“With the UN General Assembly in September, the G20 in October, and the Special Session of the World Health Assembly in November, the next three months will be a critical period for shaping the future of pandemic preparedness and response.”

Thus wrote Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), on August 25, 2021, and in so doing summarized the most important global diplomatic events that will precede the Special Session of the World Health Assembly (WHA) in Geneva on November 29. At this Special Session, the world’s leading health delegations will determine whether there will be a new international agreement to address global pandemic preparedness and response.

On September 8 and 9, the O’Neill Institute, in partnership with and supported by the Foundation for the National Institutes of Health (FNIH), convened 30 of the world’s leading authorities on global health financing, law, implementation, and emergency response to address the weaknesses and existing gaps in global pandemic preparedness that have existed in the response to the COVID-19 pandemic, and what a new agreement may or must include. The meeting was opened by WHO Director-General Tedros Adhanom Ghebreyesus. This meeting was the first of a series of global consultations that will help inform WHO and member states about key weaknesses and gaps in the international response framework before and during the COVID-19 pandemic.

The COVID-19 pandemic has revealed the fractured and crumbling state of global health law infrastructure and, more importantly, its deeply embedded inequalities. The most important infectious disease preparedness and response accord, the International Health Regulations (IHR) (2005), could not (and has not) prevented governments from failing to collect crucial information or share data with others. It never required that wealthy countries invest in the capacities of other countries to prepare for, and respond to, disease threats. IHR (2005) never required any commitment by wealthy countries to ensure that life-saving medicines, vaccines, and medical equipment flow efficiently, equitably, and rationally to the people and places that needed them most. Indeed, rich countries hoarding medicines and vaccines has been predictable and persistent.

A new international agreement promises to free itself from the constraints of historical treaties, but faces far more difficulty in negotiations and form. In November 2020, Charles Michel, president of the European Council, began circulating the idea of an international pandemic treaty at the Paris Peace Forum. In January 2021, Tedros endorsed the international pandemic treaty proposal as a way to guarantee countries’ political commitment to fighting future disease outbreaks.

The meeting participants concluded that there are three likely possibilities for change at the conclusion of the three major international meetings: political statements and resolutions; revision of the IHR (2005); and a new, legally binding international agreement, achieved through the exercise of the WHO’s special regulatory authority, or a multilateral treaty formed under the auspices of the United Nations or the World Health Organization.

In theory, an international pandemic treaty could address all the aforementioned failures, an international pandemic treaty could be negotiated under the WHO, the UN, or both. While WHO is the world’s leading health organization, its experience and expertise with finance, trade, supplies, law enforcement, and the broader economic and social disruptions caused by a pandemic are less robust.

The UN may be more effective with respect to financing and supply chain management. It also has more experience managing human rights treaties, compliance-focused treaties, and large treaties like the UN Framework Convention on Climate Change. However, the geopolitical focus of the UN would likely lead to delay and few detailed provisions.

Components of the Global Commitment, Whatever the Form

Surveillance and Communication Mechanisms

In January 2021, the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board condemned the WHO’s existing pandemic alert system, stating it “is not fit for purpose” and calling for “a new global framework…to support prevention and protection from pandemics.” Meeting participants agreed that a new agreement must address and finance surveillance at the animal-human-environment interface including control of habitat loss and increased biosafety measures.

Data and Sample Sharing

Pathogen samples and related data are critical for the development of diagnostics, therapeutics, and vaccines, yet the world’s experience with such sharing under the IHR (2005) has been one of obstruction, refusal, and delay. Meeting participants agreed that a new mechanism for data and sample sharing as well as equitable distribution of resulting benefits and products must be featured in any new agreement.

Convening International Partners Including the Private Sector

New agreements must establish standing and regularly-convening forums for those organizations that will inevitably lead the response to the next pandemic. This includes both major international organizations and the major industrial and private sector players who contribute to, and benefit from, strong pandemic preparedness.

Meaningful and Secure Financing and Effective Dispute Resolution

Current global health mechanisms have failed to address inadequate funding and investing in country capacities. Financial and training support for surveillance and manufacturing capacity in the regions that need it most must be reflected in any new agreement as well.


The regular convening of the global community over the next three months will be decisive for the world’s future. The COVID-19 pandemic has laid bare the deep inequalities between and within societies and has made urgent long-known needs to invest in the healthcare resources of low- and middle-income countries. These meetings may result in calls to action with little enforcement or funding, comprehensive revision of the IHR (2005), or an entirely new agreement that acknowledges past failures and includes real measures to address those failures. Whichever of these paths is chosen, the global community must invest and support all participants, and do so equitably, if a scenario like COVID-19 or worse is to be avoided in the future.

We thank our partners at FNIH for the support needed to identify the major issues, and look forward to contributing a summary report to the WHA Special Session record as well as to the country delegations that attend.