pandemic

• GLOBAL HEALTH: ‘On World AIDS Day we remind people that the HIV pandemic is not over’

  CIVICUS speaks with Gastón Devisich, Head of Community Engagement of Fundación Huésped’s Research Department, about the role of civil society in the fight against HIV/AIDS, both at the community level and in global governance bodies.

  Fundación Huésped is an Argentinian civil society organisation (CSO) that has been working since 1989 on public health, including on the right to health and disease control. It is a member of the regional platformCoalición Plus and, represented by Gastón, one of the two Latin American and Caribbean organisations that are part of the NGO Delegation to the UNAIDS Programme Coordinating Board.

  What have been the results of the latest round of pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and what will be their implications?

  The primary goal of the Global Fund to Fight AIDS, Tuberculosis and Malaria is to make catalytic investments and leverage innovations to drive faster progress in reducing new infections, address structural barriers to improving outcomes for these pandemics and build equity, sustainability and lasting impact. Its new strategy places people and communities front and centre in all its work, challenging power dynamics to ensure that affected communities have a voice in the fight and opportunities for a healthy future.

  The Global Fund’s Seventh Replenishment has brought in a total of US$15.7 billion. It was the culmination of a successful campaign that began more than a year ago. It is a remarkable achievement, not only because several public and private donors increased their pledges, in many cases by more than 30 per cent, but also because a record number of implementing governments – at least 20 – have stepped up to become donors as well.

  This support will be dedicated to saving 20 million lives, averting 450 million new infections and generating new hope for ending AIDS, TB and malaria. This investment will also strengthen health and community systems to increase resilience to future crises.

  Given its central role in the fight against pandemics, the Global Fund also plans to continue contributing to the global pandemic preparedness agenda in coordination with the World Health Organization, the World Bank and other partners.

  What role does civil society have in the governance of UNAIDS?

  The Joint United Nations (UN) Programme on HIV/AIDS, known as UNAIDS, was the first UN programme to have formal civil society representation on its governing body. The participation of CSOs on the UNAIDS Programme Coordinating Board is critical to the effective inclusion of community voices in this key global policy forum in the area of HIV/AIDS.

  The NGO Delegation is composed of five CSOs, three from developing countries and two from developed countries or countries with economies in transition, plus five more acting as alternate members. Our purpose is to bring the perspectives and experience of people living with HIV/AIDS and those populations particularly affected by the pandemic, as well as civil society, to ensure that UNAIDS is guided by an equitable, rights-based, gender-sensitive approach to ensuring access to comprehensive HIV prevention, diagnosis, treatment, care and support for all people.

  The existence of a community delegation within the highest governance body of a programme such as UNAIDS is critical to ensure the meaningful involvement of populations most affected by HIV at all levels of policy and programme development, implementation, monitoring and evaluation. Strengthening meaningful community engagement fosters a relationship of greater trust and respect with those of us who are the direct beneficiaries of any programme or policy.

  The involvement of all stakeholders, provided it is transparent and based on mutual understanding, can minimise misunderstandings and reduce the likelihood of unnecessary conflict or controversy. This helps improve our access to rights and the provision of quality services necessary to ensure it, as well as addressing power inequalities between decision-makers and the community to establish more equitable and horizontal relationships.

  Why is it important to incorporate the voices of communities in decision-making spaces?

  There is an urgent need to develop additional strategies to address the HIV epidemic. A wide range of factors create, intensify and perpetuate the impact of the virus and its underlying determinants may be rooted in the cultural, legal, institutional and economic fabric of society.

  To achieve a comprehensive response to HIV, it is essential to recognise power imbalances and address them by developing practices that prevent their inadvertent replication or reinforcement throughout the implementation of programmes and policies.

  Local organisations have unique expertise to contribute to the HIV response. We have critical knowledge and understanding of local cultures, perspectives and language, the local dynamics of the HIV epidemic, the concerns of the most vulnerable or marginalised populations and local priorities that other stakeholders may not necessarily have. The community can help ensure that the goals and procedures of HIV response are appropriate and acceptable for them, in order to avoid reinforcing existing inequalities.

  What does Fundación Huésped’s work consist of, both at the national level and within this global space?

  Our comprehensive approach includes the development of research, practical solutions and communication related to public health policies in Argentina and Latin America. We seek to develop scientific studies and preventive actions and advocate for rights to guarantee access to health and reduce the impact of diseases, with a focus on HIV/AIDS, viral hepatitis, vaccine-preventable diseases and other communicable diseases, as well as sexual and reproductive health.

  As representatives of civil society in UNAIDS, we actively seek the views of our communities on key issues related to UNAIDS policies and programmes, and advocate with governments and cosponsoring organisations – 10 UN organisations that make up the UNAIDS Joint Programme – for significant improvements in the implementation and evaluation of HIV/AIDS policies and programmes.

  What challenges do organisations working on HIV/AIDS face and what support do they need to continue doing their work?

  The HIV agenda is still current, with new challenges and the persistence of stigma, discrimination and rights violations. Forty years after the first cases of HIV were reported in the world, and thanks to scientific advances, the implementation of policies, plans and programmes, civil society activism and human rights achievements, there are more and better strategies available to control the virus, which could end AIDS today. Yet this year there were 1.5 million new HIV cases and 680,000 new AIDS-related deaths worldwide – including 110,000 cases and 52,000 deaths in Latin America and the Caribbean.

  World AIDS Day, 1 December, is our annual opportunity to remind people that the HIV pandemic is not over. Over the past 40 years science has generated much innovation, but these benefits do not reach all people equally. The best science in the world cannot compete with the debilitating effects of poor health systems. To end AIDS we need to correct the course of the HIV response, starting with ending inequities. A better response is needed today. We cannot afford to waste any more time.

  ---

  Get in touch with Fundación Huésped through itswebsite orFacebook page, and follow@FundHuesped on Twitter.

• No response to crisis can be effective without the support of a strong, diverse & capable civil society

  Statement at the 50^th Session of the UN Human Rights Council

  Interactive Debate on High Commissioner's report on State response to pandemics

  Delivered by Nicola Paccamiccio

  Thank you, Mister President, and thank you High Commissioner for your report.

  With the worst of the pandemic over, States and citizens look to the future while analysing the actions taken in the past. With a clearer view, we see that many States acted with a heavy hand that adversely restricted civic space in the name of national health. We see that many States chose to use the pandemic as a veil with which to cover many ongoing and some new restrictions on civil society. And, while supporting our societies in coping with the impact of prolonged lockdowns, many States ignored the needs of the sector by not including civil society in recovery plans and stimulus packages.

  Conversely, we see that civil society was resilient in the face of crackdowns. Civil society continued to organise, mobilise and offer necessary services at a community level. We see that civil society played a crucial watchdog role and in many cases paid a heavy price.

  As we look to the future, to prevent devastating health and economic effects of another pandemic, we see that no response is good enough without the support of a strong, diverse, and capable civil society. It is for this reason that civil society should be meaningfully included in all post pandemic processes, having been closest to the ground, including the pandemic treaty negotiations. States should increase their funding and access to resources for civil society and protect and promote the enabling environment for civil society. By doing so, States would be ultimately securing mechanisms, enablers and spaces that they themselves need to work with and for the societies they serve. When civil society is relevant and resilient, societies can count on the arenas for participation, confrontation and solidarity needed to face the post-pandemic challenges ahead of us.

  We thank you.

• PANDEMIC TREATY: ‘States hold a shared responsibility to keep the world safe and must be held accountable’

  CIVICUS speaks with Dame Barbara M Stocking about the need to develop a new pandemic treaty anchored in solidarity, transparency, accountability and equity.

  Barbara Stocking is chair of the Panel for a Global Public Health Convention, former president of Murray Edwards College at the University of Cambridge, former chief executive of Oxfam Great Britain and former chair of the Ebola Interim Assessment Panel.

   

   

  What is the Panel for a Global Public Health Convention, and what prompted its launch in April 2021? 

  The University of Miami decided to survey experts across the world about the topic of pandemics. This happened before the COVID-19 pandemic erupted. We needed to know if we were prepared for a pandemic and what issues needed to be tackled. I was among the experts in 2015: I chaired the Committee on Ebola that assessed the performance of the World Health Organization (WHO). An article summarising the experts’ views was published in the peer-reviewed medical journal The Lancet a few months later.

  By then the COVID-19 pandemic was well underway, and University of Miami’s president, Julio Frank, proposed doing more than publishing a report. The Panel for a Global Public Health Convention was founded in 2020 to advocate for new ways of governing and undertaking outbreak control and response, and I was asked to chair it.

  The Panel is an independent, high-level advocacy coalition. It includes former presidents such as Laura Chinchilla from Costa Rica and John Mahama from Ghana, and former Secretary-General of the Organisation for Economic Co-operation and Development, Angel Gurría. These are all people who can have influence with the WHO, its member states and other bodies. We are not campaigning publicly because we do not have the resources or the people, but we operate at the highest political level.

  In December 2021 the World Health Assembly agreed to launch the process to develop a global treaty on pandemic prevention, preparedness and response. Our panel will keep watching as the idea unfolds to make sure it accomplishes the things we think are needed to stop outbreaks turning into pandemics.

  What shortfalls in the response to the COVID-19 pandemic made the need for a treaty apparent?

  The need for a convention became obvious to everybody as a result of COVID-19, but it is not just about COVID-19. For the last 20 years, every single report concluded that we were not ready to deal with a pandemic. COVID-19 just confirmed this in the most horrifying ways.

  Preparedness is key. Governments have tried to be prepared, but they were clearly not. Why is that? For some countries it was a matter of resources, and in those cases we must ensure they get the resources to have health surveillance systems in place. However, many countries with abundant resources and excellent health systems were not ready either. One of the reasons for this is that very few countries practice preparedness. When I was in the UK health service, each hospital would practice a major incident every three years. We need the same approach in public health preparedness. Practice is key and must include not just health systems but the whole government, because if anything that big happens, ministries and heads of state must also get involved.

  The public was not prepared either. We need to make sure we deliver the right messages and we engage communities, which we know are so important.

  When it became clear that there was a virus circulating, and it was not yet clear what it was, and the WHO made the call for a public health emergency of international concern, not much was done. February 2020 was a key moment for action, yet very little happened.

  It all boiled down to a fundamental lack of understanding about what being precautionary means in the case of a pandemic. With most things in life, you can ask yourself whether a situation is going to get worse and make a realistic assessment. But with a pandemic, especially at the beginning, you don’t know how the virus will replicate, and you must move fast. But with COVID-19, states did not. They also had objections to WHO guidelines because, they said, the WHO ‘had no authority’.

  The next fundamental problem is that although we have international health regulations, people tend to not comply, and there are no enforcement and accountability mechanisms. Clearly, there is also work to be done to update international health regulations, but the biggest issue is countries agreeing to be accountable to each other. The expression we use is ‘mutual assurance’: for a state to make difficult decisions, it needs to know other states will do the same. This should sell the idea of accountability.

  There is no point in having a pandemic treaty or convention unless people are willing to be accountable. But this is often ignored because it is difficult. States are sovereign over their territories and are responsible for the health of their people, but also hold a shared responsibility to keep the world safe. This is why we need a treaty or convention.

  How could the treaty help solve these problems? 

  The principles of equity, transparency and accountability must be built into this treaty. We need to think what needs sorting out or making right, because these are the things we will be held accountable for.

  For example, on the preparedness side, there has begun to be progress, but only through peer reviews of countries to determine whether they are ready. This system would have to be scaled up. Independent reviews would be a positive thing for the treaty or convention. We need somebody other than the WHO to conduct the assessments for preparedness and response, which can be done within a treaty structure. The WHO should set the standards and provide support in the role of ‘friend of the country’. We could set up a small body. As the WHO has pretty much all the data, there is no need to start from scratch. But it must be a body with the required experience and expertise. It may have to report up, through treaty structures, to heads of state, whom we hope would form the conferences of parties overseeing this treaty or convention.

  All these things can be built in. They will not take away WHO’s powers but rather add to them.

  How has civil society participated so far in the treaty process?

  Civil society is clearly asking for more say in health issues and in the development of the pandemic treaty, and I think this is truly necessary.

  At the WHO level, the civil society participating comes mostly from international bodies and local partners, which often have a health background – and I mean ‘health’ in the broader sense, including mental health.

  When hearings were held, civil society participated actively and the scope of participating civil society organisations (CSOs) broadened to include human rights CSOs, not only because of the freedoms affected by lockdowns but also because governments were using the pandemic as an excuse to violate human rights. As a result, more and more human rights CSOs wanted to have a say in the treaty.

  In terms of participation in the treaty process itself, the WHO has a category for civil society, as ‘official observers’. But civil society should have much more influence in the discussion. At the top level, the WHO is setting up two-day events to provide evidence to stakeholders beyond member states. They held a two-day event in April, in which the Panel participated and gave its view on the topic. Another event is coming up in June.

  One major problem I have seen is centralised pandemic management. We need to engage communities, and this includes civil society. When handling a pandemic, engagement of people and organisations at the local level must be built in. This can’t be done by central government alone; local authorities must play their role to engage with these groups. 

  Expanding the treaty’s governance to include civil society would be quite challenging because member states will own the treaty they will be signing up for, either by consensus or by government ratification. There has got to be more debate on how, even if there is a conference of parties, we can include civil society more and engage with it. 

  What are the main challenges you foresee for the near future, regarding the implementation of an eventual treaty?

  The first challenge is to produce a Global Public Health Convention with strong accountability. States must accept that they are to be held accountable towards each other and the world. And although it may be tough for states to accept the idea of being assessed by independent people, we need assessments to be conducted by an independent body. We can have states overseeing its work, but it needs to be able to work independently.

  The notion of ‘shared sovereignty’ is still hard for countries to accept fully. But we are a globe; we need people working together. We are all related to each other, so we need to have the willingness to cooperate and see how we can build together. People will worry about the loss of sovereignty, but we need to help them understand how critically important this is, in both a moral and a self-interested way. It is in each one’s own interest to have others behave well towards them. These are some of the blocks we need to get over to have a very good treaty.

  In sum, states have already agreed to produce some sort of treaty or convention and are already working on it. But the question is, is it going to be the right one? If everything goes well, we will have an agreement by 2024, and then there needs to be some time for countries to ratify it – or not.

  But we must not let the momentum pass because we really must be prepared. People keep asking if we might have another pandemic in the next 10 or 20 years. Well, frankly, we might have another one next year. There is a real urgency because habitats are changing; animals and humans are getting closer and closer together.

  I see everyone relaxing a bit since COVID-19 seems to be somewhat under control. But we must not go to sleep on this. It is almost certain that this will happen again in the future. The one thing we don’t know is how soon.

  Get in touch with the Panel for a Global Public Health Convention through its website.