The deadline is nearly here. Will the global pandemic treaty be finished in time?

There are a lot of bleary-eyed, sleep-deprived negotiators in Geneva, Switzerland.

They’ve already pushed back their timetable multiple times. Now, with their deadline looming, these delegates have been working late into the night to finish what experts call one of the most important treaties of the generation.

Their negotiations are focusing on a war – but not with guns and tanks. It's a war against viruses and other infectious diseases.

Delegates from 194 countries are racing to complete a global pandemic treaty before the World Health Assembly starts next week on Monday, May 27.

The annual gathering is attended by all of the World Health Organization’s member states. At this year’s meeting, members are scheduled to adopt the treaty, a legally binding agreement aimed at both preventing and preparing for the next pandemic. Because virus experts think it’s not a matter of if, but when, the next pandemic strikes, this accord is one of the group’s most highly anticipated agenda items.

“This treaty is the most important thing in my lifetime,” says Lawrence Gostin, a university professor at Georgetown Law, where he studies global health law and has followed the pandemic treaty process closely.

“Stating the obvious, these are difficult negotiations. This is a first of its kind agreement,” said Xavier Becerra, the secretary of Health and Human Services, in a statement. “Our first responsibility is protecting the lives and livelihoods of the American people and the security of our country. We cannot do that effectively unless we are preventing, detecting and stopping outbreaks before they reach our shores.”

Why a treaty?

The idea of a pandemic treaty was born at the height of the COVID pandemic when glaring gaps in the world’s collaboration and coordination became apparent – and many lives were lost as a result. By one count, more than a million people died because dozens of poor countries had next to no vaccines while some wealthier nations were giving out boosters.

“It was a very desperate situation,” says Hadley Sultani Matendechero, deputy director general for health in Kenya. “[Vaccines] in our minds were the only antidote to this catastrophe, but we were not able to access them.”

For two years, delegates from all member states have been hashing out the terms of this new agreement in the hopes of not repeating the same missteps. This has been a fraught process – so fraught that it’s not clear whether all the member states will come to a consensus and produce a final document in time for next week’s Assembly.

Not your typical negotiation

There have been a number of stumbling blocks. First, the negotiating process has been unorthodox. “This is unlike anything I recognize,” says Zeid Ra’ad Al Hussein, who is a professor of law and human rights at the University of Pennsylvania and was an ambassador for 18 years. He’s been following the process and has hosted numerous retreats for the negotiators.

He’s participated in many treaty negotiations and, he says, typically, the negotiators are constantly coming up with new versions — often at the end of each day — in the effort to come up with a text they can all agree on. However, for most of the pandemic treaty negotiations there were drafts coming out just every few months. “Only very recently have they begun to really work the text. And that's what needs to happen,” he says.

Second, disinformation has disrupted the process. For example, politicians have falsely claimed that countries that ratify the pandemic treaty would give up their national sovereignty.

“I've never seen that before, actually. All around the world there is something like a coordinated attempt for misinformation in an attempt to frustrate this process,” says Roland Driece, one of the two co-chairs of the negotiations and the director for international cooperation at the Ministry of Health in the Netherlands.

Inside the negotiating room, the fault lines have broadly pitted the so-called Global South — countries that lack resources to build up their health systems — against the wealthier Global North. There are a slew of contentious issues — from how to finance pandemic preparedness to whether there will be a committee to make sure countries follow through on their agreements. And what experts say are three sticking points yet to be resolved.

If you give, you get

The crux of the treaty revolves around a behavior that humans of all ages struggle with: sharing.

Will the rich countries of the Global North share their vaccine and treatments with their less well-off counterparts in the Global South?

And will the countries of the Global South provide up-to-the-nanosecond information on worrisome disease outbreaks.

To encourage a spirit of sharing, negotiations have dreamed up a proposal with a daunting name: the Pathogen Access and Benefit-Sharing System.

Countries that have created treatments and vaccines must share a certain amount with the have-nots, who in turn must share the latest "pathogen access" — from the genome sequence of a new virus to biological samples.

It is “the heart” of this treaty, said Precious Matsoso, the other co-chair of the negotiations, speaking at a press conference in early May. “And, of course, without a heartbeat, you know, there’s no life.” Matsoso is the former director-general of the South African National Department of Health.

Matendechero, of Kenya, thinks this system is essential. “We would like to share in the benefits that are accruing from the information that we have provided, the data we have shared, the samples we have provided,” he says. “We would like some of those benefits to trickle down back to the Global South.”

But there has been resistance.

“Certain governments have really dug in, like the UK government simply will not do it. The European Commission is being uncooperative,” says Gostin of Georgetown Law. “It’s basically vaccine nationalism. They say, in a pandemic, their populations go first.”

The European Commission declined interview requests, saying negotiations are ongoing. However, a statement provided to NPR said the commission is fully committed to preventing and tackling pandemics and has been constructive and flexible in negotiations. “Listening to partners, we have moved our position on key issues and provided workable proposals that can attract support by stakeholders,” the statement read.

Gostin says he understands that, historically, countries have reserved and stockpiled doses for their own population, but he counters that such an approach makes everyone less safe.

“If fairness isn't a good enough reason, there are lots of self-interested reasons,” says Gostin, who is also the director of the WHO Collaborating Center on Global Health Law. “If we do equitably share, there's good empirical evidence that shows that it slows the spread of the pandemic, better than rich countries hoarding the vaccine."

Keeping an eye on nature

Another bone of contention is what the treaty should say about animal health and plant health.

There's a concept known as "One Health" which argues that the health of people, animals and the environment are all interconnected. And that there's the potential for environmental and zoological changes to cause human pandemics. This is not a new idea. Research has shown that more than 60% of new infectious diseases originate in animals, including diseases like mpox, Ebola, SARS and avian flu.

Many European countries have been insisting on the inclusion of an article about One Health in the pandemic treaty, encouraging countries to identify and address the environmental issues that can lead to pandemics. However, there is not a funding mechanism laid out in recent drafts.

“Everybody believes it's really important,” says Dame Barbara Stocking, chair of the Panel for a Global Public Health Convention, an independent international group that formed in the COVID pandemic to push for a better response to disease outbreaks. “But there is a question about how fast countries can move and especially the poorest countries.”

“We are not able to accommodate all the issues around human health,” says Matendechero of Kenya. “So why are we now even going further to try and incorporate issues on animal health, environmental health, plant health?”

He argues that there are other bodies to deal with environmental health issues, such as the United Nations Environment Programme and the Food and Agriculture Organization of the United Nations.

Gostin adds that there’s also plenty of lobbying going on. “There are so many interest groups – the logging industry, pig farmers, dairy farmers, wet markets – there are lots of very powerful commercial interests pushing against it,” he says.

Who owns the secrets?

Then there’s the matter of the secret sauce.

When a treatment or a vaccine is developed by a company they have special formulas and procedures they create. That’s their “intellectual property” and it’s protected from others. But, Matendechero of Kenya says, when there’s a public health emergency, shouldn’t it be shared? Shouldn’t the technology needed to cook up a vaccine be made available to other countries and companies to help produce more?

Matendechero and many from the Global South are advocating for intellectual property rights to become more flexible — even waived — in an emergency. They want to see the know-how shared with places in the Global South — for example, South Africa or Brazil.

“What countries in the Global South are saying is: ‘Can we have a way in which we can be allowed to now produce these countermeasures locally through local manufacturing, local production?’ ” he says. Matendechero says it’s a matter of equity.

Much of the discussion comes down to one word: voluntary. Would the secret sauce be shared voluntarily or not? Some say that forcing a company to share will stifle their willingness to invest in developing new drugs and vaccines.

“Unfortunately, the current draft includes harmful policies that would undermine medical innovation,” said Larry Kerr, deputy vice president for global health and multilateral affairs at PhRMA, a trade group representing the pharmaceutical industry in the U.S., in a statement.

U.S. lawmakers from both parties have also expressed concerns about stepping on intellectual property rights.

Time is ticking

With negotiations going until the 11th hour, experts say it is possible that the delegates miss their deadline at the World Health Assembly and request more time. It’s also possible, they say, that WHO commits to certain principles but the specifics are added later.

However, there’s a sense of urgency. Experts say there’s a drive not only to get this treaty finalized before any future health crisis – but also to finish it before the 2024 Biden-Trump election. During his presidency, Trump announced plans for the U.S. to withdraw from WHO. Gostin and others worry that if re-elected, Trump wouldn’t be supportive of this pandemic treaty.

“Nobody says that, but it's absolutely the elephant in the room,” Gostin says.

If there is no pandemic treaty, Gostin says, he thinks the world would be in a worse place than when COVID struck. “Global trust and cooperation is going to simply collapse,” he says. “We're not going to get the scientific information we need to protect our own people.”