The COVID-19 pandemic did not merely expose a virus. It exposed the fragility of an international health architecture built for a different era—one where states believed they could manage health threats within their borders, and where the World Health Organization operated more as a technical advisor than a crisis commander.

When the pandemic struck, the world discovered that its primary instrument for coordinating global health responses lacked the authority to demand transparency, the funding to act independently, and the mechanisms to ensure compliance. The International Health Regulations, revised after SARS with such optimism in 2005, proved largely unenforceable when a member state chose opacity over disclosure.

Now, as negotiations proceed on a pandemic treaty and new financing mechanisms take shape, the international community faces a fundamental choice. It can engage in institutional tinkering that preserves state prerogatives while adding layers of bureaucratic complexity. Or it can undertake genuine architectural reform that grants international institutions the authority and resources commensurate with the threats they are meant to address. The evidence from COVID-19 suggests the costs of the former approach run into the trillions of dollars and millions of lives.

The World Health Organization's response to COVID-19 was shaped less by the decisions of its leadership than by the structural constraints embedded in its constitutional design. The organization possesses no independent authority to investigate disease outbreaks within member states, no power to compel data sharing, and no enforcement mechanisms when states violate their reporting obligations under the International Health Regulations.

These constraints are not oversights. They reflect deliberate choices made by member states who created an institution designed to provide technical assistance without threatening sovereignty. The WHO operates on assessed contributions that amount to less than $500 million annually—roughly the budget of a large urban hospital—supplemented by voluntary contributions that come with donor-specified restrictions and priorities.

This funding model creates a pernicious dynamic. The organization depends financially on the very states whose compliance it is meant to monitor. When China delayed sharing critical genomic data and initially denied human-to-human transmission, the WHO possessed no independent intelligence capacity to verify these claims and no financial cushion to absorb the consequences of alienating its second-largest contributor.

The authority gap extends beyond information gathering to response coordination. The International Health Regulations allow the WHO Director-General to declare a Public Health Emergency of International Concern, but this declaration triggers recommendations, not requirements. States retain full discretion over whether to implement border measures, share medical supplies, or coordinate their responses with neighboring countries.

Reforming this architecture requires confronting uncomfortable truths about the relationship between sovereignty and collective security. States that demand autonomy during normal times cannot simultaneously expect coordinated international responses during crises. The pandemic revealed that health security, like financial stability, has become a global public good that national institutions alone cannot provide.

Takeaway

Institutions designed to advise without authority will always be outmatched by crises that require command. The gap between the WHO's formal mandate and its actual power reflects a fundamental tension between sovereignty and collective security that member states have yet to resolve.

The pandemic treaty negotiations, launched with considerable fanfare at a special World Health Assembly session in December 2021, have settled into a familiar pattern of ambitious proposals meeting entrenched resistance. The Intergovernmental Negotiating Body has produced successive drafts that reveal the core tensions likely to shape any final agreement.

The first tension concerns pathogen access and benefit sharing. Developing countries, scarred by the experience of sharing H5N1 samples only to find resulting vaccines priced beyond their reach, demand binding commitments on technology transfer and equitable access. Pharmaceutical-producing countries, backed by industry lobbying, resist provisions they characterize as threats to intellectual property rights and innovation incentives.

The second tension involves surveillance and verification. Proposals for independent investigation authority and real-time data sharing requirements have encountered resistance from states across the political spectrum who cite national security concerns, economic interests, or constitutional constraints. The resulting compromise language typically emphasizes voluntary cooperation and mutual trust—precisely the framework that failed during COVID-19.

The third tension concerns financing. Draft provisions on sustainable funding mechanisms have proliferated, but commitment to actual resource mobilization remains thin. Wealthy countries prefer project-based contributions that preserve donor control over voluntary contributions that would strengthen WHO institutional autonomy. Developing countries push for dedicated pandemic preparedness funds but struggle to secure firm financial pledges.

The most likely outcome is a framework convention that establishes aspirational principles and creates institutional machinery for future negotiations, while deferring the hardest questions to subsequent protocols. This approach—familiar from climate negotiations—allows all parties to claim progress while postponing genuine compromise. It may prove adequate for building long-term norms, but it will not deliver the binding commitments and institutional authorities that pandemic preparedness actually requires.

Takeaway

Treaty negotiations tend to produce agreements that all parties can accept rather than agreements that solve the underlying problem. The pandemic treaty's trajectory suggests it will establish useful frameworks while deferring the sovereignty trade-offs that genuine reform requires.

The pandemic prompted an unprecedented mobilization of financing mechanisms for health security. The Pandemic Fund, launched in 2022 with World Bank support, has attracted over $2 billion in pledges. The ACT-Accelerator demonstrated that coordinated financing for vaccines, therapeutics, and diagnostics could be assembled rapidly. Various regional mechanisms, from the African Union's Africa CDC to ASEAN health security funds, have expanded their mandates and budgets.

Yet the scale of these investments remains dramatically mismatched with the scale of the threat. Independent analyses estimate that adequate pandemic preparedness would require $10-15 billion in annual international financing, plus substantial domestic investments in health systems, surveillance capacity, and manufacturing capability. Current committed resources fall well short of this threshold.

More fundamentally, the new financing architecture suffers from fragmentation and unpredictability. Multiple funds with overlapping mandates compete for attention and resources. Disbursement depends on complex application processes that favor countries with existing grant-writing capacity. Replenishment cycles create uncertainty that undermines long-term planning.

The experience of development finance suggests that voluntary mechanisms are structurally inadequate for sustaining investments in prevention. When immediate crises fade from memory, donor attention shifts to newer priorities. Health security spending after SARS and Ebola followed precisely this pattern—surging briefly before returning to baseline neglect.

Sustainable financing would require either binding contribution commitments from wealthy countries, automatic revenue mechanisms such as levies on international transactions, or integration of pandemic preparedness into existing mandatory contribution frameworks. Each approach faces substantial political obstacles. But without addressing the financing gap, institutional reforms in authority and treaty obligations will amount to elaborate architecture built on inadequate foundations.

Takeaway

Prevention is chronically underfunded because its successes are invisible and its costs are immediate. Sustainable health security financing requires mechanisms that operate automatically rather than depending on the attention spans of donor governments.

The post-COVID reform agenda for global health governance is intellectually clear but politically treacherous. The pandemic demonstrated that existing institutions lack the authority, independence, and resources to manage transnational health threats. The solutions—enhanced WHO powers, binding treaty commitments, sustainable financing—are well understood by the experts negotiating in Geneva.

What remains unclear is whether member states possess the political will to accept the sovereignty constraints that effective global health governance requires. The negotiations to date suggest that most states prefer the appearance of reform to its substance, opting for framework agreements and voluntary mechanisms that preserve national prerogatives.

The institutional architecture that emerges from this reform moment will shape pandemic preparedness for decades. If it merely adds layers of bureaucracy to fundamentally unchanged power relationships, the next pandemic will find the international community no better prepared than it was in January 2020. The question is not what reforms are needed, but whether states are willing to build institutions commensurate with the threats they face.