Without accountability mechanisms or an action plan, the declaration appears unrealistic and ironic regarding its call to action. The text repeatedly addresses PPPR financing, including the following wording:
Strengthen international cooperation and coordination and financial and investment commitments to support efforts to build, strengthen and sustain capacity… including through enhanced official development assistance and adequate surge financing for future responses, and other means of innovative financing while recognizing that all people should be able to receive high-quality health care without financial hardship
…to mobilize additional timely, reliable, flexible, equitable, predictable and sustainable funding for pandemic prevention, preparedness and response, as well as funding for rapid surge financing for responses in the event of a public health emergency of international concern, strengthening financing mechanisms for global health and other relevant sectors…
One point in the call to action concerns universal access to sexual and reproductive health-care services by 2030. Achieving this relies on nations lifting conservative policies governing reproductive rights. Recent developments, such as the overturning of Roe v. Wade in the United States, now allowing U.S. states to ban abortion, cast doubt. In numerous countries, not only sexual and reproductive health care but overall healthcare faces significant challenges. These words can seem like a mere list of empty notions that governments pay lip service to.
Moving ahead, the declaration explicitly calls for a report by the UN-Secretary General. This report will offer implementation recommendations. It will be presented at another high-level meeting in 2026, initiating a comprehensive review of the declaration’s implementation. This meeting would commence “a comprehensive review of the implementation of the present declaration.”
The declaration supports alignment with the Intergovernmental Negotiating Body (INB), currently drafting a pandemic convention. It also aligns with the Working Group on the 2005 International Health Regulations (IHR), negotiating revisions to the IHR. Both processes aim to conclude with consensus texts by May 2024. However, negotiations have proven challenging due to disagreements among countries, especially regarding equitable access to pandemic products and intellectual property.
In the months leading to the May 2024 World Health Assembly and the years beyond, the world will witness whether countries honor their commitments. Global health law has limits in enforcing compliance, even with the proposed member states-led “implementation and compliance committee” linked to PPPR. All we can do is hope that countries genuinely grasp the lessons of COVID-19 and fulfill their promises.