At the height of the COVID pandemic in March of 2021, 25 heads of government and international agencies issued an extraordinary joint call for a “new international treaty for pandemic preparedness and response,” to protect the world from future pandemic threats. The treaty was scheduled for adoption at this year’s World Health Assembly, the decision-making body for the World Health Organization. Despite a devastating pandemic that resulted in over 20 million excess deaths, negotiations ground to a halt amid bitter political disagreements.
Yet there was a bright spot. On June 1, the final day of the assembly, nations adopted historic reforms of the International Health Regulations, which govern the international spread of infectious diseases, and extended negotiations on the pandemic treaty to May 2025 or earlier. These decisions reinforced the importance of multilateral institutions and international cooperation. Political will seemed to coalesce around a common desire for a healthier and more secure world.
Here’s why a pandemic treaty would be a win for people everywhere, in the Global North and South. Think of a pandemic treaty as a grand social bargain to protect future generations from the devastating and inequitable impacts of pandemics. The global social contract has two objectives: the open exchange of scientific information in real time, and the equitable allocation of medical countermeasures. These objectives are not opposed, but essential and interdependent. Each prong would make us all more secure, and the world fairer.
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Countries from the Global North have insisted on open and immediate access to scientific data, and for good reason. Surveillance and epidemiological information, transmitted swiftly, can contain outbreaks at their source and trigger early warning for the world to escalate preparedness and response. Pathogen samples and their genomic sequences are also the lifeblood of new diagnostics, vaccines and therapeutics. When they are shared with national research institutes, laboratories, and pharmaceutical companies, these data can speed the development of lifesaving medical products—a win-win scenario.
Without rapid and transparent scientific exchange, it could take years, not months, to develop a vaccine—potentially costing millions of lives in a pandemic. So, why have many low- and middle-income countries (LMICs) resisted obligations for open scientific sharing? The reason is that pathogen samples and sequence information are their only political leverage to gain a fair share of the fruits of such sharing, access to countermeasures like vaccines. LMICs point to the Nagoya Protocol, a treaty which requires that benefits arising from the utilization of countries’ sovereign genetic resources (including pathogens) are equitably shared. The global social contract, therefore, has a second component of equal importance: the equitable distribution of medical countermeasures.
During the COVID-19 pandemic, countermeasures reached LMICs wildly out of step with public health needs. By late 2021, high-income countries had fully vaccinated 75 percent of their populations while fewer than 2 percent in the poorest countries had received a single dose. These inequities resulted from an unevenly distributed manufacturing ecosystem concentrated in wealthy states. High-income governments prepurchased most of the world’s supply of vaccines, causing extreme global scarcity. The U.S and Europe, in particular, bypassed WHO’s COVAX initiative, which was designed to accelerate vaccine production and promote equity in vaccine distribution. Finally, powerful pharmaceutical companies strong-armed LMICs, using coercive measures and one-sided procurement contracts, leaving countries without affordable vaccines at the height of the emergency.
In treaty negotiations, high-income countries understood the need for meaningful mechanisms to advance equity but perhaps did not appreciate the level of distrust, even anger, felt by countries from the Global South after four years of pandemic injustice, undergirded by legacies of health inequity, exploitation and resource extraction. When LMICs are forced to wait for donations from rich governments and pharmaceutical companies, their experience has always been that lifesaving products come too little, too late. This led to the demand that governments and the private sector equitably share not just medical countermeasures but also the means of their production, including research and manufacturing capacity, know-how and technology. That would allow countries and regions to become self-reliant in producing countermeasures. Again, a benefit to all.
Now negotiators have another full year to forge an agreement. With elections looming in the U.S. and much of the world, there is urgency in forging a global treaty. Failure is not an option because it would unravel international cooperation, making us even more vulnerable to another, increasingly likely, pandemic.
The treaty’s most contentious, but potentially most transformative, contribution—its “heart”—is pathogen access and benefit sharing. This requires equitable exchange of scientific information and distribution of vaccines between both North and South. All would share science while manufacturers reserve 20 percent of vaccines to distribute based on worldwide public health need, better curbing the spread of disease.
Disadvantaged nations as well as global health advocates, have also called for an end-to-end ecosystem that would treat vaccines, tests and therapeutics as global public goods. Smaller pharmaceutical companies will need transfer of technologies and know-how, sustained financing, and flexibility in intellectual property rights, to make these locally.
Up to 75 percent of new and emerging infectious diseases, like SARS, mpox, Ebola and likely COVID, are caused by spillovers from animals. They cause 2.5 billion global illnesses and 2.7 million deaths each year. A deep prevention, one-health approach, which recognizes human, animal and environmental health interconnections, would limit these spillovers. Industries have opposed these measures, but by the close of the recent treaty negotiations, a path had emerged to their inclusion.
We should make this investment. Many smaller countries still face fiscal constraints limiting any new commitments made under the treaty. They need an additional $10.5 billion per year for preparedness, but have been allocated only $312.7 million from the World Bank’s Pandemic Fund, which itself remains badly underfunded. The worldwide COVID-19 mortality cost was $29.4 trillion as of January 2023. Pandemic preparedness is among the most cost-effective measures for high-income countries.
Populist leaders worldwide view international relations as a zero-sum game: “We win, you lose.” But the truth is there is mutual benefit in international cooperation, and to a strong pandemic treaty. The biggest threat to global health now is indifference, inaction and a failure to learn the lessons of the COVID pandemic. Let’s adopt a pandemic treaty and codify a global social bargain where everyone wins.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
Author’s Note: Lawrence Gostin is a member of the WHO Review Committee regarding amendments to the International Health Regulations (2005), directs the WHO Collaborating Center on National and Global Health Law and has been actively supporting WHO and the Intergovernmental Negotiating Body on the pandemic treaty.