The 2021 Special Session of World Health Organization (WHO) Assembly marked a pivotal moment in addressing the shortcomings in the global response to the COVID-19 pandemic, at a time when countries were still grappling with its far-reaching consequences. During that Assembly, countries pledged to establish an Intergovernmental Negotiating Body, open to all Member States and Associate Members, with the aim of developing an international instrument to improve prevention, preparedness, and response to future pandemics.
After two and a half years and nine meetings, WHO Intergovernmental Negotiating Body presented the draft Pandemic Treaty, or Agreement, to the WHO Assembly in May 2024. Unfortunately, the draft was not approved, and after further deliberations, it was decided to continue negotiations hoping to reach a consensus before the May 2025 Assembly. The delay can be attributed to the lack of agreement among Member States on the content of the Pandemic Treaty, underscoring the difficulty of reaching consensus when so many competing interests, including commercial and ideological ones, are involved. Some progress had been made in the deliberations leading up to the Assembly, but it was not sufficient. Lack of agreement on key points highlights the complexity of crafting a coordinated global response to future pandemics. Despite the efforts, full agreement was only reached on 8 of the 17 points in the introduction and on 17 of the 37 articles in the proposal, a modest 54%. Differences have emerged for different reasons. Technical and administrative issues can be resolved within the agreed timeframe, but the deeper divergences strike at the core of how we understand our social and economic models. Without a solid and consensual foundation on these fundamental issues, the Pandemic Treaty risks losing its coherence and innovative potential.
The first point of contention revolves around the importance given to gender inequalities in health. In the introduction, a group of countries (spearheaded by Iran, Russia, Egypt, Saudi Arabia, and Nigeria) refused to accept a paragraph calling for appropriate measures to eliminate discrimination against women in healthcare, particularly in relation to access to diagnostic and therapeutic services for women during pandemics. Gender discrimination in health is a critical issue that directly impacts the equity and effectiveness of any public health measures. For the treaty to be truly inclusive and effective, it is essential that it addresses these disparities. Unfortunately, the absence of gender sensitivity has affected other declarations as well, diminishing mentions of gender equity and perspective—issues that go beyond merely addressing gender inequalities. This trend is troubling, as removing references to gender in WHO resolutions undermines efforts to promote equity and justice in healthcare.
Specifically, beyond the Pandemic Treaty, resolutions on mental health, emergency preparedness, health economics, climate, and social participation have been impacted. According to sources cited by Health Policy Watch, Russia sought to remove the word “sexual” from the widely accepted (and previously supported by Russia itself) term “sexual and reproductive health”. In the Health Economics Resolution, Nigeria initially objected to using the terms “gender equity” or “promote gender mainstreaming”. In the Climate Change and Health Resolution, while three mentions of gender inequalities were retained, gender mainstreaming was removed altogether. Notably, an amendment proposed by Russia, Saudi Arabia, and Nigeria, which sought to change “gender perspective” to “consider gender equality considerations and different needs” in a resolution aimed at strengthening countries’ capacity to address natural hazards and disasters, was defeated by 76 votes to eight.
A stronger emphasis on gender equality within the treaty should be non-negotiable, particularly in Article 17, which speaks of “whole-of-government and whole-of-society approaches”. If this treaty is to be truly inclusive, it is crucial that countries supporting gender equality take a firm stance to ensure these issues remain on the international agenda, advancing inclusive policies. Other contentious issues that have been discussed relate to the global economy and the current economic model. The reluctance of some countries to cede part of their production of medical products and diagnostics to the WHO has been one of the main causes of the delay in signing the Pandemic Treaty. The proposal sought to address these inequities, exposed during the pandemic, by expanding the capacity to share knowledge and technologies, improving the equitable distribution of products, and tackling the barriers created by intellectual property. It also aimed to strengthen the WHO’s role in managing future pandemics, ensuring a faster and more effective response, particularly in the most vulnerable countries. However, the lack of consensus on these aspects has complicated the adoption of the treaty. Accepting this innovative approach would require profound changes, impacting extremely specific commercial interests, which has resulted in strong resistance. Articles 10 and 11 of the draft Pandemic Treaty called for sustainable and geographically diversified production of all products needed to combat a pandemic, as well as a commitment to transferring technology, know-how, and medical products to the most vulnerable regions to increase their independence in responding. These broad proposals, which do not specify quantities or timeframes and often include vague phrases like “mutually agreed terms”, make it difficult to achieve meaningful change, leaving the current status quo intact. This status quo, as has been widely acknowledged, was part of the problem in failing to mount a rapid and effective response. The most contentious issue in these articles revolves around the request for patent holders or relevant licensees to either waive royalty fees or charge “reasonable royalties”. The latter, being unspecific, was accepted, allowing companies to continue operating as they had been.
However, it is the WHO’s role that has sparked the most disagreement. The proposal called for the WHO to play a leading role in managing future pandemics, directly leading much of the response without relying heavily on the interests or willingness of more advanced countries. To this end, it proposed a multilateral system to be managed and coordinated by the WHO, providing secure, transparent, and accountable access to information on pathogens with pandemic potential. This information is crucial for developing new medical and diagnostic products and forms the basis of the WHO’s Pathogen Access and Benefit Sharing System (PABS), an essential initiative to ensure equitable and rapid sharing of pathogens and the benefits derived from medical and diagnostic products during future pandemics. In the end, countries accepted coordination by the WHO but not sole management, opting to maintain greater control and direct participation in decision-making despite the WHO’s representation of all countries. The underlying issue is the challenge of balancing national sovereignty with the need for an effective global response.
Another critical point, addressed in Article 12, proposed significantly strengthening the WHO’s capacity to respond to future pandemics. It was suggested that, in the event of a new pandemic, the WHO would have real-time access to 20% of the production of safe, effective, and efficient pandemic-related health products (10% in the form of donations and 10% at affordable prices for the WHO). This proposal, which should be viewed as a first step toward deeper public governance in health, where the WHO would oversee overall management, was met with resistance from countries hosting the companies that own the technology for these products. This opposition is likely influenced by those private companies. However, it is important to note that private companies cannot be blamed alone for the behaviour of countries; many of these countries are also influenced by political ideologies and nationalist sentiments, which, while understandable, complicate the pursuit of a global response.
The adoption of the Pandemic Treaty is a critical opportunity that should not be missed. It offers a chance to redefine how we respond to global challenges. The general interest must take precedence over commercial or political interests if we are to achieve an effective and equitable response to future crises. It is imperative that countries act now to craft agreements that strengthen our collective ability to face future challenges.