UNAIDS offers lessons from the AIDS pandemic on the Intergovernmental Negotiating Body Pandemic Accord Bureau text
GENEVA, 24 July 2023—The Joint United Nations Programme on HIV/AIDS (UNAIDS) offers lessons learnt from the HIV/AIDS pandemic to strengthen and sharpen the bureau text of the Pandemic Accord to ensure a truly robust response to current pandemics, and to prevent, prepare for and respond to pandemics of the future.
UNAIDS and the global response to AIDS have unique experience and insight over the past forty years in responding to pandemics. The global AIDS response has shown how effective a pandemic response can be which it outlined recently in its Global AIDS Update 2023 – The Path that Ends AIDS.
While COVID-19 increased HIV vulnerability and disrupted HIV service access for millions of people around the world, the AIDS response, systems, infrastructure and governance model also helped countries respond to both HIV and COVID-19. UNAIDS has a critical interest in protecting the gains in the HIV response, preventing future pandemics and health emergencies which impact people living with and affected by HIV and which could set back efforts to end AIDS by 2030.
Drawing on the more than a quarter-century as a global leader of the fight to end AIDS as a public health threat, UNAIDS offers the following lessons learned for strengthening the current bureau text of the Pandemic Accord:
General language
The current draft could be amended to incorporate much clearer, stronger language on the obligations of high-income countries (HICs) to ensure worldwide access to pandemic products and to proactively provide financial and technical support to enable pandemic responses in low- and middle-income countries (LMICs). The frequent use of “as appropriate” language could be replaced by clear language that conveys the obligation of states to act. In the current draft, much of the burden for prevention and surveillance falls on LMICs, without communicating clear obligations of HICs to assist and support LMICs. It could also have text that commits all countries to prioritise health and medical research.
Human rights and equity
While the draft identifies human rights and equity as core principles of pandemic preparedness, the draft could clarify language regarding the member states’ commitment to protect human rights and ensure equity in all aspects of pandemic prevention, preparedness and response (PPR). The accord could: reconsider the definition of “persons in vulnerable situations” (Art. 1); explicitly reference States obligations to protect and fulfil human rights within its “general principles” (Art. 3.1); mainstream concern for equity throughout provisions of the accord; emphasize formal and substantive equality, alongside non-discrimination, as general principles (Art. 3.1)
Equitable access
With respect to equitable access to pandemic-related products, the bureau draft uses language that suggests that recommended actions are advisory rather than obligatory. UNAIDS recommends that the draft :
- Clearly commit countries that possess pandemic-related medical technologies and knowhow to share it with LMICs in a timely and meaningful manner, including requirements in funding and purchasing agreements for institutions and companies in HICs to share intellectual property rights, technologies and knowhow with researchers and capable manufacturers in LMICs.
- Commit to provide robust financial and technical support for collaborative research between institutions in the North and South to build R&D capacity in LMICs – not only for pandemics and not only for manufacturing, but to enable LMICs to contribute to progress in science and technology for all of humanity.
- Countries to make full use of TRIPS flexibilities to address public health needs during a health emergency.
- Commit all states to waive intellectual property provisions for all pandemic-related products during pandemic and recovery periods.
- Commit Member States to provide political leadership and robust financial and technical support to build strong, flexible medical manufacturing capacity in LMICs before the next pandemic emerges. With future pandemics, surge support will be essential to adapt this capacity in LMICs to manufacture pandemic-relevant products.
- If and when demand for pandemic-relevant products outstrips supply during future pandemics, all Member States must commit to abide by WHO product allocation prioritization recommendations to ensure equitable access, with particular attention to the most vulnerable populations.
Access and benefit sharing
Although the draft specifies obligations among LMICs for actions pertaining to surveillance and the timely sharing of pathogens and data, the draft should be revised to commit Member States to ensure equitable access, including sharing the benefits and profits from the sale of these pathogens. Draw lessons from the Ebola where pathogens from Africa were shared but the medicines were stockpiled in the north leaving people in Africa waiting for charitable donations. The Accord should build on the precedence of the Pandemic Influenza Preparedness agreement (PIP) which facilitates sharing of pathogens and benefits both in terms of vaccines and profit.
Common but differentiated responsibility
While PPR is a shared responsibility of Member States, the draft could make clear that the nature and extent of responsibilities are differentiated based on each country’s financial and technological resources and capacities. As the effects of epidemics are felt most heavily in poor and vulnerable populations, countries that are home to these populations require additional assistance.
Inclusion of community and civil society
Community-led responses play critical roles in reaching marginalized communities with essential health messages and services during a pandemic – as both HIV and COVID-19 have shown – but communities remain under-resourced and inadequately integrated as key partners in national PPR efforts. The Pandemic Accord must acknowledge the central role of community-led responses and commit member states to include communities and civil society in decision-making, planning, preparation, implementation and monitoring.
Sustainable investments in health systems and infrastructure
Sustainable, resilient, well-resourced, equitable, human rights-based and people-centred health systems are essential to PPR and to efforts to achieve Universal Health Coverage. The HIV response has shown clearly how it is possible to leverage HIV investments to build stronger, inclusive, sustainable health and social service systems that respond to both HIV and other health threats. Drawing on previously recommended language on differentiated responsibilities based on national financial and technical capacity, the draft could clearly commit countries to invest major new public financing in health systems – ensuring a well-trained, well-remunerated health workforce (including community health workers); strengthening primary health care; ensuring access to health technologies (including those that are locally produced); and strengthening and effectively using health information systems.
Multisectoral governance
HIV has pioneered inclusive, accountable, participatory health governance across multiple sectors and with community, but there is a risk that PPR governance will be devised as a technocratic, top-down enterprise that does not include the central contributions of communities and civil society. The draft could insist that PPR governance mechanisms be fully inclusive of key stakeholders and integrated at national and regional levels to deal with current pandemics and future health crises. Language on whole-of-government and whole-of-society approaches should be strengthened.
Conclusion
Pandemics continue to exact enormous costs on societies across the world – an estimated 630,000 people died of AIDS-related causes in 2022, and long COVID will has lasting effects on human health and well-being and health infrastructure. In responses to HIV and COVID-19, too many countries and communities have been left to fend for themselves. Responding effectively to current and future pandemics requires the global community to summon the principles of solidarity, equity and people-centred action at the heart of the 2030 Agenda for Sustainable Development. Through learning by doing over decades, the HIV response has shown how it is possible to respond effectively to a pandemic. UNAIDS strongly encourages countries to take on board UNAIDS lessons learned when negotiating revisions to the bureau draft of the Pandemic Accord.
UNAIDS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.
