In April 2025, after years of debate, diplomatic wrangling, and cautious optimism, a draft version of the World Health Organisation’s pandemic treaty was finally agreed upon by its member states. This long-anticipated agreement is being heralded by some as a landmark moment for global health governance, a once-in-a-generation opportunity to codify international cooperation in the face of inevitable future pandemics. Yet, as with many multilateral agreements, the document is as notable for what it includes as for what it omits. If the last global health emergency laid bare the chronic inequities that exist between states, the treaty, well-meaning and in many ways ambitious, still leaves much to be desired in terms of enforceability, transparency, and global buy-in.

At the heart of the agreement lies a principle that, to many, feels overdue: that access to lifesaving diagnostics, treatments, and vaccines should not depend on where one lives or the purchasing power of one’s government. One of the treaty’s most widely discussed clauses mandates that countries which share virus samples with the international community must receive a guaranteed share of the medical countermeasures developed from them. The World Health Organization itself will be able to retain up to 20% of these resources for equitable global distribution. The logic is clear: during COVID-19, the countries that facilitated much of the early pathogen surveillance were often those who ended up at the back of the queue for vaccines and therapeutics. This clause, then, is designed to rectify that historical injustice, ensuring that the act of international cooperation is not punished but rewarded. Still, the binding nature of the treaty is already under scrutiny. Although it is nominally a legal document, its enforcement is another matter entirely. The WHO, by design, has no real power to compel sovereign states to comply with any agreement, and member state adherence to this treaty will remain essentially voluntary. If a state reneges on its commitments (by hoarding vaccines, refusing to share samples, or neglecting reporting requirements) there is little in the way of consequence aside from international pressure or reputational damage. This may be adequate for nations already inclined toward cooperation, but for others, particularly those that see health emergencies through a national security lens, it will likely be insufficient. Moreover, while the treaty includes a proposed mechanism for dispute resolution, it is still unclear how this would operate in practice during a fast-moving health emergency.

The geopolitics surrounding the treaty’s development has also played a crucial role in shaping its final form. Notably, two influential players in global health (Argentina and the United States) have opted to distance themselves from the WHO and, by extension, the treaty itself. Argentina’s President Javier Milei, continuing his campaign to dismantle what he sees as bloated international bureaucracies, announced his country’s withdrawal from the WHO, citing ideological concerns and a need to preserve national sovereignty. Meanwhile, the United States under a new Trump administration issued an executive order formally withdrawing from the WHO in January 2025. These exits strike a blow to the treaty’s legitimacy and efficacy. Without the participation of these large and influential health actors, any framework for global pandemic preparedness will be incomplete. The absence of the United States, in particular, significantly limits the potential for universal vaccine equity, given the country’s manufacturing and scientific power. Beyond geopolitics, the treaty has also triggered heated debates over civil liberties and the limits of state power during emergencies. Embedded within the draft are commitments to tackle the spread of misinformation during pandemics, as well as provisions allowing for centralised communication strategies coordinated by the WHO. While such measures are ostensibly aimed at preventing the kinds of conspiracy theories that proliferated during COVID-19, critics argue that the language remains vague and open to abuse. Without robust protections for freedom of speech, the fear is that authoritarian regimes could weaponise the treaty to silence political dissent or restrict the press under the guise of protecting public health.

Human rights organisations have also criticised the draft for failing to include explicit safeguards for marginalised groups. During the last pandemic, it was the elderly, ethnic minorities, low-income communities, and migrants who suffered disproportionately, not only in terms of health outcomes, but also in being subject to harsher enforcement measures and greater surveillance. A pandemic treaty that does not foreground equity within and between countries risks reproducing these harms in future emergencies.

The role of the pharmaceutical industry is another contested area. While many public health advocates call for the waiving of intellectual property rights during health emergencies to facilitate global access, pharmaceutical companies argue that this undermines the very ecosystem that enabled the rapid development of COVID-19 vaccines in the first place. There is truth on both sides. Without the promise of exclusive profits, few companies are likely to take on the financial risk of developing novel vaccines or treatments. Yet without stronger guarantees of equitable access, global trust in the international health system continues to erode. The treaty attempts a compromise: it preserves intellectual property but calls for fair pricing and sharing of technology. Whether this balancing act will work in practice remains to be seen. Another looming concern is whether the treaty does enough to tackle the root causes of pandemic risk. Much of the document is focused on response, on how to behave once a virus has already begun to spread. Less attention is paid to prevention. There is little in the way of binding commitments to reduce deforestation, regulate wildlife trade, or limit industrial farming: three well-established drivers of zoonotic spillover. Nor does the treaty sufficiently address the dangers of laboratory biosafety and dual-use research, despite growing international concern over these issues. In short, the treaty may help the world respond faster and more fairly, but it may do little to prevent the next pandemic from occurring in the first place.

Despite its limitations, the treaty represents a serious attempt to learn from the failures of the past. That in itself is no small achievement. After the Ebola outbreak in West Africa in 2014, there were similar calls for reform and global coordination, most of which failed to materialise. COVID-19, by virtue of its scale and its trauma, has forced a reckoning. But the success of this treaty will depend not on what is written in Geneva, but on what is done in capitals around the world. A document, even one as ambitious as this, is only as strong as the political will behind it. If pandemic preparedness is to mean more than stockpiles and strategy papers, it must be underpinned by a renewed sense of solidarity, one that understands health not as a commodity or a privilege, but as a shared global right.

As the WHO prepares for its annual assembly in May, where the treaty will be formally adopted, the world waits to see whether this agreement will herald a new era of global health collaboration, or whether, like so many before it, it will be quietly shelved when the next crisis arrives. If the past five years have taught us anything, it is that health emergencies are no longer rare, isolated events; they are now a defining feature of the 21st century. The question is whether our institutions are ready to evolve accordingly.