October 5, 2021, Vol 326, No. 13, Pages 1233-1338
An International Agreement on Pandemic Prevention and Preparedness
Lawrence O. Gostin, JD; Sam F. Halabi, JD, MPhil; Kevin A. Klock, JD
JAMA. 2021;326(13):1257-1258. doi:10.1001/jama.2021.16104
This Viewpoint discusses international efforts to address the COVID-19 and future pandemics as well as offers steps that the international community can take to fix gaps in pandemic response.
Core Content for an International Instrument
The potential breadth of pandemic prevention and preparedness is wide-ranging and negotiations among 194 WHO member states will be challenging. Responding to vast gaps in the COVID-19 pandemic response should include the following.5
The IHR focuses on response to novel outbreaks after they occur. A new instrument could focus also on prevention of naturally occurring zoonoses, which may potentially contribute to an estimated 75% of new human diseases.6 Separating animal and human populations could prevent spillovers, such as through land management, reforestation, and the effective regulation of wild animal trade and markets. Researchers have already generated predictive models to identify where spillovers are likely.
Biosecurity and Biosafety
While SARS-CoV-2 most likely occurred in nature, a laboratory leak at the Wuhan Institute of Virology is an alternative theory of the origin of the virus. Rigorous regulation and inspection of laboratory safety, as well as gain-of-function research, could help prevent unintentional or deliberate release of novel pathogens. The WHO has issued international guidance on biosafety that could be incorporated into a new agreement.7
Monitoring, Inspection, and Compliance
Responding to weak IHR compliance and accountability mechanisms, a new international instrument should enhance WHO or UN authority and legitimacy to independently verify state reports, publish crucial outbreak data without state confirmation, investigate novel outbreaks, and institute remedial actions. Norms are only effective if they are implemented at the national and local levels in a fully transparent and cooperative manner.
Research, Scientific Sharing, and Transparency
Undoubtedly, the greatest success during the pandemic response was the rapid development of vaccines and therapeutics, including with innovative mRNA technologies. Yet, open access and sharing of real-time virus samples, genomic sequencing, and clinical trial and other research data and tools were often lacking. A new legal instrument could channel significant research funding, while promoting open access, full transparency, public/private partnerships, and scientific cooperation.
Underpinning rapid and effective response to novel pathogens requires robust health system capacities, including human resources, surveillance, laboratories, and risk communication. Capacities for testing, contact tracing, and vaccinating populations are crucial. Clinics, community health workers, and hospitals are needed to care for and treat patients during spikes in serious disease, as well as meeting everyday needs such as childhood vaccinations, maternal care, and caring for patients with noncommunicable diseases. An international agreement could address states’ failures to comply with article 44 of the IHR, which calls for international technical and financial assistance to strengthen national public health capacities.8
Domestic and International Equity
The COVID-19 pandemic revealed cavernous divides based on race and ethnicity, sex, disability, and socioeconomic status both in the disproportionate numbers of hospitalizations and deaths and in access to essential medical countermeasures. High-income countries dominated the global market in diagnostics, personal protective equipment, therapeutics, and especially vaccines. The WHO and partners designed the Access to COVID-19 Tools (ACT) Accelerator to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines. Yet, as of September 3, 2021, COVAX (the ACT Accelerator’s vaccine pillar) had shipped only 236 million COVID-19 vaccines to 139 countries, leaving most lower-income health workers and vulnerable populations unprotected.9 Any new international agreement must plan for adequate supplies of medical resources and equitable allocation among countries. This could include securing supply chains, intellectual property waivers, knowledge-sharing and technology transfers, along with ample donation of supplies.10
The compound health, economic, social, and humanitarian crises caused by the novel coronavirus, SARS-CoV-2, provides a compelling justification for a new international agreement on pandemic prevention and preparedness. It is possible to significantly reduce the likelihood of future novel outbreaks and to fortify the response through international cooperation, an empowered and well-funded WHO, and strong domestic health systems.