At the height of the pandemic, world leaders proposed a bold idea. They envisioned a pandemic treaty that would obligate countries to work together to prevent future health emergencies like COVID — in other words, to cooperate in a way that didn't quite happen when SARS-CoV-2 struck.

The World Health Assembly set the deadline for such an accord: May 2024. The idea was to light a fire under the participants — and have the accord ready when the assembly convenes in Geneva. But negotiations have seized up around a series of issues. How would such a treaty be enforced? How would it be financed?

And there's a growing gulf between countries in the Global North who want to hold onto the intellectual property to create and sell vaccines, diagnostics and medicines — and countries in the Global South who say that in times of crisis, such technology should be shared.

"The question is," asks Dr. Githinji Gitahi, CEO of Amref Health Africa, "do you profit from it until the end? Or is there a moral right to allow other people access to it so that they can also manufacture this thing that is actually going to save human life?"

Gitahi says one solution is to fund companies' research and development with taxpayer dollars. In exchange, they would then share any resulting technology freely. The idea is that in the event of a public health emergency, "human life would override the profit intent." But he doubts that idea will gain much traction.

"I think it's going to be a real fight," says Gitahi. "It was a fight during COVID and people were dying. Right now, we are discussing without a crisis. So it's unlikely that anyone will give in."

Kate Dodson, vice president for global health at the United Nations Foundation, agrees that it's a hard process. "Member states are coming into these negotiations from really different experiences," she says. "I think there's a trust deficit. And some really different views about what are the best ways to try to better prepare the world for the next pandemic."

A hopeful start to treaty talks

These roadblocks weren't always inevitable. In fact, at the beginning of the conversation, everything seemed possible.

"Early drafts of the pandemic treaty were really transformational," says Lawrence Gostin, a professor of global health law at Georgetown University who's been involved with the drafting of the treaty since the start. "They looked at things that we've never looked at before."

Those ideas included a One Health approach to fighting pandemics – that means a focus on the interactions between people, animals and their environments. "We were gonna try to work on deforestation and wet markets and preventing spillover from an animal to a human that appeared to occur in Wuhan," says Gostin. "There were mechanisms for funding."

"We saw [the treaty] as an opportunity to correct a lot of wrongs," says Nelson Aghogho Evaborhene, project coordinator with the nonprofit Prediagnosis Sierra Leone.

He says there were hopes that the treaty would make things more equitable between nations. Then countries in both the Global North and South would be self-sufficient "so that the dependency on other countries for access to these technologies during pandemics [won't] really occur again."

Historic ... or a pipe dream?

As time went on, the treaty was diluted and defanged. "Political will faded," Gostin says. "Memories faded."

With the treaty sputtering, eyes turned to this week's United Nations General Assembly in New York City. On Wednesday, global leaders adopted a political declaration recognizing the need for nations to work together to prevent and respond to future pandemics. It's intended to jump-start treaty negotiations. In a statement, the World Health Organization called the declaration "historic."

Tedros Adhanom Ghebreyesus, WHO's director-general, made public remarks after the adoption. "The declaration is a strong signal from countries that they are committed to learning the lessons of the COVID-19 pandemic," he said, "and to strengthening the world's defenses against pandemics."

The declaration asserts that a strong pandemic response requires urgent and continued leadership and global solidarity. Dodson, who's attending the General Assembly this week, heard from member states that they're committed to developing a pandemic treaty. "They don't want it to flail," she says. "And that was a resounding message."

But Gitahi says the declaration is purely aspirational without any clear commitments or calls for real accountability. " I am concerned that we will not have a bold pandemic treaty," he says. "Then, in the next pandemic, whatever we had in COVID will be repeated, word for word."

"It has a lot of high-mind[ed] phrases, a lot of self-congratulation," says Gostin. "But almost nothing in terms of action, commitments or funding."

Gostin says that the window of creating a treaty that could make a real difference is rapidly closing "because political leaders are turning their attention to other issues like the Ukraine war, inflation and climate change." He worries that we could be squandering the most important moment for global health security since the founding of the WHO in 1948.

"After all of the suffering of COVID-19, all of the loss of life, pushing people into absolute poverty and loss of education," he says, "now is our one shot to do something that really can make the world a little bit safer, a little bit more secure and fairer."

But there are still optimists in the crowd. The declaration may not be perfect, but Mike Ryan, executive director of WHO's Health Emergencies Programme, likens it to a new year's resolution — in this case, a kind of promise to take action.

"The declaration itself won't solve anything," he says. "It's a piece of paper. But sometimes in life, just sometimes, you make that promise and you keep it. And we owe it to the people of the world to keep that promise."

A mere eight months remain to see how real that promise will actually become.

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