Inter-institutional Relationships in Global Health: Regulating Coordination and Ensuring Accountability

In this paper we will explore issues related to the governance of inter-organizational relationships in the field of global health - taking the multi-layered response to the 2014 West African Ebola Outbreak as our point of departure. We note that, ideally organizations engaged in global health activity would have a clear set of governance rules that would guide their behaviours, and set expectations for collaborating with other organizations, though this is rarely the case. More broadly, we highlight that there is no overarching set of principles that would cover all the possible ways in which collaborations can take place. We conclude by suggesting some principles to guide collaboration between organizations engaged in global health in the future

Is a pandemic treaty really the solution to the problems we face?

Support is growing for a pandemic treaty that would encourage states to act early to contain future pandemics. Clare Wenham (LSE), Mark Eccleston-Turner (King’s College London) and Maike Voss (KLUG) warn that it may not be the right solution to the threat

The futility of the pandemic treaty: caught between globalism and statism

In November 2021, the World Health Assembly (WHA) hosted a special session to discuss the proposed plans for a pandemic treaty. Despite the fact that there are scant details concerning the treaty, the proposal has gained considerable support in both the academic community, and at the international level. While we agree that in the wake of the numerous governance failures during COVID-19, we need to develop appropriate global solutions to be able to prevent, detect, respond to, and recover from future global health crises—and that such mechanisms should be rooted in global equity—we disagree, however, that this pandemic treaty, currently, is the most appropriate way in which to achieve this. Indeed, notions of global community, solidarity, fairness are far removed from the reality that we have seen unfolding in the actions of states responding to the pandemic. This is the crux of the tension with the proposed treaty: the balance between the ideal globalist worldview held by those in power in global health, and the practice of national security decision-making witnessed in the last 18 months. Indeed, we do not believe that a pandemic treaty will deliver what is being extolled by its proponents, and it will not solve the multiple problems of global cooperation in global health that supporters believe it will

Sovereignty, sanctions, and data sharing under international law

In September 2021, after inaugurating the Berlin-based World Health Organization (WHO) Hub for Pandemic and Epidemic Intelligence, German Health Minister Jens Spahn indicated that sanctions might be an appropriate tool to deal with WHO member states that do not cooperate on data sharing during disease outbreaks. Tedros Adhanom Ghebreyesus, director general of the WHO, affirmed this, stating that "exploring the [idea of ] sanctions may be important" in cases where collaboration fails. Such comments indicate that the WHO Hub has been designed without much consideration of data sovereignty and "access and benefit sharing" (ABS) debates occurring across multiple United Nations (UN) bodies, including the WHO. Threats of sanctions do little to promote the ideals of equity and solidarity often touted as foundational to global health governance. They entrench the idea that pathogen samples and associated data are "bargaining chips" rather than vital inputs to public health research and pandemic response

'Equity' in the pandemic treaty : the false hope of 'access and benefit-sharing'

During COVID-19 the international community repeatedly called for the equitable distribution of vaccines and other medical countermeasures. However, there was a substantial gap between this rhetoric and state action. High-income countries secured significantly more doses than they required, leaving many low-income countries unable to vaccinate their populations. Current negotiations for the new Pandemic Treaty under the World Health Organization (WHO) attempt to narrow the gap between rhetoric and behaviour by building the concept of equity into the Treaty's substantive content. But equity is difficult to define, much less to operationalize. Presently, WHO member states appear to have chosen "access and benefit sharing" (ABS) as the sole mechanism for operationalizing equity in the Treaty. This paper examines ABS as a mechanism, its use in public health, and argues that ABS is fundamentally flawed, unable to achieve equity. It proposes other options for an equitable international response to future pandemic threats

C-621/15 - W And Others v Sanofi Pasteur: An Example of Judicial Distortion and Indifference to Science

This case commentary examines the CJEU’s recent decision in C-621/15 W and Others v Sanofi Pasteur MSD SNC [2017] ECR I. This commentary critically examines the decision through the lens of the cultural conflict between law and science. We argue that the CJEU’s decision reflects both a distortion of scientific knowledge and an improper indifference to the legitimate methods by which scientific knowledge is generated in the context of vaccines. These judicial approaches may, the authors argue, inadvertently fuel the vaccine scepticism that is growing across the developed world, and in particular in Europe

Implementation, compliance, and pandemic legal obligations : negotiations ought not focus on enforcement and sanction

Member states of the World Health Organization (WHO) are undertaking ambitious governance reforms to prevent, prepare for, and respond to pandemics by concurrently negotiating both a new international legal instrument (henceforth called “the Pandemic Treaty”) and amendments to the International Health Regulations (IHR). We therefore find ourselves at a critical juncture in global health governance, with the opportunity to strengthen pandemic prevention, preparedness, and response through international law. One issue being given considerable prominence in each of these negotiations is how compliance by member states with their obligations can best be achieved. We argue that any efforts to ensure compliance with these instruments should be seen as part of broader efforts to ensure effective and equitable implementation, as opposed to being overly focused on formal compliance mechanisms and the possibility of punitive action in response to noncompliance

Pathogens and Equity in the Pandemic Treaty - Key Takeaways for Negotiators

Pathogens are essential ingredients to monitor the spread of disease, and for developing and producing the vaccines we use to fight infectious disease. Under international law, pathogens are not a resource freely available for use for the greater good. Instead, countries have sovereign rights over the pathogens isolated within their territories, and access can only be provided with the prior informed consent of the country of origin, subject to mutually agreed terms. Under this international system, access to pathogens should be accompanied by the sharing of benefits such as access to medical countermeasures. Such a system has been presented as a tool to counter global inequality in a pandemic. In response to the widespread inequity witnessed during the COVID-19 pandemic, Member States of the World Health Organisation (WHO) are currently negotiating a new international legal instrument, intended to prevent pandemics and mitigate associated inequalities – the Pandemic Accord or the Pandemic Treaty. Negotiations on this Treaty launched in March 2022 and are set to conclude by May 2024; a remarkably short time frame in international law terms. The new instrument is intended to be grounded in equity, with equity positioned as both an objective and as an operational output. The Pandemic Treaty is intended to prevent future pandemics, improve pandemic response, mitigate associated inequalities (such as inequitable vaccine access), and improve compliance with international law during infectious disease emergencies. One option currently being explored in the negotiations for a Pandemic Treaty to operationalise equity is the establishment of a complex system of ABS for pathogens of pandemic potential, under the auspices of the WHO. On 19th July 2023, and with the assistance of funding received from the Royal Society of Edinburgh, project leads Dr Stephanie Switzer (University of Strathclyde) and Dr Mark Eccleston-Turner (King’s College, London), organised an event with the British Institute of International and Comparative Law on pathogen sharing and equity under the Pandemic Treaty, with a particular focus on vaccine inequity during the COVID-19 public health emergency. This event was convened by Anthony Wenton, Research Fellow in Public International Law, British Institute of International and Comparative Law (BIICL), moderated by Dr Stephanie Switzer, with contributions from Professor Gian Luca Burci of the Graduate Institute Geneva, Prof Elisa Morgera, One Ocean Hub, University of Strathclyde, Dr Mark Eccleston-Turner, King’s College London, Dr Michelle Rourke, Griffith University, Australia and Professor John Harrington, University of Cardiff. Harry Upton of King’s College London acted as rapporteur for the event. In the below briefing document, we provide an overview of discussions at the event, accompanied by key reflections, tools, and takeaways for negotiators to the Pandemic Treaty