May 21, 2024

The simmering fears over bird flu should leave no doubt: The health of humans and our fellow animals is inextricably linked.

Covid-19 was likely transmitted from animals to humans, and millions died as a result. The world is now anxiously watching for any sign that H5N1, i.e., the bird flu, could cause another pandemic so soon after the last one.

For years, public health experts have preached the importance of a One Health philosophy: treating the health of the environment, animals, and human beings as a single issue that requires a comprehensive approach because the health of one affects the others. On the ground, however, it remains a work in progress; the slow implementation of livestock surveillance for bird flu is only the latest example of that struggle.

The world’s nations are currently negotiating a pandemic treaty that was supposed to prevent humanity from repeating the mistakes of Covid-19. In particular, the agreement was seen as an opportunity to put those One Health principles into practice.

But we might miss our chance. As the pandemic fades into memory, self-interest appears to be winning out over global cooperation.

What the world could do — and what it seems like it’ll do instead

In December 2021, the World Health Assembly, the governing body of the World Health Organization, announced that it would “draft and negotiate a convention, agreement or other international instrument … to strengthen pandemic prevention, preparedness and response.” The goal was to create a binding international agreement that would compel countries around the world to take steps to prevent future pandemics and, should those efforts fail, to ensure smoother coordination in any future public health emergency.

Negotiators are supposed to largely wrap up their work by Friday, May 10. Representatives from the world’s governments will convene in Geneva on May 27 for the World Health Assembly. The plan is for the pandemic accord to be ratified before the assembly adjourns.

Even with the threat of H5N1 looming, however, it has become clear the world is downsizing its ambitions for the treaty. In place of firm commitments are vague aspirations.

On two important sections — the One Health measures and the establishment of a system to share pathogens between countries — the latest draft text would defer momentous operational decisions until at least 2026.

One Health has been one of the major points of contention: Rich countries want it because it would lead to a significant investment in disease surveillance in poorer countries, where it is easier for threatening pathogens to lurk unnoticed. But poorer countries dislike it for the same reason, arguing it amounts to a massive unfunded mandate placed on them.

“It’s a vital step to reduce future pandemic risks. But achieving this demands substantial and costly changes,” Suerie Moon, co-director of the Global Health Centre (GHC) at the Graduate Institute of International and Development Studies, told Geneva Solutions. “It requires changing how we raise livestock and animals.”

Comparing the text of an October 2023 draft of the treaty and the most recent draft reveals the dwindling ambition. In the earlier version, there were specific commitments that called for stronger animal surveillance, more research and more education for health workers and communities, and a “whole of government” and “whole of society” approach.

In the latest draft, much of that language has been removed. Governments are given more leeway to “promote” and “engage” One Health principles as they see fit.

The problem is — again — money.

No one wants another pandemic. But no one wants to pay up to prevent one.

Poor countries already spend significantly less money on health care than wealthy nations. Historically, long-term economic growth has been the way to increase health expenditures.

If developed nations want developing ones to make new investments now, the middle and low-income countries argue that the rich countries should be willing to help pay for it.

But at the same time they are demanding One Health investments, those rich nations are balking at a proposal that would help the world identify and fight potentially dangerous pathogens.

I wrote about this issue in late February. It’s called pathogen access and benefit sharing (PABS). The idea is that rich countries or the pharma manufacturers should pay for access to pathogens of concern that are identified in developing countries and commit to sharing the benefits derived from that access — i.e., diagnostics and vaccines that are ultimately produced — with those poorer countries. That provision has been a priority for the developing world after the pandemic, when Covid-19 vaccines were slow to reach low-income nations in Africa and the rest of the world.

But the rich countries don’t like it. They, along with the pharmaceutical companies they represent, argue such a system would be too bureaucratic and risk slowing down innovation in a future public health emergency.

Some experts have noted the irony of the US and Europe insisting on unfettered access to pathogens from low-income countries at the same time the US government is facing criticism for being slow to share data about H5N1.

“The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response,” Dr. Christian Walzer, executive director of health at the Wildlife Conservation Society, said in a statement. “While the Global North is demanding transparent and rapid access to pathogen data from the Global South … it seems unwilling to share such information with the world.”

The two issues have become entwined in last-minute horse-trading. Based on the latest reporting, developed countries are trying to force a compromise by dangling PABS in exchange for the One Health provisions.

But as of now, the most likely outcome appears to be, at best, a symbolic commitment to One Health principles and a directive to reach an agreement on more specific provisions in the next two years.

Such a disappointing resolution, even as concerns about bird flu grow, is symptomatic of the world’s struggles to apply the lessons of Covid-19. As the urgency with which the negotiations began continues to fade, self-interest and geopolitical rivalries are standing in the way of making the world safer from pandemics.

Let’s hope we don’t pay the price for that shortsightedness.

This story originally appeared in Today, Explained, Vox’s flagship daily newsletter. Sign up here for future editions.


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