Pandemic treaty is a win for multilateralism and global health

In April in Geneva, as the US withdrew from engagement in global health, member states of the World Health Organization (WHO) agreed the text of a historic new treaty for pandemic prevention, preparedness, and response.1 After three years of discussion, the agreement will be tabled for approval at the upcoming World Health Assembly (WHA).1 The agreement is a step forward for equity and global solidarity. It includes a range of new commitments that, if financed and implemented, will make the world safer from and during pandemics. It is also a powerful reminder that multilateralism is alive and well—with or without the US.2

The treaty sets out a comprehensive framework for action. It covers what needs to change now and in the future to build a stronger and more collaborative system for pandemic prevention, preparedness, and response. Although not as bold in some areas as originally hoped, it commits countries to strengthen health systems including primary care, protect health workers, improve access to publicly funded research and development, promote equitable distribution and rapid scale-up of pandemic related health product manufacturing, incentivise technology transfer, facilitate global supply chains and logistics, and strengthen regulatory systems.3 It will also be the first ever binding commitment to tackle outbreaks at their source by linking human, animal, and environmental health.

These measures, taken collectively, can futureproof countries against the actions or hegemony of any single state. They also support countries to move away from a system dependent on trust and benevolence, which was unsuccessful during the covid-19 emergency, to one promoting regional and national self-sufficiency. The measures provide a framework to build on and help tackle drivers of disease outbreaks, such as effective surveillance, risk communication and community trust, prevention of animal-human spillover, and early access to medical products, including vaccines, to prevent outbreaks before they become health emergencies.

The treaty includes an important commitment to vaccine sharing and affordable pricing, but the matter of pathogen access and benefit sharing (PABS) remains unresolved. A PABS system obligates countries to share sequence data and benefits that arise from the use of those data, such as new vaccine development. In other words, if countries give, they get something in return. South Africa’s sharing of sequence data for the omicron variant during covid-19 illustrates previous failures regarding PABS4; despite releasing sequence data, South Africa got a slap in the face when rich nations banned their travel, they received no access to the resulting vaccines,5 and, overall, they paid much higher prices than wealthier countries. The treaty contains some text on principles around PABS, but the negotiators left the details to an annex that has yet to be written and agreed, targeting WHA approval in May 2025. If approved, it becomes an integral part of the treaty.

Financing is another shortcoming. The text focuses on increasing domestic funding and mobilising additional financial resources, but the language on exactly how to do this is weak. An accountability mechanism for ensuring countries meet their commitments is also missing. Although monitoring implementation is referenced, the agreement lacks a provision for an independent compliance body, a routine practice in many international treaties.6

What happens next will be determined at the upcoming WHA. Member states will consider a resolution to approve the current text and establish the process for what follows. First on the to-do list is the WHA’s appointment of an Intergovernmental Working Group of Member States to develop and present the PABS annex for approval, with the support of an expert group.7

Once the annex is approved, the working group will begin the nuts and bolts of preparing for the first meeting of the treaty governing body. Known as the Conference of the Parties, this body comprises the member states that ratify or accede to the treaty. Preparation includes drafting procedural and financial rules, budgets, and starting to set up some of the functions. It also includes developing, with WHO, a new Global Supply Chain and Logistics Network, to facilitate timely access to pandemic related health products and a coordinating financial mechanism, to support financing for the implementation of the agreement.

Concurrently, the treaty would become “open for signature” and member states will begin their respective national processes to ratify, accept, or approve the agreement. After 60 countries complete that process, the treaty comes into force and is legally binding for those countries. Any other WHO member state can join over time.8

So, although the recent consensus on the text represents a commitment to global health and security, there is a long road ahead. First, states must agree on the PABS annex that is yet to be written. This will likely face many of the same challenges and political disagreements experienced over the past three years. Wealthy countries will be resistant to give up on anything that could threaten their pharmaceutical industry strongholds, and less wealthy countries will be hesitant to give up on access to vaccines and other medical countermeasures. Second, countries will need to start preparing to implement the treaty. That means investing in the people, laws, systems, and tools required to realise this agreement. Finally, moving forward requires financing for the process itself and work at the national level. With the current funding crisis in global health due to the US withdrawal, cutbacks in overseas development assistance from France, Germany, Norway, the UK, and other donors, and rising national debt and tariffs, it’s going to be a tough time to raise funds at global or national levels.

Even with these caveats and the heavy lifting required, the agreement is a win. The question on the next pandemic is not “if” but “when,” but, with this blueprint, countries are already more prepared.