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Covid 19: Why we need a global pandemic treaty

BMJ 2021; 375 doi: (Published 02 December 2021) Cite this as: BMJ 2021;375:n2963

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  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}
    Follow Fiona on Twitter @fgodlee

The world was not prepared for this pandemic. While countries affected by severe acute respiratory syndrome (SARS) in 2003 responded quickly and efficiently to the early warnings of covid-19, most stumbled at the first hurdle and are still not catching up.

For a rich nation, the UK has performed particularly poorly. A damning report from a people’s inquiry concludes that the government has been grossly negligent, amounting to misconduct in public office (doi:10.1136/bmj.n2955).1 And although lessons may have been learnt about procurement and stockpiling of personal protective equipment (doi:10.1136/bmj.n2849),2 there is now a worrying and costly fixation on unproved antiviral drugs, with echoes of the Tamiflu saga ( The UK was the first country, now followed by the US (doi:10.1136/bmj.n2984),3 to approve an antiviral for covid-19, on the evidence of a single clinical trial, apparently to fulfil an “impossible promise” by politicians to have two antivirals ready for use by the autumn (doi:10.1136/bmj.n2611).4 This despite incontrovertible evidence that the virus is airborne, that a combination of masks, screens, social distancing, and ventilation can stop transmission (see our interactive graphic, and that the real money must urgently go on improving indoor air quality (doi:10.1136/bmj.n2895).5

Each country has had its own reasons for failures in preparing for emergencies, including wrong assumptions about potential threats. For the UK it was flu, for the US bioterrorism, prompting stockpiles of smallpox vaccine and nerve gas antidote (doi:10.1136/bmj.n2849).2 Paradoxically perhaps, some countries in Africa have shown what can be done, using their hard won understanding of health emergencies (doi:10.1136/bmj.n2512).6 Their response included the genome sequencing that alerted the world to the new variant, omicron.

How should countries respond to omicron? Some have closed their borders (doi:10.1136/bmj.n2943),7 but stopping incoming flights from southern Africa is surely political and pointless and will damage international collaboration. Instead we need effective quarantine, contact tracing, and testing of travellers. And we should tighten preventive precautions until we know more (doi:10.1136/bmj.n2941).8

Covid-19 has laid bare national but also global shortcomings, writes WHO’s director general, Tedros Adhanom Ghebreyesus (,9 as part of two major BMJ collections of articles on pandemic preparedness published this week (; We need to revamp the world’s collective response, Tedros says. Key to that revamping will be a legally binding international treaty on pandemic preparedness and response, with a commitment to sharing data, information, resources, knowledge, and tools.

The world was not prepared for this pandemic (doi:10.1136/bmj-2021-067518).10 We need a global treaty if we are to prepare for the next one.

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