The University of Miami Public Health Policy Lab and the AHF Global Public Health Institute are expressing concern over the preliminary wording of the zero draft of the Political Declaration of the United Nations General Assembly High-level Meeting on Pandemic Prevention, Preparedness, and Response. The organizations are specifically troubled by the declaration's inadequate treatment of governance and accountability.

The failure to call for a High-level council of heads of state and an independent system of accountability represents a substantial missed opportunity to involve heads of state and government in the future global health security architecture that is primarily being negotiated at the level of the World Health Organization (WHO). The groups stress that these oversights must be rectified for the declaration to fulfill its potential effectively.

"We applaud the UN for elevating concerns about pandemic prevention, preparedness and response to the level of heads of state. However, the declaration fails to address the crucial need for independent and objective oversight and for a mechanism to enhance compliance. Without such accountability mechanisms a pandemic accord will fail to deliver on its promises," said José Szapocznik, Ph.D., professor at the University of Miami Department of Public Health Sciences.

There is concern regarding the role of the World Health Organization (WHO) as the central directing and coordinating authority. The groups argue that a whole-of-society and whole-of-government approach is necessary, which demands the involvement of heads of state, as pandemics are not solely an issue of health. Past health emergencies have seen the WHO struggle with prevention, preparedness, and response, partially due to its consensus-driven decision-making process, overreliance on donors, and inability to enforce member states' compliance with binding obligations under the International Health Regulations.

Jorge Saavedra, Director of the AHF Global Public Health Institute, emphasized that, "The WHO is critical, but its past failures in its ability to effectively incentivize compliance and disincentivize non-compliance with the International Health Regulations is cause for serious concern. This makes us question whether the Organization or an organ closely associated with it like the proposed Implementation and Compliance Committee of the Pandemic accord under negotiation can effectively hold Parties accountable for critical obligations.”

In response to these concerns, the groups support reshaping global governance and advocate for the creation of a high-level council independent of the WHO. This council could follow the model of the Global Health Threats Council, proposed by Helen Clark, Ellen Johnson Sirleaf, and the Independent Panel for Pandemic Prevention, Preparedness, and Response. Such a council would embrace a holistic approach to pandemic prevention, preparedness, and response by elevating political commitment, tracking progress, ensuring high-level advocacy, mobilizing funding, and strengthening accountability. The council would also comprise a rotating group of heads of state or government, and representatives from civil society, academia, and the private sector.

Chief concern regarding leadership and accountability is that the pandemic agreement drafts that have emerged from the WHO INB process so far have failed to adequately address these issues. And without leadership and accountability, the agreement could fail to achieve its main objective of preventing, preparing for, and if necessary, responding to pandemics. Previous work by leading experts in the field suggest that without accountability and enforcement, treaties such as this are unlikely to achieve their objective.

This calls for the UNGA to clearly demand real solutions to these issues, not just rubber stamp some of the same failed policies that got us here in the first place. If we don't address this, we risk falling into another cycle of panic and neglect.

About AIDS Healthcare Foundation (AHF)

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