After three years of contentious negotiations, the member nations of the World Health Organization have agreed on a draft of a “pandemic treaty” designed to help the global community better prevent and respond to health crises.
The agreement is aimed at averting the fractious, faltering response to the Covid-19 pandemic, which left many poor nations with limited access to vaccines and treatments. It would oblige wealthy nations to share key information on pathogens, and technology for interventions such as vaccines, with the rest of the world.
The member states are expected to adopt the treaty, which will be legally binding, next month. The United States, which stopped participating in negotiations after President Trump announced plans to withdraw from the W.H.O., is not expected to ratify the treaty.
The draft treaty is more limited in scope than the vision the W.H.O. first proposed during the throes of the Covid pandemic, but it is significant as the first major multilateral agreement in a world where the United States is no longer the unquestioned anchor.
“It shows that with or without the U.S., the world can pull together for global health, and a recognition that pandemics require global solidarity,” said Nina Schwalbe, a global health consultant who has held leadership roles in U.S. and international organizations and who followed the negotiations closely. “They pushed past their red lines and they got to agreement. That’s no easy feat for 191 states. And there’s a lot in there. It’s maybe not as strong as we wanted on many issues, but there’s lots to build on.”
In December 2021, the W.H.O. convened a group of negotiators to hammer out the terms of a new global agreement that it hoped would help countries respond more swiftly and effectively to future health threats.
Negotiations were slow and difficult and often derailed by national interests. High-income countries were averse to firm language on sharing diagnostics, treatments and other technologies, and developing countries were reluctant to take on new obligations that did not come with additional resources.
European nations with large pharmaceutical and biotechnology industries — along with the United States, when it was participating in the talks under the Biden administration — in particular resisted the language on sharing technology and intellectual property. To reach the final deal, Europe accepted concessions on that language, while African countries gave Europe more of what it wanted on agricultural and wildlife surveillance.
Brazil was crucial in brokering an 11th-hour agreement between the Group of 7 nations, led by Germany, and blocs of developing countries that were often in opposition, especially over what they saw as equity issues.
China was a largely silent participant in the negotiations, participants said, aligned with the bloc demanding greater equity but not advancing major agenda items. Under the terms of the accord, China would be compelled to be more forthcoming about an outbreak than it was about the coronavirus in the early days of the pandemic.
The draft treaty includes a provision guaranteeing that countries that share pathogen samples and genetic sequences will get access to any diagnostics, vaccines or treatments that are developed as a result. The W.H.O. would receive a minimum of 10 percent of manufacturers’ products as they are made, as a donation, and up to another 10 percent at “affordable prices,” to distribute to the world’s poorest countries.
The draft treaty does not have any enforcement mechanism, which means that in a situation like the fierce competition for Covid vaccines, there would be no way to ensure countries adhere to the terms to which they had agreed.
But in a time of multiplying infectious disease threats — including avian influenza, mpox and Marburg virus — some public health experts said that the treaty was groundbreaking, in part because it takes a holistic view of epidemics, addressing not only how to respond to new outbreaks but also the steps to prevent them in the first place.
For instance, the treaty requires member nations to develop their own pandemic prevention and surveillance plans. As part of those plans, the treaty says, countries should identify circumstances under which pathogens might jump from animals into humans, a phenomenon known as spillover, and take actions to reduce that risk.
“This agreement, if adopted next month, would be the first binding international agreement toward spillover prevention,” said Dr. Neil Vora, a senior adviser at Conservation International and the executive director of the Preventing Pandemics at the Source Coalition. “And that is urgently needed and represents a leap forward.”
Some nations initially balked at some of these pandemic prevention obligations, viewing them as onerous and expensive, said Alexandra Finch, a senior associate at the O’Neill Institute for National and Global Health Law at Georgetown University.
The lack of a dedicated source of funding in the treaty to help countries pay for this work emerged as an early sticking point, Ms. Finch said. But the final language says nations will embark upon this work “subject to the availability of resources.”
“I did wish that there was a dedicated funding line for prevention,” Ms. Finch said. “Countries could have been a bit more comfortable being more ambitious.”
Another contentious issue was the language on technologies, such as vaccines, that are developed with public funding. Countries will be required to develop national policies for putting public-interest conditions on research and development funding, given to either universities or companies, that guarantee “timely and equitable access” to resulting drugs or diagnostics during pandemics.
Such conditions could include publishing clinical trial results; allowing other companies to manufacture the products, regardless of patents; and capping prices, said Michelle Childs, policy advocacy director for the nonprofit drug development agency DNDi, who was in Geneva during the talks to provide suggestions to negotiators. Those measures could help avoid what happened during the Covid pandemic, when the Biden administration could not compel vaccine makers to share information on products they had developed relying heavily on government-funded research.
Deisy Ventura, a professor of global health ethics at the University of São Paulo, said that finalizing the treaty without the direct involvement of the United States helped create space for an important shift in thinking about pandemic response. She described the U.S. perspective as a primarily biomedical approach focused on how to keep pathogens from entering the country’s borders.
“Surveillance systems that keep diseases where they originate — that’s not a vision of global health that is about eradicating diseases or changing the social conditions that allow them to emerge,” she said.
The agreement is “very far from what we were dreaming of” when negotiations began, “that we will have joint, multilateral coordination and that national selfishness will be overcome,” Dr. Ventura said. But, she added, it nevertheless has huge symbolic value.
“It is an indispensable political gesture: 191 countries that are affirming the possibility of building multilateralism without depending on the United States,” she said. “The agreement is less important than the fact that the negotiations did not fail.”
Ms. Schwalbe said the agreement still had value without U.S. participation even though the United States led the world in developing the Covid vaccines that helped end that pandemic.
“We got spoiled thinking that a vaccine was going to be the answer to the next pandemic, and that’s not a given,” she said. “But in terms of preventing spillover with animals, protecting the work force better, there’s so many things that can be done right now that will better prepare the world. And the U.S., the only thing that we’re going to lose is us being not as prepared.”
The absence of the United States was unfortunate, Dr. Vora said. “Pathogens do not respect borders,” he said. “If there’s any weak link in the chain, then all of us are susceptible.”
But, Dr. Vora added, the absence of one country should not detract from a “landmark” achievement. “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.”
