This year, the UN General Assembly and World Health Organisation will negotiate setting up collaborative mechanisms for protecting against future health crisis. Failing to take on-board the pandemic policy work already undertaken by public health experts would be a political failure.

Two important multilateral initiatives should be agreed this year to set up collaborative actions/mechanisms to protect against future health crisis. Key objectives are to preserve the efficacy of precious antimicrobial drugs and be able to react more quickly to pandemics, including by agreed access to health and genetic data, and protective resources as needed. These negotiations are being facilitated through the UN General Assembly (UNGA) and ongoing within the World Health Organisation (WHO).

Both negotiations involve a recognition of the capacity and constraints faced by developing countries. Other elements yet to be agreed include the Pathogen Access and Benefit Sharing Agreement (Article 12). Outstanding issues link to intellectual property/access to pharmaceuticals and to World Trade Organization (WTO) obligations, and related commitments embedded in Free Trade Agreements (FTAs) and Investor State Dispute Settlement Agreements.

Developing policy positions on antimicrobial resistance (AMR) and Pandemic Preparedness cannot be assessed through a narrow health lens. Policies linked to food security, environment, trade, and assessments based on national interest (not special interests) should be in the mix. This is a governance challenge as it requires high levels of policy cohesion within and between bureaucracies to ensure governments are better prepared for future pandemics.

Time is not on our side to get these mechanisms operating, particularly with the ongoing spread of H5N1 avian influenza affecting poultry supplies, and now also killing many species of mammals. This H5N1 virus also surprised the scientific community by infecting US dairy cows, and has not yet received sufficient attention to gage what this might mean for global health, food security, and trade. The information below provides an overview with links to the texts being negotiated.

Antimicrobial Resistance (AMR)

On 26 September the UN General Assembly will convene a high-level meeting on AMR. Governments will be presented with a Political Declaration setting new targets and practical actions to accelerate political action to help preserve the efficacy of existing antimicrobials. Little real progress has been made in developing new antibiotics, despite significant financial and research investments—so preserving existing stocks from overuse and misuse must be prioritised.

The exponential rise in AMR is deadly serious. Governments’ must act decisively to help preserve these lifesaving drugs essential for human health. But defining how these drugs  should be used is a politically contested space. The largest users of antimicrobials are private food producing industries—animal, aquaculture, and plant sectors.

Balancing these competing priorities will be played out in the lead up to UNGA as the Political Declaration is finalised. Unfortunately, significant political commitments made to produce antibiotic free beef and chicken by major US producers are now being watered down as their profits are affected. This places further pressure on the negotiators to ensure outcomes are consistent with preserving citizens health and access to life-saving antimicrobials.

Pandemic Prevention, Preparedness and Response Treaty

Background and key documents on this Draft Treaty raise many of the same political issues as mentioned in the UNGA AMR Decision above. Negotiations to complete the Treaty began three years ago and, to the concern of many health experts, it is not yet finalised, including the sensitive Pathogen Access and Benefit Sharing Article 12. This is the current draft text and an overview of negotiations now taking place.

The UK Parliament, responding to petitions from the public, has issued this informative  Background Briefing and Report. It is a commendable exercise in transparency. And worthwhile noting that the UK Parliament also has a Standing Committee specifically dealing with the issue of Antimicrobial Resistance.

For those interested in multilateral negotiations, these two health related issues outlined above should be understood for their policy complexity. The bureaucracies tasked with protecting health, food security, and the complex trade related elements tend to operate in silos. This fragmentation can skew policy priorities and national interest outcomes, as well as  citizens’ health and confidence in food system matter.

H5N1 now affecting mammals – and dairy cows

The discovery of H5N1 bird flu infecting dairy cows in the US surprised both farmers and scientists. The public would rightly have expected an urgent policy response at the highest level at the mere hint of a virulent pathogenic Avian Influenza H5N1 mutating. This Bird Flu already caused the death of millions of poultry globally, and now the H5N1 virus has spread into mammals—killing significant numbers of wild and diverse species.

Already, H5N1 bird flu has infected 157 herds of dairy cows in 13 US states. The transmission mechanism is not yet proven, but infected cow’s milk is of a different colour and thickness and it contains live H5N1 virus. According to health authorities, when the milk is pasteurised it only contains dead virus fragments, but warnings have been issued not to drink raw milk.

To the concern of the scientific community, many farms and state health authorities have not collaborated with the Centre for Disease Control (CDC) even when financial incentives have been put on the table. To date, three workers appear to have been infected, but this figure cannot necessarily be relied upon. This lack of basic data also ignores the need to preserve consumer confidence in the food chain. Only recently five states have offered collaboration enabling testing of milk and farmworkers.

Scientists are still assessing key questions—whether it is the milking machinery spreading the virus to cows or some other, yet unknown process. Scientists are also concerned that the cows might be able to spread the virus as a respiratory disease as some have been found to have nasal secretions more like influenza symptoms. With this latter observation there is unease that the virus might hold the potential to attack cows that are raised for meat rather than milk.

The US scientific community is now openly expressing their frustration at the failure to access important genetic data and blood samples from cows and farm workers to analyse possible virus mutations and the extent of H5N1 spread. Such resistance to urgently address this biosecurity issue are also of concern globally.

A very recent study, undertaken by scientific experts in Kansas, collaborating with German researchers to speed this research, have run experiments deliberately infecting cows in high-level biosecurity facilities. The results of these small trials will be important, but by not facilitating appropriate access to the environment of the affected herds—in a developed country industrial farm setting—is raising alarm within the scientific community in the US and outside. Gaining a full analysis of this fast moving and changing virus is essential.

There is some evidence this specific form of bird flu is being spread though the milking machines. If correct, then urgent regulatory measures could be put in place to ensure the mechanical milking machines are sterilised after each use. But any alteration to this highly automated process will be expensive and time consuming, and the milk could end up being tainted by the cleaning product. To add to the farmers woes there are other troubling reports of the virus spreading back into wild birds and mammals and to domestic cats.

To plug the information gap the CDC is now testing wastewater for H5N1 and also signed a US$38 million contract with Google’s sister wastewater testing company, Verily. The US and the European Union (EU) are signing contracts with several vaccine producers, and Finland is taking precautionary measures to proactively vaccinate dairy workers. Some media coverage is also emerging, but many questions remain about the broader biosecurity, food, and animal supply chain and trade issues.

Bringing clarity to this dairy cow H5N1 outbreak has some way to run with many possible outcomes for the US and globally. Governments have not recovered from the consequences of the Covid 19 pandemic, but they should be actively engaged to face any emerging challenge.

Failing to take on-board the important pandemic policy work already undertaken by numerous public health experts—to finalise the years of work negotiating the Pandemic Prevention, Preparedness, and Response Treaty or to fundamentally address the use and misuse of our most precious antimicrobials—would be a political failure.

As we now know the bugs are much cleverer and fast changing than our slow-moving governments who often delay too long to address their citizens’ health and wellbeing and the global environment.

At the time of publication Australia is one of the few countries that remains free of avian influenza H5N1. Australia has however reported one human case of A(H5N1)—a traveller returning from India. Australia reported this information for distribution through the WHO International Health Regulations (IHR) network

Anna George is a former Australian ambassador and multilateral negotiator, and is crrently an adjunct professor at the College of Arts, Business, Law, and Social Sciences at Murdoch University. Her interests include the trade and security aspects linked to the spread of antimicrobial resistance through the international food chain and the role of FTAs and WTO obligations influencing government’s decision making.

This article is published under a Creative Commons License and may be republished with attribution.