Putting equity - especially gender equity - at the heart of a Pandemic Treaty

Roopa Dhatt, Ann Keeling, & Becca Reisdorf

The COVID-19 pandemic has claimed the lives of over 5 million people globally and laid bare existing inequalities, with low- and middle-income countries hardest hit and women and girls disproportionately impacted, experiencing increased violence, disrupted sexual and reproductive health services, loss of income and an increased care workload. Furthermore, women's voices and expertise continue to be sidelined.

In an unprecedented move, WHO member governments are meeting this week in a special session of the World Health Assembly to discuss the possibility of drafting a new global legal instrument being referred to as a Pandemic Treaty. At WHA74 in May of this year, numerous governments, led by Australia and Chile, called on the international community to meet to compose a new, legally binding document to supplement the current International Health Regulations (IHR). The IHR were put in place in 2005 to dictate the actions to be taken by States in a global public health emergency but many argue that the COVID-19 pandemic has exposed the weaknesses of the IHR, most importantly in relation to health system strengthening.

Calls from some members of the international community for a Pandemic Treaty present a unique opportunity for gender-equality to be hard-wired into public health emergency responses. We identify six key areas.

Firstly, a Pandemic Treaty must ensure human rights, equity and universality principles are enshrined into preparedness and response, looking beyond immediate impacts such as infection and incidence, to assess and mitigate downstream effects of policies, such as increased domestic violence during lockdown and curfew. Human rights and civil society groups must be included in preparedness activities, in order to provide greater consideration to marginalized groups during all phases of an epidemic lifecycle. In addition, the Treaty should enhance, complement and must not diminish or impair the effective discharge of existing human rights obligations in international human rights law and standards.

Secondly, to ensure gender mainstreaming, the treaty must set out to actively include women and other marginalized populations equally in decision making. COVID-19 task forces globally had only 24% representation from women, a situation which impacted negatively on women and girls, as their voices were not heard and their demands not included. Since women are 70% of the health workforce, they are the experts in health systems. We need all talent at the table. Representation counts and it is vital for future public health emergencies to include the knowledge and voices of all members of society. At the global level, that means gender and geographical balance, ensuring that the Global South has a leading voice in global health decision making.

Thirdly, to tackle future pandemics, data collection and analysis must be disaggregated by sex as a key element to its functioning. Evidence-based policy making has been proven to have better health and social outcomes and is key to future pandemic preparedness and response. In the COVID-19 pandemic, the majority of governments are not reporting data on mortality, infections in the general population and amongst health workers. It is vital to understand the risk of infection and death by men, women and other genders in order to design protective strategies and measures.

Fourthly, talks on the Pandemic Treaty must include sound and robust funding mechanisms, with earmarked financial resources for health system strengthening, diagnostics and treatment equity and research and development. Vaccine inequity has been one of the defining features of the COVID-19 pandemic. After nearly two years of the pandemic, fewer than 6% of people in Africa have been fully immunised against Covid-19 and millions of health workers and vulnerable populations have yet to receive a single dose. By the end of 2022 12 billion doses of vaccines will have been produced, enough to vaccinate the entire world but vaccines are not reaching low income countries. Funding must reach all populations, especially those hardest hit and most vulnerable to the impacts of public health emergencies, with systems in place for high-income countries to support low- and middle-income countries and strong accountability mechanisms.

Fifthly, health system strengthening must be a key element in any Pandemic Treaty, with a special focus on supporting countries to reach Universal Health Coverage (UHC) as member states have committed to do by 2030, and ensuring primary health services are accessible by all during health crises. Sexual and reproductive health services and treatment for non communicable diseases and other conditions have been interrupted by the pandemic in almost all countries across the world, leading to increased rates of unintended pregnancies, unsafe abortions and maternal mortality, and premature mortality from other causes.

Finally, health systems do not function without health workers, 70% of whom are women globally. Currently, the world needs an additional 18 million health workers in low-and middle-income countries to reach UHC. With the pandemic this serious global health worker shortage has gone critical. Health workers have been lost to the virus and millions infected by COVID-19 will have longer term health impacts. In addition, after nearly two years on the pandemic frontlines, women health workers, in particular, are planning to leave the profession, mentally exhausted and feeling undervalued. It is time for a new social contract for women health and care workers that recognizes women's contribution to global health security, through decent and safe working conditions, equal pay and leadership opportunities. Women contribute an estimated USD$1.5 trillion to global health annually in the form of unpaid work. Over 5 million women have worked in critical health systems roles in the pandemic, either unpaid or grossly underpaid. Strong health systems that will withstand a global health emergency cannot be built on the unpaid work of the world's poorest women.

When governments meet at the World Health Assembly Special Session from 29th November to 1st December, they will have many options for strengthening the global response to future health emergencies, a Pandemic Treaty being one. The status quo, however, is not an option. The COVID-19 pandemic has shown that the International Health Regulations are not sufficient to tackle the wide-reaching impacts of pandemics on the health of populations and on the economic and social well-being of societies. The virus does not discriminate but societies do and the impact of the pandemic has hit some social groups — women and girls especially — and some countries far harder than it has hit others who have had the protection of furlough schemes and vaccines. Whether or not member states opt for a Pandemic Treaty, the six points we raise above must be tackled as a matter of urgency to build strong health systems and global health security. Equity -including gender equity- must be the central building block of inclusive pandemic recovery.