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JOURNAL ARTICLES

Governance provisions in the WHO Pandemic Agreement draft

The WHO Pandemic Agreement draft lacks sufficient accountability measures. While it introduces a Conference of the Parties (COP) for governance, crucial details such as review scope and consequences for non-compliance remain unclear. Ambiguities persist, including provisions allowing parties to opt out of reporting obligations, and softened language regarding commitment. Without a clear accountability mechanism, relying solely on good faith, as evidenced by past treaties, may not ensure effective implementation, as seen in the COVID-19 response.

Nina Schwalbe, Elliot Hannon, Lynda Gilby, Susanna Lehtimaki

Shaping Global Health Law through United Nations Governance: The UN High-Level Meeting on Pandemic Prevention, Preparedness and Response

The UN General Assembly High-Level Meeting (HLM) on pandemic prevention, preparedness, and response (PPR) failed to garner significant high-level commitment and momentum for global health emergency governance. Despite its aim to highlight a pressing policy issue slipping down the international agenda, diplomatic tensions among member states, lack of consensus on crucial matters, and a weak UN Political Declaration in New York indicate challenges ahead for negotiations at the World Health Organization in Geneva. This article explores the UN's evolving role in global health governance, analyzes the diplomatic process leading to the UN HLM on pandemic PPR, and evaluates the contributions and shortcomings of its resulting Political Declaration.

Benjamin Mason Meier, Alexandra Finch, Nina Schwalbe

Getting in Formation: WHO Constitutional Heads of Power and the Pandemic Agreement

WHO Member States are nearing the end of negotiations for a proposed Pandemic Agreement, considering whether to adopt it under Article 19 or Article 21 of the WHO Constitution. Over the last two years of negotiations, the form of the treaty seemed settled on Article 19. However, the possibility of adopting the Pandemic Agreement under Article 21 has substantively re-emerged. While this may seem to many a simple question of an “opt in” or “opt out” approach, the legal and normative realities are somewhat more nuanced and require careful consideration by negotiators. Member States must carefully consider these factors, which will have critical implications for the future of global health and global health law-making.

Alexandra L Phelan, Nina Schwalbe

The new pandemic treaty: Are we in safer hands? Probably not

The latest draft of the pandemic treaty falls short of expectations with governance revisions that lack accountability measures, leaving oversight to Member States through a World Health Assembly (WHA) committee. The proposed Implementation and Compliance Committee, now subordinate to the WHA, lacks independence and access to crucial information, raising concerns about effective monitoring and enforcement. Without robust compliance mechanisms and independent oversight, the treaty risks being ineffective in addressing the multisectoral challenges of pandemic preparedness and response, highlighting the need for urgent revisions before final negotiations conclude.

Nina Schwalbe, Elliot Hannon, Susanna Lehtimaki

Where there is a will, there is a way: independent assessment of member state compliance with the pandemic agreement

On Oct 16, the world got its first glimpse of the complete draft negotiating text of the proposed pandemic agreement aimed at improving collective pandemic prevention, preparedness, and response. In our analysis of the pandemic preliminary draft, we found gaps in crucial areas such as health system resilience and equal access, while noticing the lack of an independent accountability mechanism. Understanding the limitations of relying solely on self-reporting and peer review from previous frameworks, we assert the necessity of establishing a dedicated, independently mandated monitoring committee to ensure compliance.

Susanna Lehtimaki, Elliot Hannon, Layth Hanbali, Daniela-Filipa Soltan, Kimberley Peek, Tiffany Nassiri-Ansari, Nina Schwalbe

Independent monitoring and the new pandemic agreement

Negotiations are ongoing at the WHO for a binding pandemic prevention agreement, but past agreements haven't guaranteed effective implementation. We found that while enforcement mechanisms are crucial, they're inconsistently applied and often rely on softer political approaches rather than strict legal measures. To address this, we propose an independent monitoring mechanism to assess and report on countries' adherence to the pandemic agreement, utilizing various data sources and reporting to a higher political body for enhanced compliance.

Layth Hanbali, Elliot Hannon, Susanna Lehtimaki, Christine McNab, Nina Schwalbe

Primary health care: a cornerstone of pandemic prevention, preparedness, response, and recovery

The COVID-19 crisis highlighted the devastating consequences of neglecting primary health care (PHC) before, during, and after a pandemic. This regression created a vicious cycle of vulnerability, especially for groups at high risk of disease. Therefore, PHC should not be an afterthought—it must be core to pandemic prevention, preparedness, response, and recovery (PPR).

Arush Lal and Nina Schwalbe 

We cannot give up on the global pandemic treaty

Nearly two years after countries agreed to develop a new pandemic treaty, the prospect of achieving a bold new global agreement to prepare and respond to future disease threats is slipping away. Perhaps the last chance is the UN General Assembly’s High-Level Meeting on Pandemics in September. The meeting is a major opportunity for political leaders to show the sustained commitment that will be necessary to prevent and respond to future pandemics.

Nina Schwalbe 

Bold moves for vaccine manufacturing equity

The COVID-19 pandemic resulted in an unprecedented global crisis, and although there was unprecedented
speed of development of new vaccines, the benefits from licensing effective vaccines in record time were
not felt by all. More equitable distribution of vaccines requires an ecosystem that supports sustainable manufacturing capabilities to produce them locally.

Nina Schwalbe and Ole Kristian Aars

Independent monitoring for the pandemic accord: a non-negotiable provision

The COVID-19 pandemic has exposed the need for a coordinated global response to pandemics. In response, the Intergovernmental Negotiating Body for a pandemic accord will discuss a zero draft in February 2023, with the aim of presenting an accord for implementation in 2024. We conducted a comprehensive literature review of 11 monitoring mechanisms and consulted with experts from around the world. Based on our research, we propose the establishment of an independent monitoring committee to assess state parties' compliance with and reporting of the pandemic accord.

Layth Hanbali, Susanna Lehtimaki, Elliot Hannon, Christine McNab, Nina Schwalbe

We need a pandemic treaty — but it must hold nations accountable

The cycle of state denial and downplaying followed by disastrous consequences is a familiar pattern in public health crises, as demonstrated during the COVID-19 pandemic. This behavior has far-reaching consequences that extend beyond individual states, impacting global health and security. To prevent similar outcomes in the future, it is crucial to establish a robust global pandemic treaty that emphasizes accountability and compliance to enhance preparedness and response efforts worldwide. An independent monitoring committee, separate from existing organizations like the WHO, could play a key role in ensuring that states adhere to treaty conditions and take proactive measures to address emerging health threats effectively.

Nina Schwalbe and Elliot Hannon

We need a new global compact on vaccines

Amid the emergence of monkeypox cases in the US and Europe, efforts are underway to vaccinate populations using the smallpox vaccine, which offers some cross-protection. However, this vaccine is in limited supply and primarily sought after by wealthy countries. The global vaccine production model favors affluent Western nations over Africa, where monkeypox has circulated for decades without adequate vaccine deployment. Proposals like a Trips waiver are seen as initial steps, highlighting the need for significant changes in vaccine manufacturing and distribution to ensure equitable global access.

Nina Schwalbe 

Strengthening Gavi is a way forward for global vaccine equity

The upcoming Biden administration COVID-19 summit will shine a spotlight on global vaccine equity failure, where only 16% of people in low-income countries are vaccinated, compared to 80% in high-income nations. To address this, lessons from successful initiatives like Gavi, the Vaccine Alliance, suggest strengthening Gavi's role by negotiating equity provisions in vaccine procurement contracts and investing in local vaccine manufacturing training. Efforts must also prioritize strengthening vaccine delivery systems, engaging communities, and reaching marginalized populations to achieve equitable global vaccination.

Nina Schwalbe

Why we still need a pandemic treaty

The 2022 World Health Assembly saw Member States discussing amendments to the International Health Regulations. Despite meeting in person for the first time since COVID-19, little progress was made on solutions for future pandemics due to procedural focus. In this article, we highlight the historical background and limitations of the IHR, exposed during the pandemic, as well as how data and evidence currently play too small a role in decision making. We propose committing to a pandemic treaty to be prepared for when the next pandemic hits.

Elliot Hannon, Layth Hanbali, Susanna Lehtimaki, Nina Schwalbe

Use of financial incentives to increase adult vaccination coverage: A narrative review of lessons learned from COVID-19 and other adult vaccination efforts

To encourage COVID-19 vaccination, governments have offered a wide range of incentives to their populations ranging from cash to cows. Often these programs were rolled out at scale before assessing potential effectiveness. To inform future policy, our narrative review sought to understand the evidence base informing these programs and the extent to which they are effective. While we found evidence on cash transfers increasing both the coverage and intention to be vaccinated, improvements in coverage were limited. Lottery or other non-cash incentives did not appear to have an impact on vaccination for COVID-19.

Nina Schwalbe, Layth Hanbali, Marta C Nunes, Susanna Lehtimaki

Increasing efficiency in vaccine production: A primer for change

The COVID-19 pandemic has highlighted the importance of vaccines as public health and pandemic preparedness tools and amplified the importance of issues ranging from equitable distribution to reliable supply of quality, affordable vaccines. These issues however are not new. Delays in time from the first dose in a high-income country to introduction at scale in a low-income country can take years. These delays are driven by several challenges, some of which are unique to the vaccine development ecosystem. The patenting and overall intellectual property (IP) protection are complex, regulatory oversight is rigorous, manufacturing processes require technical support or know-how transfer from the innovator, and market dynamics create obstacles to delivering at scale. This paper provides an overview of the vaccine research and development process and where reform of the current system could increase access.

Ole Kristian Aars, Michael Clark, Nina Schwalbe

Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview

Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care

Susanna Lehtimaki, Jana Martic, Brian Wahl, Katherine Foster, Nina Schwalbe

The World Should Treat Pandemics Like It Treats Chemical Weapons

While the world is still battling COVID-19, it’s time to start preparing for the next pandemic—above all, how to prevent it. We need to take pandemic containment as seriously as we take other dangers of mass destruction, such as nuclear proliferation and chemical weapons. Global treaties to prevent the spread of these weapons offer a toolbox that can be used or adapted to help prevent the spread of viruses as well.

Nina Schwalbe and Susanna Lehtimaki

Data Sharing and Global Public Health: Defining What We Mean by Data

As the volume of public health data expands and data are more interconnected, a broad range of data is being used to support research and inform global health policies and practice. We expand on an existing framework to provide a classification of data into four broad archetypes patient data, health systems data, routine public health data, and health research data. It should be noted that this categorization is used to describe how these data are generated and not necessarily their application or use. 

Nina Schwalbe, Brian Wahl, Jingyi Song, Susanna Lehtimaki

Artificial intelligence (AI) and the future of global health

Although AI-driven health interventions can help to address several existing and emerging health challenges, many issues are not sufficiently described in these studies and warrant further exploration. These issues relate to the development of AI-driven health interventions; how efficacy and effectiveness are assessed and reported; planning for deployment at scale; and the ethical, regulatory, and economic standards and guidelines that will help to protect the interests of communities in low and middle income countries.

Nina Schwalbe and Brian Wahl

Accelerating access to medicines in a changing world

Many access tools were designed and implemented by donors, with relatively little engagement from patients or interaction with the systems into which the product is or will be introduced.

Hannah Ketler, Susanna Lehtimaki, Nina Schwalbe

COVID-19: Rethinking risk

Although older age and underlying conditions are visible markers of increased risk, people subject to structural inequities are more likely to develop underlying conditions and receive poor quality health care for management of those conditions and of COVID-19.

Nina Schwalbe, Susanna Lehtimaki, Juan Pablo Gutiérrez

Why are we closing schools?

Keeping kids out of the classroom will make recovering from the pandemic harder in the long term, while not keeping us any safer in the near term. Reopening schools doesn’t appear to meaningfully increase the level of risk faced by teachers or students, but closing them causes well-documented damage to students. Evidence from around the world—and even from New York City—shows not only that many schools should remain open, but that officials should take more steps to open up classrooms.

Nina Schwalbe

Apples and oranges? Can second-generation vaccines become as low cost as generic medicines?

A step change in cost will require fundamental shifts in vaccine technologies and how they are developed, regulated and even manufactured. 

Aurelia Nguyen and Nina Schwalbe

Expanding the use of community health workers in urban settings

As global and national policymakers deliberate approaches to achieving the SDGs, including for universal health coverage, the delivery of community-based interventions involving CHWs in urban settings should be strongly considered. 

Brian Wahl, Susanna Lehtimaki, Stefan Germann, Nina Schwalbe

Global Public Goods for Health​ (GPGs)

n a new policy paper, we’ve examined the potential support for GPGs from four organizations that provide the most development assistance for health: Gavi, the Global Fund, World Bank, and World Health Organization. 

Gavin Yamey, Jessica Kraus, Sara Fewer, Nina Schwalbe

Artificial intelligence (AI) and global health

As resource-poor settings become more connected and the data they produce of higher quality, the ability of AI to address health challenges will likely expand.

Brian Wahl, Aline Cossy-Gantner, Stefan Germann, Nina Schwalbe

Time's up for journal gender bias

From January, 2013, through February, 2018, The Lancet published the reports of 39 Commissions….only 34% of all named commissioners have been women. 

Nina Schwalbe and Jennifer Fearon 

Maternal and child health and non-communicable diseases

Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs. 

Luisa Brumana, Alvaro Arroyo, Nina Schwalbe, Susanna Lehtimaki, David Hipgrave

Generation Men 

The Fearless Girl statue that faces down Wall Street's charging bull grabbed international headlines and triggered a debate about the glass ceiling that continues to obstruct women. 

Nina Schwalbe  

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