When the next pandemic strikes, the world should be better prepared. At least, that’s the promise states made at the World Health Organization’s (WHO) World Health Assembly on 19 May when they adopted the first global pandemic treaty. This milestone in international health cooperation emerged from three years of difficult negotiations, informed by the harsh lessons learned from COVID-19’s devastating global impacts.

Yet this victory for multilateralism comes at a deeply difficult moment. The WHO, as the organisation tasked with implementing the agreement, faces its starkest ever financial crisis following the withdrawal of the USA, its biggest donor. Meanwhile, disagreements between states threaten to undermine the treaty’s aspirations. Some of the big decisions that would make the experience of the next pandemic a more equitable one for the world’s majority are still to be negotiated.

A treaty born from COVID-19’s failures

Processes to negotiate the Pandemic Agreement came as a response to the disjointed international reaction to the COVID-19 pandemic. When the virus spread across borders, global north countries hoarded vaccines for their populations while much of the world remained unprotected – an approach that as well as being manifestly unfair enabled the virus to further mutate. The treaty’s text emphasises the need for proper pandemic prevention, preparedness and response in all states, with the potential to enhance multilateral cooperation during health crises.

With 124 countries voting in favour, 11 abstaining and none voting against, many diplomats presented the agreement’s finalisation as a victory for global cooperation. It comes at a time when multilateralism is being severely tested, with powerful governments tearing up international rules, pulling out of international bodies and slashing funding.

Given this, the window of opportunity to reach some kind of agreement was rapidly closing. Support for a pandemic treaty was greatest in the immediate aftermath of the COVID-19 emergency. But as the years have gone on, the lessons of that pandemic have begun to be forgotten. Many have wanted to move on and put the pandemic behind them, and governments have refocused on other issues.

In some countries, disinformation campaigns have led to the election of governments opposed to vaccines. Such has been the case in Slovakia, where the nationalist government of Robert Fico recently suspended COVID-19 vaccinations following a state-commissioned report that drew from conspiracy theories about mRNA vaccines. The government has challenged the treaty’s legitimacy and was among those that abstained in the final vote.

A major absence also loomed large over the final negotiations. Upon his inauguration in January, President Trump announced the USA would withdraw from the WHO and halt all funding.

The withdrawal of a superpower like the USA harms the legitimacy of the WHO, an organisation it helped found and had consistently financially supported. It also sends a signal to other populist governments that withdrawal is an option. Trump’s Health Secretary, Robert F Kennedy Jr, a long-running opponent of vaccines, spoke via video link during the World Health Assembly to call on other governments to leave.

Some may follow suit. Argentina, under the far-right leadership of President Javier Milei, announced its withdrawal in February. Argentinian civil society groups have campaigned against the move, but the government reiterated its position when Kennedy visited Argentina in May. Hungary is also considering quitting the WHO.

Funding crisis

US withdrawal will leave an enormous funding gap. In the pre-Trump era, the USA was the WHO’s biggest contributor: it provided US$1.28 billion for its 2022-2023 budget, including US$218 million in assessed contributions, US$1.02 billion in voluntary contributions and US$47 million towards a contingency fund for emergencies. This amounted to 12 per cent of the WHO’s approved budget and roughly 15 per cent of its actual budget.

As the treaty was agreed, WHO Director-General Tedros Adhanom Ghebreyesus painted a disturbing picture of the organisation’s financial situation. Its 2022-2023 budget showed a US$2 billion shortfall and its current salary gap is over US$500 million. On top of US withdrawal, the WHO’s longstanding reliance on voluntary funding from a small group of donors makes it vulnerable at a time when global health has become less of a political priority.

The proposed budget for 2026-2027 has already been slashed by 21 per cent, even after states agreed at the World Health Assembly to raise their mandatory contributions by 20 per cent, and this reduced budget is expected to receive only around 60 per cent of the funding needed. The WHO will likely have to cut staff and close offices in many countries, which can only restrict the reach and impact of its work.

These challenges reflect a lack of political will: states are making the choice of cutting down on global cooperation while boosting their defence spending. The current WHO funding gap of US$2.1 billion is the equivalent of just eight hours of global military expenditure.

Big issues kicked down the road

Deteriorating political realities made it crucial to reach an agreement as soon as possible, even if this meant kicking some difficult decisions down the road. After a negotiation process that cost over US$200 million, the Pandemic Agreement is left with severe weaknesses. Its final text contains more rhetoric and aspirational language than tangible obligations.

The treaty lacks dedicated funding and robust enforcement mechanisms, which means the blatant inequalities that defined the global response to COVID-19 are likely to remain unconfronted. It doesn’t tackle the most critical and contested issues, including the international sharing of pathogens and vaccine access.

The treaty will take effect only following the negotiation of an annex on a pathogen access and benefit-sharing system, a process that could take a further two years. Negotiations over how states will share tests, vaccines, treatments and associated technologies are only beginning. Once the annex is ready, the treaty will open for ratification, and it will only enter into force when it’s been ratified by at least 60 states. This means actual implementation is likely still a long way away.

The current impasse reflects an enduring faultline between global south states that need better access to affordable health products and technologies, and global north states siding with powerful pharmaceutical corporations that want their assets protected, even when data from the global south has been used to develop them. Wealthy governments are making their decisions safe in the knowledge they’ll be at the front of the line when the next pandemic starts, while the world’s poorest people will again face the brunt of the devastation.

Political will needed

The Pandemic Agreement is a step forward at a time when international cooperation faces increasing attacks. That 124 countries demonstrated their commitment to multilateral action on global health threats offers hope. But substantial work remains if the treaty is to enable a truly global and fair response to the next health crisis.

For that to happen, the world’s wealthiest states need to put narrow self-interest calculations aside and commit to sharing their privilege with the rest of the world. States also need to address the issue of long-term funding. Right now, global leaders have agreed on the need for coordinated pandemic preparedness, but the institution meant to lead this doesn’t have the resources needed to put goals into action.

The next pandemic will test not just scientific capabilities, but also collective commitment to the shared global values the treaty is supposed to represent. Political will and funding are needed to turn lofty aspirations into meaningful action.

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