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To: Dr. Tedros Adhanom Ghebreyesus, Director General, World Health Organization

CC: Ms. Inger Andersen, Executive Director, United Nations Environment Programme
Mr. Roland Driece, Co-Chair, Intergovernmental Negotiating Body
Dr. Monique Eloit, Director General, World Organization for Animal Health
Mr. Kazuho Taguchi, Vice Chair, Intergovernmental Negotiating Body
Ms. Precious Matsoso, Co-Chair, Intergovernmental Negotiating Body
Dr. Qu Dongyu, Director General, Food and Agriculture Organization
Mr. Ahmed Salama Soliman, Vice Chair, Intergovernmental Negotiating Body
Ambassador Tovar da Silva Nunes, Vice Chair, Intergovernmental Negotiating Body
Dr. Viroj Tangcharoensathien, Vice Chair, Intergovernmental Negotiating Body

Open Letter to the World Health Organization

Re: Support from the Medical and Public Health Community for a Pandemic Prevention Treaty

As medical, public health, and similarly aligned organizations and individuals, we the undersigned support the work of the World Health Organization (WHO), the Intergovernmental Negotiating Body (INB), and all stakeholders to develop an international instrument on pandemic prevention, preparedness, and response. We applaud and encourage an emphasis on primary prevention, including efforts to reduce the risk for the emergence of novel zoonotic pathogens.

Between January 1, 2020, and December 31, 2021, COVID-19, which is caused by the SARS-CoV-2 pathogen, claimed almost six million human lives worldwide. During the same period, there were almost 300 million confirmed cases of COVID-19 in 222 countries and territories. Excess mortality due to the COVID-19 pandemic has exceeded 18 million. Deadly hotspots have included farms and meatpacking plants—places where people are especially vulnerable.

People of color, who are members of the global majority, have been disproportionately affected by the pandemic, and more than five million children have lost a parent or other primary caregiver. COVID-19 mitigation measures resulted in the largest disruption in schooling in history, and hard-won fights for women, children, and individuals living in poverty have begun to reverse during the pandemic.

The pandemic has deepened existing global and local social and economic disparities, and it has exacerbated the risk for interpersonal violence, human trafficking, child labor, and forced marriage. It has also complicated public health concerns, such as communicable and noncommunicable disease risk, disaster preparedness and response, and forced migration.

The COVID-19 pandemic has strained the healthcare system and those who work in it. A shortage of beds, medical staff, and financial resources delayed childhood vaccinations, cancer treatment, surgeries, and obstetrical care. Nearly half of all patients who are hospitalized with COVID-19 develop complications, suggesting that long-term problems from COVID-19 could strain healthcare systems for years. Healthcare workers are exhausted, burned out, and leaving their chosen fields, resulting in serious workforce shortages.

Overall, the economic costs of the pandemic could total an estimated US$16 trillion.
The world cannot afford another pandemic on this scale. Pandemic prevention must be a vital part of any future legal instrument on pandemics.

Although the origin of SARS-CoV-2 is still under investigation, a growing body of evidence confirms that ecosystem degradation, habitat loss and fragmentation, biodiversity loss, encroachment into wildlife habitats, the commercial trade in wild animals, and intensive animal farming increase the risk of emerging infectious disease outbreaks and exacerbate other negative impacts on human and animal health. Around 75% of emerging infectious diseases in humans originate in animals. As a result, any effective approach to pandemic prevention must address the root causes of disease, as well as disease surveillance, monitoring, control, and mitigation.

To prevent future pandemics, we must change the way we interact with animals and their habitats. Failure to do so will negatively impact public health, as we have seen with COVID-19. Never has the link between human, animal, and environmental health and well-being been so evident.

Prevention measures should align with the One Health definitions prepared by the One Health High-Level Expert Panel (OHHLEP) and supported by the quadripartite of the WHO, the United Nations Environment Programme (UNEP), the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE). This definition recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent, and that stakeholders need to foster well-being and address threats to health and ecosystems.

A pandemic prevention instrument must therefore include attention to antimicrobial resistance; epidemiological drivers such as climate change, industrial development, ecosystem change, and social and economic inequities; and interdisciplinary strategies enabled by economic incentives, legal remedies, and public education.

Although the International Health Regulations (IHR) requirements, which provide an overarching framework for global health security concerns, are instrumental, a pandemic prevention treaty could and should be expanded to sectors beyond health to create a broad continuum of prevention and preparedness.

A global threat such as a pandemic requires a united global response, coordinated through a dedicated mechanism—a pandemic instrument to align global action on the national, regional, and international level. Stakeholders working on improving outcomes for human, animal, and environmental health and well-being should also be invited to share their expertise.

Mitigating pandemic risk lies in the role and responsibility of various international and national bodies. Cross-sectoral collaboration is the only way to develop sustainable solutions to prevent health crises and reduce the risk of future pandemics in line with a “whole of society” and “whole of government” approach, as stipulated in the World Health Assembly Second Special Session.

As medical, public health, and similarly aligned organizations and individuals, we voice strong support for an international pandemic prevention agreement, rooted in a wider, just One Health approach that addresses the need for primary prevention, including the interconnections between human, animal, and planetary health and well-being and related social and ecological determinants of health. An instrument that mirrors the approach set forth in the World Health Organization (WHO) Framework Convention on Tobacco Control would provide intergovernmental bodies, national governments, and other stakeholders with the tools needed to ensure the health of all.

Respectfully submitted by the undersigned,

Signatories speak on their own behalf, and not on behalf of their affiliated institutions.

Additional signatures from medical, public health, and similarly aligned individuals and organizations are welcome here.

Last updated July 18, 2022.

A Well-Fed World

Cristián Apiolaza Acevedo, Lawyer, Santiago, Chile

Mariana Arellano Corbello, MA, Corporate Campaigns Coordinator, Mexico City, Mexico

Association for Prevention Teaching and Research

Olympia Auset, Founder, SÜPRSEED, Los Angeles, CA, USA

Nandita Bajaj, BEng, MEd, Executive Director, Population Balance, St Paul, Minnesota, USA

Katherine Baker, Fédération Québécoise des Massothérapeutes, Québec, Canada

Dr. Liv Baker Van de Graaff, PhD, Educator and Researcher, Hunter College, CUNY; PAN Works, New York, NY, USA

Dr. Georges C. Benjamin, MD, MACP, Executive Director, American Public Health Association

Dr. Utpal Kumar Bhattacharya, Academic, Indian Institute of Management Indore, Indore, India

Alexandra Bookis, Policy Specialist, Washington, DC, USA

Brighter Green

Dr. Ayanna V. Buckner, MD, MPH, FACPM, Preventive Medicine and Internal Medicine Physician; Principal, Community Health Cooperative, Atlanta, GA, USA

Dr. Janice Bush, DVM, MSc, BSc, Graduate Research Assistant (Intracellular Pathogens), North Carolina State University, Raleigh, NC, USA

Dr. Jaylee Caruso, MD, Resident Physician, Albuquerque, NM, USA

Child Labor Coalition

Dr. Simon Coghlan, PhD (Philosophy), BVSc, M (Bioethics), Senior Lecturer in Digital Ethics, Centre for AI and Digital Ethics (CAIDE), The University of Melbourne; Adjunct Fellow Faculty of Health and Medical Sciences, University of Adelaide, Melbourne, Victoria, Australia

Dr. Elena Contreras, DVM, MS, PhD, Veterinarian, Northport, New York, USA

Sarah Cooper, MSc, University of Montréal, Montréal, Canada

Chelsea Davis, Community Organizer, Beaverton, OR, USA

Paul Davis, Policy Director, R2H Action (Right to Health), Baltimore, MD, USA

Carter Dillard, JD, Attorney and Policy Advisor, Fair Start Movement, Los Angeles, CA, USA

Dr. Mohammad Taghi Ehsani, Medical Doctor, Vienna, VA, USA

Dr. Jehan (Gigi) El-Bayoumi, MD, FACP, Physician; Professor of Medicine and Founding Director, Rodham Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

Fair Start Movement

Anthony Feliciano, Health Advocate, Commission on the Public’s Health System, New York, NY, USA

Dr. Nihad Fejzic, DVM, PhD, Veterinary Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Dr. Hope Ferdowsian, MD, MPH, FACP, FACPM, Internal Medicine and Preventive Medicine Physician; Associate Professor of Medicine, University of New Mexico School of Medicine; President & CEO, Phoenix Zones Initiative; Senior Editor, CABI One Health; Medical Expert, Physicians for Human Rights, Albuquerque, NM, USA

Dr. Morris M. Flood, DHSc, MPA, Public Health Advisor, Clarksburg, MD, USA

Dr. Agustin Fuentes, PhD, Professor of Anthropology, Department of Anthropology, Princeton University, Princeton, NJ, USA

Dr. Diamone Gathers, MD, Physician, University of New Mexico School of Medicine, Albuquerque, NM, USA

Elna Gavrankapetanovic, President, Association of One Health Bosnia Herzegovina, Sarajevo, Bosnia and Herzegovina

Dr. Jen Girgen, JD, PhD (Criminology and Criminal Justice), Professor, Marblehead, MA, USA

Dr. John Paul Gluck, PhD, Psychologist and Bioethicist, University of New Mexico, Albuquerque, NM, USA

Dr. Jaana Gold, DDS, PhD, MPH, CPH, Dental Public Health Professional,
AT Still University, University of Florida, Gainesville, FL, USA

Dr. Norbert I. Goldfield, MD, Physician, Northampton, MA, USA

Lawrence O. Gostin, JD, Faculty Director, O’Neill Institute for National and Global Health Law and Director, World Health Organization Collaborating Center on National & Global Health Law, Washington, DC, USA

Nilang Gor, MS, Cell and Molecular Biology, Scientist, Genetic and Infectious Diseases, Berkeley, California, USA

Dr. Linda D. Green, MD, Physician; Student Medical Care Section, American Public Health Association, Mount Rainier, Maryland, USA

Dr. Kim Gruetzmacher, PhD, Veterinarian and Biomedical Scientist (Emerging Zoonoses, Biodiversity, and Health Nexus), Museum für Naturkunde, Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany

Kathy Hessler, JD, LLM, Clinical Professor of Law, Lewis & Clark Law School, Portland, OR, USA

Dr. LeRoi S. Hicks, MD, MPH, FACP, Chief Medical Officer, Wilmington Hospital; Physician Leader, Institute for Research in Equity and Community Health (iREACH), ChristianaCare; President, Society of General Internal Medicine; Professor of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University

Dr. Marc D. Hiller, DrPH, Emeritus Associate Professor of Health Management and Policy, University of New Hampshire, Hampton, New Hampshire, USA

Caroline Hugh, MPH, Analyst, New York, NY, USA

Marty Irby, Center for a Humane Economy, Bethesda, MD, USA

Catherine Jadav MSc, RN, Research Manager, Compassion in World Farming, Surrey, UK

Dr. Jane Johnson, BSc (Hons), Dip Arts (Hons) PhD, Philosopher and Bioethicist, Macquarie University, Sydney, New South Wales, Australia

Dr. L Syd M Johnson, PhD, Associate Professor, Upstate Medical University, Syracuse, NY, USA

Dr. Mark Jones, BVSc, MSc (Stir), MSc (UL), MRCVS, Veterinarian and Head of Policy, Born Free Foundation, UK

Dr. Utsha Khatri, MD, MSHP, Emergency Medicine Physician, New York, NY, USA

Dr. Michael Khoury, MD, Physician, Georgia Human Rights Clinic, Emory University School of Medicine, Atlanta, GA, USA

Dr. Caroline Kilsdonk, DVM, MA, Veterinarian, Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Saint-Hyacinthe, Québec, Canada

Dr. Chi Kim, MD, Internal Medicine Physician, Seattle, WA, USA

Dr. Barbara J. King, PhD, Emerita Professor, Anthropology, William & Mary, Williamsburg, VA, USA

Dr. M. “Tonette” Krousel-Wood, MD, MSPH, FACPM, Board President, American College of Preventive Medicine

Dr. Nikhil Kulkarni, MD, Physician Anesthesiologist and Partner, Anesthesia Associates of New Mexico, Albuquerque, NM, USA

Dr. Vijay Kulkarni, MD, Physician and Surgeon, Englewood Cliffs, NJ, USA

Dr. Sumedha Kulkarni, MD, Physician Anesthesiologist, Englewood Cliffs, NJ, USA

Dr. Lucja Lange, Doctor of Sociology, Researcher and Lecturer, Institute of Sociology, University of Lodz, Lodz, Poland

Dr. Elizabeth Lawrence, MD, Professor of Internal Medicine and Chief Wellness Officer, UNM School of Medicine, Albuquerque, NM, USA

Benjamin Levenson, Deputy Director, Justice is Global, Chicago, IL, USA

Dr. Martha Lincoln, PhD, Assistant Professor of Medical Anthropology, San Francisco State University, San Francisco, CA, USA

Dr. Joann Michele Lindenmayer, DVM, MPH, Epidemiologist, Department of Public Health and Community Medicine, Tufts Medical School, Boston, MA, USA

Dr. Paul A. Locke, MPH, JD, DrPH, Faculty, Arlington, VA, USA

Andrea L. Lowe, MPH, CPH, Public Health Professional; Chair, American Public Health Ethics Section, Lincoln, Nebraska, USA

Dr. Andrea Lyman, MD, MSc, MS, Physician, New York, NY, USA

Mia MacDonald, MPP, Harvard Kennedy School of Government, Executive Director, Brighter Green, Brooklyn, NY, USA

Risa M. Mandell, MSW, LCSW, Clinical Social Work Psychotherapy, Ambler, PA, USA

Charlotte Manvell, BS, Graduate Research Assistant, Raleigh, NC, USA

Dr. Angela K. Martin, PhD, Assistant Professor in Philosophy, University of Basel, Basel, Switzerland

Dr. Katherine C. McKenzie, MD, Physician, Yale School of Medicine, New Haven, CT, USA

Dr. Karen McPhail-Bell, PhD, Health and Community Researcher, Redwood City, CA, USA

Dr. Debra Merskin, PhD, Professor, University of Oregon, Eugene, OR, USA

Dr. Ranit Mishori, MD, MHS, FAAFP, Physician, Georgetown University School of Medicine, Washington, DC, USA

Dr. Alaina Moon, DVM, Diplomate ACVIM, Veterinary Internist, Olympia, WA, USA

Dr. Brad B. Moore, MD, MPH, FACP, Dip. ABLM, Physician, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

Dr. Padmini Murthy MD, MPH, Physician, Public Health Specialist, and Professor, New York Medical College; American Medical Women’s Association, New York, NY, USA

Queenie Nguyen, Finance Manager (Healthcare Sector), Santa Monica, CA, USA

Dr. Gideon Nkeyasha, Senior Veterinarian, Narok County Government Kenya, Kajiado, Kenya

Dr. Joachim Nieuwland, DVM, PhD, Assistant Professor, Utrecht University, Wageningen University & Research, Utrecht, the Netherlands

Sandy Noel, MPH, Statewide Planning Coordinator, Florida Department of Health, Tallahassee, FL, USA

Elizabeth Novogratz, President, Species Unite, Brooklyn, NY, USA

Dr. Sonda Oppewal, PhD, RN, Nursing Professor, University of North Carolina at Chapel Hill, NC, USA

Dr. Jay Patankar, MD, Emergency Medicine and Palliative Care Physician, Frederick, MD, USA

Dr. Emily Peitzman, MD, Physician (Pediatrics), University of California San Francisco, San Francisco, CA, USA

Dr. Kinley Penjor, MD, MPH, Public Health Specialist, Ministry of Health, Bhutan, Thimphu, Bhutan

Dr. Jessica Pierce, PhD, Bioethicist, Center for Bioethics and Humanities, Anschutz Medical Campus of the University of Colorado, Denver, CO, USA

Dr. Louise Potvin, PhD, Professor and Scientific Director, CReSP (Centre de Recherche en Santé Publique), Université de Montréal and CIUSSS Centre-Sud-de-Montréal, Montréal, Québec, Canada

Dianne M. Radmore, Denman Island, British Columbia, Canada

Dr. Kavita Rajasekhar, MD MPH, Public Health Physician, New York City, NY, USA

Dr. Rajesh K. Reddy, JD, PhD, Animal Law Education, International Coalition for Animal Protection, Portland, OR, USA

Latrinda Riley, MSHS, MBA, Pharmaceutical Industry Professional, New Hill, NC, USA

Rocio Rodriguez, MPH, Public Health Practitioner, Santa Rosa, CA, USA

Dr. Theresa Rohr-Kirchgraber, MD, Professor of Medicine, AU/UGA Medical Partnership, Athens, GA, USA

Dr. Evan Romrell MD, FAAP, Hospitalist (Internal Medicine and Pediatrics), Billings, MT, USA

Adolfo Sansolini, Director, AnimalWelfareAndTrade, London, UK

Dr. Samantha Sawicki, MD, Internal Medicine, Geriatrics, and Palliative Care Physician, University of Chicago, Chicago, IL, USA

Dr. Dana Sanders, MD, Physician, Memphis, TN, USA

Dr. Stacie Schmidt, MD, Internal Medicine Physician, Decatur, GA, USA

Dr. Jeff Sebo, PhD, Clinical Associate Professor of Environmental Studies; Affiliated Professor of Bioethics, Medical Ethics, Philosophy, and Law; Director of the Animal Studies MA Program, New York University, New York, NY, USA

Sonia Silva, MPA, Director, International Students & Programs, California State University, Bakersfield, CA, USA

Dr. Janet Simon, DPM, Podiatric Physician, Albuquerque, NM, USA

Society of General Internal Medicine

Jennie Spector, LCSW, Social Work, Indivisible Nation BK, Brooklyn, NY, USA

Susan Spahr, One Health Advocacy Project, Newmarket, Ontario, Canada

Dr. Monika St Jean, MD, Attending Physician Anesthesiologist, Advanced Perioperative Medicine Associates, Paramus, NJ, USA

Barbara Stagno, CAARE, Dobbs Ferry, NY, USA

Anna Spurek, COO, Green REV Institute, Warsaw, Poland

Dr. Angela Sy, DrPH, MPH, Professor and Researcher, Honolulu, HI, USA

Dr. Jahan Tavakoli, MD, Physician (Oncology), San Rafael, CA, USA

Julie Taylor, Educator, Sydney, New South Wales, Australia

Dr. Kirrilly Thompson, PhD, Cultural Anthropologist, University of Newcastle, University of South Australia, New South Wales, Australia

Dr. Nalini Visvanathan, MPH, PhD, Independent Researcher, Silver Spring, MD, USA

Dr. Carmel Williams, PhD, Auckland, New Zealand

Dr. Karen Anne Wolf, PhD, RN, NP, Professor of Nursing (Retired), Lewisburg, PA, USA

Alex Wolfe, Senior Field Organizer and Corporate Engagement Lead, The Humane League, New York, NY, USA

Toti Jean Marc Yale, CEO and Founder, Education and English for You, Abidjan, Lagunes, Cote d’Ivoire

Dr. Sandul Yasobant, PhD, MPH, Public Health Researcher, Indian Institute of Public Health Gandhinagar, Gujarat, India

Dr. Jackson T. Zee, PhD, BVSc, Director of Global Affairs and Disaster Resilience, FOUR PAWS International, Vienna, Austria

Dr. Amy Zeidan, MD, Emergency Medicine Physician, Emory University, Atlanta, GA, USA

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