Multilateralism is not being treated in ICU
In Geneva, 124 nations voted to adopt only the second major legal accord in the World Health Organization's history — a pandemic treaty born from the inequities laid bare by COVID-19, when wealthy nations hoarded vaccines while the developing world waited. The agreement seeks to ensure that when the next crisis arrives, access to lifesaving tools will be distributed more justly across humanity. Yet the treaty's moral weight is complicated by the absence of the United States, by the absence of enforcement teeth, and by the unfinished architecture of its most consequential provisions. What was adopted is less a solution than a collective promise — and the distance between a promise and its fulfillment remains, as ever, the central question of human cooperation.
- Three years of painstaking negotiation culminated in a historic vote, but the US withdrawal under the Trump administration cast a long shadow over what should have been an unambiguous triumph.
- The treaty's core tension is structural: it asks pharmaceutical companies and wealthy nations to prioritize equity over profit, but provides no mechanism to compel them when the pressure to do otherwise becomes overwhelming.
- Supporters celebrated multilateralism's survival, while critics — including US Health Secretary RFK Jr. — argued the agreement simply enshrines the same failures that defined the world's COVID-19 response.
- Critical provisions on pathogen-sharing and guaranteed vaccine access remain unfinished, with finalization pushed to next year's assembly, leaving the treaty's most consequential chapters still unwritten.
- Ratification by national legislatures and actual compliance by drugmakers remain deeply uncertain — the treaty's true test will only come when the next pandemic arrives and the instinct to hoard reasserts itself.
On Tuesday in Geneva, delegates from 124 countries voted to adopt a pandemic preparedness treaty — only the second major legal agreement in WHO history, after the tobacco control accord of two decades ago. Eleven nations abstained. None opposed. The vote was the culmination of more than three years of negotiations that began in the shadow of Omicron, when the grotesque inequality of global vaccine distribution could no longer be ignored.
The treaty commits countries to work toward equitable access to vaccines, treatments, and diagnostics in future crises. It asks manufacturers to donate or sell at reduced cost twenty percent of their production, to share manufacturing knowledge with producers in poorer nations, and to strengthen early detection of emerging diseases. WHO Director-General Tedros Adhanom Ghebreyesus called it a victory for science and multilateralism. Co-chair Precious Matsoso framed it as proof that the world can still act together.
But the celebration was shadowed by absence. The United States, once the anchor of global health leadership, withdrew from negotiations after the Trump administration pulled the country from the WHO entirely. In a recorded message, Health Secretary Robert F. Kennedy Jr. dismissed the treaty as a monument to the organization's unreformed failures. His remarks went largely unacknowledged as other nations lined up to offer praise.
Even supporters concede the treaty's limits. It carries no enforcement mechanisms, offers no guarantee that manufacturers will deliver doses quickly enough to vulnerable nations, and reflects the compromises required to keep wealthy countries at the table. Push too hard, and they walk away; concede too much, and the agreement becomes symbolic.
Much remains unresolved. The rules governing how countries share pathogen samples — and how benefits from resulting vaccines flow back to those countries — are still being negotiated and won't be finalized until next year. Ratification by national legislatures is uncertain. And the deepest uncertainty lies beyond all of that: whether governments and drugmakers will honor their commitments when the next crisis arrives and the temptation to prioritize national interest reasserts itself. As departing WHO emergency chief Mike Ryan reminded the delegates, health workers will again stand on the frontlines. Whether this treaty arms them — or merely gestures toward doing so — depends entirely on what comes next.
In Geneva on Tuesday, delegates from around the world formally adopted a treaty designed to prevent the world from stumbling through the next pandemic the way it did the last one. The agreement, hammered out over more than three years of negotiation, represents the second major legal accord the World Health Organization has ever reached—the first being a tobacco control treaty more than two decades ago. One hundred twenty-four countries voted in favor. Eleven abstained. None opposed it.
The treaty emerged from a specific wound. In late 2021, as the Omicron variant spread globally, the inequality in vaccine access became impossible to ignore. Wealthy nations had secured doses while developing countries went without. The negotiators who gathered then, and kept gathering through three years of talks, were trying to build guardrails against that happening again. The agreement commits countries to work toward equitable distribution of vaccines, treatments, and diagnostic tests when the next crisis arrives. It calls for manufacturers to donate or sell at reduced prices twenty percent of what they produce. It encourages drugmakers to share manufacturing knowledge with companies in poorer nations. It asks countries to strengthen their ability to detect emerging diseases and to reduce the risk of pathogens jumping from animals to people.
Tedros Adhanom Ghebreyesus, the WHO's director-general, called it a historic milestone and a victory for science and multilateral action. Precious Matsoso, a South African regulatory expert who co-chaired the negotiating body, framed it as proof that the world still functions together, that multilateralism is not yet on life support. Teodoro Herbosa, the Philippines' health secretary, described it as a product of painstaking dialogue, a signal of hope in a divided world.
But the treaty's moment of triumph is shadowed by an absence. The United States, which once led global health efforts, withdrew from the negotiations earlier this year after the Trump administration decided to pull the country and its funding from the WHO. That departure was not discussed Monday as countries lined up to praise the agreement. In a recorded message played at the assembly, Robert F. Kennedy Jr., now the U.S. health secretary, argued that the WHO had learned nothing from its pandemic failures and that the treaty would simply lock in the same dysfunction.
Even among supporters, there is acknowledgment of what the treaty does not do. It contains no enforcement mechanisms. It does not guarantee that manufacturers will supply doses to developing countries quickly enough or in sufficient quantity. Some experts worry it does not go far enough in forcing wealthy nations and pharmaceutical companies to prioritize equity over profit. The negotiators faced a difficult balance: push too hard for developing nations' demands and wealthy countries might walk away; give too much ground to corporate interests and the treaty becomes hollow. They chose the middle ground, which means the agreement is stronger than nothing but weaker than what advocates had hoped for.
Significant work remains. Countries are still negotiating the details of how nations will share virus samples and genetic sequences when they discover new pathogens, and how access to vaccines and treatments developed from that information will be guaranteed. Those provisions are not expected to be finalized until next year's assembly. Member states also have to ratify the treaty in their own legislatures. And then comes the hardest part: whether countries and drugmakers will actually follow through when the next crisis arrives and the pressure to hoard and profit becomes intense.
Mike Ryan, who runs the WHO's health emergency program and is leaving the organization amid budget cuts, spoke to the delegates as they prepared to vote. He reminded them that health workers will again stand on the frontlines of a pandemic. The question, he said, is whether the world will give them the tools, the drugs, the oxygen, the vaccines they need. Whether this treaty becomes a gift to the world or merely a well-intentioned document depends on what happens next.
Notable Quotes
The agreement is a victory for public health, science, and multilateral action. It will ensure we, collectively, can better protect the world from future pandemic threats.— Tedros Adhanom Ghebreyesus, WHO Director-General
In a time of growing geopolitical tensions and seismic changes, this agreement is proof that the world is still together. Multilateralism is not being treated in ICU.— Precious Matsoso, South African regulatory expert and negotiating co-chair
The Hearth Conversation Another angle on the story
Why does it matter that the U.S. withdrew? Couldn't the rest of the world just move forward?
The U.S. is the largest funder of global health work and has enormous influence over pharmaceutical companies. Its absence signals that when the next crisis hits, there may not be consensus. It also weakens the treaty's moral authority—it's harder to ask countries to sacrifice for equity when a major power says the whole thing is broken.
The treaty doesn't have enforcement mechanisms. So what happens if a country just ignores it?
That's the real question. International law relies heavily on reputation and peer pressure. If a wealthy nation hoards vaccines while the treaty says it shouldn't, other countries will remember. But there's no court that can force compliance. It's a promise, not a law with teeth.
The manufacturers are supposed to donate or sell at low prices twenty percent of production. Why only twenty percent?
Because the negotiators had to keep pharmaceutical companies at the table. Push too hard and they walk away, and then there's no agreement at all. Twenty percent is a compromise—better than the zero percent guarantee that existed before, but far less than advocates wanted.
If it's so limited, why are people calling it historic?
Because it's the first time the world has formally agreed that pandemic response should prioritize equity. The last pandemic showed us what happens when it doesn't. This treaty says that has to change. Whether it actually does is still unwritten.