The Fight Over the Next Pandemic (2024)

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From The New York Times, I’m Michael Barbaro. This is “The Daily.”

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Today, at the height of the COVID pandemic, nearly 200 countries started negotiating a plan to ensure they did better when the next pandemic inevitably arrives. Their deadline for that plan was last week.

My colleague Apoorva Mandavilli explains why so far, those negotiations have failed.

It’s Thursday, June 6.

So, Apoorva, something that was supposed to happen and happen right now that I think most of us didn’t even was ever in the works hasn’t happened. And that’s a global plan for the next pandemic. So tell us this entire story.

Think back to 2021, the very worst days of COVID when we had thousands of people dying in the US and in the rest of the world. There was just so much confusion about whether to wear masks or not, whether to close schools. And it was very difficult to think what any country should do.

Right.

And so in the middle of that chaos and confusion —

Carrying the hopes of a country, the first shipment of coronavirus vaccines reach Australian skies.

— we did get the vaccines.

Then all of a sudden, there was this hope. But the thing is that those vaccines were really mostly available in the richer countries.

So we in the United States and a lot of countries in the European Union and some of the other high and middle income countries had the vaccines.

But elsewhere in the world, there were no vaccines really. It became obvious to some low and middle income countries that they were not going to do very well in this pandemic. There were all these advanced purchase orders from the richer countries. And they were having some very tough negotiations with pharma companies that were charging them more than they were charging the rich countries.

And by the end of that horrible, horrible year, more than 90 percent of people in the richer countries had had two doses of vaccine. But 2 percent of people in low income countries had had any vaccines. So that really just striking inequity made people realize this was just a mess. We did not know how to deal with the pandemic.

So in December 2021, by the end of this year of inequity —

— the World Health Organization brought together all the countries —

— and launched this process to come up with a playbook to really think about how all the countries of the world need to prevent and respond to the next pandemic and do it in a way that would protect everybody, rich and poor, across the world. And the WHO decided that this discussion could not be just an informal conversation between health ministers, that this needed to be an international treaty, a legally binding treaty so that every country has to take this very seriously and everybody agrees on how to do this next time.

Hmm. So at the very height of COVID’s awfulness, these countries in the WHO are saying, we know you all are very, very busy fighting this pandemic. It is taking up all your time and energy. But we need you to now start to think about how badly this is going and not just fight the current pandemic but start planning on a better way to fight the next one. That’s kind of a big ask.

It is a big ask, but what is the alternative? That we come to the next pandemic and have a repeat of all of the chaos and confusion we saw during COVID? So I think it was an acknowledgment that we needed it. We needed to come up with a plan. And it became obvious that part of that plan needed to be a way to repair the mistrust that had formed between low income countries and high income countries and that without repairing that, we just did not really stand a good chance of fighting the next pandemic.

Right. And, of course, the thing about a global pandemic is that any weak link, any country that’s not doing its part or getting what it needs, becomes a problem for every other country. That’s the nature of a pandemic. We need — we talked about this with you, we talked about this with our colleagues throughout the pandemic — a system where there’s a strong program and plan in every country so that the virus can be stamped out.

Exactly. I mean, in the United States, more people died because of variants than they did because of the original virus. And a lot of those variants started in countries that did not have access to vaccines.

OK, so what do these talks start to actually look like? And just how many countries end up being involved in them?

So all of the countries that are member states of the World Health Organization were involved in this. 194 countries.

Wow.

And they all sent delegates to meet to draft something and then to discuss every aspect of it and try to come to a consensus. And the goal was to get that to a point where all the countries were ready to sign off on it by May 2024. They had meetings over a period of two and a half years to talk through this. Some sections they all agreed on pretty easily. You can imagine the general goals like, yes, we should have a good plan to fight a pandemic. Or yes, we should have good research on vaccines and drugs, things like that, the general sort of philosophical goals everybody agrees on.

Right. Principles are always the easiest thing to negotiate.

The easiest thing to negotiate. But then you start getting into how this happens, right? And it’s actually kind of interesting. In the draft, if you look at the drafts, they have areas that are green, which means everybody sort of agreed, and yellow, which means they’re starting to come to an agreement, their sort of general consensus, and then white, which means it’s really no agreement. They’re just not even on the same page. And when you look at what’s green across all of these drafts, the philosophical goal is green from the start, no problem.

The yellow started to come slowly, these areas of consensus, things like, for example, safety measures in the labs that work with dangerous viruses. And that’s not just because one of the theories about COVID is that the virus leaked from a lab. We know from long before COVID that lab safety is very important for making sure that those dangerous viruses don’t get out into the world. There is also agreement around how countries should do surveillance to see what outbreaks might be emerging. And some of that stuff is tricky.

Why is it tricky? I mean, isn’t there a pretty standard playbook for trying to detect a virus and what to do once you detect it?

Sure. But there are some things that are big sticking points like money. Not all countries have the resources to do the kind of surveillance that they need to do. And so who funds that? And then some countries have vested interests, like Argentina wouldn’t want any rules that forbid export of certain kinds of meat products because that’s a big part of their economy.

There are countries where live animal markets are a thing, and not just in China, which we’re all familiar with, is another origin theory for COVID. Lots of other countries rely on these markets. And they don’t want to have very strict rules about which animals can be held together and how densely packed they can or can’t be. So when you start to get into the details there, it is actually difficult to reach consensus on some of these things.

But they have made a lot of progress. And they have come to yellow and green on some important things like that every country should have a health care workforce trained to respond to a pandemic, that they should make best efforts to have local production of things like vaccines and drugs, and that they should provide all of these resources to their own citizens. Things like that, those are all under agreement. They’re all green now.

So what exactly is holding these negotiations back? What ends up being the biggest remaining conflict?

It won’t surprise you to hear, Michael, that the biggest conflict is exactly what all of this began with, which is the lack of access that low income countries have to things like vaccines.

There have been interesting proposals in the drafts and one in particular that would solve at least some of this issue. But it’s been very difficult to convince rich countries, middle income countries, and low income countries that that proposal would be of great benefit to everybody involved.

We’ll be right back. So, Apoorva, tell us about this particular proposal that could do a lot of work to solve the inequities at the center of these negotiations and why that proposal has created so much conflict.

The heart of the section that has really created the most conflict is whether low income countries get access to vaccines in a timely manner and at a cost that is affordable to them. And all the low income countries recognize that they don’t have a lot of bargaining power. They were treated pretty poorly by pharma companies during this past pandemic. And so they’ve been thinking about setting things up so that that does not happen again, that the next time around, they are not left behind.

Right. But like you said, they don’t have a lot of power to bargain.

They don’t. But there have been times when poor countries have come up with a way to make everybody else realize that they’re essential to this whole process. So let me give you an example of this that really, I think, illustrates how much everybody else needs the low income nations during an outbreak.

So in 2006, Indonesia was battling a bird flu outbreak. And they had been very dutifully sending samples of the virus that they had in their country to the World Health Organization labs to analyze. And that information helps pharma companies develop things like vaccines.

Or tests, right.

Or tests. And in this particular case, the Indonesian Health Ministry approached the World Health Organization to say, look, we’ve given you these samples. We have people dying in our country. And we need access to vaccines and drugs. And the WHO told them, sorry, we don’t directly distribute any of that. You have to talk to the manufacturers.

Hmm.

And this is where that leverage becomes really important because Indonesia did not actually have leverage with these pharma companies. And so the vaccine manufacturer told them that they would sell them vaccines but at commercial prices that that country cannot afford. And then a drug manufacturer told them that they did not have enough drugs to give Indonesia because richer countries had placed enough purchase orders that there was a delay of two years. So [LAUGHS]: Indonesia was so angry about all of this that they declined to share any more samples with the WHO.

So Indonesia basically says, we will never again make the mistake of promptly sharing information about a potentially deadly pathogen because we learned that we get nothing in return.

Right. And understanding that realization also has driven a lot of the conversation in the drafting of this treaty where low income countries have essentially said, we recognize that you need us to share these samples. But we are not going to do that unless you can promise to us that we will get some access to vaccines and drugs that you make based on the samples we give you. So we want something in return for the information we provide to you.

What is the specific proposal that comes from this realization?

Yeah, this proposal has created a lot of controversy, so there are versions of it. But the most recent one says essentially that if the low income countries share their samples with the WHO that pharma companies have to give the WHO 10 percent of the vaccines they make as a donation and then 10 percent either at a non-profit cost or just a deeply discounted rate also to the WHO. And then the WHO would distribute that 20 percent of vaccines that they get from the pharma companies to the countries that are in most need.

Hmm. So this proposal, which feels very innovative, is the ultimate manifestation of poor countries’ power in this dynamic. If they don’t get vaccines, then the big countries will never get the information about a virus that’s necessary for there to have ever been a vaccine. It’s really interesting.

It is. And this is the biggest chip that low income countries have. So they are not willing to budge on this. But guess who doesn’t like this? Pharmaceutical companies and the countries that really support the interests of the pharmaceutical companies. And that includes the United States, Germany, Switzerland, some of the big players, places where these companies are a big presence and a very powerful lobby.

What specifically have these pharmaceutical companies and the countries like the US that have so many of them said about this proposal?

So the countries, they are willing to give in principle and say that the pharmaceutical companies will voluntarily give some of the vaccines to the WHO, but they don’t want it mandated. Whereas the low income countries, they want it to be really codified so that there is no loophole. And the conversations have gone round and round on that one word, “voluntary.”

Apoorva, is it safe to assume that a country like the US, which, of course, has a booming and very profitable pharmaceutical industry, won’t sign on to these proposals unless that word “voluntary” is in the deal, that they cannot abide by one where it’s mandatory that these big pharmaceutical companies have to give up so much of their vaccine to poorer countries?

They are not going to say that in so many words, but yes. And the United States actually has come up with some very nice plans to help some of these low income countries set up infrastructure and be prepared for pandemics. But I think crossing pharmaceutical companies is not a place they will go.

Hmm. So is that really the only big obstacle left in these negotiations? Or is there anything else?

Oh, there’s lots more.

There has been so much misinformation and disinformation around this whole issue just like there has been about every aspect of COVID. And a lot of it centers around the hesitation and the opposition that many populist leaders have expressed. In the US, for example, there are Republican senators and governors who have come out against the treaty. And they say that this is a power grab by the WHO, that it is going to allow the director general of the WHO to tell the US what to do, whether to have mask mandates, whether to have vaccine mandates, none of which is true, by the way.

And in a bid to counter some of that misinformation, there is actually an explicit line in the treaty saying that the treaty respects the sovereignty of all the individual nations. They’ve tried to address that head on. But it hasn’t really made all of that chatter go away.

Mm-hmm. How much does this practically matter, the fact that a handful or perhaps more than a handful of Republicans in the US are skeptical of this and think ideologically speaking that it oversteps the bounds of what a treaty should do? I mean, ultimately, do they have any power over whether the US signs this treaty?

They do because delegates can agree to this treaty at the WHO, but everybody has to bring it back to their home countries. And in the US, the treaty then has to be approved for ratification by the Senate. You have to have a two thirds majority in the Senate say, yes, we agree to this treaty. So if you have a number of Republican senators who are absolutely opposed to it, it may not pass.

Mm. So it very much feels like so many of the issues that made everyone think this treaty was necessary, inequities between rich countries and poor countries and misinformation and ideological skepticism of how to handle a pandemic to begin with that really defined COVID for us, that those forces are now making it very hard for this treaty to actually be reached. They never really went away.

They never went away. It felt like there was about five seconds when everyone was united in thinking that we needed something different, and there was a lot of goodwill. But a lot of that has evaporated. And we’re getting very quickly to a point where people have forgotten what COVID looked like and felt like and what the devastation was like and have gone back to old positions on we don’t want to share. We don’t want to give anything away. Everything for us first. All of the thinking that led to the problems during COVID.

So what realistically happens now? And do you based on your reporting think that this treaty has any real chance of being completed and passed by the 194 countries involved in it?

Well, the draft was supposed to be finalized at the meeting last week of the World Health Assembly. And that didn’t happen. But they did set a deadline to say that the negotiations will continue. And then they’ll hope to have something done by next year’s meeting.

But there’s just so much in flux right now. There are elections all over the world. Who knows what Donald Trump will do if he gets elected? We know that he withdrew from the WHO the last time around. And he has even said that he may shut down the pandemic preparedness office in the White House. So he’s not particularly invested in this whole topic, this whole issue.

And in the meantime, we already have so many threats that are really picking up. For global health experts and for reporters like myself who watch all this stuff, it’s a bit alarming that we now have bird flu right here in the United States. And the next pandemic, pretty much every expert I talk to agrees it’s not a question of if, but when. And if we had had this treaty ready, if we can ever have this treaty ready, we would be so much better prepared for something like that to happen. But it just doesn’t seem all that likely right now.

Well, Apoorva, thank you very much. We appreciate it.

Thank you.

We’ll be right back.

Here’s what else you need to know today. In a last minute about face, New York Governor Kathy Hochul said she would block a long awaited tolling plan known as congestion pricing that was set to begin at the end of the month. The program, the first of its kind in the US, would have charged as much as $15 for cars entering the busiest parts of Manhattan. The goal was to alleviate traffic, reduce pollution, and raise money for the city’s aging subway system. But Hochul argued that the tolls threatened the city’s fragile economic recovery after the pandemic.

And on Thursday, former romantic partners of Hunter Biden, the president’s son, testified in a Delaware courtroom about the depths of his drug addiction and the toll that it took on them. The testimony, including how much Hunter Biden spent on drugs and the type of drugs he used, was designed to establish that he was a chronic drug abuser who lied when he claimed to be sober on an application for a handgun in 2018.

Today’s episode was produced by Alex Stern, Carlos Prieto, and Stella Tan with help from Will Reid and Rikki Novetsky. It was edited by Lexie Diao and Devon Taylor, contains original music by Marion Lozano, Pat McCusker, and Diane Wong, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.