Additional signatures from medical, public health, and similarly aligned individuals and organizations are welcome here.
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 March 21, 2023.
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. Utpal Kumar Bhattacharya, Academic, Indian Institute of Management Indore, Indore, India
Alexandra Bookis, Policy Specialist, Washington, DC, USA
Desiree Bowman, Customer Service Representative, 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
Andean Clark, Teacher, Pasadena, CA, USA
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
Clay Compton, Bellevue, WA, USA
Marcia Condoy Truyenque, Lawyer, Animal Law in Peru, Lima, Peru
Dr. Elena Contreras, DVM, MS, PhD, Veterinarian, Northport, New York, USA
Sarah Cooper, MSc, University of Montréal, Montréal, Canada
Kathleen Corby, Nonprofit Marketer for animal welfare organizations, Pine Plains, NY, USA
Clark Curtis, Writer, Washington, NC, USA
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. Sunshine Eckstrom, DVM, Veterinarian, AVMA, AVA, Haleiwa, HI, 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. Carrie P. Freeman, PhD, Professor of Communication, George State University, Atlanta, GA, 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
Iris Ho, Head of Campaigns and Policy, Pan African Sanctuary Alliance (PASA), Chevy Chase, Maryland, 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
Jane Kotzmann, Alfred Deakin Postdoctoral Fellow, School of Law, Deakin University, Peregian Springs, Australia
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
Marsha Rakestraw, MLS, Humane Educator, Nonprofit Professional, Activist, Portland, Oregon, USA
Dr. Kavita Rajasekhar, MD MPH, Public Health Physician, New York City, NY, USA
Barbara Rebelo, Activist, Toronto Anti-Vivisection Alliance, Toronto, Ontario, Canada
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
Una Rose, Blogger, Toronto, Canada
Dr. Allen T. Rutberg, PhD, Research Associate Professor, Center for Animals and Public Policy, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
Parvez Salim, Physiotherapist, Gurgaon, India
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
Cassidy Thompson, Studio Artist, Factory Farming Awareness Coalition, Columbus, Ohio, USA
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
Dr. Brandi T. Wren, PhD, Purdue University, Colorado Springs, CO, 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. Joanna Zamiechowska, BSEE, Data Scientist, Vienna, Austria
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