Draft of WHO Pandemic Agreement plays down primary prevention
Authors: Robyn Alders, John H Amuasi, Sania Ashraf, Daniel Becker, Salome A Bukachi, Sakib Burza, Sarah Cleveland, Omnia El Omrani, Ngozi A Erondu, Juliana Machado Ferreira, Latiffah Hassan, Binbin Li, James Lloyd-Smith, Ted Loch-Temzelides, Wanda Markotter, Osondu Ogbuoji, Malik Peiris, Dirk Pfeiffer, Raina K Plowright, Alexander Popp, Nicole Redvers, Benjamin Roche, John E Scanlon, Nigel Sizer, Mariana Vale, Neil M Vora, Chris Walzer, Sejal Worah, Thomas C Mettenleiter, Andrea S Winkler
Journal: The Lancet (2024)

As scientists who are deeply engaged in reducing the risk of another pandemic, we are concerned that primary pandemic prevention—actions taken to reduce the risk of an outbreak occurring at all—gets inadequate attention in the draft text of the WHO Pandemic Agreement, released on Oct 16, 2023.1WHOProposal for the negotiating text of the WHO Pandemic Agreement.https://apps.who.int/gb/inb/pdf_files/inb7/A_INB7_3-en.pdfDate: Oct 30, 2023Date accessed: November 22, 2023Google Scholar Primary pandemic prevention (or similar concepts such as deep prevention, upstream prevention, or primordial prevention) is not once mentioned in the text. Where the term prevention is used, it often refers to post-spillover secondary pandemic prevention, which focuses on actions taken after a pathogen has spilled over from animals to humans, which is often referred to as preparedness and response. Only four sentences in the 30-page document mention the spillover of pathogens between animals and humans, the origin of most—if not all—recent viral pandemics. We define spillover as the transmission of an infectious agent from one vertebrate species to another where it is not expected to be typically present. The draft text includes language to promote a holistic One Health approach,2Amuasi JH Lucas T Horton R Winkler AS Reconnecting for our future: The Lancet One Health Commission.Lancet. 2020; 395: 1469-1471Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar which should be expanded to highlight the importance of primary prevention as emphasised by the Quadripartite's One Health High-Level Expert Panel.3Adisasmito WB Almuhairi S Behravesh CB et al.One Health: a new definition for a sustainable and healthy future.PLoS Pathog. 2022; 18e1010537 PubMed Google Scholar One Health recognises the inextricable interconnections between human, animal, and ecological health, and the need to address the drivers of pathogen spillover.4Markotter W Mettenleiter TC Adisasmito WB et al.Prevention of zoonotic spillover: from relying on response to reducing the risk at source.PLoS Pathog. 2023; 19e1011504 PubMed Google Scholar Factors thought to increase spillover risk include livestock management practices associated with particular production systems; certain illegal, regulated, and unregulated wild animal trade; wild animal consumption in urban and non-urban settings (while stressing the importance of respecting traditional and Indigenous Peoples' traditions and rights); climate change; and loss of natural ecosystems and biodiversity (mainly deforestation).5Bernstein AS Ando AW Loch-Temzelides T et al.The costs and benefits of primary prevention of zoonotic pandemics.Sci Adv. 2022; 8eabl4183 Crossref Scopus (89) Google Scholar, 6Vora NM Hassan L Plowright RK et al.The Lancet-PPATS Commission on Prevention of Viral Spillover: reducing the risk of pandemics through primary prevention.Lancet. 2023; (published online Oct 11.)https://doi.org/10.1016/S0140-6736(23)01064-4Summary Full Text Full Text PDF Scopus (1) Google Scholar Effective implementation of a One Health approach requires adequate resourcing, particularly from high-income countries. Compared with the cost of containment and response following an outbreak, the relatively small annual investments needed for spillover prevention could reduce loss of life and economic disruptions caused by a potential future pandemic.5Bernstein AS Ando AW Loch-Temzelides T et al.The costs and benefits of primary prevention of zoonotic pandemics.Sci Adv. 2022; 8eabl4183 Crossref Scopus (89) Google Scholar Such actions include financing workforce and preventive action capacity for domestic animal and wildlife health, community engagement, monitoring, environmental protection, and enhanced research and innovation on primary prevention that target the core drivers of these emergencies. A central stated objective of the proposed Pandemic Agreement is health equity.1WHOProposal for the negotiating text of the WHO Pandemic Agreement.https://apps.who.int/gb/inb/pdf_files/inb7/A_INB7_3-en.pdfDate: Oct 30, 2023Date accessed: November 22, 2023Google Scholar Spillover prevention protects everyone, everywhere, and might thus have especially strong benefits for communities at high risk of adverse outcomes from pandemics. Unfortunately, this is not sufficiently acknowledged in the draft agreement. In addition, the relatively low level of engagement by and with many low-income and middle-income countries compared with high-income countries in the WHO Pandemic Agreement draft negotiations raises concerns regarding the potential for perpetuating existing inequities, both through the process and in the outcomes of the negotiations. We call on member states, especially the Group of Twenty countries, to overcome their differences and take concrete steps to ensure successful outcomes in the negotiations by rebuilding the trust lost during the COVID-19 response. This process can start with more meaningful funding mechanisms to support the agreement's implementation. The language on finance in the draft is caveated, with no binding commitment of new resources. The dangers of future pandemics, conceivably more harmful than COVID-19, are real and imminent. For example, highly pathogenic avian influenza H5N1 virus, which has devastated poultry industries and global wild bird populations and currently threatens numerous mammalian species, could accrue traits enabling sustained spread in humans, with high levels of mortality and social and economic disruption.7Kuiken T Fouchier RAM Koopmans MPG Being ready for the next influenza pandemic?.Lancet Infect Dis. 2023; 23: 398-399Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar The measures needed to reduce these threats also come with important co-benefits such as helping to address climate change, biodiversity loss, equity, and animal welfare. TCM is co-chair of the One Health High-Level Expert Panel and chair of the advisory board to the Federal Ministry of Economic Cooperation and Development, Germany. ASW is co-chair of the Lancet One Health Commission and reports support from the German Federal Ministry of Education and Research. Members of the Lancet-PPATS Commission on Prevention of Viral Spillover and their affiliations are listed in the appendix (pp 1–2). Download .pdf (.16 MB) Help with pdf files Supplementary appendix