Countries around the globe have failed to reach consensus on the terms of a treaty that would unify the world in a strategy against the inevitable next pandemic, trumping the nationalist ethos that emerged during Covid-19.
The deliberations, which were scheduled to be a central item at the weeklong meeting of the World Health Assembly beginning Monday in Geneva, aimed to correct the inequities in access to vaccines and treatments between wealthier nations and poorer ones that became glaringly apparent during the Covid pandemic.
Although much of the urgency around Covid has faded since the treaty negotiations began two years ago, public health experts are still acutely aware of the pandemic potential of emerging pathogens, familiar threats like bird flu and mpox, and once-vanquished diseases like smallpox.
“Those of us in public health recognize that another pandemic really could be around the corner,” said Loyce Pace, an assistant secretary at the Department of Health and Human Services, who oversees the negotiations in her role as the United States liaison to the World Health Organization.
Negotiators had hoped to adopt the treaty next week. But canceled meetings and fractious debates — sometimes over a single word — stalled agreement on key sections, including equitable access to vaccines.
The negotiating body plans to ask for more time to continue the discussions.
“I’m still optimistic,” said Dr. Jean Kaseya, director general of Africa Centers for Disease Control and Prevention. “I think the continent wants this agreement. I think the world wants this agreement.”
Once adopted, the treaty would set legally binding policies for member countries of the W.H.O., including the United States, on surveillance of pathogens, rapid sharing of outbreak data, and local manufacturing and supply chains for vaccines and treatments, among others.
Contrary to rhetoric from some politicians in the United States and Britain, it would not enable the W.H.O. to dictate national policies on masking, or use armed troops to enforce lockdowns and vaccine mandates.
Next week’s deadline was self-imposed, and some public health experts have said it was far too ambitious — most treaties take many years — for such a complex endeavor. But negotiators were scrambling to ratify the treaty before elections in the United States and multiple European countries.
“Donald Trump is in the room,” said Lawrence Gostin, director of the W.H.O. Center on Global Health Law, who has helped to draft and negotiate the treaty.
“If Trump is elected, he will likely torpedo the negotiations and even withdraw from W.H.O.,” Mr. Gostin said.
During his tenure as president, Mr. Trump severed ties with the W.H.O., and he has recently signaled that, if re-elected, he might shutter the White House pandemic preparedness office.
Among the biggest bones of contention in the draft treaty is a section called Pathogen Access and Benefits Sharing, under which countries would be required to swiftly share genetic sequences and samples of emerging pathogens. This information is crucial for rapid development of diagnostic tests, vaccines and treatments.
Low-income nations, including those in Africa, want to be compensated for the information with quick and equitable access to the developed tests, vaccines and treatments. They have also asked that pharmaceutical manufacturers share information that would allow local companies to manufacture the products at low cost.
“We don’t want to see Western countries coming to collect pathogens, going with pathogens, making medicines, making vaccines, without sending back to us these benefits,” Dr. Kaseya said.
Member countries have only ever agreed to one other health treaty, the 2003 Framework Convention on Tobacco Control, which strengthened control of the tobacco industry and decreased smoking rates in participating countries. But they were jolted by the devastation of the Covid pandemic and the inequities it reinforced to embark on a second.
The countries are also working on bolstering the W.H.O.’s International Health Regulations, which were last revised in 2005 and set detailed rules for countries to follow in the event of an outbreak that may breach borders.
In May 2021, an independent review of the global reaction to Covid-19 “found weak links at every point in the chain of preparedness and response.”
The pandemic also deepened mistrust between wealthier nations and poorer ones. By the end of 2021, more than 90 percent of people in some high-income countries had received two doses of Covid vaccines, compared with less than 2 percent in low-income nations. The lack of access to vaccines is thought to have caused more than a million deaths in low-income nations.
The treaty would be an acknowledgment of sorts that an outbreak anywhere threatens the entire globe, and that providing vaccines and other resources is beneficial to everyone. Variants of the coronavirus that emerged in countries with large unvaccinated populations swiftly swept across the world.
“Nearly half of U.S. deaths came from variants, so it’s in everybody’s interest to have a strong accord,” said Peter Maybarduk, who directs Public Citizen’s Access to Medicines program.
In December 2021, the W.H.O. established a group of negotiators to develop a legally binding treaty that would enable every country to prevent, detect and control epidemics, and allow for equitable allocation of vaccines and drugs.
More than two years into the negotiations, negotiators have agreed, at least in principle, on some sections of the draft.
But much of the good will generated during Covid has evaporated, and national interests have returned to the fore. Countries like Switzerland and the United States have been reluctant to accept terms that may affect the pharmaceutical industry; others like Argentina have fought against strict regulations on meat exports.
“It’s evident that people have very short memories,” said Dr. Sharon Lewin, director of the Cumming Global Center for Pandemic Therapeutics in Melbourne.
“But it can happen again, and it can happen with a pathogen that is far trickier to deal with than Covid was,” she warned.
One proposal for the Pathogen Access and Benefits Sharing section would require manufacturers to set aside 10 percent of vaccines to be donated, and another 10 percent to be provided at cost to the W.H.O. for distribution to low-income nations.
But that idea proved to be too complicated, said Roland Driece, who is one of the leaders of the negotiations. “We found along the way that that was too ambitious in the time frame.”
Instead, a working group established by the World Health Assembly will be tasked with hammering out the details of that section by May 2026, Mr. Driece said.
The terms of the proposed agreement have generated some confusion. In Britain, Nigel Farage, the conservative broadcaster and populist politician, and some other conservative politicians have claimed that the W.H.O. would force richer countries to give away 20 percent of their vaccines.
But that is an incorrect reading of the proposed agreement, Mr. Driece said. “It’s not the countries that have to come up with those vaccines, it’s the companies,” he said. Pharmaceutical companies would commit to the system in exchange for guaranteed access to data and samples needed to make their products.
Britain will not sign the treaty unless “it is firmly in the U.K. national interest and respects national sovereignty,” a spokesperson for the country’s health department told Reuters earlier this month.
In the United States, Republican senators have demanded that the Biden administration reject the treaty because it would “potentially weaken U.S. sovereignty.”
Dr. Tedros Adhanom Ghebreyesus, W.H.O.’s director general, has roundly criticized what he called the “the litany of lies and conspiracy theories,” noting that the organization does not have the authority to dictate national public health policies, nor does it seek such power.
The secrecy surrounding the negotiations has made it difficult to counter misinformation, said James Love, director of Knowledge Ecology International, one of the few nonprofits with a window into the negotiations.
Having more people allowed into the discussion rooms or to see the drafts as they evolve would help clarify complicated aspects of the treaty, Mr. Love said.
“Also, the public could relax a bit if they’re actually reading the actual agreement on a regular basis,” he said.
Some proposals in the draft treaty would require massive investments, another sticking point in the negotiations.
To monitor emerging pathogens, wealthier nations endorse a so-called One Health strategy, which recognizes the interconnections between people, animals, plants and their shared environment. They want low-income countries to regulate live animal markets and limit trade in animal products — a big economic blow for some nations.
Last month, the Biden administration released its own strategy for global health security, with a focus on bilateral partnerships aimed at helping 50 countries bolster their pandemic response systems. The administration hopes to expand the list to 100 countries by the end of the year.
American support would help the countries, most of which are in Asia and Africa, strengthen their One Health systems and better manage outbreaks.
The U.S. strategy is meant to be complementary to the global treaty, and cannot serve as an alternative, public health experts said.
“In my view, this is the most important moment in global health since W.H.O. was founded in 1948,” Mr. Gostin said. “It would just be an unforgivable tragedy if we let this slip away after all the suffering of Covid.”
