Abstract

The World Health Organization (WHO) is currently in advanced stages of developing a ‘WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response’ (also known as WHO CA+, referred to below as: Pandemic Agreement).1 Rightly, the instrument places equity at the centre. Yet, it currently also omits reference to an impactful tool to promote equity that has been adopted in an unprecedented manner during COVID-19—a set of measures known as disadvantage indices. Embedding disadvantage indices would provide concrete constructive guidance; align the Pandemic Agreement with the use of indices by other United Nations (UN) agencies; help realise the Agreement’s goal of addressing social and other determinants of health within countries, and furthermore offer feasible ways improving equity in allocation across countries. WHO member states began work on a Pandemic Agreement in December 2021. The current timeline envisages a final version to be considered by the May 2024 World Health Assembly.1 The publicly available version of the Pandemic Agreement at the time of writing comprises 36 articles under three separate chapters (Bureau’s Text, A/INB/7/3, 30 Oct 2023).1 Chapter 1 provides general scene setting describes objectives, and highlights key terms. While the concept of equity is still somewhat implicit and would benefit from further articulation,2 overall, there seems to be a latent understanding that inequity obtains when there are unfair differences in health outcomes and opportunities within and across countries. Correspondingly, ‘[e]quity is at the centre of pandemic prevention, preparedness, response, both at the national level within States and at the international level between States. It requires, inter alia, specific measures to protect persons in vulnerable situations’.1 Chapter 3 addresses procedural issues, such as the establishment and rules of interactions of different types of advisory committees. Chapter 2 is titled ‘The world together equitably: …