Pandemic Treaty: US Proposes Amending Existing International Health Rules First; Germany Presses for Sanctions
WHO Director General Dr Tedros Adhanom Ghebreyesus (speaking here in Berlin) has thrown his weight behind a new Pandemic Treaty – but the US thinks reform of existing rules, might be a better way forward.

While a “pandemic treaty” could take years to establish, the World Health Organization’s (WHO) International Health Regulations (IHR) could be revised more rapidly to significantly improve global disease outbreak response, top US officials are saying.  The statements coincided with a 3-day working group meeting of WHO member states to discuss ways to strengthen the global muscle behind pandemic preparedness and response. 

“Some major strides to advance global health security may take years to accomplish, for example, the creation of a new international instrument on preparedness and response, which the WHO and a number of other countries have endorsed,” US Secretary of State Antony J. Blinken and US Secretary of Health and Human Services Xavier Becerra wrote in JAMA.

“But it is not necessary to choose between a new instrument and a revised standing legal framework; immediate steps can make a meaningful difference. One is strengthening the WHO’s International Health Regulations (IHR), adopted by the World Health Assembly in 1969 and revised in 2005,” they argued.

The IHR, they add, “is the legal framework under which 196 States Parties are responsible for developing their capacities to prevent, detect, report, and respond to public health emergencies within their borders, to prevent them from spreading to other countries”. 

The COVID-19 pandemic has revealed the IHR weaknesses “that can be fixed, particularly around early warning systems, coordinating the response, and information sharing”, they added.

US Statements coincide with working group meeting on Treaty proposal

The US policy statement coincided with the second meeting of the working group on the proposed ‘pandemic treaty’ proposal, which is then due to be debated at a special session of the World Health Assembly (WHA) scheduled for 29 November to 1 December.

It prompted an immediate response from Professor Ilona Kickbusch, a member of the Global Preparedness Monitoring Board, who pointed out that there is no guarantee that transforming the IHRs would be easier than adopting a pandemic treaty.

Kickbusch’s comments also reflects the divide between Europe and the United States over the pandemic proposal. Germany,  along with the European Union, has strongly supported the treaty initiative as a measure that would raise the level of awareness and debate over pandemic response – which prior to COVID had been consigned to technical units in ministries of health, lacking authority to guide major policy choices.

Since last November, the European Union has been advocating for a pandemic treaty similar to the Framework Convention on Tobacco Control, but has faced opposition from the US, Russia and Brazil. (The tobacco convention provides signatories with evidence-based tobacco control strategies that they are obliged to implement, albeit incrementally.)

WHO Director-General Dr Tedros Adhanom Ghebreyesus has also spoken out repeatedly in support of a ‘pandemic treaty’ along the lines of the Framework Convention on Tobacco Control. 

“The vaccine crisis illustrates the fundamental weakness at the root of the pandemic: the lack of global solidarity and sharing – sharing of information and data, biological samples, resources, technology and tools,” Dr Tedros told a recent meeting of WHO’s African leaders.

“That’s why there is now an emerging global consensus for the idea of an international treaty or other legal instruments, to provide the basis for improved international cooperation to prepare for, detect and respond to epidemics and pandemics,” he said

WHO has lobbied heavily along with the European Union for support of the new pandemic treaty – but the United States says reform of existing IHR rules might be a better way forward.

Speaking at the WHA in June, Mike Ryan, WHO Health Emergencies Programme Executive Director, also spoke out in favour of the treaty despite the fact that WHO technical staff have historically avoided taking positions on controversial policy choices before member states. 

“My personal view is that we need a political treaty that makes the highest-level commitment to the principles of global health security — and then we can get on with building the blocks on this foundation,” Ryan told a briefing on pandemic preparedness.

Germany and allies want to make rules on pandemic response more binding

Whether a full-fledged treaty is adopted, or the IHR rules revised, another key debate has centered around how to make the rules more binding on member states. This has been sharpened over China’s reluctance to fully co-operate with the WHO-appointed group investigating the origins of the SARS-CoV2 virus – including unfettered access to data and destinations in China where the SARS-CoV2 virus, or its closest genomic relatives, may have first emerged and spread.

Germany’s Health Minister Jens Spahn has proposed on two occasions recently that sanctions should also be imposed against countries that hide information about future outbreaks.

Speaking at the launch of a WHO pandemics intelligence hub in Berlin, Spahn called on China “to finally become fully cooperative, and to make the explanation of the origin of the coronavirus transparent to the international community.”

He also added that “there must be something that follows” if countries failed to co-operate with the WHO on pandemics – noting that even transparent democracies like Germany might shirk from opening its doors to independent investigations unless they were bound to do so through a global mandate.

Meanwhile, Tedros said that a pandemic treaty should have all the incentives, or the carrots” but acknowledged that “maybe exploring the sanctions may be important”.

Civil society complains of exclusion from discussions

Meanwhile, some civil society groups are also questioning the wisdom of a new pandemic treaty – while objecting to the marginal role they have been allowed to play in the discussions of the WHO Member State Working Group. 

According to the modalities established by WHO, “Non-State actors” are unable to attend or speak at open sessions of the working group but can provide inputs via an electronic portal, an open ‘hearing’, and/or a segment of a session.

Some civil society advocates support IHR reform rather than Pandemic Treaty

Civil society debate the pandemic treaty proposal in May – hosted by the Geneva Global Health Hub (

Some leading civil society advocates have also supported the US position that devoting energy to the establishment of a pandemic treaty may be a waste of time – when existing IHR rules, which are part of a binding convention can also be strengthened.

In a blog published by the Third World Network on Thursday, Nithin Ramakrishnan and KM Gopakumar charged that the WHO administration (bureau) was prejudging the outcome of the member state discussions – which are supposed to consider whether a pandemic treaty would be useful in  the first place.   The authors claimed that a WHO analytical paper and draft programme of work for the meeting  had prejudged the outcome of discussions through a series of “leading questions” to working group members:

“The Bureau’s questions focus on the merits of developing new instruments straight away. Secondly, it asks what steps Member States would need to take in order to ascribe relative priority to a new instrument. Thirdly, it goes on to ask what criteria and scope should be included or excluded from the new instrument. Finally, the Bureau nails down the need for a “new framework convention” by asking whether the Member States share the idea for another “framework”.

These four questions sequentially are prejudging the outcome of the Working Group meeting and to be suggestive of a pandemic treaty,” the authors said.

A WHO background analysis also fails to provide a logic for why a new agreement would be needed to solve the problems that have surfaced during the COVID pandemic, they added.

“WHO Secretariat’s analytical paper has attempted to set the background … arguing that some of the proposed recommendations of the various [pandemic review] committees require new agreement/agreements. Not a single reason is provided in the analytical paper as to why some of these recommendations require a new agreement,” the authors said.

They pointed out that nine out of the ten key recommendations made by the series of independent reviews of the COVID pandemic’s emergency response mechanisms “could be realized effectively through the International Health Regulations (IHR), either by amending or by adding annxes to IHR.

Concluded the authors:  “The only point amongst the recommendations which requires a framework convention is the recommendation which states that there must be an establishment of a new framework convention. This has precisely been the problematic approach right from the beginning.

“None of the expert bodies which called for a new framework convention reasoned out why it is needed or how it will be more effective than the present regime. The WHO secretariat and the Bureau of the Member States Working Group are the latest to join such a pursuit.”


Image Credits: EU Council.

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