Global pandemic fears:- Attempts to agree a treaty to manage future pandemics risk losing momentum, health leaders gathered at the World Health Assembly warned, as fears grow over outbreaks of bird flu in the US and mpox in the Democratic Republic of the Congo.

Crowded cities, global travel and climate change heighten the risk from zoonotic viruses – those transmitted between humans and animals – raising the spectre of another pandemic like COVID-19, or worse.

Scientists are particularly concerned about growing cases of bird flu – known as H5N1 – among US cattle, and an outbreak of mpox – formerly known as monkeypox – raging in the Democratic Republic of Congo.

“We have H5N1 knocking on the door,” said Ayoade Alakija, chair of FIND, a nonprofit in Geneva that promotes the development of diagnostic technology.

“We don’t have time to wait.”

The US Centers for Disease Control has warned of an outbreak in the Democratic Republic of the Congo of a strain of mpox – known as clade I mpox – which is significantly more severe than the clade II strain which spread around the world in 2022.

“The increasing number of reported suspected clade I mpox cases in the Democratic Republic of the Congo poses a global threat for potential spread,” the agency said last month, adding that there had been more than 20,000 suspected cases and 975 deaths reported in the country since January 2023.

It comes as the 194 member states of the World Health Organization (WHO) ended their annual gathering in Geneva, Switzerland, on Saturday (1 June) without the agreement they had planned to reach on the much-debated Pandemic Prevention, Preparedness, and Response Agreement.

Negotiations will continue, buoyed by the last-minute success in Geneva of a less-noticed, parallel effort to update the International Health Regulations (IHR), a set of rules aimed at preventing the spread of disease across borders.

However, disease experts at the meeting expressed concern that with pandemic threats looming, both agreements may be too little, too late. Neither will come into force until 2027 at the earliest.

Stockpiles

After failings in the international response to COVID-19 left lower-income countries unable to acquire adequate vaccines, while rich countries stockpiled millions of doses, few dispute that the world needs better ways of managing pandemics.

Negotiations for a treaty were launched in December 2021 while COVID-19 was still rampaging, with 2024 set as the deadline.

By the end of planned negotiations on 24 May, negotiators in Geneva said they had resolved 80 per cent of their initial disagreements. The US called it “an integral part of a wider effort to improve the global health infrastructure”, while all 55 members of the African Union declared they “spoke with one voice” in support of the treaty.

However, “fundamental differences remain in core issues”, US health secretary Xavier Becerra told delegates. Those issues mostly involve what delegates in Geneva called the treaty’s “grand bargain” – pathogen access and benefit sharing.

Anti-WHO protesters gather outside the World Health Assembly in Geneva. Credit: Debora MacKenzie

This calls on countries, including low-income countries where the risk of new diseases is highest, to share pathogen samples and genomic sequencing data to allow scientists to track pathogens and design vaccines, drugs and diagnostics against them. In return the mostly high-income countries that produce these countermeasures pledge to share them with low-income countries, along with the know-how to manufacture them.

The treaty also calls for a global supply chain and logistics network to see that vital supplies, such as vaccines, vials and syringes, are shipped to where they are needed.

However, high-income countries are reluctant to give products away, especially know-how protected by intellectual property rights. In the talks, Thiru Balasubramaniam of Knowledge Ecology International accused leaders of giving “primacy to industrial and trade goals at the expense of health”.

As midnight approached in Geneva on 1 June, WHO director-general Tedros Adhanom Ghebreyesus told exhausted delegates the treaty negotiations would continue until the 2025 assembly “at the latest” – a compromise between African countries that wanted a December deadline, and the US, which warned the complex issues could take two years to settle.

But some fear momentum may be waning.

“When we decided to draft this accord, we all wore masks,” Precious Matsoso of South Africa, co-chair of the negotiations, said in Geneva. Now, with the emergency over, “the window of opportunity is closing,” she warned.

If talks drag on, she fears, “it will almost be like COVID never happened”.

Negotiators are encouraged, however, by the last-minute agreement in Geneva of revisions to the IHR, which require countries to detect, report and respond to outbreaks that can affect trade and travel, not just potential pandemics. AlphaGalileo/SP