How to protect the world from the next pandemic

"History teaches us that the next pandemic is a matter of when, not if," warned World Health Organization Director-General Tedros Adhanom Ghebreyesus earlier this year. He is right. That is why it is vital that the world's governments successfully conclude their work of negotiating an accord on pandemic prevention, preparedness, and response. Negotiators were not able to meet the latest deadline for an agreement. They need more time, but they must also be mindful that time is running out.

We believe that an accord can be agreed that protects the world, if governments internalise the lessons of the AIDS and Covid-19 pandemics. But some are proving slow to recognise this.

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The draft pandemic accord opens with a bold and inspiring statement endorsing solidarity, equity, and human rights. These principles underpin effective prevention and response, and early proposed versions of the accord included binding commitments from governments to put them into practice. But the negotiations have generated pressure to water down several of these commitments, to the extent that some proposed versions would not guarantee that the response to the next pandemic would be any stronger than the response to Covid-19.

So far, the negotiations have been marked by a divide between the Global North and the Global South—the same divide that impeded the Covid-19 response. Low- and middle-income countries point out the need for binding commitments to ensure that medical technologies are produced and distributed widely next time. But they have faced opposition on this point from some wealthy countries, even though it is in everyone's interest to ensure equitable and universal access to the products—from diagnostic tools to vaccines—needed to beat pandemics.

Health products need not be scarce: geographically diversified production can help ensure ample supply. But, too often, after governments have poured public funding into the pursuit of lifesaving medical breakthroughs, they have handed exclusive rights over the resulting vaccines and treatments to private pharmaceutical companies. The inevitable result is that doses are provided only to countries that can afford to pay high prices for them, leaving poorer countries struggling to secure vaccines, tests, and treatments in a timely manner. This deadly scarcity is not a bug in the system; it is a defining feature of private monopolies.

World leaders were slow to recognise this during the AIDS pandemic. In the late 1990s and early 2000s, 12 million Africans died from AIDS while waiting for life-saving medicines that were widely available to people in the Global North. Then the Global South started producing more affordable generic medicines, and the cost of treatment plummeted from well over $10,000 per patient per year to well below $100. Now, three-quarters of people living with HIV are getting the treatment they need to live long and full lives. If universal access to AIDS treatment is guaranteed, the world can eliminate AIDS as a public-health threat by 2030. Beyond saving millions of lives, this would bolster global stability, health security, and economic growth, with high-income countries also benefiting.

One would have expected these hard-won lessons to shape the Covid-19 response. They did not. Instead, pharmaceutical companies were given vaccine monopolies, so doses were delivered to wealthy countries first, leaving poorer countries unable to secure supplies—with tragic results. A more equitable Covid-19 vaccine rollout could have saved 1.3 million lives in the first year alone. This does not include the massive indirect losses of life and health caused by the redirection of health resources toward Covid-19 cases.

Beyond the high human costs have been severe economic repercussions. According to one estimate, vaccine inequity cost the global economy $2.3 trillion. Ultimately, countries in the Global North have been playing a negative-sum game: the increased profits for a few pharmaceutical companies—and a few billionaire pharmaceutical barons—are dwarfed by the losses for everyone else.

The pillars of effective pandemic prevention, preparedness, and response are well-known: relevant knowledge and technology must be shared openly, and vaccines, tests, and treatments must be produced widely. To this end, sufficient funding needs to be provided at the national and international levels, and intellectual-property barriers that prevent safe, capable manufacturers from joining the pandemic response must be removed.

Voluntary action is not enough. The United States and the European Union have recognised this and implemented selective measures to mandate the sharing of technology and knowhow. The pandemic accord needs to take this further, with binding commitments for all countries to share relevant resources and knowledge openly during a pandemic. Without such commitments, the world would not be able to achieve the accord's objectives.

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We cannot rely on the goodwill of pharmaceutical companies to ensure that global health is prioritised over profiteering. During the Covid-19 crisis, intense public pressure drove BioNTech and Moderna to pledge to launch operations in Africa. It was a minor concession from companies that, along with Pfizer, made $1,000 per second by supplying vaccines to rich countries first. But even that proved to be too much for them: now that the news cycle has moved on, BioNTech has massively scaled back its plans for African production, and Moderna has shelved its plans entirely. The lesson is clear: governments can ensure access to health products only by mandating it.

Having lived through two deadly pandemics—in which we, like so many others, watched friends and family suffer and die—it is unbearable to imagine a repeat of such devastation. The pandemic accord offers hope for a better, more equitable way forward. To succeed, leaders must match their lofty rhetoric with iron-clad guarantees that the response to the next pandemic will reflect what we learned from the last one.

Winnie Byanyima is Executive Director of UNAIDS and Under-Secretary-General of the United Nations.

Joseph E Stiglitz, a former chief economist of the World Bank and former chair of the US President's Council of Economic Advisers, is professor at Columbia University, and a Nobel laureate in economics.

Views expressed in this article are the author's own.

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