“If you do not change direction, you will end up where you are heading”. This famous quote, often attributed to Lao-Tzu, could be used to describe a global health ecosystem still struggling to unite and defeat COVID-19. It also begs the question –do we need to do things differently? World leaders think so. In May 2021, 194 countries passed a World Health Assembly (WHA) resolution to host a special session devoted to the consideration of developing an international pandemic agreement. On 1 December 2021, this session was held and the WHA agreed to draft and negotiate a new World Health Organization (WHO) convention to strengthen pandemic prevention, preparedness and response.

“If you do not change direction, you will end up where you are heading”. This famous quote, often attributed to Lao-Tzu, could be used to describe a global health ecosystem still struggling to unite and defeat COVID-19.

Pros of a new covenant

• Tackle inequity: Global health law and policies are typically conservative. This covenant provides an opportunity to be transformative and consider more innovative ways to support countries to address growing global health inequities. This could include redistribution of global health resources for countries to bolster women’s leadership opportunities or enhance specific capacities required by a new covenant. In addition, the covenant needs to support countries to build institutional political will to drive supportive laws and policies addressing health inequities from within.
• Define clear roles: The global health ecosystem is a complex mix of longstanding and emerging actors. More clearly defined roles could help reduce fragmentated pandemic responses going forward. Additionally, The Independent Panel, tasked with examining the lessons learned from COVID-19 and previous pandemics, found that WHO does not have the authority or sustainable resources for their global health stewardship role.
• Highlight process: An evidence-based, inclusive process is planned to develop the new covenant, which could boost its sustainability and compliance from member states. This includes WHO’s role to support the intergovernmental negotiating board, by facilitating the participation of other United Nations system bodies, non-state actors, and other relevant stakeholders.
• Integrate lessons learned: This covenant provides an opportunity to integrate lessons learned from COVID-19 and address other vulnerabilities exposed in the global health infrastructure in recent years.

Cons of a new covenant

• Wavering political commitment: Increasing nationalistic behaviors amongst politicians make it more difficult to build consensus. While the International Health Regulations (IHR) is already adopted, amendments might be necessary going forward. In addition, populistic leaders continue to question WHO’s legitimacy and could use this opportunity to further undermine the process.
• Resources/time: Developing a new covenant would take more time than amending existing agreements, such as IHR. For reference, the Framework Convention on Tobacco Control, the first convention WHO used its constitutional authority to develop, took 12 years to be adopted.

Topics for serious consideration

• Equity: Globally, the COVID-19 pandemic response was rife with nationalist self-interested behaviors and inequities. In particular, the ‘Global South’ was left behind (e.g., vaccine access). Addressing equity requires serious reflection and must be central to any new agreement.
• Resources: Development, implementation, and monitoring of a new covenant will need guaranteed resources through sustainable funding streams.
• Intellectual property rights: Ability to streamline waiving intellectual property rights for life-saving diagnostics, therapeutics, and vaccines during a pandemic should be discussed.
• Compliance: Robust accountability mechanisms, together with incentives, should be considered to promote compliance with the new treaty.
• One Health: Avoiding future pandemics requires addressing upstream causes. Integrating One Health approach considerations and discussing broader determinants of pandemics, including climate change is essential.
• Misinformation: Misinformation undermines trust in global health institutions and measures to combat sources of misinformation should be seriously considered.
• Non-state actors: Non-state health actors are growing rapidly and WHO needs to better engage with them to harness their potential. In line with this, governance of non-state actors (e.g., private for-profit) also needs to be enhanced to prevent negative outcomes.

The COVID-19 pandemic has put health at the center of the global development discussion. It has provided an extraordinary opportunity to create a new agreement that will hopefully strengthen the global health ecosystem’s capacity to equitably prevent and respond to pandemics going forward.

The COVID-19 pandemic has put health at the center of the global development discussion. It has provided an extraordinary opportunity to create a new agreement that will hopefully strengthen the global health ecosystem’s capacity to equitably prevent and respond to pandemics going forward.