Intended for healthcare professionals


WHO member states agree better ways to detect health threats and set new deadline for pandemic treaty

BMJ 2024; 385 doi: (Published 04 June 2024) Cite this as: BMJ 2024;385:q1227
  1. Luke Taylor
  1. Bogota

The negotiation of a pandemic accord intended to prevent the global disaster seen during covid-19 should be completed in the next year, WHO officials in Geneva announced this weekend.

WHO extended the deadline for the accord to be finalised—to the 2025 World Health Assembly—after the organisation’s 194 member states failed to agree on a text by the 24 May deadline, despite more than two years of negotiations. Although country representatives were unable to agree on the new legally binding global convention on pandemics, they did manage to agree on updates to the international health regulations (IHR), the legally binding framework first drawn up in 1969 to improve the world’s response to global health threats.

“The amendments to the international health regulations will bolster countries’ ability to detect and respond to future outbreaks and pandemics by strengthening their own national capacities and coordination between fellow states, on disease surveillance, information sharing, and response,” said WHO’s director general, Tedros Adhanom Ghebreyesus, on 1 June. “This is built on commitment to equity, an understanding that health threats do not recognise national borders, and that preparedness is a collective endeavour.”

The revised IHR includes a commitment to strengthening access to medical products and financing and stronger, more precise language that should accelerate the detection of health threats and the necessary global action to manage them.

Among the additions to the IHR, which was last updated in 2005, is the obligation for countries to report “clusters of severe acute respiratory disease of unknown or novel cause” and for WHO to share information about a health threat that has potential for international spread, even when the originating country does not want WHO’s collaboration.

The amended regulations also define “pandemic emergencies” for the first time. The UN organisation said that the new category of health alert should “trigger more effective international collaboration in response to events that are at risk of becoming, or have become, a pandemic.”

Higher level of alert

The new “pandemic emergency” is a higher level of alert than a public health emergency of international concern (PHEIC), which was declared for covid-19 on 30 January 2020 before the coronavirus went on to take seven million lives.

To meet the new, higher threshold of pandemic emergency a new disease must be identified that meets several criteria, including that it is “at high risk of having wide geographical spread to and within multiple states” and it “exceeds or is at high risk of exceeding the capacity of health systems to respond in those states.”

The IHR amendments should help the world prevent future pandemics if countries meet their new obligations, said Helen Clark, former New Zealand prime minister and co-chair of the Independent Panel for Pandemic Preparedness and Response. “These amended international health regulations, if fully implemented, can result in a system that can better detect health threats and stop them before they become international emergencies,” Clark said. “I congratulate WHO member states for agreeing to regulations intended to improve information sharing about outbreaks and action to ensure that countries have access to health products to contain outbreaks, including to the financing required.”

Critics of the IHR have pointed out that countries disregarded the framework during the covid-19 pandemic, a problem they hope will be rectified by a dedicated pandemic accord that has more obligations for states and tougher language to make sure they comply with them.

Negotiating the new pandemic accord from scratch has proved more tricky than amending the existing IHR, however. Countries have not found a consensus on how many vaccines and medical supplies should be redistributed to poorer nations in the case of a pandemic. Technology transfer and financing for low and middle income have also split opinions.

How much more time is needed to find an agreement had also divided countries, but WHO member nations finally agreed on 1 June to get the pandemic treaty finalised by the time they return to Geneva in June 2025.

“Full implementation of the international health regulations brings the world closer to being safer from pandemic threats. A new pandemic agreement with equity at its heart would further strengthen the rules around and guide international collaboration,” Clark said.