It did not receive much attention at the time, but one of the more consequential gatherings at the United Nations during UNGA was a high-level meeting on Pandemic Prevention, Preparedness and Response.
The meeting was intended to build momentum toward a global Pandemic Agreement that was negotiated at the WHO last year, but which left a few key issues unresolved. Chief among them is the creation of a so-called Pathogen Access and Benefit-Sharing System, or PABS. The basic idea is that countries that share viral samples with pharmaceutical companies and researchers should, in turn, have access to the vaccines, medicines, and other products developed from those samples.
All of this was up for discussion at the UN meeting, but the United States ultimately blocked the adoption of a consensus outcome document.
Joining me to discuss what happened at this meeting, why it matters, and what comes next for a global agreement on pandemic prevention, preparedness and response is Courtney Carson, Senior Director of Programs at RANI, an NGO.
Our conversation is freely available across all podcast listening platforms, including Apple Podcasts and Spotify.
Transcript is edited for clarity
Mark Leon Goldberg: Welcome to Global Dispatches, the podcast that helps you understand the world through conversations with the people who know it best. I’m your host, Mark Leon Goldberg, an international affairs journalist who’s been covering global politics for more than two decades. Enjoy the show, and please visit globaldispatches.org to learn more, sign up for our newsletter, and support independent journalism with a global perspective.
I am joined today by Courtney Carson, Senior Director at RANI, the Resilience Action Network International. Courtney, by way of introduction, can you tell us a little bit about what RANI is in your work?
Courtney Carson: RANI, as you said, stands for Resilience Action Network International, and we are an advocacy network that helps drive policy change to address societal resilience at the highest level and what that means in terms of being prepared for the intersecting threats that challenge our societal resilience. We were founded in early 2020 as Pandemic Action Network, and really trying to mobilize an advocacy community around response to the COVID-19 pandemic and building the systems and structures that were needed for pandemic prevention and preparedness going forward.
Over time, as we’ve all grown to better understand the intersecting threats to human health, global health security, and resilience, we’ve evolved to become Resilience Action Network International.
Mark Leon Goldberg: And, of course, you follow very closely the topic of our conversation today: ongoing efforts to create a pandemic agreement. And we are speaking about a week after the high-level meeting on pandemic prevention, preparedness and response, which took place at the United Nations during UNGA.
Now, this meeting didn’t receive a huge amount of mainstream media attention, but within the global health community, it was considered a very significant meeting. Why was that? Why was this meeting so important?
Courtney Carson: High-level meetings at the United Nations serve a primary purpose, and that’s to galvanize political leader-level attention to pressing issues of our time. And that is the primary purpose of this high-level meeting is trying to resubmit high-level leadership and attention to pandemic threats. Obviously, this was top of mind during COVID-19. But as we’re all dealing with the aftermath of that pandemic, most leaders have been very keen to put these issues in the rearview mirror.
It’s lost public support and everyone is ready to forget about the lived experiences we all went through, even though most of the solutions needed to help prevent a similar type of health emergency from happening again haven’t been advanced or haven’t been advanced as much as they needed to be. So, the High Level Meeting served as an opportunity to refocus leaders’ attention and galvanize action to help fill the gaps that still exist.
Mark Leon Goldberg: And, it’s funny, as you said, if this meeting were to have to happen like five years ago, it would have gotten a ton of media attention, not just from Global Dispatches, but from like the New York Times, the Washington Post. But as you said, this topic really has fallen from media’s attention. But there has been significant progress over the years towards an international agreement around what to do sort of next time a pandemic hits.
And this culminated to a certain degree last year at the World Health Organization, where the World Health Assembly adopted a pandemic agreement. But part of that pandemic agreement was not agreed upon. And until this part of that pandemic agreement is agreed upon, the whole thing can’t be adopted. So, can you explain that dynamic by way of introduction for the audience?
Courtney Carson: So, in the aftermath of COVID-19, one of the major political rallying cries was around creating a pandemic treaty, is what it was called at that moment in time, to help outline sort of like the rules of the road for how we would act together for the common good if there were another pandemic threat and what steps might be taken to help prevent epidemics from blossoming into a full-blown global pandemic. And that was a process that moved through the World Health Organization and became known as the Pandemic Agreement.
Despite the leader-level attention to that process as it started, when the rubber started hitting the road on what does it actually mean to align on policies and priorities and financing to make sure the global system is better prepared for pandemic threats, the devil was in the details. And trying to find common ground between countries with different priorities and interests was a challenge, especially for really grounding the political agreement in equity and reflecting on the horrific inequitable access to COVID-19 countermeasures, including and beyond vaccines that we saw during the pandemic.
And that continues to be one of the sticking points is how do we actually operationalize a global system for equity? And what does equity mean in practice? And that’s where that process is still stuck, on the Pathogen Access and Benefit-Sharing System, also known as PABS.
Mark Leon Goldberg: That seems to be one of the key stumbling blocks right now: the Pathogen Access and Benefit-Sharing System, or PABS, as you said, that while most countries at the World Health Organization agreed to this pandemic treaty, there’s this annex that includes the Pathogen Access and Benefit-Sharing System that was not agreed upon. And until that annex is agreed upon, the whole thing can’t be sent out for ratification and adoption and can’t come into force.
So please explain to listeners who have never heard of this thing, what is PABS? Why is it significant, and like what are the stumbling blocks?
Courtney Carson: Right now, PABS is one of the most major mechanisms linked to the pandemic agreement to help operationalize more equitable access to countermeasures during a pandemic emergency. When the drafting of the pandemic agreement initially started, there were sort of other inroads to help advance more equitable access to tools. But as the political process developed, PABS sort of became, at least regarded as the primary pathway for equity in the pandemic agreement.
Mark Leon Goldberg: And what does it mean? What does it include?
Courtney Carson: Pathogen Access and Benefit-Sharing System is the idea that countries or jurisdictions that help identify a novel pathogen or a novel strain of a pathogen, and when they share that data with other countries, with pharmaceutical companies, or whomever might use that data to help develop a countermeasure, would then in turn get benefits from sharing the pathogen data. And that benefit could be many things, but in this case, it’s linked to equitable access to the countermeasures that are developed as a result of sharing that pathogen data.
Mark Leon Goldberg: So, for example, if a novel virus is found in the Democratic Republic of Congo, the DRC would send their samples to advanced laboratories elsewhere in the Global North or the West. And because they have done the right thing and shared this sample with wealthier countries with more capabilities to build vaccines or countermeasures, the expectation is that they therefore would be able to receive those countermeasures, those vaccines at some like reasonable price.
Courtney Carson: Or no cost potentially.
Mark Leon Goldberg: And so it’s this idea that we’re all in this together, right? That if you, as a countr,y do the right thing, you share your data, this virus data, with the rest of the world, the rest of the world is not just going to profit off of that. They’re going to also help you defend yourself, your countries.
Courtney Carson: Yes. And it’s also in part a reaction to what happened during COVID-19 when you saw countries like South Africa sharing data on new variants of COVID and facing economic isolation and other types of fallouts instead of more recognition of sharing how the virus has been developing, which greatly informed the future of vaccine candidates and different things like that.
Mark Leon Goldberg: I mean, that seems perfectly reasonable to me. Why is it, therefore, that some countries, I guess presumably in the global north, don’t want this agreement?
Courtney Carson: What’s happening right now is a challenge between balancing the access to information and what appropriate level of benefits are. And the big push from an equity perspective is to make sure that access and benefits are on equal footing. And that’s not necessarily seen as how the proposals are right now. It can feel that countries are being asked to give up more in the access they provide to information than they would be guaranteed to receive in benefits, or there’s caveats to the benefits.
And there’s also a push to have legal arrangements already drafted up so that there’s more certainty for what the benefits would be versus, “Well, we will do this if these following conditions are met.” And understandably, countries, especially those who feel that they had been burned during the COVID pandemic, are not looking to sign up for a system where they feel like they may be giving away information and not getting appropriate benefits in return, especially when they live that experience, to some extent, in the not-so-recent past.
Mark Leon Goldberg: So, that seemed to be the kind of hang-up and the debate heading into this big high-level meeting at the United Nations last week, where, as you said, the intention behind these high-level meetings is to have very senior political attention at the minister level, the foreign minister, even the prime minister level, focus on these issues to try to resolve an impasse like this. So, what happened at this meeting?
Courtney Carson: Well, one of the things that RANI, in partnership with other organizations we worked with called the Friends of the High-Level Meeting on Pandemic Prevention, Preparedness, and Response, had been working to was to help decouple, in some ways, this high-level meeting process from the processes that were happening in Geneva around the pandemic agreement and PABS negotiations, because one of the strong suits about addressing these issues at the United Nations in New York is that you take it out of purely a health realm and can address pandemic threats as a whole of society, whole of government initiative.
So, when there was a high-level meeting in 2023 on this topic, there was a lot of hesitancy on what could be in the political declaration because there was the pandemic agreement process still happening in Geneva. And leaders did not want to get ahead of the political process in that realm. But if we make the case that we’re in New York, this is more than a health thing, we can keep letting the PABS negotiations happen, and we can still make progress on other issues where there are gaps related to pandemic prevention, preparedness, and response. That’s what this New York process should be for, not to relitigate what’s happening in Geneva or get ahead of what may be happening there.
Mark Leon Goldberg: And there was this intention, this idea that there would be a political declaration, which is the outcome document often of meetings like this, which is a consensus declaration of where we, all the countries of the world who are participating in this meeting, can agree on this particular issue. Yet, at this meeting last Friday, there was no political declaration adopted by consensus. So, what transpired to block that consensus that enabled the failure of this political declaration to be agreed upon?
Courtney Carson: I wouldn’t call it a failure right now, and we’re still hoping that the political declaration will advance this calendar year. But a lot of the policy-sticking details are some of the same ones that challenge the pandemic agreement process, and what are some of the thornier issues to come to alignment on, especially between countries in the global north and countries in the global south? Technology transfer and different aspects of that that touch on pharmaceutical R&D and manufacturing are those that continue to be challenging.
And then when you bring things like this to a more general UN body, you start to see political tensions from other processes or other parts of geopolitics enter the arena. So, during the drafting stage of the political declaration, there’s a process where you have a text, countries negotiate on it, and then it’s open for silence procedure, where you say this is the draft. Countries have an opportunity to comment on it. If silence is not broken, we’re going to keep moving forward.
Unfortunately, with each iteration of the draft, silence was broken. And then in August, the co-facilitators of the process said, “Silence was broken again, but we feel this is the strongest document we can get from a consensus perspective. So, we’re going to keep moving it as it’s currently drafted,” in hopes that once it got down the line a little further, once there could be some bilateral meetings with different member states, some of the issues could be resolved so that people wouldn’t speak out against it. That did not totally happen in this case.
And there were still unresolved issues that prevented countries from being able to say, “We can advance this with a consensus process at the high-level meeting.”
Mark Leon Goldberg: Which countries? Because the reporting I saw suggested that it was mostly the United States and a handful of smaller countries that formally blocked consensus. What was the United States objections?
Courtney Carson: I think advocates, at least, were mentally prepared for the United States to come in with objections to this process, as they have in a lot of multilateral processes to date. And some of the objections are around issues like sexual and reproductive health and rights, which don’t necessarily need to come into play in this arena. But if it’s a health-related issue and it could possibly touch on those things, there’s an opportunity to lodge objections.
Part of it has to do with industrial policies and what is seen to be in the best interests of the United States. Some parts of it are around how much the United States engaged productively in the negotiating process of the political declaration versus just coming in at the end and saying, “Eh, we don’t like this.”
Mark Leon Goldberg: Which is, in my view, that’s probably what happened. And you’re nodding. But yeah, it did seem that the United States kind of made a show of blocking consensus. And it was around, as you said, seemingly mostly ancillary issues in the document of language that as a reporter covering the UN and many other of these processes, they just sort of routinely now, as a matter of form, just block consensus when there’s reference to reproductive health because they think it’s code for abortion or whatever.
And so, you did see at this HLM, this High Level Meeting, the blocking of consensus. But in the room, what was the overwhelming or overriding mood and view about where we stand right now on a process towards a global cooperative arrangement on pandemic prevention, preparedness, and response? Because the U.S. is an outlier here, but it’s an outlier to what is seemingly a broader consensus.
Courtney Carson: And even when you listen to remarks delivered by U.S. diplomats, they start with the premise that we understand that pandemics are a global issue where we need to work together. So, I think, by and large, the recognition is there. It’s just where is the willingness to make the political policy and financing changes that are really needed to make the biggest difference. And I think financing is an area where we’re still not seeing enough progress as is needed.
And while you hear member states give remarks about how they are committed to global solidarity against pandemic threats, that diseases know no borders, and these are things that came up time and time again, not many, if any, countries were willing to go to bat for global-level financing that’s needed to keep the global community prepared. And we learned in the aftermath of COVID-19 that there’s at least a $15 billion annual gap for global-level financing for pandemic prevention and preparedness.
And though it was something that we and other organizations really pushed for, we could not secure language to that effect in the political declaration because geopolitics and the politics around financing in general are so fraught at this moment in time. Even acknowledging the gap, let alone committing to close the gap, was something that couldn’t be addressed even by member states who are very supportive of these issues.
Mark Leon Goldberg: You mentioned earlier that even though this particular meeting failed to adopt a political declaration on pandemic prevention, preparedness, and response, there is still an opportunity later this year for the world to come together and at least advance the conversation, advance the diplomacy on this issue. What is that opportunity?
Courtney Carson: I don’t believe that the sort of specific next steps have been outlined yet, but there will be further meetings of the General Assembly this calendar year where action can be taken to help advance the political declaration. As far as I know, there hasn’t been any determination as to whether that means the declaration text will be reopened and renegotiated to some extent, if it will be continued conversations bilaterally to help understand member state concerns and work to help alleviate them.
And it’s also not clear yet to me whether advancing the political declaration will necessarily mean that a vote is required or if there are still pathways to try to move this in more of a consensus way. But we saw something similar happen with the political declaration on non-communicable diseases last year. And though it was a protracted process, the declaration was still able to pass at the end of the year. So, from an advocacy perspective, we’re working with our partners to let member states know that this process is important, that they owe it to their citizens to advance this political declaration and not to let this fall through the cracks.
Mark Leon Goldberg: So, it was at the High Level Meeting, though, that Dr. Tedros, the Executive Director of the World Health Organization, sort of urged member states to quickly pass that PABS annex and that PABS agreement so that the pandemic treaty, the accord, could start to be in a place where it could be ratified by governments and then come into force. Because, again, until that one Pathogen Access and Benefit Sharing part of the agreement is agreed, it just can’t move forward. So, what are the opportunities then for the advancement on the PABS part of this whole matrix?
Courtney Carson: So, there are scheduled negotiations on the PABS annex for the rest of this year. But the sticking point is getting negotiators to come to the table actually willing to compromise. I think several experts around UNGA said it’s not really a negotiation when you show up and just keep saying your same points over and over, potentially a little louder or with different emphasis, right? We know what the positions are. There needs to be some effort to meet closer to the middle and show that there’s a willingness, potentially on both sides, to find common ground not just stick to your position.
So, that’s where the effort is needed is where can there be movement towards compromise, because if we keep showing up with the negotiations, with little room to move, the negotiations are going to continue as they have been, because even though this Pathogen Access and Benefits Sharing annex was kicked down the road after the adoption of the pandemic agreement, these issues were being negotiated during the negotiation of the rest of the pandemic agreement. So, this has been a long negotiation. The points are well known. We need to get past that towards what are the solutions.
Mark Leon Goldberg: Well, I guess then what could be like the diplomatic breakthrough that enables the kind of compromise that you envision that sort of enables governments to come to the table, not just reasserting their previously held positions, but being able to compromise?
Courtney Carson: I think it’s a really challenging question because it has to do a lot with how medical research and development is funded. It has to do with who are the players in medical R&D — where do profits come from? What are reasonable profits? What is considered a global public good? And can we all align on that? And there are so many complicated issues baked into that, trying to just say, “Well, of course, the pharmaceutical industry should guarantee access to vaccines during a pandemic.” Sounds like the easy solution.
But if we’re also not addressing upstream how the early investments are being made in countermeasure development, we’re not really solving the problem. We’re putting a band-aid on it. So, it’s a larger issue that needs a comprehensive solution, and we’re still trying to get at it in a piecemeal way.
Mark Leon Goldberg: Is there anything like another point you wanted to make, any question I didn’t ask?
Courtney Carson: I think the other point that I would make is that with the political declaration from the High Level Meeting, with the pandemic agreement, with the PABS annex, there’s still a lag time between getting something in policy and implementation. And while all of these political processes are important, many would still say they’re not at the depth that is truly needed to be transformative.
So, as advocates, we have a really strong push to say these political processes are important, but we cannot wait until the political processes are resolved or aligned or ratified to start making the changes, to make the policies, to make the investments that are needed to make our communities better prepared for pandemic threats. You can see what are in the outlines of these documents. Countries and regions can start implementing these things now, even if they’re not policy, and thinking ahead to what’s needed.
Mark Leon Goldberg: Courtney, thank you so much for your time. This was really helpful.
Courtney Carson: Yeah, thank you.
Mark Leon Goldberg: Thanks for listening to Global Dispatches. The show is produced by me, Mark Leon Goldberg. It is edited and mixed by Levi Sharpe. If you are listening on Apple Podcasts, make sure to follow the show and enable automatic downloads to get new episodes as soon as they’re released. On Spotify, tap the bell icon to get a notification when we publish new episodes. And of course, please visit globaldispatches.org to get on our free mailing list, get in touch with me, and access our full archive.
Thank you.
