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Why the WHO is pushing for a global ‘pandemic treaty’

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The global response to covid-19 was a disorganized, inequitable disaster. At least 5 million people around the world have died from covid-19. There are still around 50,000 reported deaths a week. Even wealthy and vaccine-abundant places like the United States and Western Europe are seeing persistently high cases, while lower-income nations are running roughly a decade behind them in vaccination rates in one analysis.

Later this month, officials from around the world will convene for a special meeting to discuss how the global system that responded to covid-19 can be fixed before future pandemics. The meeting, an exceedingly rare special session of the World Health Assembly to begin Nov. 29, will see deliberations on how to strengthen the World Health Organization among its member states.

Though less hyped than the U.N. climate conference currently underway in Glasgow, Scotland, the event has ambitions almost as lofty — and perhaps almost as difficult to achieve. Among the more radical ideas is a binding piece of international legislation on pandemic preparedness — a “pandemic treaty” — that would set in place new, global architecture for dealing with future outbreaks to avoid the mistakes of covid-19.

The idea has high-profile backers, including WHO Director General Tedros Adhanom Ghebreyesus and scores of world leaders from Europe, Asia, Africa and Latin America. But some countries are less enthusiastic: The United States, Brazil, China and Russia all have not backed calls for the treaty. To opponents, such a measure could impinge on national sovereignty and curtail private sector innovation.

Some skeptics worry the proposal would bring more ineffective international bureaucracy, pointing toward problems with rules under the revised International Health Regulations adopted in 2005 following the SARS epidemic.

It has become clear over recent weeks, however, that calls for a treaty are gaining momentum. A working group that had been meeting for months finalized a report last week that called on the assembly to begin drafting a “WHO Convention, Agreement or other international instrument on pandemic preparedness and response.” It is not clear, however, how far countries will go.

“The question is what is the scale of ambition in terms of how much do we want to strengthen the global system and how far is a country willing to go to do that?” said Suerie Moon, co-director of the Global Health Center at the Graduate Institute of International and Development Studies in Geneva. “Are they willing, for example, to negotiate binding international rules to do that? Are they willing to put money on the table?

A new treaty would inevitably touch upon two of this pandemic’s most controversial issues: inequality in access to vaccines and treatments, and the search for the pandemic’s origins.

The former issue has drawn attention this week, as U.S. Secretary of State Antony Blinken hosted a meeting to discuss the goal of vaccinating 70 percent of the world by next September. Though there has been some progress, that goal remains far off: only 2.5 percent of people in low-income countries have been fully vaccinated, according to data compiled by the One Campaign. Covax, a WHO-backed effort to distribute doses fairly, has come nowhere near its own targets as rich countries bought up vaccines.

The hope is that a pandemic treaty could prevent such inequities. At a media briefing this week, WHO Principal Legal Officer Steven Solomon pointed to a 2011 agreement on pandemic influenza that ensured supplies for the global health body. “Under that framework, WHO now has legally binding contracts for hundreds of millions of pandemic influenza vaccine if and when a pandemic of influenza takes place,” Solomon said.

A more controversial idea is that a treaty could require nations to pool research and development resources with the benefit of guaranteed access. Some supporters argue it could upend the pharmaceutical industry far more than a “TRIPS waiver” being discussed at the World Trade Organization, a proposal to temporarily exempt countries from enforcing intellectual property rights for coronavirus vaccines and related diagnostics.

Traditionally, the United States has been one of the most powerful critics of measures like this. But it has thrown its weight behind the proposed waiver — an encouraging shift for proponents of new rules to avert inequities in future pandemics.

“At this point, Biden is more open to this type of negotiation than Obama ever was,” said James Love, director of Knowledge Ecology International, a nonprofit group that advocates for fairer knowledge sharing.

Legally binding procedures at the start of a pandemic to share information and allow outside investigators are another possible feature of a treaty, but they would run into a highly politicized problem: the still murky origins of covid-19 and China’s obstruction of a WHO-backed investigation.

In September, Tedros and German Health Minister Jens Spahn suggested there could be sanctions for countries that refuse to share pandemic information. A treaty should “have all the incentives or the carrots,” Tedros said at a news conference with Spahn in Berlin on Sept. 1. “But maybe exploring the sanctions may be important,” he added, according to Politico Europe.

China wouldn’t be the only country concerned about a more aggressive approach to transparency. “One of the most politically sensitive issues is the question of the authority of an international body to investigate the sight of an outbreak,” Moon said.

With negotiations ongoing, it remains unclear where many countries stand. Though the working group was eventually able to produce a report through consensus, it left vague which countries backed a new treaty, a reform to the 2005 International Health Regulations, both or neither. Even the document produced was a battle, with lengthy debates over wording and even punctuation.

It is not yet clear if the United States opposes a treaty. While Politico Europe reported in May that Washington was trying to “kill” negotiations for a treaty, observers say that the U.S. delegation has played a productive role in the working group. (The delegation declined to comment for this article). China’s position remains ambiguous, while other nations like Brazil and Russia have expressed skepticism.

Even if the need for a treaty is agreed upon at the World Health Assembly, which ends Dec. 1, it may take years to finalize the details. In the United States, that could well mean a change in political leadership — but even without that, a treaty would require a two-thirds majority in the U.S. Senate to go into law. Even if a treaty is agreed upon, it will ultimately be possible for a country to not sign on, or to simply renege on its commitments.

But with a future pandemic all but assured, and the failures of a global response to this one still fresh, many hope that countries will be able to put aside some of their differences in the model of countries working together on joint, albeit nonbinding, climate change pledges. “There is no treaty, no contract, which is perfect,” WHO’s Solomon said this week. “But the international community works to create binding agreements because they are better than the alternative.”

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Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will likely knock out monoclonal antibodies, targeted drugs that can be used as a treatment or to protect immunocompromised people.

Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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