Inequities in access to COVID-19 vaccines, treatments and tests have been vast and intractable. In light of these and other failures in the global response to COVID-19, attention has turned to negotiations at the World Health Organization (WHO) for a new legal instrument, the proposed Pandemic Agreement, as a way to design better systems for the future. This paper aims to analyse measures proposed in 2021-24 by WHO Member States for inclusion in the Pandemic Agreement to address equitable access to health products and technologies for pandemics, and their potential to advance equitable access.

We used a systematic process to collect policy documents related to the Pandemic Agreement negotiations from the WHO website, along with academic and grey literature relevant to the proposed measures under study. Walt and Gilson’s health policy triangle was employed to analyse proposed measures and the negotiating dynamics in four domains: policy context, content, process and actors. Data relevant to each domain were extracted using Excel and thematically analysed.

Findings suggest that the political context for the negotiations presents a significant challenge. Over successive drafts, proposed provisions to advance equitable access have been weakened and provide little leverage over the behaviour of the pharmaceutical industry and high-income countries which has restricted access to pandemic-related products in the past. The negotiating process lacks transparency, hindering the input of experts and constituencies from low and middle-income countries and enabling greater influence of elites and commercial actors. The May 2024 deadline to conclude the Agreement was missed, and while the timeline for the negotiations has been extended to May 2025, the negotiations face ongoing challenges.

Findings suggest that public health advocates should focus not just on building support for measures to effectively address equitable access, but also on influencing the negotiating process and involvement of actors with vested interests.

Corporations shape public health through their products, services, operations and employment practices, constituting a major influence on the commercial determinants of health. Environmental, Social and Governance (ESG) reporting frameworks emerged in the past few decades as a tool to increase transparency and accountability of companies’ environmental and social impacts, but they often overlook their health impacts. This has allowed companies in harmful industries, such as British American Tobacco, to achieve high ESG ratings despite their negative health contributions.

To bridge this gap, this presentation explores how health considerations can be integrated into ESG reporting, including whether Australia’s proposed mandatory climate-related financial disclosures regime, which was introduced into Parliament on 27 March 2024, might serve as a model. It looks at two methods of integrating health into existing ESG frameworks: first, leveraging existing ESG metrics to give an indirect indication of a company’s health impacts, and second, introducing health-specific metrics to provide a more direct understanding of a company’s health footprint.

It argues that current ESG reporting frameworks, which often focus on the reporting of metrics that affect a company’s financial value, are not well suited to health-related impacts. This is because they focus too much on risks to the company, and therefore fail to recognise that many ESG impacts of corporate activity are externalised, meaning the costs fall on society, not the company.

What is needed is a more comprehensive understanding of ESG reporting that requires companies to report on the impacts of their activities on the broader community, including recognising the inherent healthfulness of their products and services. Without accounting for the externalised costs of a company’s activities, integrating health considerations into current ESG reporting frameworks will provide an incomplete picture of the corporate sector’s health impacts.

2nd Presenter: Dr Elizabeth Sheargold, Monash University.

The popularity and health impacts of e-cigarette consumption are increasingly raising public health concerns, particularly around impacts on young people. The World Health Organization (WHO) has called for action to address these public health concerns, but there is not yet any multilateral consensus around how to address e-cigarette consumption.
As policymakers and legislators design policy in this area, they need to consider the potentially significant restrictions that international trade and investment law can impose on domestic public health regulation. Australia's experience defending tobacco plain packaging highlighted that public health regulations can be characterised as a barrier to trade, expropriation and/or restriction on use of trade marks, among other claims. E-cigarette regulation may engage similar rules, and in addition raises potential claims of discrimination because the regulatory approaches states are adopting often draw distinctions between types of e-cigarettes. Advocates and policy makers need to recognise that e-cigarette regulations are likely to engage with key World Trade Organization (WTO) agreements relating to trade in goods and the protection of intellectual property rights, as well as investment treaties, and ensure that regulations have sufficient justification to be defended against claims by e-cigarette producers. At the same time, they must respect obligations found in the Framework Convention on Tobacco Control, the WHO and human rights agreements.
This paper explores these concerns, identifying important lessons from trade and investment disputes concerning tobacco control measures that can guide States in e-cigarette regulatory design. Developing e-cigarette measures is a particularly complex task for states because of ongoing uncertainty around the health impacts of e-cigarettes but Australia has the opportunity to shape multilateral consensus, as it did for plain packaging. This paper proposes a careful regulatory approach that ensures that justifications for regulation explicitly recognise domestic public health interests and achieves consistency with international trade and investment agreements.

From 2026, all packaged alcohol products sold in Ireland will be required to include a statement on the label, ‘There is a direct link between alcohol and fatal cancers’, along with other health warnings and information. With this new measure, Ireland becomes the first country in the world to mandate that all packaged alcohol products sold in the country contain a warning linking any level of alcohol consumption to cancer.

Ireland’s Public Health (Alcohol) (Labelling) Regulations 2023 were introduced by the Irish Minister of Health in May 2023 to give effect to health labelling measures introduced as part of comprehensive alcohol control laws in Ireland. The Regulations have been very contentious in the WTO’s Technical Barriers to Trade Committee (TBT) where alcohol-exporting countries have raised concerns about the Irish measure. Among the concerns raised include disagreement as to the label’s consistency with EU food regulations and a proposed EU health warning for alcohol, as well as disputes regarding the evidence linking alcohol consumption and cancer.

This presentation will examine the merits of the arguments raised in the WTO TBT Committee about Ireland’s Regulations, including the consistency of the measure with the WTO Agreements. It will look at whether international and regional instruments governing alcohol, such as food standards and key WHO statements on alcohol, may facilitate or hinder Ireland’s efforts to introduce world leading alcohol warning labels.

Background: Close to 4 million deaths worldwide are attributable to inadequate fruit and vegetable consumption (2017). Increasing fruit and vegetable consumption is a key strategy for promoting health and environmental outcomes in food systems. However, the relative affordability of fruit and vegetables has been decreasing, in part due to the entrenched agricultural subsidy systems targeting a limited range of staple commodities at the expense of a more diverse nutritious food supply. Recognising this, the UN is calling for a ‘repurposing’ of agricultural investments to improve access to an affordable, healthy diet, including fruit and vegetables.1 This provides health advocates with an opportunity to advocate for fiscal and market incentives with potential to create meaningful shifts for nutrition within the system, cognizant of tradeoffs against other development objectives.
Methods: The aim of this paper was to develop an understanding for health advocates ways that fiscal and market incentives could be ‘repurposed’ to promote fruit and vegetables. We undertook a qualitative policy analysis, and interviewed 33 food systems stakeholders in Sri Lanka, to map the complexity of the fiscal and market incentives being used by food systems sectors, and to identify where investments are needed in order to build the production, supply and demand of fruit and vegetables.
Findings and recommendations: We found fiscal and market incentives were implemented through a myriad of policy and legislative approaches pointed towards trade and investment, revenue, consumer protection, health promotion, industry development, environmental protections, and agrarian development. We demonstrate for public health audiences how ‘repurposing’ can be designed to address deficiencies for fruit and vegetable supply chains. Health policy makers can build political acceptability by working with agricultural and other policymakers to develop an agenda that achieves multiple policy priorities and mitigates potential trade-offs.

Background and aim: The World Health Organization recommends front-of-pack nutrition labelling (FOPNL) as a ‘best-buy’ to promote healthier diets, but provides limited guidance on the form FOPNL should take. Recent innovation includes mandatory nutrient-specific warnings in the Americas and voluntary overall ratings in Europe and Australasia. Resistance to some FOPNL systems is evidenced by real or threatened legal challenges, including concerns raised at the World Trade Organization (WTO). Potential trade impacts of national labelling requirements prompted the international food standards agency, the Codex Alimentarius Commission (Codex), to negotiate guidance on FOPNL. The aim of this work was to analyse what new Codex Guidelines mean for national and regional health policymakers.

Methods: We analysed Annex 2 of Codex Guidelines on Nutrition Labelling using text of the final published Guidelines and public information on their negotiation reported by the Codex Committee on Food Labelling.

Results: Codex Member States, industry organisations, and an increasing number of public health and consumer organisations participated in the Guidelines’ development. Key provisions of the adopted Guidelines include: a broad purpose and definition of FOPNL which provides significant flexibility to select evidence-based FOPNL systems appropriate for different national and/or regional contexts; explicit recognition that FOPNL can be voluntary or mandatory in line with national legislation; a scope which suggests FOPNL should be applied on a broad range of prepackaged foods with room for national-level exclusions; and, recommendation that FOPNL be developed by government in consultation with other stakeholders, allowing room for conflict-of-interest safeguards to be applied.

Conclusions: Codex Guidelines leave policy space for a variety of best-practice, evidence-based FOPNL systems to be developed and implemented by health policymakers as contextually appropriate in their jurisdictions. Adoption of the Guidelines also provides an important reference point in the WTO and other trade forums where progressive health policymaking may be challenged.

Plastic pollution is a global crisis. The United Nations Environment Programme is developing a legally binding instrument, often known as the Plastics Treaty, to address this. This presentation examines how the proposed treaty could regulate plastic waste from tobacco products and related electronic devices, particularly cigarette filters – the most littered plastic item in the world. It highlights the environmental harms of tobacco and the importance of managing conflicts of interest to ensure public health and environmental protection are prioritised over industry interests.

The presentation analyses the options proposed by the Plastics Treaty draft to regulate plastic waste from tobacco products and related electronic devices. It examines key outcomes from the recent negotiation session, where several countries called for a ban on cigarette filters. It outlines the World Health Organization’s position on the treaty and explores how it could be aligned with the WHO Framework Convention on Tobacco Control (FCTC), particularly in light of the decision of the Tenth Session of the Conference of Parties to the FCTC on the protection of the environment from tobacco.

The text of the Plastics Treaty is expected to be settled at the final negotiation session at the end of this year. While there was no explicit country opposition to the cigarette filter ban at the last session, there is pushback against the treaty as a whole from certain industries. This highlights the need for robust conflicts of interest measures to counter industry influence that could weaken the treaty. The presentation draws on Article 5.3 of the FCTC, which protects public health policies from tobacco industry interference, and discusses how it could be applied to the Plastics Treaty context to ensure countries have control over safeguarding their citizens’ health and the environment.