THE GENEVA HEALTH FILES INTERVIEW"It can’t be that a WHO Accord is silent on equity":
INB Co-Chairs Matsoso & Driece
By Priti Patnaik & Nishant Sirohi
July 2023
We sat down for a tête-à-tête with INB Co-Chairs Roland Driece andPrecious Matsoso on the sidelines of the sixth INB meeting underway in
Geneva this week. On July 18, the second day of the meeting, Geneva Health
Files spoke with the Co-Chairs on their views on the discussions and thechallenges in the process. This verbatim interview has been lightly edited to
improve readability.

INB Co-Chairs Roland Driece & Precious Matsoso at INB6 WHO, Geneva.
July 2023 (Image Credit: Priti Patnaik)
Geneva Health Files [GHF] Q1. How are you? How are the discussions going
this week?

Precious Matsoso [PM]: We are good. Actually, today is quite nice.
Roland Driece [RD]: It’s not easy, but that we know.

PM: Well, yesterday was quite a tough in that when you start with thesemeetings, it is actually interesting to see how countries to get [talking to]each other, who's going to be the first to raise the nameplate. I am amazedthat Bangladesh now does that. They were the first to raise the nameplate
which is good because it breaks the ice and while others take quite a while
because they want to listen to what their colleagues are going to say, so thatthey can react.
But I am always respectful of how countries want to participate. You don't
want to put pressure on them. Let them speak when they are ready and letthem speak to make a meaningful contribution.
[GHF] So do you think that the body language is improving? Is there greater
trust?

RD: Well, yes, I think the trust is growing but that doesn't mean that we are
there yet. I think one of the reasons that some of the countries are waiting forothers to speak is because so many articles are interrelated. They like to hear
what they had to say about it, to see how they can react on it. We had
discussions on Differentiated Responsibilities (CBDR) and turns out thateverybody feels that there are differences between countries. And if there aredifferences between capabilities of countries, to live up to any of theobligations that you might put on them. So, there's no discussion on that. But
the question is, what you do with that? If you recognize that is the fact, whatkind of consequences do you attach to that? You say, okay, it's fine that you
do not do anything, or do you say now, you have to try to do everything you
can, but we will help you with it. And that's what we try to steer. Of course,
but then the proposal here is - if we are going to do that - we need money.
Well, that's the next chapter: finance. That's the one we are dealing with now.
So, everything is so interrelated that the countries are sometimes a little bit
leaning backwards to see how the discussions evolve.
PM: The question of finance is that it works. It is finance for
implementation, finance for capacity building. Even capacity for R&D,
capacity for health systems, and capacity to build prevention andpreparedness. Because as you recall during COVID-19, preparedness wasgrossly underfunded. So, this time around, whatever financing mechanisms

[we agree to], if there's no investment in prevention and preparedness, later itwill be déjà vu. We will see once more that we failed. So, there are also theseother areas where there are capacity questions.
RD: It's also about recovery and recovery is even more complicated. Nobody
is saying that recovery is unimportant. Many countries suffered during the
COVID-19 pandemic. African countries also talk about debt relief, forexample. I fully understand that from their perspective, but then you havedifferent discussions, taking place on the same article which makes things….
when European countries, Australia or Canada, they talk about financing, theimplementation of pandemic policies. When we talk about recovery, thenNigeria and other countries [for example] would say it is about healthsystems.
PM: On one hand, the instrument makes reference to domestic financing
which is important because every country must take responsibility for its
citizens. However, if you look at the pandemic fund, it is a select group ofcountries. And they are asking, what is their role… Because they think that
this is intrusive, it mustn't be this kind of dependency culture. We are
creating financing determinant, how the funds should be allocated. They
think the governance should be described. And the spirit of inclusivity must
be not in word only as a principle, but it must be reflected in the instrument.
RM: But what you ideally would want in the end, everybody says okay, theset of requirements, obligations whatever we will determine in the
instrument. They all want to live up to that as good as we can and where we
can't make it, not because we are unwilling, but because we just simply do
not have the means or the capacities to do that. Then there is financial
resources and technology. There is knowledge, predictable knowledge andpredictable findings, like you say technology transfer to help them to get
where they need to go. That's what in the ideal world will be the outcome of
this.
[GHF] Q2. There is a perception that the negotiations on the amendments to
the IHR are technical in nature and that the INB is the more political process– the Pandemic Accord is the political instrument. Is that in some sense
unfair? You not only have to start working on a new instrument from ascratch unlike the amendments to the IHR, but you also have to meet thepolitical aspirations of such diverse, group of countries. It is a tall task, isn’t
it? Is this expectation justified? Ultimately, you are also addressing similar
kind of issues as those being discussed in the IHR forum.

PM: So, you are right, actually. If you look at the creation of this whole
Pandemic Accord process, the decision that was taken it was pre-empted by
the head of the States. So, it assumes that political nature. There were 26
heads of States [pushing for] a Pandemic Accord. They are not technicians;
they would have recognized that you already have IHR. But because they arepoliticians, they would view this much more broadly. It wasn't just about
laws, it is about life, it is about their economies. They have recognized thatyou needed something at a much higher level. From that perspective, I think
there is still that expectation we need to come up with something that is muchbroader - of which the IHR should fit into and in a seamless way so that itshould not be viewed as one competing with the other, it must be seen as acontinuum.

Image credit: Photo by Pixabay, Pexels[GHF] Q3. What would be success for the INB? Success in terms of, youknow, meeting key political goals. I am not asking about “low-hanging fruits”
because that varies according to different countries. What will success look
like, let’s say 12 months or 24 months from now?

RD: I think we as a Bureau we have never determined success. So, we all
might give a different answer in that respect. So, there is not one answer
possible and that's also because from the start of the process, we neverdetermined what the outcome should be. If you take one step back, you say
well why are we doing this? Because as a world, we did not collaborate goodenough when pandemic broke out, in order to avoid people from dying, tohave people with access to countermeasures, everything that happens could
have been better if we had collaborated better from the start. But having said
that how to get there was a white paper. And it was us all sitting together, andsaying okay what should we then do to improve the situation. That is why it'sdifficult to say what success is personally and you might say somethingelse… [pointing to PM]
That's what you see also, reflected in the room as well. And we have got the
EU or the US might have a different view of success, than say maybe theAfrican Union. But I would think personally, and that's always difficult
because then people might think, oh, that's where he wants to go and it's notme that wants to go somewhere. It should be INB that wants to go
somewhere. I think success is, if we could say in 24 months, we haveestablished arrangements that make sure that people in countries are able toimprove the pandemic preparedness systems, because they are helped
financially in technology and other means…that we have arrangements formore equitable access to life-saving countermeasures. What we saw was, ofcourse, that a lot of things were donated or given, but always later than theWestern countries had for themselves. So, if we have some kind of anarrangement that is made fairer, that a certain percentage could be madeavailable at the most critical time for countries that were left out this time.
That would be good. And I think it's also important that countries are willingto invest in detection capacity of diseases and sharing of pathogenic
information that is relevant to everybody in the world. I think, for me, thosewill be key factors.
PM: Well, on my part, I mean, you know, it's been equity, equity, equity,
equity, equity. Success will be measured by how we have operationalized
equity and how we've come up with obligatory provisions. That equity is notjust a cliché, but that there are clear provisions that can enable equitableaccess. I mean, we've always spoken about equitable access but we have notsaid what implementation will look like. So, if this instrument can help us
achieve that, I think it would be a major achievement.
We traveled this road before. And, obviously, something must give, and I canretrace from HIV/AIDS days. It's been the same debate about equitable
access, it happened during COVID-19 and seen with M-Pox. M-Pox
happened after COVID-19 and one would have thought that, people would
have recognized and thought that equity is a problem. Let's just fix it. So, itmeans we need something more obligatory that will make Member Statescommit.
[GHF] I think there is a growing sense that in the event that the IHR is not
expanded to include obligations of equity then there will be a lot of
expectations and pressure on the INB process to deliver on those goals.

RD: I think we have to deliver on equity. That was one of the reasons why
we started and but the reason why my approach is a bit broader thanPrecious’ approach… I feel that in order for letting whatever country western countries or richer countries - whatever label you want to give them,to deliver on that equity, it should be clear that there is something in thegame for them as well. And that is the willingness of other countries to invest
in preparedness…that is the detection capacity and sharing of pathogenic
information without hindrances and it should be flowing cycle, so to say inthe end.
PM: I guess, this issue of sharing, there's also this notion that the emphasis isput more on sharing than, without understanding what the benefits are. And if
you look at the existing instruments, for example the PIP framework alreadyhas a provision that brings a balanced approach. But we also have Nagoya
protocol in CBD and it's where you have enlisted benefits. And some have
said, there must be a delinkage. You probably understand that it's almost likedéjà vu. We always say delinkage [in the context of delinking prices of drugs
to investments in R&D]…here it's not the delinkage, it's linkage! So, it'salmost like, it is the opposite of the previous debates about delinkage. Delink
the price from R&D cost, now this time, I say link CBD sharing of pathogens
with benefits.

Frankly, Members States should just define what benefits are. In some
instruments, they refer to mandatory and non-mandatory. Other say, havethem as separate provisions - meaning don't have an article that brings them
together, have an article that talks about sharing and an article that talks
about benefits. Others are saying, just collapse them in, have them as one.
For me, just even having those provisions as how you organize them in the
structure, it's one step further. And if you have the instrument, that does noteven make any reference to benefits, I think it would be, it will be difficult tosell. But if you have an instrument that already has both and how you link,
the two is probably the next step, and it's a matter of negotiations.
RD: It’s interesting to see how you want to have the instrument or do you
consider an article on access and benefit sharing within the instrument or do
you consider the whole instrument as an access and benefit sharing system?
That's the bit of the discussion we are having and both are possible goals but
I can even imagine that you say it should be both in there and it doesn't
matter so much where it is, as long as it is there in obligatory form.
PM: That one thing that is coming out clearly, I mean, repeatedly in different
provisions it is about governance. If you look at the issues that emerged
during COVID-19, it is about coordination at national level coordination
globally, and governance mechanisms that exist. And we are discussing
financing, and some of the countries that want to understand governance. We
are discussing other provisions and they want to understand governance. So
somewhere, we will have to discuss governance and come up with very clear
arrangements, institutional arrangements on how this Accord is going to be
governed. But this is also in relation to IHR - because if you look at thearchitecture on governance it is still not so aligned with what is envisaged
with the Accord. And what is missing with the WHO architecture is that it issilent on equity, and this is what countries have expressed as a concern. It
can’t be that a WHO [Accord] is silent on equity. There were someshortcomings, with whatever structures have been put in place - look at the
ACT Accelerator….the involvement of civil society and different countries
and, and how represented they were. This is also about governance…
[GHF] Q4. Following up on ABS …would you agree that it is potentially oneof the most important elements of the Accord. And do you think it is reallyrealistically possible to come up with a set of governance mechanisms for the
ABS or even sort of detailed provisions for the ABS, such as including it as anannex to the main instrument in time or before you conclude thesenegotiations?

PM: Well, I'm actually optimistic. I know that Roland and me have a
different view. I'm optimistic. I'll tell you why I am. It is because thecountries that stand to lose, really want to see something provided but thatcan work. It is not enough to just come up with provisions that are written insuch a way that you actually delay implementation. For instance, you comeup with a framework of some sort, but you leave it for later…We have an
instrument but only to defer the crucial elements. So, some of the countries
are saying in the event that we can't agree…we must still make sure whatever
we conclude now captures the essence of what is needed for ABS to work.
RD: I think that's well…I think this counts for you as well, my aim, our aim
is to deliver in May next year. And that's the aim and maybe it will not be an
instrument that is 100% completely ready and some maybe which there are
elements that will be later added. I hope it is ready, but maybe we're not, butthat can only fly I think if we have a core on which we agree by May nextyear.
PM: It needs to have essential elements.
RD: That's it. And so, that means in my view and that's not necessarily theview of the INB, but that there is some obligatory language on equity,especially access to medical countermeasures, that there is some agreement
on financing of it and have helped by implementing the provisions of the
instruments. That there is some kind of an arrangement, on the sharing of
information and I think of those elements could be addressed in a way that
there is that it's balanced, that could create trust among the parties that theysay, okay, if we can arrange this now, but then we have to trust that later on
we will also deliver on the other aspects. But if there's nothing, if it's anempty shell why would I have trust that we will deliver later on?
PM: But there's also this debate about WHO’s role, the centrality of theWHO. I mean it differs from one group of countries to the other and I cantalk about developing countries. I mean all of them have relied on WHO foryears for support. So, it is the lens that is used. It's always about whether
countries have benefited from WHO support or not. In most instancesdeveloped countries, I mean some of them don't even have WHO country
offices so they don't even know what the WHO country office role is. So, forthose who have benefited understand it better, having said that there areothers who are of the view that perhaps you need something that is moreurgent. So, the bureaucratic process that requires the World Health Assembly
to approve…what is it that would be that would make sure that things canmove faster. We need something that is supportive of decision-making andthis governance arrangements. But make sure that it doesn't undermine thesupport that has always existed for WHO but of course with the recognition
that there are other multilateral agencies that have always played the role you
know, UNICEF, WFP and so on. So, those are important. But perhaps look at
how this can work together and what kind of coordination is needed, because
you also don't want in a country, a competition between these agencies
because it is also what we have witnessed.
[GHF] Q5. Do you expect that before the end of the year countries could
demand for additional time to conclude the negotiations? Earlier in the week
you kind of indicated that quality is also important and that you would notwant to compromise on it.

PM: Actually, what we have had all of them say is that we are all committed
to meeting 2024. I haven't had since yesterday up to today, I haven't had asingle country saying, I think we are going to be delayed. All of themdeveloped and developing, saying May 24 should happen. We're allcommitted. So, I don't know whether that will change, but for what we've
had, they're all saying May ‘24.
RD: I think the reason why they say that is one hand because we havededicated ourselves to that goal. But also, because people see that thepolitical attention in general is required for so many different topics aroundthe world that if you delay this much further into time, you might not havethe urgency we have now.
PM: And that the risks are also complacency over time and amnesia.

PM: Quality and kind of content, of course, we don't want an instrument thatis empty. I know that informals may not be perfect and we are hoping thatcountries will make the best use of these informals and we are hoping thatthey will also agree that you can bring in experts to improve content.
[GHF] In the informals?

RD: Yes, in the informals, because some have asked for that, but they must
agree that they can bring experts. They have only referred to WHO experts,
but there are other experts beyond WHO you can bring value into their
discussions and help guide content.
RD: And at the same time, we hear, of course, when smaller countries say,yeah, it's pressuring us. Yeah, that's difficult. So, we need the right balance
between the two. I think if it's up to the Chairs we will drive this as far as wecan, as best as we can.
PM: But would like you to watch this space in September.
[GHF] So, is that when the first draft is coming?

PM: We are not going to use the word first draft. You know what the risk
is…I want to see first, they will expect second and third and fourth and fifth.
So, we don't say first…
[GHF] So, let's say, the next draft.

PM: Will tell you what is called in September. We are still consulting.
RD: It will be a moment that we will produce something.
[GHF] Q6 What is your message for member states?

PM: Well, they have a window of opportunity actually between now andbeginning of next year to move. I think it's easy to say to move with speed
but ensure that as they do that, they don't undermine the process of engaging.
Because what I've seen, even with the informals, they actually meetinformally but they met a bit too formal. And informals must be informal.

They have become it's almost like an extension of the INB. And we would
like that to be more informal.
RD: I have said to have talked to many Member States as well. It's fine tokeep some of your cards to your chest, but at least have some cards.
PM: Have the courage to open up.
RD: Know what is really important for you and understand what is important
for the other ones. Because if you only keep up that big picture, what you
want, that's difficult to reach an agreement.
PM: …Keeping it to the end. I mean who would want to incorporate newthings when they are ready to negotiate. So, I think at some stage they needto start negotiating…Some of them have said treaty-making ten years.
[GHF] I think there's also disagreement on what to negotiate on, right?
There's no agreement that can we actually get. Is the Bureau's text
negotiating text?

PM: No, it's not. It was never intended for that because we told them thatyou have a compilation text with 208 pages. We can put it on the board. You
can start negotiations. You can't. I mean that text that has so many
paragraphs that are facing in different directions. Where do you start? You
have got 10 different ideas in one paragraph. So, what do you negotiate outof the 10? So, if you collapse the 10 you come up with two. They need to say
okay if we like one not the other then it's okay if you like one can, we use it
then for negotiations. If you say you don't like both then we say draft andalternative so that we get them something that can be the basis fornegotiation. Otherwise, you can use compilation, it's everybody's ideas.
[GHF] So now they can add text.

RD: We are not having discussions on text and we do that deliberately
because this is not a negotiation text.
PM: But in the informal you say they can come up with a proposal that they
all agree on because we want to use the proposal when we draft the next
version.

RD: We are not in a phase where we say, we want to redraft a sentence…
that is not the stage we are in. We want to get agreement on the elements.
That's the phase, we're in.
PM: And the idea is that if you look at what we've presented, some of them
have come up with, very good ideas. They have said, oh, you know, in thisarticle, there are missing elements. So, let them incorporate those missing
elements when they give us their proposal. But we want to empower the cofacilitators to start doing something. And if some are saying, you know, inthe compilation, we had better language, the co-facilitators must haveflexibility to start using that and come up with a proposal. We would like to
see them present something to us, so that we can use as the Bureau.
[GHF] Merci beaucoup for your time Co-Chairs. I really appreciate this.

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