In 2021, when excess deaths from COVID-19 reached an all-time high, countries everywhere called on the World Health Organization (WHO) to prevent another such tragedy. In the following years, those calls evolved into a comprehensive proposal to redefine the WHO’s authority and add to the International Health Regulations (IHR), a legally binding set of rules applying to all WHO members. In theory, it would give the WHO more power to reallocate medical resources, influence policy, and coordinate an international response. In reality, negotiations have already stalled.
Negotiations for the World Health Organization's pandemic treaty continued past the deadline as countries struggled to agree on key points.
Of course, passing any international agreement is no easy feat. If successful, the so-called “WHO convention” would be an extraordinary example of international compromise, as only two other global health agreements like it exist (the IHR and the Framework Convention on Tobacco Control). However, likely due to potential transgressions on national sovereignty and mistrust of the WHO over its flawed COVID-19 response, negotiations have broken down.
So What’s the Controversy About?
In 2021, wealthy nations hoarded medical supplies to the detriment of poorer ones. As a result, many lower-income nations saw more excess deaths in 2021 than in 2020, even when vaccines existed and some high-income countries had an excess of supply.
One of the most hotly debated points in the treaty seeks to address this by requiring countries to provide 20% of key medical products—vaccines, treatments, tests, and more—to the WHO during a pandemic. The hope is that such an agreement would allow the WHO to fairly distribute resources on a global scale, preventing a replay of COVID-19's darkest days.
Even though vaccines and treatments were available by 2021, COVID deaths continued to surge as poor countries struggled to secure supplies. Data source: The Economist
As expected, this part of the treaty is deeply unpopular in wealthy nations. Even if it saves lives in lower-income areas, people will still undoubtedly die in rich ones as a result. Without explicitly citing this section, the UK has already refused to sign the current treaty draft, stating that any agreement would need to be “firmly in the UK national interest.”
Some proponents of the treaty argue that disease does not respect borders, and allowing future pandemics to spread in other parts of the world could backfire for wealthy countries, especially if vaccine or drug resistance develops. On the contrary, major COVID variants that tore through the world in 2021—Alpha, Delta, Gamma, and more—appeared too early to be stopped by vaccines, and new variants continue to appear to this day despite vaccination. Unfortunately, the pandemic showed that hoarding medical supplies, while harmful to the world, may very well be in a nation’s best interest.
Another question to consider is whether rich countries follow through during an actual emergency. Yes, the agreement would technically be binding to all WHO member states, thereby covering much of the world, but nations can still leave the organization as they please. The US, arguably the most important member state of the WHO, temporarily left the organization in 2020, so what’s stopping other countries from doing the same? After all, no leader in the current negotiation has to deal with the public pressure one would likely experience during a pandemic. When bodies are actually piling up, it seems doubtful that we can rely on international collaboration.
Despite global support for the pandemic treaty, its missing backing from key players like China and the United States.
There are also concerns over the impact of the agreement on national sovereignty. In 2024, nearly every Republican governor in the United States signed a joint letter against the treaty, arguing that it granted the WHO “unprecedented and unconstitutional powers over the United States.” Their primary concerns appear to be over mechanisms for the WHO to declare public health emergencies (though the WHO has already declared such emergencies) and call on member states to censor health-related misinformation.
And it’s not just wealthy nations expressing their concern over the treaty. The most recent draft seeks to make countries share information on new outbreaks promptly. This would have an especially large impact on developing countries, where many new diseases appear due to a combination of poor health infrastructure and rising human contact with animal diseases.
Currently, many of these countries are demanding compensation for sharing information that will contribute to the development of medical countermeasures. One proposal is a subscription system where pharmaceutical companies pay for access to key data.
Given their historical disadvantage in accessing medical supplies, it’s not hard to see why developing nations would feel this way. Pharmaceutical companies are notorious for their predatory practices, and poorer countries currently lack the leverage they need to push back. Wealthier national governments are unlikely to be of much help either, given their hoarding practices during past health emergencies. Unfortunately, a successful compromise seems unlikely given how resistant Big Pharma has been to past attempts at regulation.
At this point, it’s becoming hard for these countries to see why they should share information at all, just like how wealthy countries don’t see why they should share medical supplies. This certainly wasn't helped by what happened during the COVID-19 pandemic. In 2021, when South Africa reported an oubtreak of the new Omicron variant (which was already too widespread to stop), its only reward came in the form of ineffective travel restrictions.
What Happens Now?
After 2 years of negotiation, countries failed to meet the initial deadline for finalizing the pandemic treaty on May 24, 2024. While this could deal a serious blow to our response to future outbreaks, it won't be fatal. The fact that countries everywhere are participating in negotiations at all lends hope to the possibility of global coordination.
An image from the 77th World Health Assembly, where leaders previously hoped to have a pandemic treaty ready for ratification.
Currently, the WHO believes that negotiations will conclude by 2025. Unfortunately, it seems increasingly likely that many key issues will go unsolved due to the number of competing interests involved in the talks. Since getting everyone to agree will be impossible under any circumstances, there are 3 options to proceed:
Treaty: the current form supported by negotiators. This would be the most legally binding option and requires a two-thirds majority to ratify.
Regulation: a legally binding agreement like the current IHR. This would only require a simple majority to pass, but given the IHR’s inability to contain past pandemics, this is not the most popular option.
Resolution: recommendations that are not legally binding. This also requires a simple majority and would be easiest to pass, but again does little to fight future pandemics.
Whatever the outcome, these negotiations will undoubtedly shape how we fight all health emergencies, not just pandemics. With the lessons of the last pandemic still fresh in the collective memory of humanity, now is a crucial time for leaders everywhere to compromise. Health security is as critical a global issue as any other, and ignoring it will have devastating consequences.
Comments