Universal health coverage must be central to the pandemic accord

As the Intergovernmental Negotiating Body (INB) convenes for its seventh meeting in November (6-10) and December (4-6) 2023, we call on member states to build on the commitments made at the United Nations General Assembly’s High-level meetings in September 2023.  

In the Political Declarations adopted at the high-level meetings, member states recognized universal health coverage (UHC), based on a primary health care approach, as a necessary means for achieving robust and sustainable pandemic prevention, preparedness and response (see paragraph 27 PPR PD, A/RES/78/3 and paragraph 41, UHC Political Declaration, A/RES/78/4). 

However, we are concerned that UHC is only referred to as a goal in the current draft (A/INB/7/3) and not as "an essential foundation for effective pandemic prevention, preparedness, response and recovery" as suggested in earlier drafts (A/INB/4/3, preambular section, para 28). 

UHC can help mitigate against exacerbating existing inequities and access to services and is of key importance to ensure that health systems are strong and resilient, and therefore also better prepared to prevent, detect and respond to outbreaks with pandemic potential. UHC and health security are two intertwined goals to protect everyone, everywhere - in crisis and calm - and they are achieved through the same health system. 

This is why the pandemic accord should operationalize UHC and elevate a primary health care approach for effective pandemic prevention, preparedness, response and recovery. Therefore, we propose to incorporate core elements related to UHC and primary health care in relevant provisions, including:  

• Maintaining access to essential and routine health services to at least pre-pandemic levels, and exceeding those where possible;  
• Sustaining protected and well-supported health and care workforces, which are primarily comprised of women;  
• Mitigating barriers to accessing needed health services, commodities and information, particularly by ensuring affordability and non-discrimination in access to countermeasures necessary to prevent the spread of diseases and to protect people during pandemics (these should be free at point of delivery);  
• Integrating pandemic prevention, preparedness and response planning into primary health care systems (such as by leveraging disaggregated data from routine primary health care records to enhance surveillance and monitoring);  
• Institutionalizing participatory governance arrangements that enable meaningful multistakeholder, whole-of-society engagement, including civil society and communities. This is critical to respond to the needs of communities (especially considering various needs based on gender, ethnicity and socioeconomic status) and to build trust, which in turn leads to greater uptake of essential public health services. 

Effective pandemic prevention, preparedness, response and recovery is not possible without universal health coverage. Member states must now build on commitments made at the high-level meetings and recognize the essential function of UHC for pandemic prevention, preparedness, response and recovery in the pandemic treaty. 

-By Gabriela Cuevas and Justin Koonin, Co-chairs of UHC2030 Steering Committee 

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Background: 

In December 2021, the World Health Assembly (WHA) established an intergovernmental negotiating body (INB) to draft and negotiate a convention, agreement or other international instrument under the Constitution of the World Health Organization to strengthen pandemic prevention, preparedness and response. Following two rounds of public hearings (in April and September 2022) and four informal, focused consultations (in September and October 2022), a zero draft of the accord (Zero draft of the WHO CA+ for the consideration of the Intergovernmental Negotiating Body at its fourth meeting WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response, "WHO CA+") was discussed at INB4, INB5 and INB6 in February, April, June and July 2023. The INB delivered a progress report to the 76th World Health Assembly in 2023 and will submit its outcome for consideration by the 77th World Health Assembly in 2024.

Find more information here on why it is important to integrate UHC in the pandemic accord.