additional instrument.

Bureau’s proposals for ‘One Health approach’ definition and Article 4

In Article 1 on “use of terms”, the INB Bureau proposed to remove developing countries’ text suggestion in the definition of ‘One Health approach’, which proposed to address social, economic and environmental determinants of health in an equitable manner.

The developing country Member States in INB were not happy with the definition of One Health approach as contained in the negotiating text, which is an adopted text from the OHHLEP’s proposed definition. According to them, the definition neglects principles of equity and common but differentiated responsibilities which are critical to One Health approach. To address the gaps, developing countries have made the above proposal in Article 1. Nevertheless, developed countries were not willing to commit to address the health determinants under One Health approach and only wanted to focus on technical aspects of the approach.

Thus, the Bureau, aiming to achieve consensus, proposed an alternative phrase “while contributing to sustainable health” again borrowing words from the OHHLEP.

On Article 4, the Bureau significantly expanded the provision by adding new paragraphs as well as expanding the existing paragraphs. The INB12 text concluded with 5 paragraphs in this provision. The Bureau’s new text has 7 paragraphs.

Paragraph 1 obligates Parties to progressively strengthen pandemic prevention and surveillance capacities, consistent with the International Health Regulations. Paragraph 2 talks about plans, programmes and actions for pandemic prevention and surveillance including coordinated multi-sectoral surveillance. Paragraph 3 refers to a range of environmental, climatic, social, anthropogenic and economic factors, including hunger and poverty, that may increase the risk of pandemics, and requires Parties to consider these factors in policies and laws at various levels. Paragraph 4 wants to bring all stakeholders together to ensure pandemic prevention, surveillance and One Health approach. Paragraph 5 talks about a need for development of the proposed actions under paragraph 2. Paragraph 6 offers WHO’s technical support when requested and finally paragraph 7 empowers WHO to develop guidelines and such other non-binding measures.

The major proposals are in paragraph 2, in which surveillance is re-emphasised multiple times including in the chapeau and in subparagraphs. The chapeau to the paragraph which proposes strengthening multisectoral surveillance capacities, is followed by proposed specific actions for coordinated multi-sectoral surveillance to detect zoonotic spillover risks, vector borne diseases, early detection at the community level, and identification of drivers, settings, human activities etc. that increase the risk of infectious and communicable diseases.

The Bureau also inserted proposals to require sharing of outputs of surveillance and risk assessment with WHO and other relevant agencies.

Changes demanded by Africa and Developing Countries

Developing countries such as Indonesia, India, Malaysia, Bangladesh, Iran etc., along with the Africa Group, plus Egypt and South Sudan, though welcoming the Bureau text, stressed on the need to balance the text. They called to reduce the ill-effects that may be caused due to disproportionate focus on surveillance, and information sharing in Article 4.

The developing countries expressed their worries that merely surveillance, and risk prediction cannot lead to prevention, and said there needs to be meaningful interventions with regard to socio-economic and environmental determinants of health. They also said any interventions and preventive measures should take necessary precaution so as to not inequitably interfere with people’s lives and communities’ livelihood.

First and foremost, developing countries demanded for the change in the definition of ‘One Health approach’ to include meaningful measures and equity. The Bureau has proposed the following definition, modifying the text available under Article 1 on use of terms:

(a)    “One Health approach” for pandemic prevention, preparedness and response means an integrated multisectoral and transdisciplinary approach that aims to sustainably balance and optimize the health of people, animals and ecosystems, [ADD while contributing to sustainable development] [DEL including by addressing various social, economic and environmental determinants of health in an equitable manner]. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent.

The phrase “including by addressing various social, economic and environmental determinants of health in an equitable manner” is the definitional element proposed by Malaysia and other developing countries during previous INB meetings. The Bureau proposed to delete this insertion and to insert “while contributing to sustainable development” as a compromise.

Developing countries however rejected this. Bangladesh suggested to retain the proposal made by Malaysia and others. For Bangladesh, this meant to explain what the approach will do and how. Bangladesh explained to the INB that the phrase “contributing to sustainable development” does not import the notion of equity automatically and neither does it explain what governments must do.

Several times in the INB meetings, developing countries have reminded the INB that the definition from OHHELP has faced significant criticism for lack of equity during the meeting of the Conference of Parties to the Convention on Biological Diversity and its Subsidiary Body of Scientific, Technic and Technological Advice. Nevertheless, the developed countries wanted to directly import sentences from the OHHLEP definition.

Similarly developing countries articulated the need to balance the provisions under Article 4 paragraph 2, in particular with regard to actions that need to be taken post-surveillance and measures to mitigate any disproportionate interference with people’s lives.

For instance, under Article 4.2.g., the Africa group stated that the identification of areas and activities that are prone to zoonotic spillover could target communities and people living in those areas or carrying out activities. It was important to ensure preventive measures do not penalise them or do not violate their rights.

 

The Bureau has proposed this text in Article 4.2.g:

… “prevention of infectious disease transmission between animals and humans, including zoonotic disease spill-over, [ADD by identifying settings and activities that create or increase the risk of disease emergence and re-emergence at the human-animal-environment interface, and taking measures to reduce risks of zoonotic spillover and spillback associated with these settings and activities, including measures aimed at prevention at , as well as safe and responsible management of wildlife, farm and companion animals];…”

However, after the interventions of the Africa Group, Malaysia and Bangladesh and a few other developing countries, this text was modified and repositioned as paragraph (a bis). It currently reads as follows:

(a bis) prevention of infectious disease transmission between animals and humans, including zoonotic disease spill-over and spill-back, [by taking measures to identify and reduce pandemic risks associated with settings, activities and human interactions involving wildlife, farm and companion animals, including measures aimed at prevention at source, while recognizing the importance of communities’ livelihoods;]

The square brackets above in paragraph (a bis) indicate there is still no initial convergence on the text. However, following the developing country delegations’ interventions the text as it now stands is more considerate of the communities that live in close contact with animals and the environment. The text in backets is proposed by the Bureau by taking into account various interventions from Member States. 

Further, developing countries clearly stated that the measures to notify and inform WHO should follow the channels and standards set under the International Health Regulations (IHR) 2005, as amended in 2024. Under Article 4.2.b. the Bureau has proposed the following language:

… “coordinated multi-sectoral surveillance to detect and conduct risk assessment of emerging or re-emerging pathogens, including pathogens in animal populations that may present significant risks of zoonotic spillover as well as sharing of the outputs of relevant surveillance and risk assessments within their territories with WHO and other relevant agencies to enhance early detection.”

Thus, the Bureau’s text requires Parties to share with “WHO and other relevant agencies” all “outputs of relevant surveillance and risk assessment” including that of pathogens that have any spillover potential. This is inconsistent with IHR 2005, where State Parties to IHR 2005 are only required to notify WHO when an event occurs which has potential to cause public health emergency of international concern. The WHO is further under constraints in IHR 2005 regarding forward sharing of information to other State Parties or other intergovernmental agencies.

Developing countries pointed out this inconsistency. They explained that IHR 2005 continues to be the core basic document to prevent pandemics and public health emergencies and the WHO pandemic instrument cannot work to undermine the systems and paradigms under IHR 2005.  Otherwise, communities in which outbreak happens will be quite often ill-treated and their interests will not be protected.

Accordingly, draft Article 4.2.b. was modified into the following:

… “coordinated multi-sectoral surveillance to detect and conduct risk assessment of emerging or re-emerging pathogens with pandemic potential, [including pathogens in animal populations] that may present significant risks of zoonotic spillover, as well as sharing of the outputs of relevant surveillance and risk assessments amongst relevant sectors within its territory to enhance early detection;”

Thus, the new proposal is to share information between sectors (meaning departments of wildlife, health and agriculture etc.) within the country for early risk assessment and containment at source. Any measure pursuant to such detection will have to follow the standards of IHR 2005 as well as protect community livelihoods as per Article 4.2.(a bis) of the pandemic instrument.

According to developing countries, both the changes in Article 4.2.(a bis), and 4.2.b. constitute crucial changes to Article 4 in order to ensure the measures that will follow surveillance and monitoring will be equitable.

Meanwhile Bangladesh has proposed another paragraph which seeks to provide mandate to the Conference of Parties to the pandemic instrument to develop mechanisms for facilitating equitable access to resources needed for the implementation of various elements of Article 4.2.

The text proposal from Bangladesh is in the negotiating draft as Article 4.2.ter. It reads: “The Conference of Parties shall also develop mechanisms for facilitating equitable access to products, tools and other resources required for the implementation of the provision on antimicrobial resistance, vector-borne diseases and vaccines for routine immunization etc. in particular for the developing countries.”

The Africa Group also wanted the INB to keep reference to “public health priorities” of countries in the chapeau of Article 4.2. The Group explained that there are several elements mentioned under proposed paragraph 2, however, not all elements are of the same importance for all countries. It said there should be policy space and discretion for countries to prioritise the elements that are of immediate concern for them during the implementation of the provision.

An Africa Group delegate told Third World Network (TWN) “This policy space is important for real delivery of these provisions, given that there is significant resource crunch in developing countries that might not be fully addressed given the recent political shifts in the U.S. and the rest of the world”.

Summing up the debates and responding to rumours that developing countries are opposed to pandemic prevention measures, a developing country delegate told TWN: “We are suggesting texts to make prevention a workable idea. We know surveillance needs to be followed up by actions, and action can sometimes cause unintended consequences that may be harmful. Therefore, we need to balance decision making to take measures and implementation of measures. We think of this comprehensively.  Some tend to think a commitment to scientific concepts like One Health approach and a promise to do charity after surveillance can prevent diseases or international spread of diseases. They are the ones who claim developing countries are opposed to pandemic prevention and One Health. I mean who on earth wants to avoid prevention of diseases”.

EU seeks to strengthen surveillance but hesitates to commit resources

During INB13, the E.U. also tried to alter the Bureau’s text with a different motive. They sought to strengthen surveillance and dilute the obligation to assist developing countries in the implementation of pandemic prevention measures as well as to share financial and technological resources with them.

 

The E.U. circulated a document on 17 February to a few selected countries with two alternative proposals for Article 4. Alternative A is the text which the E.U. tabled in INB13 for discussions “in the spirit of compromise”. Alternative B indicates the E.U.’s preferred language, and would be proposed should there be a need to negotiate an new instrument on pandemic prevention and surveillance.  The E.U. stated in the document:

“It should be clarified that such edits [Alternative A] do not represent our preferred option, which would include more specific and clearly set-out provisions [Alternative B]. Such more detailed provisions would need to be further considered, also with the support of experts, in an evidence-based process that could only seriously be conducted after the May 2025 WHA… This strategic approach builds on the notion highlighted by the Bureau in the N.B. introduced under paragraph 5 being shared by all negotiating Parties – i.e. a common understanding that if no agreement is reached by May further work will follow to develop an Annex. In case the approach by the Bureau is opposed or challenged by several negotiating Parties, it would put the above strategy into question. It would then be important to stress that it would not be an option neither for the EU, nor for the EU (Member States), to become party to a Pandemic Agreement that does not include meaningful provisions on prevention.”

Later, on 18 February, another document was made available by the E.U. to the whole of INB titled “Article 4 Proposals for Improvements 18th February version”. This document contained only Alternative A. The delegates who were privy to both documents confirm that there is no qualitative difference between both Alternatives, except for the fact that B is a more wordy and lengthy text, compared to A.

“Essentially the proposed obligations are more or less the same,” said a developing country delegate.

The E.U. seems to be working to promote surveillance and monitoring rather than real interventions that are required for prevention. For example, Article 4.2.h of the Bureau’s text proposed: … “(h) surveillance, risk assessments and prevention of vector-borne disease that may lead to pandemic emergencies, including developing, strengthening and maintaining capacities”.

The E.U. proposed to change this text as follows: … “surveillance, risk assessments and prevention of vector-borne disease that may lead to pandemic emergencies, including [ADD by] developing, strengthening and main training capacities [ADD and by monitoring changes to environmental factors that can impact vector distribution, animal movement, or disease emergencies]”

The square brackets are the changes proposed by the E.U.

According to a developing country delegate, “The proposal seems to perpetrate a misunderstanding of the concept of pandemic prevention. How can we prevent pandemics “by monitoring changes” in the environment? Do we not need to take real action to reduce environmental changes that increase pandemic risks?”

“The E.U. seems to be fighting for data extraction, and do not want to commit to any obligations beyond surveillance information sharing and risks assessment. This helps them to force us (developing countries) to take environmental actions under the umbrella of health law and they (developed countries) can get rid of common but differentiated responsibilities,” said another developing country negotiator.

For instance, the E.U. suggested to make these changes to the Article 4.2.b of the Bureau’s text:

… “coordinated multi-sectoral surveillance [ADD through the implementation of measures] to detect [DEL and conduct risk assessment of] emerging or re-emerging pathogens, including pathogens in animal populations that may present significant risks of zoonotic spillover, [ADD the implementation of joint risk assessments of such pathogens], as well as [ADD the] sharing of the outputs of relevant surveillance and risk assessments within their territories with WHO and other relevant agencies to enhance early detection”.

According to the E.U. the use of the words “implementation” and “measures” in Article 4.2.b is intended to make the provision more operational in nature. While the E.U. proposed these changes and several other changes to Article 4.2. strengthening the nature of surveillance obligation, they sought to place the actions that lead to real prevention in soft law.

For instance, the E.U. sought to change the nature of sharing of technological and financial resources for the implementation of Article 4 into a voluntary mode, by linking such assistance to proposed Articles 11 and 20.

In paragraph 5 where there is discussion to develop further provisions for Article 4, the E.U. proposed these changes to its subparagraph b:

… “5(b)           cooperation to implement the provisions of this article, in particular through technical assistance, capacity building, technology transfer [ADD in accordance with Article 11] and financing [ADD in accordance with Article 20], [DEL where possible], and in support of global, regional and national initiatives aimed at preventing public health emergencies of international concern including pandemic emergencies, with particular consideration given to developing country parties. [ADD In developing such provisions, special attention should be given to the development and strengthening of local, national, and where possible regional, capabilities, including by means of human resources development.]”

[Articles 11 and 20, respectively on technology transfer and financing of pandemic prevention, preparedness and response are among the weakest provisions in the draft pandemic instrument, whose fate will remain the same unless there is serious reconsideration of the current language with initial agreement.]

It is clear that without assistance in terms of sharing of funds and technological resources developing countries cannot meaningfully implement prevention measures. It is also clear that the E.U. does not want to commit resources for developing countries. This will put developing countries into a situation where they have to keep detecting and notifying factors or events that increase pandemic risk, but then to address those factors and events, they will have to rely on themselves and market mechanisms.+