Global health leaders called for the Pandemic Agreement adopted at the 78th World Health Assembly to deliver where past efforts failed—equitable access to life-saving technologies and services during times of crisis. 

The call took place during an event organized by the UNAIDS’ convened Global Council on Inequality, AIDS and Pandemics featuring senior South African diplomat, Precious Matsoso, Co-Chair of the Intergovernmental Negotiating Body for the Pandemic Agreement, UNAIDS Executive Director Winnie Byanyima, former Health Minister of Brazil Nísia Trindade, and Spain’s Health Secretary Javier Padilla Bernáldez. 

The panel reflected on decades of experience from the global HIV response, how its lessons were not learned during the rollout of COVID-19 vaccines, and what needs to change before the next global pandemic crisis. 

“This agreement makes it clear that a principle of pandemic response will be sharing what has been paid for publicly. This is so important for us,” Ms Byanyima told participants. “Twelve million people in Africa died waiting for HIV antiretrovirals; they say that 1.3 million lives could have been saved during COVID-19 had the vaccines been shared equitably. This agreement has laid a foundation for building on that experience and ensuring that never again will millions around the world be dying when a life-saving technology is there.” 

Precious Matsoso, a former Director-General of South Africa’s National Department of Health, said that the Pandemic Agreement is “not the end in itself, but the beginning of a process” in addressing inequalities in pandemic preparedness and response, and that even while countries are ratifying the agreement, they can act on its principles and provisions. 

“You don't have to wait to ensure that there is personal protective equipment for your health workforce, you don't have to wait to start strengthening your health system,” she said. “If you want products to be approved, if you want research and development to happen, if you want diversified local protection ... you don't have to wait. You can start having those measures put in place in different countries.” 

Former Minister Trindade stated that, in September 2021, 76% of the world’s COVID-19 vaccine supply was concentrated in only 10% of the world’s countries. Brazil and the G20 have launched a Global Coalition on Local and Regional Production, Innovation and Equitable Access that aims to strengthen the capacities of countries to develop and manufacture health technologies for neglected disease, like Dengue, and diseases that impact vulnerable populations, like HIV. 

“As technology and the scientific basis of [disease control] have advanced, at the same time, inequalities [in access] have enlarged,” Trindade said. “Diseases that were not seen as neglected became neglected, because it's not a problem of the disease, it's a problem of power, economic interest and so on.” 

Ms Byanyima noted that innovative technologies for the AIDS response, such as long-acting injectable antiretroviral medicines for HIV prevention and treatment, have been slow to rollout, and global targets for pre-exposure prophylaxis, known as PrEP, will not be reached. 

A promising long-acting antiretroviral from Gilead Sciences, lenacapavir, requires only two injections per year to prevent HIV infection. Gilead has signed agreements with six companies to make and sell generic lenacapavir. UNAIDS has called for more manufacturers in the Global South, and especially sub-Saharan Africa, to be granted licences, and for the generic version to be sold in more countries in order to accelerate access. 

“There is this amazing technology that Gilead has invented,” Ms Byanyima said, “However, it's not yet available. And it could take years and years to become available. This is not a way to fight and win against a pandemic.” 

Secretary Padilla Bernáldez said that the technology transfer provisions in the Pandemic Agreement could help accelerate access. “The pandemic agreement is going to be the framework that we are going to use when talking about lenecapavir,” Mr Padilla said. “These words on technology transfer [in the Pandemic Agreement] are maybe not the ideal that we would have chosen, but for sure, they are going to make us able to go further.” 

Moderator Matthew Kavanagh, Director of Georgetown University’s Center for Global Health Policy & Politics, called on countries to make the most of the opportunities created by the historic agreement. “The Pandemic Agreement is not everything we would want, but it is the beginning of a powerful movement ... a sign that global health, despite reports of its death, is far from dead,” he said. “We can keep pushing towards something that is equitable, powerful, and improves people's health.”  

Watch the full event: