The recent inability of the international community to finalize a global pandemic agreement has highlighted significant weaknesses in our ability to manage future major infectious disease crises. The likelihood of another pandemic, similar to COVID-19, which was the worst in a century, is on the rise. The World Health Organization (WHO) has made notable progress by adopting useful updates to the legally-binding International Health Regulations. While this development is commendable, it is not sufficient. Even with governmental approval of the revised regulations, a pandemic agreement is our best hope to prevent a repeat of past events. Global approaches to transnational health threats date back to the international sanitary conference of 1851, which aimed to control cholera spread. Many initiatives have since been launched to boost global health security, including the WHO’s founding in 1946. The 2005 International Health Regulations were pivotal in this journey, introducing modern risk assessment and establishing a global monitoring system for significant public health threats.
However, the tools introduced were soon found wanting in tackling the complex and rapidly evolving threats posed by zoonotic diseases, when animal pathogens jump to humans. Earlier this month, the 194 WHO World Health Assembly members approved several significant amendments to the International Health Regulations by consensus. These amendments include: a definition of a “pandemic emergency” that underscores the severity of such events within the broader context of public health concerns; a stronger emphasis on prevention with a focus on “preparedness”; efforts to ensure equitable access to medical supplies and finances with a focus on “equity and solidarity”; a new “coordinating financial mechanism”; a mandate for each country to set up a “national authority” to enhance the application of international health regulations domestically and internationally; a requirement for countries to build and improve “risk communication” abilities, including combatting misinformation; and a modified “decision instrument” to better detect new respiratory infections with high pandemic potential. However, not all proposed amendments were enacted.
Some experts recommended incorporating lessons from Asia-Pacific countries that employed elimination strategies during COVID-19 to delay the spread, allowing time for vaccine distribution and other measures. This strategy benefited both wealthy islands like New Zealand, Australia, Singapore, and Taiwan, and low- and middle-income nations in Asia like Vietnam, Thailand, Cambodia, Laos, and Mongolia, resulting in lower excess mortality rates where the pandemic was better controlled. Despite its success, the idea of elimination at the source, sometimes called containment, was not included in the revision. Other potential improvements that were not incorporated include measures to prevent zoonotic diseases from spreading from animals, enhanced sharing of scientific data and samples, and increased accountability. New Zealand now has 18 months to review the proposed changes and may choose to take reservations on aspects it disagrees with, though this could undermine the unity of the proposed amendments.
A pandemic agreement has the potential to address numerous necessary reforms beyond the International Health Regulations. However, reaching global consensus is proving challenging. There are significant disagreements between wealthy and developing countries over the distribution and pricing of vaccines, treatments, and diagnostics for less affluent nations. The sharing of pathogen data has also been a sticking point. Negotiations have further been complicated by groundless claims that the WHO will gain authority to enforce measures like lockdowns and vaccine mandates. Due to these difficulties, there has been no consensus on a pandemic agreement text. The WHO has outlined the next steps for further talks, but these negotiations are already delayed by several years. Faced with threats ranging from war to environmental destruction and pandemics, no single nation can completely protect its citizens from the most severe common threats to humanity. Although the need for global unity and collaboration is more crucial than ever, support for many essential areas of international law is dwindling.