Share Twitter Facebook Email Copy URL

For the past two years, members of the World Health Organization (WHO) have been embroiled in negotiations aimed at crafting an international agreement to better prepare for and respond to future pandemics. However, progress has been sluggish, with discussions hitting an impasse. The crux of the deadlock lies in conflicting priorities between the Global North, which emphasizes safeguarding its own health security and industries, and the Global South, advocating for equitable access to health products, expanding local manufacturing capabilities in the Global South, and solidarity in pandemic prevention and response efforts. Consequently, the May 2024 deadline for signing a pandemic treaty was not met. At the 77^th World Health Assembly (WHA77), member states decided to extend negotiations for a year. On the one hand, this raises concerns about the WHO’s ability to secure global preparedness for future pandemics. On the other hand, it also means WHA77 avoided the trap of adopting a treaty text that lacks legally binding obligations to operationalise equity and solidarity.     

The WHO’s Struggle for Independence and Effective Leadership

The WHO, a United Nations specialized agency responsible for people’s health worldwide, faces a precarious struggle for sovereignty amidst mounting challenges, despite past successes like eradicating smallpox and championing community-based primary health care. Encroachment of neoliberal economics, and the agenda-shaping influence of transnational corporations, charitable foundations, and powerful nations pose threats to its autonomy. Decades of severe budget constraints and reliance on external funding or voluntary member contributions compromise decision-making and program prioritization. The constraints led to richer nations and powerful donors influencing many of the WHO’s agendas and policies. Growing collaborative efforts with institutions like the World Bank have often prioritized profit-driven healthcare models and further strengthened the WHO’s relationship with health industries, over the WHO’s original vision of social medicine and equitable health access, exacerbating global health disparities. Civil societies and community health groups as well as academic groups, particularly those representing people from the Global South, are increasingly sidelined in the WHO’s agenda setting and policymaking because they can’t compete with the capacity and resources industry-backed groups have. The same also happens to small and less powerful countries. The WHO struggles to assert its independence and fulfill its mandate, raising concerns about ensuring health for all amid growing external pressures and alternative global health initiatives. The growing geopolitical complexities complicate the WHO’s efforts to reach a consensus in global health policymaking.

The WHO Amidst Political Turmoil and Vaccine Inequity

The WHO’s struggles to assert authority and meet its obligations became apparent throughout the COVID-19 pandemic. Despite advocating for swift preparedness and response after China’s lockdown of Wuhan, skepticism emerged due to concerns about the agency’s perceived pro-China bias, fueled by China’s increased contributions to the WHO in recent years, even though these contributions are relatively small compared to those of major contributors like the USA and wealthy nations such as Germany. Consequently, COVID-19 spread unchecked worldwide as the WHO and member countries became embroiled in political blame games. At the heart of this issue lies a crisis of trust in the institution.

When COVID-19 vaccines were developed successfully, the WHO initiated efforts to address global needs for health products. ACT-A (Access to COVID-19 Tools Accelerator) aimed to accelerate the development, production, and fair distribution of COVID-19 tests, treatments, and vaccines worldwide. COVAX, part of ACT-A, focused on equitable vaccine access by pooling resources for fair distribution, especially to low- and middle-income countries. ACT-A and COVAX faced several challenges that hindered their success. One major issue was vaccine nationalism, where wealthier countries prioritized their own populations over global equity, leading to hoarding of doses. The WHO struggled to leverage its authority and influence over its member states to ensure equitable distribution of vaccines to address the pandemic effectively.

The Emergence of the Pandemic Treaty and Amendments to the International Health Regulations

In response to numerous failures and unpreparedness in dealing with Covid-19, European Union (EU) leaders convened in February 2021. They concluded that global multilateral cooperation was essential to address present and future health threats, leading to the proposal for an international treaty on pandemics. This agenda gained momentum by mid-2021, championed by the WHO Secretariat and Group of 20 (G20), and was subsequently approved in a rare special session of the World Health Assembly (WHA) in December 2021. An Intergovernmental Negotiating Body (INB) was then established to draft and negotiate the international agreement, famously known as the pandemic treaty.

The commencement of negotiations for the pandemic treaty caught many off guard, as many countries, especially in the Global South, were still grappling with Covid-19 and the lack of widespread vaccine distribution. Much of civil society remained unaware of these discussions until the special session of WHA, and many organisations at the time were focused on securing a TRIPS waiver for Covid-19 tests, treatments and vaccines. Those who were aware questioned the need for a pandemic treaty and its timing. Typically, before forming an internationally binding treaty, many discussions would take place, considering reports from academic and civil society communities, and reasoning behind the treaty’s necessity. However, in the case of the pandemic treaty, the reasoning was unclear, and there was no room for discussion. What’s evident is the push for an international agreement on pandemics, as if it was a panacea for all future pandemics.

Resistance emerged, with arguments suggesting that health emergencies could be managed through global solidarity and by adhering to and enhancing the existing International Health Regulations (IHR) 2005, an internationally binding legal framework for health emergencies preparedness and response. Concerns were raised about punitive measures, such as region-wide travel bans imposed by wealthy countries in response to South Africa’s report of a new Omicron strain. Consequently, it was decided to negotiate an amendment to the IHR 2005 led by a special working group alongside the discussions for the pandemic treaty.

Navigating Tight Timelines and Equity Concerns: Struggles in Crafting the Pandemic Treaty

The tight 2-year deadline for negotiating the pandemic treaty and amending the IHR aimed for drafts by April 2024, ready for approval at the 77th WHA in May 2024. Many doubted the feasibility of negotiating such a treaty within this timeframe, given the complexity and diverse national interests involved. The Framework Convention on Tobacco Control (FCTC), for instance, took 10 years to negotiate and approve, highlighting the usual duration for international agreements. This rushed process strained country delegates and civil societies, particularly from smaller and poorer nations, who juggled multiple negotiations in Geneva with limited capacity and decreasing civil society involvement in closed sessions. This marginalized critical inputs for drafting texts, leaving under-capacity countries unsupported. With marginalization of critical civil society voices and the emphasis on “time is very short,” Global South countries are effectively coerced into conforming to the timeline set by more powerful nations and compromising on their actual needs.

Until early 2024, the INB process lacked substantive negotiations. Countries failed to agree on a negotiating text or engage in line-by-line discussions. Despite various draft texts proposed by the INB Bureau, none were adopted as negotiation bases. Informal working groups met between formal INB meetings, but Global South countries’ pro-equity proposals often went unincorporated into official documentation, despite consensus in their working groups.

Some pro-equity proposals included:

• recognizes the principle of common but differentiated responsibilities (CBDR), acknowledging varying state capacities in pandemic response. All countries share a moral duty for basic outbreak prevention, with more advanced economies expected to finance a larger share;
• explicitly protects countries from retaliation for adopting Trade-Related Aspects of Intellectual Property Rights (TRIPS) measures during pandemics and automatically suspends IP rights that hinder health product access;
• establishes a pathogen access and benefit-sharing (PABS) system to ensure countries sharing pandemic-causing pathogens can access resulting health products;
• establishes new financing mechanisms to aid developing countries in meeting treaty obligations; and
• institutionalizes technology transfer to boost pharmaceutical manufacturing in the Global South.

These proposals aim to empower Global South countries during pandemics, moving beyond charity-based interventions like COVAX and bilateral donations that often leave them with inadequate health product access and little control over implementation.

WHO’s Path to Equitable Pandemic Preparedness

The WHO’s ongoing negotiations for an international pandemic treaty highlight a deep divide between the Global North’s focus on health security and industrial interests, and the Global South’s push for equitable access to health products and strengthened local manufacturing. The extension of negotiations beyond the May 2024 deadline at WHA77 reflects these tensions and underscores the WHO’s struggle for independence amid external pressures and funding constraints.

While recent amendments to the IHR at WHA77 represent progress in recognizing access to health products and promoting international cooperation during health emergencies, meaningful advancements hinge on implementing a functional PABS system, facilitating workable technology transfer, and a secure and accountable information-sharing mechanisms. Member states must prioritize unity to prevent fragmentation in international health emergency laws, such as dividing the pandemic instrument into separate entities like a PABS instrument and a One Health instrument.

Moving forward, a comprehensive approach that fosters inclusivity among nations and civil societies is essential for the WHO to effectively address future global health emergencies and uphold its mandate to ensure health equity worldwide.

Dian Maria Blandina is a member of Geneva Global Health Hub (G2H2) Steering Committee for the People's Health Movement and a PhD researcher at the Aristotle University of Thessaloniki.
Lauren Paremoer is the Steering Council Representative for the Democratising Global Health Governance Programme of People's Health Movement and a Senior Lecturer in Political Studies at the University of Cape Town.
More about Global Health Governance at People's Health Movement