It’s been five years since the World Health Organization (WHO) declared COVID-19 to be a global pandemic. The virus killed over seven million people, contributed to at least twice as many deaths and wreaked economic, political and social havoc that societies haven’t recovered from. Despite this devastating experience, the international community has so far failed to establish an effective framework for pandemic prevention and response.

Negotiations on the WHO’s proposed pandemic treaty, which is supposed to be agreed this year, remain stalled. This lack of progress comes at a critical time when experts warn that the next global health crisis is a matter of when rather than if. There’s an estimated 25 per cent chance of an outbreak of a magnitude similar to COVID-19 happening in the next 10 years, rising to a 50 per cent chance within 25 years.

The dangers are growing. Diseases now spread more easily due to the growing global movement of goods and people while the risks of transmission from animals to humans are increased by climate change, environmental destruction and population growth. Yet international cooperation remains lacking. Civil society is urging states to rise to the occasion and step up the negotiations.

The case for a global treaty

The absence of international frameworks for cooperation led to a fragmented global response to COVID-19, characterised by vaccine nationalism, hoarding of medical supplies and uncoordinated travel restrictions. The pandemic brutally exposed the weaknesses in the current global health architecture and laid bare and deepened global inequalities. While the wealthiest nations secured early access to vaccines and treatments, people in most global south countries were left waiting, sometimes for years. At the height of the crisis, 75 per cent of available vaccines had been given out in just 10 countries. This inequity was morally indefensible and epidemiologically self-defeating. New variants emerged in under-vaccinated regions, threatening everyone. They showed that in a pandemic no one is safe until everyone is safe.

If strong global cooperation had been in place and governments had been prepared, the pandemic could have been stopped in its tracks much earlier, and its worst consequences could have been avoided. Many deaths could have been prevented, as could the deep economic impacts caused by extended lockdowns, which continue to have political implications today as one of the drivers of rising support for populist and authoritarian politicians in many countries.

Progress and divisions

In the wake of these systemic failures, the World Health Assembly, the WHO’s governing body, took action in a special session in December 2021. By consensus, member states established an Intergovernmental Negotiating Body (INB) with an ambitious but clear mandate: to create a framework to prevent future pandemics where possible and ensure a coordinated and equitable response when prevention fails.

The INB began work in February 2022, bringing together negotiators from over 190 states. By March 2023, negotiators had produced a zero draft that outlined core principles and provisions, focusing on early detection and warning systems, equitable access to medical countermeasures and sustainable funding mechanisms for pandemic preparedness.

But after the initial momentum, negotiations stalled. What began as a unified response to shared trauma soon fractured along familiar geopolitical faultlines between global north and global south states.

Global north states, including the UK, USA and several European Union countries, have pushed back against provisions they claim infringe national sovereignty. These include the scope of the WHO’s authority to declare public health emergencies of international concern and the binding nature of response obligations. The US delegation in particular opposed language that would commit states to allocating specific percentages of their pandemic products for international distribution.

Meanwhile, global south states led by the African Union have insisted on stronger guarantees for technology transfer and fair access to medical countermeasures. They argue that any agreement requiring them to share pathogen samples and DNA data must guarantee them access to vaccines and treatments developed from these materials. The African bloc is also pushing for a loosening of intellectual property protections on medicines and vaccines during health emergencies, calling for automatic waivers of some patent rights.

These divisions reflect deeper tensions. Pharmaceutical giants have immense lobbying power and the global north states where they’re headquartered tend to protect their interests, prioritising incentives to develop new drugs, including through strong intellectual property protections, and supply chain security. Global south states in contrast want more knowledge sharing and the ability to manufacture generic drugs in their countries.

Recent developments

Despite these tensions, negotiators have made progress on some fronts. After intense negotiations in late 2024, consensus emerged on three critical provisions: research and development, sustainable and diversified local production and sustainable financing.

If adopted in its current form, the provision on research and development could make a difference. It would require that research financed by public funds include provisions for technology transfer and non-exclusive licensing for producers in lower-income countries. With manufacturing capacity better spread across the world, treatments and vaccines would be more accessible to people in global south countries during future health emergencies.

Similarly, the provision on local production would commit states to supporting the development of manufacturing capacity in regions where it’s most needed, particularly Africa and some Southeast Asian countries. Meanwhile the provision on sustainable financing would establish a new pandemic preparedness fund with mandatory contributions depending on each country’s wealth.

A critical window

In a welcome acknowledgment of the urgency required, in June 2024 states committed to finalising negotiations within a year.

The INB has scheduled a final five-day negotiating session in April, after which the agreement should be presented to the 78th World Health Assembly in May. It’s unclear whether fundamental differences can be resolved by then, but negotiators remain cautiously optimistic. WHO Director-General Tedros Adhanom Ghebreyesus has characterised this as a ‘now or never’ moment for the treaty, emphasising that further delays would risk killing the process.

But now there’s a major new threat. Shortly after returning to office, Donald Trump signed an executive order announcing the USA’s withdrawal from the WHO, effective January 2026, and immediately suspending participation in treaty negotiations. This represents a severe blow to the process because the USA is the WHO’s largest contributor, and as a superpower and home to pharmaceutical giants, what it does and fails to do has global impacts.

The INB process has already cost an estimated US$201 million. If the treaty fails after such investment, that’s a loss of resources that arguably could have been directly spent on pandemic preparedness in the countries that need it most. Trust in multilateral institutions may well erode even further.

In these difficult circumstances, the treaty’s proponents argue that a robust agreement is still possible. But there needs to be a willingness to compromise. States such as Australia, Canada and Japan must step up their diplomatic engagement to bridge global south-global north divides. Philanthropic organisations and development banks must also develop tangible financing plans to help implement the treaty.

And there’s a huge role for civil society, including to build public support and pressure states to get behind the treaty. States must recognise civil society as a full partner. Civil society can help review and improve pandemic preparedness plans and, in the event of a pandemic, it can reach communities that governments can’t. Civil society was at the forefront of COVID-19 response, providing lifesaving services when governments failed to act, defending human rights amid pandemic restrictions and holding governments to account over the decisions they made. Civil society will be crucial for keeping up the pressure to have the treaty finalised, adopted and ratified, and then domesticated, properly implemented and adequately financed.

The stakes are high. The next pandemic could erupt at any time. Without effective international coordination, there’s a risk of repeating the lethal failures of the COVID-19 response. An equitable, enforceable pandemic treaty improves the prospects of avoiding millions of preventable deaths when the next pandemic strikes. In the coming months it will become clear whether global north states can put narrow self-interest aside in the interests of collective safety.

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