One of the key lessons emerging from the COVID-19 pandemic has been that the failure of countries to sufficiently work together worsened and prolonged this deadly public health emergency.
Formal negotiations are underway to develop a pandemic treaty under the auspices of the World Health Organization (WHO): an international agreement setting out commitments by countries to collective action on future pandemic prevention, preparedness and response.
Governments are now developing their positioning on a so-called Zero Draft of this treaty. Around 100 representatives of Canadian provinces and territories, Indigenous peoples, youth, civil society, private sector and academia — plus another 100 virtual participants — gathered in Ottawa in March 2023. The purpose, as stated in the participants’ pre-forum documents, was to “help inform the development of Canada’s priorities and objectives in the creation of a pandemic instrument.”
Few, if any, governments have so far held consultations, and the Canadian government should be commended for doing so. The need for meaningful engagement is clear. The COVID-19 pandemic has had a profound but inequitable impact on people’s lives, and we need deeper understanding of the diverse individual and shared experiences of this pandemic.
There is also an opportunity to better align the rhetoric of solidarity, frequently used by the Canadian government during the pandemic, with real action. Perhaps most importantly, the degree to which Canadians support effective international co-operation, as essential to future pandemic preparedness and response, will shape Canada’s positioning on the draft treaty.
To support meaningful engagement, we offer the following observations as in-person and virtual attendees of the recent engagement forum.
The quality of any engagement effort depends on who does and does not participate. Organizers declined to circulate a participant list, citing privacy considerations, so it remains difficult to assess how representative of diversity the forum was.
It is important to know how the partner and stakeholder groups were decided upon. Also, did organizers aim to keep the number of representatives for each group roughly the same (implying their moral equivalence) or were numbers weighted? For example, with 20 per cent of Canada’s population under 30 years of age, would 10-15 youth representatives be sufficient?
Other concerns include: Was there a cap on participant numbers overall or per group? What thought was given to representativeness within each group? The private sector, for example, seemed largely composed of pharmaceutical industry representatives, but what about other industries?
The process for gathering perspectives determines how meaningful the engagement is. The process in Ottawa largely consisted of plenary presentations and six one-hour breakout groups.
Each of the breakout groups focused on a broad preset topic. Briefing papers for each topic were provided, but critically absent was a succinct summary of Canada’s current positioning on these issues. Breakout groups were divided into tables of five or six people.
Relationships of trust and shared understandings are central to conducting meaningful exchange. Absent a participant list, table members were given five minutes to introduce themselves before engaging in rapid-fire discussions. This tight timeframe made it difficult to integrate insights from participants with varied levels of content expertise on specific topics.
As one participant put it, “one question potentially contained multiple doctoral dissertations.”
Moreover, the exclusive focus on discussing preset questions strictly bounded what could be discussed. One of us (Joel Lexchin) described this as eliciting what the government wanted to hear rather than what needed to be said.
Further concerns are raised by how the views expressed and notes taken in the breakout groups were not contextualized by the positioning of the speakers, especially given the strong presence of the pharmaceutical industry. It’s unclear how the Canadian government will draw meaning from, and then weigh the validity of different statements put forth including by vested interests.
The opportunity provided to comment chapter-by-chapter on the zero draft through an online system is likely to prove more useful by generating specific insights for negotiators.
Lessons and opportunities
Overall, we believe the consultations could have yielded deeper insights by:
- providing a better briefing for participants on attendees and the engagement process,
- offering summaries of available evidence to inform discussions,
- allowing more focused and longer conversations guided by content experts.
We recognize inclusive governance takes time and effort at the best of times. Emerging from a prolonged pandemic, which has opened fissures across Canadian society and globally, the task is now even more challenging.
Yet Canadian and other governments must persist in these laudable efforts as they approach treaty negotiations. Meaningful engagement aims to gather insights towards nuanced, responsive and productive solutions to complex problems. In addition to informing government positioning, meaningful engagement will help renew faith, eroded during the pandemic, in democratic processes.
This rebuilding of trust in government and public health systems will be essential for underpinning public support of a pandemic treaty. Genuinely listening to diverse voices, building authentic relationships of trust, and advancing deeper understanding will be key ingredients to moving global pandemic governance forward.
As the historic pandemic treaty negotiations commence, continued engagement efforts will not only be in the best interests of Canadians, but a timely opportunity for Canada to model participatory democratic processes on the global stage.
A meaningful process of Canadian consultation will encourage similar efforts in other countries where vested interests, rather than the voices of the many, continue to dominate.
Kelley Lee receives funding from the Canadian Institutes of Health Research, New Frontiers for Research Fund, and Social Sciences and Humanities Research Council of Canada. The Pacific Institute on Pathogens, Pandemics and Society (PIPPS) receives funding from the BC Ministry of Health.
In 2019-2022, Joel Lexchin received payments for writing briefs on the role of promotion in generating prescriptions for two legal firms. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written.
Katrina Plamondon receives funding from Michael Smith Health Research BC, CIHR, SSHRC, and the KGH Foundation. She is an advisor on the National Scientific Advisory Committee for Global Health and co-chairs the University Advisory Council for the Canadian Association for Global Health.
Roojin Habibi is a member of the WHO Review Committee regarding amendments to the International Health Regulations (2005).