World Nations Agree To Historic First Global Pandemic Treaty – Without The US

“The nations of the world made history in Geneva today,” Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said in a statement Wednesday, after treaty talks concluded for the final time. 

“In reaching consensus on the Pandemic Agreement, not only did they put in place a generational accord to make the world safer, they have also demonstrated that multilateralism is alive and well,” he said, “and that in our divided world, nations can still work together to find common ground, and a shared response to shared threats.”

The agreement was negotiated and accepted by all 194 of the WHO member states – with one notable exception. And yes – it is, unfortunately, precisely who you think: the US, who had until that point been a major voice in the negotiations, dropped out in January after Donald Trump announced the nation’s imminent withdrawal from the WHO.

Nevertheless, the treaty is being heralded as a landmark victory for worldwide health and wellbeing. Despite the many extensions and pitfalls along the way, “three years is a stellar speed for drafting international agreements,” Ellen ‘t Hoen, a Dutch lawyer and public health advocate, told Science this week.

This is “no small feat,” she added, “and a victory for multilateralism.”

What does the treaty include?

If the COVID-19 pandemic taught us anything, it was just how underprepared we were. Even in highly developed and rich nations like the US and UK, health workers were overwhelmed and undersupported, with those on the front line facing severe shortages in supplies for both their patients and themselves. Worldwide, mental health issues including depression, anxiety, insomnia, and even post-traumatic stress disorder shot up among health workers; in the most extreme cases, hundreds of thousands of them died protecting those under their care.

No surprise, then, that the first article to be “greened” – that is, accepted by negotiating parties on a textual basis – was one promising better protections for health workers. “It cannot be that health workers who are the front line do not have personal protective equipment,” pointed out Precious Matsoso, South African co-chair of the Intergovernmental Negotiating Body (INB) behind this week’s achievement.

Similarly controversial during the pandemic was the inequity of vaccine access. To take an example: by May 2022, enough doses of the lifesaving jabs had been administered in high- and upper-middle-income countries that they could have vaccinated their entire populations twice over; at the same point, in low-income nations, fewer than one in six people had received even a single dose. 

This issue, too, has been accounted for within the treaty. It’s not what many negotiators wanted: while most agreed on the need for greater co-operation and distribution of vaccines, drugs, and diagnostics from richer to poorer nations, many of those richer nations resisted the idea in practical terms.

“There was a point in the negotiations when there was a real feeling that some developed countries just would not accept any set-asides,” Aalisha Sahukhan, lead negotiator for Fiji, told Science. “[That] would have been devastating to the treaty itself because the inequities regarding vaccines, treatments, and drugs were just so prominent during COVID-19.”

In the final draft, however, a compromise was reached: in exchange for 10 percent of these medicines as donations, and 10 percent at “affordable prices”, poorer and developing nations would commit to greater transparency and surveillance of wildlife, agriculture, and evolving pathogens. That includes China, where COVID-19 originated, and whose initial caginess about the outbreak was widely criticized during the pandemic.

The treaty also addresses pandemic prevention, including through the WHO’s so-called “One Health” approach – an “an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems,” the Organization explains. 

Other parts include measures to “[build] geographically diverse research and development capacities; […] [mobilize] a skilled, trained and multidisciplinary national and global health emergency workforce; [set] up a coordinating financial mechanism; [take] concrete measures to strengthen preparedness, readiness and health system functions and resilience; and [establish] a global supply chain and logistics network,” per the WHO statement.

What happens next?

So far, the proposal is just that – not yet binding or even signed by member states. That’s expected to change next month, however, when it will be presented to the World Health Assembly and, if adopted, become legally binding.

Past that, though, it’s not necessarily smooth sailing. Getting all these nations to agree on the text may have been arduous – but having them put it into practice, in the absence of any enforcement mechanism, is a challenge we have yet to see play out.

What about the US?

Ah, the elephant in the room. Despite being a major influence for much of the negotiations, the United States pulled out at the 11th hour after the Trump administration entered power and announced its exit from the WHO. As such, the nation – previously the unquestioned linchpin of such negotiations – is not going to be involved in the signing or implementation of the new treaty.

It’s a blow for international health, no question – after all, “pathogens do not respect borders,” pointed out Neil Vora, a senior adviser at Conservation International and the executive director of the Preventing Pandemics at the Source Coalition. 

“If there’s any weak link in the chain, then all of us are susceptible,” he told the New York Times this week.

But for the remaining countries, the US’s absence may have been something of a blessing in disguise. “I have the distinct sense that it’s actually rallied the international community, particularly Europe,” said Lawrence Gostin, a specialist in health law and policy at Georgetown University. 

“Instead of collapsing in the face of President Trump’s assault on global health, the world came together,” Gostin told Nature.

But as only the second international agreement of this type in the WHO’s 75-year history – and the first ever without the US – the draft treaty is a “landmark” achievement regardless of one country’s non-participation, Vora told the New York Times. 

“It makes the world a safer place, and it’s a great starting point for additional action,” he said. “Because we have a lot of threats knocking at our door right now.”