In January 2020, the World Health Organization found itself in a position it had occupied before: urging countries to act on a looming threat while lacking the authority to make them listen. Within weeks, the most sophisticated global health architecture ever constructed proved stunningly inadequate for the crisis it was supposedly built to handle.

The COVID-19 pandemic didn't reveal new flaws in global health governance. It amplified ones that experts had flagged for decades — from the WHO's toothless enforcement powers to the absence of any credible mechanism for equitable vaccine distribution. The 2005 International Health Regulations were supposed to be the lesson learned from SARS. They weren't enough.

But crises have a way of unsticking what politics cannot. The pandemic has now catalyzed the most ambitious renegotiation of international health agreements since the WHO's founding in 1948. Whether those negotiations produce meaningful reform or another round of well-intentioned paper promises depends on whether states are willing to trade sovereignty for security — a bargain global governance has always struggled to close.

The World Health Organization is often described as the world's health authority. The word authority does a lot of heavy lifting in that sentence. In practice, the WHO operates more like a convener, advisor, and clearinghouse than a body that can compel action. Its constitution grants it the power to adopt regulations and issue recommendations, but member states retain near-total discretion over whether and how they comply.

This structural weakness was on full display during COVID-19. When China delayed sharing critical epidemiological data in the early weeks of the outbreak, the WHO had no legal mechanism to demand transparency. When countries imposed travel bans that contradicted WHO guidance, there were no consequences. The 2005 International Health Regulations — revised specifically after SARS to strengthen global preparedness — require states to notify the WHO of potential public health emergencies. But notification without verification, and guidance without enforcement, left the system running on trust at precisely the moment trust was in shortest supply.

The root of the problem is institutional design shaped by geopolitics. The WHO depends on member state contributions for its funding, which means it cannot afford to alienate major donors. Its Director-General must navigate a landscape where scientific imperatives constantly collide with diplomatic sensitivities. During the pandemic, this translated into cautious language, delayed declarations, and a reluctance to publicly call out non-compliance — all of which eroded public confidence in the institution.

None of this was surprising to people who study global governance. The WHO was never designed to be a supranational enforcement body. It was built in 1948 as a coordination mechanism among sovereign states, and its architecture reflects that era's assumptions about how international cooperation works. COVID exposed not a broken system but a system operating exactly as designed — in a world that had outgrown those design parameters.

Takeaway

The WHO's weakness isn't a bug — it's a feature of a system built on the premise that sovereignty comes first. Until states accept meaningful constraints on their autonomy during health emergencies, the world's top health body will remain an advisor that countries can ignore when the stakes are highest.

COVAX was supposed to be the answer. Launched in 2020 as a global initiative to pool resources and ensure equitable vaccine distribution, it represented the most ambitious attempt at collective action in public health history. The idea was elegant: wealthy nations would co-invest in a portfolio of vaccine candidates, and in return, doses would be allocated globally based on need, not purchasing power. In theory, it aligned self-interest with solidarity. In practice, it was outbid by the countries it needed most.

The United States, United Kingdom, European Union, and other wealthy nations signed bilateral deals directly with pharmaceutical companies, securing enough doses to vaccinate their populations multiple times over. By the time COVAX began distributing its first shipments in early 2021, high-income countries had already administered hundreds of millions of doses. The initiative's original target — two billion doses by the end of 2021 — was missed by a wide margin. Vaccine nationalism, the very problem COVAX was designed to solve, overwhelmed it.

This wasn't simply greed. It was a textbook collective action problem. No individual government could justify telling its own citizens to wait while doses went abroad — not when elections, public anger, and genuine public health urgency were all pressing in the same direction. The political incentives were entirely misaligned with the global optimum. Even leaders who understood the epidemiological argument — that an unvaccinated world breeds variants that threaten everyone — couldn't translate that logic into domestic political capital fast enough.

COVAX's partial failure taught the global health community a hard lesson about institutional design. Voluntary pooling mechanisms that depend on goodwill tend to collapse under pressure. Future frameworks will need either binding commitments with real enforcement mechanisms, or structural incentives that make cooperation the easier choice — not just the morally correct one. The question is whether pandemic memory lasts long enough to build them.

Takeaway

COVAX didn't fail because countries were selfish. It failed because its design assumed goodwill would override domestic political pressure during a crisis — the exact moment when domestic pressure is most intense. Effective global systems need to be designed for worst-case politics, not best-case solidarity.

In December 2021, the World Health Assembly took a historic step: it established an intergovernmental negotiating body to draft a new international agreement on pandemic preparedness and response. Often referred to as the "pandemic treaty," this negotiation represents the most significant attempt to overhaul global health governance since the International Health Regulations were revised in 2005. The ambition is sweeping — to create binding commitments on surveillance, data sharing, equitable access to medical countermeasures, and coordinated response protocols.

The negotiations have been contentious. Low- and middle-income countries, having watched wealthy nations hoard vaccines and therapeutics, are insisting on provisions that guarantee equitable access to pathogen data and the benefits derived from it — a principle known as "access and benefit-sharing." Wealthy nations, meanwhile, are wary of commitments that could constrain their flexibility during emergencies or force technology transfers they consider commercially sensitive. Pharmaceutical companies are lobbying against provisions that might weaken intellectual property protections.

At the heart of the debate is a tension that runs through all of global governance: the gap between what collective problems require and what sovereign states are willing to concede. A pandemic treaty with real teeth would need mechanisms for rapid, transparent information sharing; pre-negotiated frameworks for resource allocation; independent verification and compliance monitoring; and — critically — consequences for non-compliance. Each of these elements touches a nerve of national sovereignty.

As of now, negotiators have missed their original May 2024 deadline and extended talks. The outcome remains uncertain. But the very existence of the negotiations marks a shift. For the first time, there is broad international acknowledgment that the current framework is inadequate and that voluntary commitments are not enough. Whether that acknowledgment translates into enforceable architecture — or dissolves as pandemic urgency fades — will define global health governance for decades to come.

Takeaway

The pandemic treaty negotiations are less about health than about a fundamental question of global governance: can sovereign states agree to binding constraints on their future behavior to prevent a shared catastrophe? History suggests they can — but usually only after the catastrophe, and only while the memory still burns.

COVID-19 didn't break global health governance. It revealed a system that was already operating at the limits of its original design — a design rooted in voluntary cooperation, diplomatic caution, and the primacy of state sovereignty over collective need.

The reforms now under negotiation represent a genuine opportunity to build something more resilient. But the window is narrowing. Pandemic fatigue is real, political attention has shifted, and the structural incentives that favor national self-interest over global coordination haven't changed.

The question isn't whether the next pandemic will come. It's whether the architecture built in the aftermath of this one will be robust enough to handle it — or whether the world will find itself, once again, improvising its way through a crisis it saw coming.