I was disconcerted to read that the last of the formal Pandemic Accord meetings for 2024 closed tonight (6 December 2024) without reaching an agreement. My colleague, Professor Nina Schwalbe, summed it up perfectly in her bluesky post. “Member States have missed a once-in-a-generation opportunity to make a difference because national interests prevailed over global solidarity”.
The World Health Assembly established the Intergovernmental Negotiating Body (INB) almost three years ago to “draft and negotiate a convention, agreement or other international instrument under the Constitution of the World Health Organization to strengthen pandemic prevention, preparedness and response”. When the WHA established the INB, we were in the middle of the COVID-19 pandemic. There was a visceral urgency to figure out better ways to work together globally to prevent and manage the next pandemic. Now, it’s all a bit “meh“.
In the last month, we have been gifted non-ignorable data points by the fates, which should have focused the mind. We did not need special skills to read the tea leaves at the bottom of the cup or divine the future from goat entrails.
- The American people re-elected Donald Trump as President of the United States and handed him a clear mandate. He campaigned on a populist America First policy and has declared (and demonstrated) an antipathy towards global treaties and accords that threaten global health.
- Trump also announced that Robert F. Kennedy Jr. (RFK Jr), a vaccine denier, would be the Health Secretary. RFK Jr is also on record that there is too much focus on infectious diseases.
Together, these will create geopolitical friction in negotiating a pandemic accord that may be impossible to overcome. Fate has also been teasing us with news of infectious diseases among those geopolitical tea leaves.
- A mystery infectious disease has appeared in a remote area of the Democratic Republic of Congo. According to the Ministry of Public Health, there have been 394 cases and 30 deaths.
- Influenza A subtype H5N1 is the stuff of infectious disease specialists’ nightmares. It has a very high case fatality rate–typical ‘flu’ has a fatality rate of <1%. H5N1 has a case fatality rate of around 50%. The saving grace has been that it had not adapted to human-to-human transmission. Human transmission might be about to change. It has swept through U.S. dairy herds and is found in raw milk. Did I mention that RFK Jr. is a fan of raw milk?
This failure is particularly bitter because they’re walking away from the negotiating table when the stars are aligning for potential future crises. We have a new U.S. administration openly sceptical of global health cooperation, an increasingly complex geopolitical landscape, and emerging pathogens testing our surveillance and response capabilities. The window of opportunity that opened during COVID-19–when the world’s attention was focused on pandemic preparedness–appears to be rapidly closing.