What happened?
On 16 April, member states at the World Health Organization (WHO) concluded negotiations on a pandemic treaty, an international, legally binding agreement to coordinate pandemic prevention, preparedness and response.
The ‘WHO Pandemic Agreement’ was drafted and negotiated in response to the onset of the Covid-19 pandemic, which began in early 2020 and directly led to over seven million deaths globally, although this is likely an underestimate of the actual death toll.
The negotiations began in December 2021 and included thirteen rounds of formal meetings alongside informal meetings between the rounds on specific aspects of the draft agreement. The draft agreement will be voted on this month at the World Health Assembly, which serves as the legislative, decision-making body of the WHO.
The Pandemic Agreement is only the second treaty negotiated on an international public health issue under the auspices of the WHO, the first being the Framework Convention on Tobacco Control which came into force in 2005.
“The nations of the world made history in Geneva today,” said Dr Tedros Adhanom Ghebreyesus, the top WHO official said following the conclusion of negotiations. “In reaching consensus on the Pandemic Agreement, not only did they put in place a generational accord to make the world safer, they have also demonstrated that multilateralism is alive and well, and that in our divided world, nations can still work together to find common ground, and a shared response to shared threats.”
Why does it matter?
The Covid-19 pandemic brought into stark view the gaps in global pandemic prevention, preparedness, and coordination. In the first months of the pandemic, shortages led to prices of personal protective equipment (PPE) doubling or tripling with countries competing for supply on the open market. Vaccine distribution was unequal between countries—for instance Africa administering only 3 percent of total vaccines despite having over 17 percent of global population—as high-income countries stockpiled vaccines for booster doses.
The Pandemic Agreement was negotiated as a “once-in-a-generation” opportunity to address the inequalities seen during the Covid-19 pandemic by improving global access to technologies like vaccines and personal protective equipment, alongside information and expertise sharing.
Professor Alan Bernstein, Director of Oxford Global Health, described the treaty as a “gamechanger”. “For the first time, there’s a legally binding framework to help the world prevent, prepare for, and respond to future public health emergencies.”
Professor Bernstein told The Oxford Blue that the agreement facilitates “faster data sharing on emerging pathogens, equitable access to vaccines, treatments and diagnostics, and a more coordinated response to shared threats”.
“At its core is the Pathogen Access and Benefit-Sharing System (PABS), which commits countries to provide 10 percent of pandemic-related tools to the WHO, with another 10 percent made available at ‘affordable prices’. This mechanism is vital for ensuring that low-income countries have timely access to vaccines, treatments and diagnostics.”
Other provisions of the treaty include the creation of a global supply chain and logistics network for the procurement and stockpiling of pandemic-related health products and to support the creation of production facilities for these products in developing countries to ensure geographically diverse supply.
“Crucially, the treaty promotes countries’ autonomy for collective security – each nation retains control over how it fulfils its obligations while contributing to global health resilience,” Professor Bernstein added.
“The challenge now is turning this shared vision into concrete action.”
What next?
While the Pandemic Agreement, described in an editorial by scientific journal Nature as a “triumph in a world being torn apart”, is a significant milestone in international public health, certain provisions have been viewed as not ambitious enough.
An editorial in medical journal Lancet described the PABS commitment of 20 percent as “shameful and unjust”. “[Twenty percent] is better than nothing, but it does not equate to a truly equitable and just approach. COVID-19 saw a handful of high-income countries hoard vaccine doses acquired through bilateral deals with manufacturers. This situation not only undermined the WHO-led COVAX initiative, but also contributed to mortality and morbidity in the many countries that relied heavily on inadequate donations.”
The editorial also criticized the lack of independent monitoring and enforcement mechanisms as the agreement text gives countries responsibility for monitoring their own pandemic preparedness.
“There are no clear consequences for countries that fail to comply with the terms. These issues risk selective adherence, undermining the effectiveness and fairness of the agreement.”
The United States will not be signatory to the treaty following U.S. President Donald Trump initiating the withdrawal of the country from WHO. The U.S. was the organization’s largest financial contributor and is also a major player in infectious disease monitoring and research, as the home to the Centers for Disease Control and Prevention (CDC) and large vaccine manufacturers like Pfizer and Moderna.
While the U.S.’s withdrawal weakens the coverage of the treaty, statements by countries and non-governmental groups following the negotiations were largely optimistic. Speaking to Reuters, Nina Schwalbe, the founder of global health think tank Spark Street Advisors, said: “This is a historic moment and a show, that with or without the U.S., countries are committed to working together and to the power of multilateralism.”