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The pandemic agreement: Achieving an African win for health security inequity

The COVID-19 pandemic has exposed the frailty and disparities of global health systems, especially in Africa, highlighting the inadequacy of the response and the need for reform. Vaccine nationalism and lack of inclusivity characterized early responses, raising concerns about the effectiveness of global health security frameworks like the International Health Regulations (IHR). In response, the WHO formed an Intergovernmental Negotiating Body to draft a new Pandemic Agreement aimed at ensuring equity and addressing policy gaps. While progress has been made on governance, compliance, and R&D, consensus on critical issues like pathogen access, benefit sharing, and pandemic financing remains elusive.

Nicaise Ndembi, Nebiyu Dereje, Fifa A. Rahman, Benjamin Djoudalbaye, Aggrey Aluso, Nina Schwalbe, Tajudeen Raji, Mosoka P. Fallah, Sofonias K. Tessema, Mohamed Moussif, Sultani Matendechero, Olive Shisana, Alain N. Ngongo, Jean Kaseya

Beyond “business as usual”: Lessons from FIFA for fair benefit-sharing in global health

Researchers and agencies from low- and middle-income countries often contribute significantly to public health data but lack adequate compensation. Incentivizing data sharing is crucial for effective pandemic response, yet current legal frameworks have limitations. We explore adapting FIFA's benefit-sharing model, which rewards grassroots contributions and redistributes benefits, to global health. Despite challenges like integrating with existing frameworks and ensuring international buy-in, this model offers a promising approach to more equitable data sharing and benefit distribution.

Brian Wahl, Gabriel Butin, Spring Gombe, Nina Schwalbe

From lemming to leader: Moving beyond Gross Domestic Product (GDP) to bring health financing assistance into the 21st century

Nearly 90 years after GDP was introduced to measure economic growth, there are increasing calls to stop using it and GNI for broader purposes, such as determining eligibility for development assistance and access to medicines. These measures prioritize economic growth over population health, masking inequalities and excluding many in poor health. Alternatives like New Zealand's Living Standards Framework and the Multidimensional Poverty Index offer more nuanced assessments of well-being and poverty. Transitioning to these measures requires reliable data, standardization, and political will to shift away from the "growth at any cost" mindset and towards financing good health for all by 2030.

Tiffany Nassiri-Ansari, Nina Schwalbe, Susanna Lehtimaki

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 column 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

WHO Member States are negotiating a Pandemic Treaty. But will countries follow the new rules?

An independent monitoring mechanism is essential for the Pandemic Accord. Negotiators must remember to keep Member States accountable. It's feasible, viable, achievable and vital for preparing for the inevitable next pandemic.

Elliot Hannon, Nina Schwalbe, 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

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 

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

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

Brown University Pandemic Center - Panel

Spark Street Advisors' CEO Nina Schwalbe was a featured panelist as part of Brown University's Pandemic Center Pandemics & Society series, which focuses on current pandemic threats and response systems as well as how to build preparedness for the future. The webinar, hosted by Wilmot James, Professor of Practice and Senior Adviser to the Pandemic Center, convened an expert panel to assess the strengths and limitations of the current draft of the treaty and its prospects for adoption.


Brown University Pandemic Center Webinar, 
23 May 2024

BBC Newshour - Interview

Spark Street Advisors' CEO Nina Schwalbe was a featured guest on BBC Newshour with James Menendez on March 29, 2024, discussing what exactly is the Pandemic Accord, what the sticky points were during the ninth meeting of the Intergovernmental Negotiating Body (INB9), and why it matters that countries are going to extra rounds of negotiations before the 77th World Health Assembly in May 2024. 

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BBC Newshour interview,
29 March 2024

Briefing notes for negotiators for the resumed session of #INB9

We created briefing notes to help negotiators, stakeholders, and the media understand Pathogen Access and Benefit Sharing (PABS), treaty governance, and other key issues under negotiation at the resumed ninth meeting of the Intergovernmental Negotiating Body (INB9). 

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Line edits on the Pandemic Accord text

Briefing notes for negotiators in preparation for #INB9

We created briefing notes to help negotiators, stakeholders, and the media understand Pathogen Access and Benefit Sharing (PABS), treaty governance, and other key issues under negotiation at the ninth meeting of the Intergovernmental Negotiating Body (INB9). 

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WHO Pathogen Access and Benefit Sharing System (PABS)

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Treaty governance

Independent Monitoring for the Pandemic Accord - A Proposal For Action

Based on evidence from monitoring other treaties, expert interviews, and analysis of various forms of independence, we have developed a proposal outlining the “draft zero” Terms of Reference for a Pandemic Agreement Independent Monitoring Committee. This report builds on earlier research (see below). 

As summarized in the report and policy brief, the primary purpose of an Independent Committee would be to verify the timeliness, completeness, and accuracy of Member State reports. It would complement state self-reporting and peer review outlined in the current draft of the Pandemic Agreement. 


The negotiating text of the Pandemic Agreement, released on 16 October, puts forward the potential creation of an ‘Implementation and Compliance Committee’ as a subsidiary body to the Conference of the Parties, made up of experts nominated by states. We hope our analysis can inform the Committee's establishment and note that it must perform an independent monitoring function to be effective.

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Independent Monitoring for the Pandemic Agreement – A Proposal for Action Final Report

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Independent Monitoring for the Pandemic Agreement  – A Proposal for Action Policy Brief

Independent Monitoring Mechanism for the Pandemic Accord - Accountability for a Safer World

This November 2022 analysis by Spark Street Advisors features a proposal for independent monitoring of state compliance with an eventual pandemic accord. A short policy brief and key messages are also available to download and share.

A pandemic accord, being negotiated by a World Health Assembly Intergovernmental Negotiating Body (INB), is scheduled to be agreed in May 2024.  Our proposal is based on analysis of monitoring approaches to relevant international treaties, literature reviews, and in-depth interviews and inputs from 40 experts from around the world. 

The result of our research is recommendation for an independent monitoring committee which is fully autonomous, able to verify state reports through data triangulation. It reports to a body consisting of or directly accountable to heads of state and government. The committee would focus on elevating instances of non-compliance or inadequacy. Its reports would be available to the public.


To learn more about existing and newly-established mechanisms and initiatives related to pandemic preparedness and response (PPR), check out our rolling review, published in collaboration with the United Nations University International Institute for Global Health.

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Independent Monitoring for the Pandemic Agreement – A Proposal for Action Final Report

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Independent Monitoring for the Pandemic Agreement  – A Proposal for Action Policy Brief


Independent Monitoring Mechanism for the Pandemic Accord – Advocacy Brief

Briefing notes for the High-Level Meetings at the UN General Assembly

This April 2023 briefing notes aims to serve as resource for the High-Level Meetings (HLM) on Tuberculosis (TB), Universal Health Coverage (UCH) and Pandemic Prevention, Preparedness and Response (PPR). They lay out joint priorities areas and puts forward distinct “asks” for the HLM on PPR in September 2023 and is available to download and share.​


Tuberculosis Prevention and Care and Pandemic Prevention, Preparedness and Response - Briefing Paper

Universal Health Coverage and Pandemic Prevention, Preparedness and Response - Briefing Paper

Universal Health Coverage and Pandemic Prevention, Preparedness and Response - Briefing Paper

Independent Review and Investigation Mechanisms to Prevent Future Pandemics: A Proposed Way Forward

To inform the design of an accountability system for a pandemic treaty, we explored institutional mechanisms with a mandate to review state compliance with key international agreements and conduct independent country investigations in a manner that manages sovereign considerations.


The report summarizes the findings of our review of 19 international mechanisms. While we found no single global mechanism that could serve as a model in its own right, there is potential to combine aspects of existing mechanisms to support a strong, enforceable treaty. These aspects include i) Periodic review - based on the model of human rights treaties, with independent experts as the authorized monitoring body to ensure independence. ii) On-site investigations - based on the model by the Committee on Prevention of Torture according to which visits cannot be blocked by state parties. iii) Non-negotiable design principles - including accountability; independence; transparency and data sharing; speed; emphasis on capabilities; and incentives. iv) Technical support - WHO can provide countries with technical assistance, tools, monitoring, and assessment to enhance emergency preparedness and response.

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Independent Review and Investigation Mechanisms to Prevent Future Pandemics -
A Proposed Way Forward

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Independent Review and Investigation Mechanisms to Prevent Future Pandemics -
A Proposed Way Forward
(Policy Brief)

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