By Anthony Oguguo, QEScholar and PhD Student, Faculty of Law, University of Ottawa, Canada
The inadequacies of the global health law framework during the pandemic necessitated the review of the International Health Regulations (IHR) and the drafting of a new pandemic treaty. The IHR 2024 (as amended) and the pandemic treaty aim to address fundamental questions of fairness, equity, and inclusivity before and during a pandemic. The deficiencies centered prominently on the unequal access to vaccines and other life saving health innovations to low and medium-income countries (LMICs) and the need for global solidarity among other issues. The inequities reflect the hierarchical global power structure where the donors of the pathogens necessary for the innovations are terms of access to the benefits from the product arising from R&D supported by the donated pathogens and their digital data sequencing information. In Article 12, the pandemic treaty provides for pathogen access and benefit sharing (PABS) during pandemics. However, its details are still subject to continued negotiation by the Intergovernmental Working Group (IGWG) charged with developed a PABS Annex to the pandemic treaty. The IGWG, has up to May 2026 to resolve issues arising from equitable PABS regime, espcially access to vaccines and medical countermeasures. Those issues continue to polarize the global North and South along entrenched positions.
While access to vaccines is fundamentally the crux of IGWG’s negotiations, the gender implications that have been neglected in the pandemic treaty framework ought to be brought to the fore as part of the discussion on a fair, equal, and inclusive PABS policy. The impacts of pandemics are not gender neutral as they exacerbate existing gender inequalities and social disparities. The situation is more dire in Africa, and indeed, many LMICs where women bear a disproportionate burden of disease as firstline of informal caregivers. Women constitute 70% of the social service and health workforce. They are more disposed to infections during pandemics despite their weaker political and decision making roles in most societies globally. Gender considerations are important in a global framework on access to life-saving vaccines in pandemic outbreaks. Though the IGWG has been gender sensitive in its leadership structure, it is important that gendered considerations be made an integral part of discussions on Article 12 PABS Annex policy document to ensure equity and fairness to all.
The challenges faced by African countries during the COVID-19 pandemic regarding access to vaccines inspired the creation of WHO-supported mRNA vaccine hubs in South Africa, Senegal, Nigeria, and three other nations. The goal for these hubs is to enhance self-reliance, increase vaccine access, and promote technology transfer. However, much of the discussions at the IGWG has centered on the disputes between the Global North and Global South over technical and legal issues related to PABS. Meanwhile, the topic of gender equity has been overlooked. The outcome of the IGWG negotiations will impact Africa, both as a donor of pathogens and a recipient of benefits from innovations derived from those pathogens. It will also directly affect the proposed WHO-supported mNRA vaccine hubs in Africa. As the IGWG continues negotiating an annex to the pandemic treaty under Article 12, how it manages the tensions within PABS will determine whether the treaty’s goals of solidarity, fairness, equity, and inclusivity are fully achieved. The outcome will also determine whether the treaty risks perpetuating historical inequalities, power hierarchies, and neglect of gender equity and women’s empowerment in pandemic preparedness.
Article 12 and the Politics of Pathogens.
Article 12 of the pandemic treaty provides for equitable benefits to countries that share pathogen samples and related sequencing data from the samples with the WHO in exchange for access to vaccines and other health countermeasures developed from such samples. The basic idea is that those who provide biological materials used for global R&D in public health must have equitable access to the resulting lifesaving technologies from such materials. The LMICs, including African states, have insisted that the voluntary or incentive-based models of PABS proved ineffective during the COVID-19 pandemic. Wealthy countries engaged in massive hoarding of vaccines and pandemic therapeutics despite much-talked-about global solidarity. LMICs have made the case at the IGWG for an equity-focused and binding mechanism under the WHO’s control. The high-income countries (HICs), in contrast, argue for a flexible, technical arrangement that protects intellectual property rights over health innovations. The interests of all stakeholders converge around the ideas of equity, fairness, justice, protection of intellectual property rights, global solidarity, and sovereignty. Overarching questions include who owns the pathogens, who decides how they are used, and who gets benefits from global biological innovations. LMICs emphasize that pathogens are shared resources whose benefits ought to return to source countries in the form of finished products, capacity building, and technology transfer. The approach constrast slightly with the concept of pathogens as part of global commons.
It is hoped that the pandemic treaty and the Annex under Article 12 will mark a corrective shift from the Western-biased global health order experienced during the COVID-19 pandemic. As a complement to that expectation, the WHO continues its efforts to establish vaccine hubs in South Africa, Kenya, Egypt, Nigeria, and Senegal, with South Africa serving as the primary hub to boost local production of mNRA vaccines and reduce the continent’s dependence on vaccine imports. The South African hub continues to point the direction with a sound combination of private sector involvement and government support. The Nigerian hub is supported by the Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC), which mobilizes support funding for the hub. The Nigerian hub signifies an ambitious health sovereignty program. It aspires to build indigenous capacity through the training of local scientists for manufacturing mNRA vaccines and other lines of vaccines. It is also focused on improving gender equity and women’s empowerment.
Gender Equity and Inclusivity in Pandemic Preparedness
From a critical lens, gender inclusivity, a key component of Sustainable Development Goals (SDG) 5, has been rarely mentioned in the PABS negotiation or the pandemic treaty. As pointed out earlier, women constitute the backbone of pandemic preparedness, both in terms of care and the majority of the social and health workforce. The involvement of women has great implications not only for PABS effectiveness but also impacts on the health workforce for the vaccine hubs. Health inequities (including inequities in PABS) are complex and require an essential understanding of the intricate interplay of power dynamics and interconnected structural determinants such as gender, race and class.The PABS Annex currently under negotiation, and the emergent vaccine hubs may also be sensitive to gender for greater effectiveness and attainment of fairness, equity, solidarity and inclusiveness. Should that not be the case, they risk replicating existnting status quo around gender imbalance while entrenching gender inequality.
SDG 5 commits countries to ensuring the involvement and participation of women in all levels of decision-making. While the leadership of the IGWG reflects a level of gender inclusivity, all the legal frameworks for pandemic preparedness –the International Health Regulations (IHR) and the pandemic treaty remain largely silent on gendered considerations in the general health policy document. The inclusion of gender-responsive regimen in the PABS framework and vaccine hub structure would, in addition to fulfilling SDG 5 goals also stregthen health outcomes. Such integration also aligns with the Feminist Global Health Framework (FGHF) that examines power imbalances and disparities in global health policy and systems, emphasizing equity, intersectionality, and reproductive justice to reduce discrimination and build a more inclusive, responsive, and resilient health system.
Building a resilient global health regime requires that gender equity must be made an integral part of the order, woven into PABS agreement, technology transfer and structure of vaccine hubs and laboratory established to enhance global health equity. Attaining health sovereignty without gender equity will be hollow. Pandemic preparedness response must reflect new realities and do away with a fraught global health that has continued to fail the most vulnerable peoples of the global south, espcially in Africa, as well as women all over the world.
