Integrating Equity Considerations in an International Pandemic Instrument

BACKGROUND: The COVID-19 pandemic is widely regarded as a catastrophic failure of global governance with far-reaching consequences. Actions from wealthy countries severely limited access to essential medicines and supplies for the majority of the world's population. While the World Health Assembly has established an intergovernmental negotiating body (INB) to draft an instrument to strengthen pandemic prevention, preparedness and response, and equity considerations have been positioned as central to this process, there remains a danger that international power imbalances sabotage meaningful equity action. What priorities should an equity-centred pandemic instrument reflect? METHODS: Using a sequential deliberative dialogue (DD) methodology, international participants were purposefully selected for expertise, life experience, and spheres of influence. Two Fall 2022 dialogues were virtually convened to coincide with the study's official representation at the INB process and participants were engaged to respond specifically to the instrument's development. Dialogue findings were synthesized with a Systematic Equity Action-Analysis1 and participants were invited to review and respond. RESULTS: Alongside specific recommendations to prevent future inequitable pandemic responses, three overarching equity-centred approaches were identified as crucial: (1) consistently align stated intentions with operational proposals; (2) openly acknowledge causes and contexts of global inequity; and (3) create mechanisms for accountability and enforcement. CONCLUSIONS: Achieving equity in international instruments is possible, but vague language threatens this potential. Beyond aspirational rhetoric, deliberate and coherent equity-promoting mechanisms are needed throughout the pandemic instrument in order to avoid the next catastrophic failure of global governance. 1. Plamondon et al. Turning the tide on inequity through systematic equity action-analysis. BMC Public Health. 2023;23(1):890. KEY MESSAGES: • Despite a rhetoric of ‘virtuous’ equity statements by the world's power and resource-wealthy countries, global contexts of inequity will continue or worsen without mitigation. • Given future pandemics are likely, the cost of not mitigating inequities through this treaty poses risks to global public health.