In late 2021, as the world reeled from the arrival of the highly contagious omicron variant of the coronavirus, representatives of almost 200 countries met — some online, some in-person in Geneva — hoping to forestall a future worldwide outbreak by developing the first-ever global pandemic accord. The deadline for a deal? May 2024. The costs of not reaching one? Incalculable, experts say. An unknown future pathogen could have far more devastating consequences than SARS-CoV-2, which cost some 7 million lives and trillions of dollars in economic losses. But even as negotiators pack in extra hours, the goal of clinching a legally binding pact by next month is far from certain — despite a new draft document being delivered in recent days. The main sticking point involves access to vital information about new threats that may emerge — and to the vaccines and medicines that could contain that threat. “It’s the most momentous time in global health security since 1948,” when the World Health Organization was established, said Lawrence O. Gostin, director of the WHO Collaborating Center for National and Global Health Law at Georgetown University. The backdrop to today’s negotiations is starkly different from the years after World War II when countries united around principles guaranteeing universal human rights and protecting public health. The unifying fear of covid has been replaced by worries about repeating the injustices that tainted the response to the pandemic, deepening rifts between the Global North and the Global South.

The reasons are clear. A paper published in October 2022 in the journal Nature showed that by the end of 2021, nearly 50 percent of the global population had received two doses of coronavirus vaccine but that huge disparities existed between high-income countries, where coverage was close to 75 percent, and many low-income countries, where less than 2 percent of the population had received two doses. At the same time, South Africa, where the omicron variant was identified, felt punished by travel bans instead of being praised for its scientists’ epidemiological acumen and openness. “We felt like we were beggars when it came to vaccine availability,” South African President Cyril Ramaphosa recalled at a global financial summit in 2023. “We felt like life in the Northern Hemisphere is much more important than life in the Global South.” The United States has signaled its support for a legally binding agreement, including leveraging its purchasing power to expand access to medicines around the world. But the United States, like many European Union countries, is the object of mistrust because it is the seat of the powerful pharmaceutical industry, which is reluctant to relax control over manufacturing know-how.

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