# Key Takeaways - The PIP Framework has two distinct parts: (1) The main body sets out nonbinding member state commitments ,and directions to the WHO's D-G and Secretariat; and (2) the annexes incorporate the standard material transfer agreement (SMTA) (annexes 1, 2) as well as terms of reference for the advisory group (annex 3), existing and future WHO GISRIS laboratories (annex 4), and WHO collaborating centers for influenza (annex 5). - PIP Framework is interesting because there is [[public private partnership]]. Private companies who received samples, must make monetary contributions to the WHO. - PIP Framework has a sustainable financing mechanism requiring companies using [[GISRS]] to make an annual partnership contribution, with the funds used to improve influenza preparedness and response-for example, disease burden studies, laboratory and surveillance capacity, access, and effective deployment (art. 6 (14)). ==The annual contributions must be equivalent to 50 percent of GISRS running costs==, with the advisory group determining the breakdown between private contributors. - In May 2013 the WHO released adistribution of partnership agreement among companies. > [!NOTE] Standard Material Transfer Agreement (SMTA) 2 Benefit-Sharing Commitments > The SMTA 2 requires companies to select two commitments from six benefit-sharing options in the model contract: (1) donating at least 10 percent of pandemic vaccine production to the WHO; (2) reserving at least 10 percent of pandemic vaccine production at affordable prices for the WHO; (3) donating a predetermined, but unspecified, minimum number of antiviral courses to the WHO; (4) reserving a predetermined, but yet unspecified, minimum number of antiviral courses at affordable prices to the WHO; (5) granting licenses to manufacturers in developing countries on mutually agreed, fair terms (including affordable royalties) on technology, know-how, product, and processes under patent; (6) granting royalty-free, nonexclusive licenses to industry or the WHO for pandemic influenza vaccines, adjuvants, antivirals, and diagnostics, with the WHO permitted to sublicense them to developing country manufacturers. “but what incentives do companies have to sign SMTAs? Industry's main 'incentive is not so much related to pandemic influenza (which occurs irregularly), but to ensuring the sustainability of the global surveillance system that is necessary for producing seasonal vaccines that generate consistent profits.” (Gostin, 2014, p. 377) “By the May 2013 World Health Assembly, two years after the PIP Framework's adoption, only one vaccine manufacturer had signed an SMTA 2. Negotiations with other manufacturers are ongoing, but until SMTAs are signed, GISRS labs will continue to fulfill requests for biological materials with the understanding that recipients will discuss SMTAs going forward.43 To ensure success of the PIP Framework, the WHO will have to speed up implementation and ensure transparency regarding funding and distribution of vaccines.” (Gostin, 2014, p. 377) # Global Health Justice: The Imperative of Innovative Governance “Although states would deploy public health countermeasures, only an effective vaccine could avoid an ensuing global catastrophe. The most likely outcome would be that affluent countries in the global North would gain access to the vaccine, while the global South had to wait. The reason this scenario isrealistic is that most vaccine producers do business in Europe, North America, and Australia.” (Gostin, 2014, p. 380) “An influenza pandemic, therefore, raises a critical problem of [[distributive justice]]-how to fairly allocate scarce life-saving resources. Extant [[global health governance]] is inadequate: the PIP Framework was never intended as arobust redistributive mechanism, but rather as adiplomatic resolution of apolitical impasse.” (Gostin, 2014, p. 381) [[If the vaccine pool were viable, the advantages of global health security would far exceed the economic costs]]. Although it may appear counterintuitive, powerful countries would have a vested interest in negotiating an equity scheme. Imagine the geopolitical ramifications of apandemic that divided the world. The blatant injustices of a pandemic could thwart international relations on matters of vital concern-for example, arms control, climate change, and trade. Whether the venue is the G-7 or the United Nations, the traditional powers rely on cooperative relations with emerging economies. For their part, [[vaccine companies have an interest in correcting market failures to ensure a more stable demand for vaccines]]. The mutual interests shared, among stakeholders could create a pathway for advancing global health justice. The question then becomes whether stakeholders will recognize their enlightened self-interest and act decisively before the next pandemic, or whether they will take their chances in the ongoing battle between nature and science.