Lancet Commentary Focuses on Global Pandemic Accountability

Commentary in a recent issue of the prestigious journal The Lancet Public Health featured José Szapocznik, Ph.D., professor and chair emeritus of the University of Miami Miller School of Medicine’s Department of Public Health Sciences, along with other members of the Panel for a Global Public Health Convention.

The published commentary, “An effective pandemic treaty requires accountability,” explains that to prevent future outbreaks from becoming pandemics and effectively contain pandemics once they occur, the proposed pandemic treaty must hold countries accountable. Research shows that unenforced treaties fail to deliver. The commentary provides examples of different mechanisms for enforcement that may be effective with low- and middle-income countries compared to wealthier ones.

The panel, on which Dr. Szapocznik serves as head of the secretariat, was formed in 2021 to address the need for a better worldwide system to respond to and prevent future pandemics.

University of Miami President Julio Frenk, M.D., M.P.H., Ph.D., an internationally renowned public health expert, said, “A legally binding international agreement on pandemic prevention, preparedness, and response needs to take a multilateral view of sovereignty, in which nations have a right to determine and manage their approach to public health. They also have a responsibility to ensure that activities within their jurisdiction or control do not cause damage to other states and their peoples.”

In its initial study, the panel interviewed 29 health experts from around the world, finding issues with global governance of pandemics as the main challenge to effective pandemic prevention and mitigation.

“One can’t simply prevent or fight a pandemic country by country,” Dr. Szapocznik said. “We established this panel to advocate for an effective treaty that will assure solidarity, equity, transparency, and accountability. We aim to correct past issues by ensuring equity not just with regard to common goods such as vaccines, but also with regard to countries receiving the technical collaboration and funding they need to develop a minimum capacity to identify outbreaks and respond to them effectively.

“After all, in pandemics, it requires all countries to fight them, and when even one country is unable or unwilling, the whole world suffers,” he said.

Establishing Accountability

The publication describes an accountability mechanism involving incentives for low- and middle-income countries, tying funding in a future year to achievement of milestones in the current year. Failure to meet milestones set by the country will result in delays in funding for the following year, until such milestones are either met or renegotiated.

Funding, however, is not a meaningful incentive for high-income counties. And neither low-, middle-, nor high-income countries are likely to agree to include sanctions in the proposed treaty.

The authors propose using an existing mechanism of the International Monetary Fund (IMF) Article IV: the periodic evaluation of each country for financial stability as an accountability mechanism. It is known that pandemics cause financial instability. Hence, if the IMF were to include outbreak/pandemic preparation and response (as will be required by the treaty) in their assessment of a country’s potential for financial instability, those reports would reflect their relative compliance with the treaty. This would, in effect, be a mechanism for accountability for all countries, regardless of the size of their economies.

These IMF assessments are taken seriously in the business world. Credit agencies take the findings of these reports into consideration when establishing countries’ credit ratings, which affect the interest rates they pay for borrowing money.

“If a country is not well prepared to contain an outbreak, it is placing the entire world’s health and economy at risk,” Dr. Szapocznik said. “For a pandemic treaty to deliver, to prevent future pandemics, countries must be mutually assured that all other countries are also doing the hard work to protect the world. All countries, through either solidarity, incentives, or disincentives, must comply with treaty provisions.”

The Panel for a Global Public Health Convention has made progress in influencing countries—including the U.S.—to consider the benefits of a legally binding international agreement, convention, or treaty. As the U.S. is a major leader in global health, U.S. leadership will be essential even if the Senate fails to ratify the treaty by a two-thirds majority.

“Pandemics are happening closer and closer in time, with airborne viruses being the most dangerous,” said Guilherme Ferrari Faviero, lead research analyst for the Global Public Health Convention in the Department of Public Health Sciences. “The amount of money, resources, and other efforts needed to prevent pandemics are a relative drop in the bucket, compared to the potential lives lost and economic devastation that can occur without a legal binding treaty that includes effective accountability mechanisms.”

Currently, the panel continues to meet public health officials and other leaders in countries around the world to gain support. Other ongoing efforts include publishing studies, position papers, and op-eds in Africa, Europe, Latin America, and elsewhere, to educate the public about the importance of a pandemic treaty with accountability.

The research of the secretariat is funded by the AIDS Healthcare Foundation (AHF); Jorge Saavedra, executive director of the AHF Global Public Health Institute, is a collaborator on the secretariat’s work.

Tags: AHF Global Public Health Institute, AIDS Healthcare Foundation, COVID-19, Department of Public Health Sciences, Dr. José Szapocznik, Dr. Julio Frenk, Miller School of Medicine, The Lancet Public Health