At the height of the Covid-19 pandemic, 25 heads of government issued an extraordinary call for a new international treaty for preventing, preparing for, and responding to pandemics. For two years, World Health Organization member states have been negotiating an international agreement scheduled for adoption at the World Health Assembly this month. Yet, late Friday in Geneva, negotiations ground to a halt. While most of the draft treaty text was “greened,” meaning accepted by the parties, member states failed to reach consensus on critical issues.
With the World Health Assembly starting Monday, negotiators simply ran out of time to agree on the most contentious issues. As negotiations closed, WHO Director-General Tedros Adhanom Ghebreyesus said, “My wish is that we will come out of the Health Assembly re-energized and inspired, because the world still needs a pandemic treaty and the world needs to be prepared. … This is not a failure.”
This week the World Health Assembly must extend the mandate to continue negotiating a pandemic agreement. We urge political leaders to set a firm deadline, either a special session of the assembly in December or a finalization the treaty in May 2025.
The world urgently needs global rules for reducing the risk of another pandemic, whether from H5N1 or another threat. To prevent such a disaster, we need international law for exchanging scientific information in real time, equitably distributing drugs and vaccines, building global manufacturing capacity, and rebuilding trust between countries. Advances in technologies — like synthetic biology powered by artificial intelligence — risk enabling a wide range of nefarious actors to create and potentially enhance novel pathogens.
The next pandemic may be closer than we realize and extending the negotiations — whether six or 12 months — requires a careful balance between sufficient additional time to reach consensus and having a prepared international community.
Prevention and One Health
Prevention of novel outbreaks is key to avoiding the next crisis. Since an estimated 60%-75% of new or emerging infectious diseases are zoonotic in origin, we must address animal health threats before they can spill over to become human health threats. In new research just published, biodiversity loss, climate change, and chemical pollution were found to all contribute to disease emergence. A “One Health” approach recognizes the intersections between animal health, human health, and the environment. Global regulation of land use and deforestation, trade in wild animals, intensive farming and the overuse of antibiotics in farmed animals, and wet markets (which likely originated Covid-19) could all help prevent zoonotic spillovers. Protecting dairy farmers, for example, could help prevent a wider human outbreak of H5N1 influenza. While One Health has been deeply contested by delegates, by the close of talks significant paths forward were in sight, including negotiation of an annex to the treaty on prevention and One Health.
Rapid access to pathogen samples and sequences
When an outbreak does occur, countries must share scientific information in real time to prevent spread and develop lifesaving vaccines and drugs. China, for example, failed to rapidly share information with WHO early in the Covid-19 pandemic. Beyond epidemiologic data, countries must rapidly and comprehensively share pathogen samples and their associated genetic sequence data. These are necessary for detecting outbreaks, tracking their spread, and used for the development of diagnostics, therapeutics, and vaccines. Despite this, the international legal system does not require this sharing, and arguably disincentivizes scientific exchange. Every country would benefit from strong international rules for rapid access to pathogen samples and sequences.
Equitably share benefits
Rules mandating access to pathogens must also be accompanied by binding obligations to equitably share the benefits. If there were a single message sent by low- and middle-income countries over two years of negotiations, it is that rich countries and industry exploit pathogen samples and sequences by developing lifesaving products and then hoarding them. Ensuring that medical countermeasures are equitably distributed based on public health risk, need, and demand is critical for stopping epidemics before they become pandemics and preventing the emergence of dangerous variants.
Rules for sharing benefits equitably also ensure consistency with international law, such as the Nagoya Protocol, crafted to address the historical and ongoing inequitable exploitation of genetic resources. Guaranteeing vaccine equity would rebuild the trust between the Global North and South that was shattered during Covid-19, and in turn, enhance cooperation to prevent and deter outbreaks in the future. A recent proposal was the development of a separate legal instrument that would cover a Pathogen Access and Benefits Sharing (PABS) system, to be negotiated over a two-year time frame. In extending the pandemic agreement negotiations, it’s important that member states don’t lose the urgency of developing the PABS system by pushing it even further down the road.
Build global vaccine capabilities
Pathogen access and benefits-sharing is only one aspect of vaccine equity. Only 1% of Covid-19 vaccine doses were delivered to low-income countries in the year after they were available in high-income countries, perpetuated by the concentration of manufacturing capacity in the Global North and the pre-purchasing global vaccine supply. There are clear solutions, such as ensuring financial resources to build regional research and manufacturing facilities, securing supply chains, and transferring the technology necessary for producing medical products. All of these are highly contested terrain in pandemic agreement drafts.
Rebuild global trust
Rebuilding trust between countries is essential to global health security. Without trust, countries won’t report outbreaks promptly, and they won’t freely exchange epidemiologic information, virus samples, and sequencing data. The pandemic agreement, like climate treaties, should create an independent Conference of Parties (COP) that would monitor and facilitate compliance, hold governments to account, and create new forms of regulation to fortify global health security. Politically, an empowered COP could raise public and political awareness of pandemic threats.
Improving the negotiation process
If negotiations are extended, member states should consider altering the processes and format of negotiations to improve the chances of agreement. This should include allowing parallel negotiations and informal processes to facilitate progress on outstanding issues. The negotiations should also be more transparent, enabling civil society and academia to observe proceedings and assist with technical and legal challenges. This would also facilitate the public’s observation of the process, addressing misunderstandings about the treaty and building trust in the process and the treaty itself.
A little over two years ago and guided by the principle of solidarity, member states agreed to start negotiations, emphasizing the need to address critical gaps in pandemic prevention, preparedness, and response, prioritizing the need for equity. Substantial time and financial resources have been expended in negotiations. With elections in more than 64 countries worldwide this year, including in the United States, time is of the essence. For all those who we lost to the pandemic, and to save lives in the next pandemic, it’s past time to create a safer and fairer world for ourselves and our children.
Alexandra L. Phelan is an associate professor and senior scholar at the Johns Hopkins Center for Health Security and faculty director (policy) at the Johns Hopkins Institute for Planetary Health. Lawrence O. Gostin is Distinguished Professor of Global Health Law at the O’Neill Institute, Georgetown University Law Center, and director of the WHO Center on Global Health Law. His book “Global Health Security: A Blueprint for the Future” is published by Harvard University Press (2021).
Disclosure: Gostin has supported WHO in the drafting and negotiating of the pandemic agreement and is a member of the WHO International Review Committee on the International Health Regulations. Phelan has been involved in the negotiations as a relevant stakeholder and informally advising member states on the pandemic agreement.