Pandemic prevention, preparedness and response accord

In light of the impact of the COVID-19 pandemic, WHO’s 194 Member States established a process to draft and negotiate a new convention, agreement, or other international instrument (referred to in the rest of this FAQ, generally, as an “accord”) on pandemic preparedness and response. This was driven by the need to ensure communities, governments, and all sectors of society – within countries and globally – are better prepared and protected, in order to prevent and respond to future pandemics. The great loss of human life, disruption to households and societies at large, and impact on development are among the factors cited by governments to support the need for lasting action to prevent a repeat of such crises.

At the heart of the proposed accord is the need to ensure equity in both access to the tools needed to prevent pandemics (including technologies like vaccines, personal protective equipment, information and expertise) and access to health care for all people.

WHO Member States have developed multiple global legally binding agreements, conventions, accords, and other types of international instruments to protect and promote people’s health, including the WHO Constitution itself, the WHO Framework Convention on Tobacco Control, and the International Health Regulations.

Such instruments were created by Member States to secure and foster further collaboration in multiple areas that impact on the health and well-being of people in communities, countries and globally.

These international instruments represent a commitment by countries of the world to address the health needs of their citizens to advance their health status and strengthen the socio-economic status of their communities at large.

The process to consider such an international accord for pandemic prevention, preparedness and response is one that was launched by, is being led fully by, and will be decided by WHO’s Member States.

In December 2021, at a special session of the World Health Assembly – WHO’s highest decision-making body, comprising of all of its 194 sovereign member countries – WHO’s Member States decided to establish an intergovernmental negotiating body (INB), representing all regions of the world, to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response, with a view to adoption under Article 19 of the WHO Constitution, other provisions of the Constitution as may be deemed appropriate by the INB.

Article 19 gives the 194 Member States forming the Health Assembly the authority to adopt conventions or agreements on any matter within WHO’s competence. The sole instrument established under Article 19 to date is the WHO Framework Convention on Tobacco Control, which has made a significant and rapid contribution to protecting people from tobacco since its entry into force in 2005.

The World Health Assembly decision establishing the Intergovernmental Negotiating Body (INB) and its work on this new international accord stressed that WHO’s Member States, who will be working in their sovereign capacity, should guide their efforts by the principle of solidarity with all people and countries, and that the accord should frame practical actions to deal with both causes and consequences of pandemics and other health emergencies.

The INB process has allowed various constituencies to be actively engaged through:

• written and oral inputs from Member States and relevant stakeholders on the successive iterations of the work, including the Substantive Elements, the Working Draft, the Conceptual Zero Draft and the Zero Draft;
• regional consultations;
• informal, focused consultations on selected key issues, including with experts;
• public hearings  for interested parties and stakeholders to express their views; and
• regular information briefings.

In December 2021, WHO’s Member States requested the WHO Director-General to convene the meetings of the Intergovernmental Negotiating Body and support its work, including by facilitating the participation of other United Nations system bodies, non-state actors, and other relevant stakeholders in the process to the extent decided by the 194 Member States forming part of the negotiations.

The WHO Secretariat’s job is to support countries – its Member States – as they negotiate and agree on the new international accord. The WHO Secretariat does not determine the contents of any possible international accord.

Besides WHO Member States, the process for developing a possible new accord is providing extensive opportunities for engagement with relevant stakeholders, including other United Nations system bodies, and a wide range of other non-State actors in official relations with the WHO, to ensure robust and inclusive participation in the proceedings of the Intergovernmental Negotiating Body. Furthermore, WHO is seeking complementary inputs through public hearings with stakeholders including: international organizations; civil society; the private sector; philanthropic organizations; scientific, medical, public policy and academic institutions and other entities with relevant knowledge, experience and/or expertise.

WHO’s Member States held their first meeting of the Intergovernmental Negotiating Body (INB) on 24 February 2022 and met nine times through to 24 May 2024. During that period, they met virtually and in person on a regular basis, according to the timeline of the INB, which was set out in document A/INB/3/4, and between meetings held intersessional discussions.   

The INB was mandated to submit its final outcome to the Seventy-seventh World Health Assembly in May 2024. On 1 June 2024, recognizing that the INB had achieved progress and reached initial agreement on many provisions of the proposed WHO Pandemic Agreement, and that further work needed to be done on remaining elements, the Health Assembly decided to extend the INB’s mandate to finish its work as soon as possible, and submit its outcome for consideration by the Seventy-eighth World Health Assembly in May 2025, or earlier by a special session of the World Health Assembly if possible in 2024.

The Health Assembly also decided that the next meeting of the INB shall be held in July 2024, in hybrid mode with interpretation.

On 1 June 2024, the World Health Assembly extended the mandate of the INB, deciding that this work on the proposed WHO Pandemic Agreement must be finished as soon as possible, and the outcome be submitted for the consideration of the Seventy-eighth World Health Assembly in May 2025, or earlier by a Special Session of the World Health Assembly, if possible, in 2024. 

The Health Assembly directed that the next meeting of the INB following the World Health Assembly held in 2024 shall be in July 2024, in hybrid mode with interpretation.

The Intergovernmental Negotiating Body is, per the World Health Assembly decision, operating based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus. Public updates are provided at all relevant steps of the process. The INB website is the main source of information.

More information on the INB

As the process of the Intergovernmental Negotiating Body is solely the decision of WHO’s 194 sovereign Member States, WHO’s Member States will ultimately determine the form and content of the new accord, including its objectives, principle(s), and scope.

The new accord could represent a global commitment to work together, as an international community, to help prevent disease outbreaks from impacting individuals, communities, countries and the world in the same way as the COVID-19 pandemic did.

Importantly, any new accord would be expected to establish principles, priorities and targets for pandemic preparedness and response, with the aim to:

• build resilience to pandemics;
• support prevention, detection, and responses to outbreaks with pandemic potential;
• ensure equitable access to pandemic countermeasures; and
• support global coordination through a stronger and more accountable WHO.

The new accord could complement other initiatives, actions and measures aimed at making the world safer from pandemics, including the International Health Regulations and global institutions and systems working to equitably share health technologies, information and expertise.

The proposed accord could take the lessons learned from the COVID-19 pandemic and use them to build back better. Equity is one of the key principles being discussed as part of the work on the new accord.

A new accord could promote political commitment at the highest level, through ensuring an all-of-government and whole-of-society approach within countries, and sustained and sufficient political and financial investment within and among countries. 

Among other things, the new accord could, if WHO’s Member States so decide, address gaps that have been highlighted by the COVID-19 pandemic, including the following key areas for action:

• global preparedness and response arrangements – including at the human-animal interface – to help anticipate and prevent future pandemics and address them more effectively when they do arise;
• sustained, predictable funding for health emergency preparedness and response, including from domestic budgets to support preparedness measures and help ensure that the world is prepared and can respond to the emergence of dangerous pathogens; and
• governance and oversight mechanisms to increase trust, ensure accountability and foster transparency.

The International Health Regulations (2005) (the “IHR”) is a key international instrument on international health, rooted in the WHO Constitution. The IHR was established to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.

The work on the new accord on pandemic prevention, preparedness and response would aim to be coherent with, and complement, the IHR. The Health Assembly decision SSA2(5) establishing the INB noted the “need for coherence and complementarity between the process of developing the new instrument and the ongoing work […] regard to implementation and strengthening of the IHR (2005)”.

In May 2022, the World Health Assembly agreed to start a process to consider “targeted” amendments to the IHR. This work was led by a dedicated Member-State led working group process (the Working Group on Amendments to the International Health Regulations (2005)). The Working Group held its first meeting on 14–15 November 2022 and ended its work on 24 May 2024. A Drafting Group established by the Seventy-seventh World Health Assembly concluded the work initiated by the Working Group, after Member States agreed a package of amendments to the IHR.

The amendments to the International Health Regulations, agreed by the Seventy-seventh World Health Assembly on 1 June 2024, include the definition of a Pandemic Emergency, which represents the new highest level of alarm contained within the IHR and available for use by the WHO Director-General.

The Pandemic Emergency definition builds on the existing mechanisms of the IHR, including the determination of public health emergency of international concern.

A Pandemic Emergency aims to trigger a more effective international collaboration in response to events that are at risk of becoming, or have become, a pandemic.

Each and all of the six following criteria must be met for an “event” (which, according to the IHR, means a manifestation of disease or an occurrence that creates a potential for disease) to be determined a “Pandemic Emergency”.

These are:

1. it must be a Public Health Emergency of International Concern (PHEIC). A PHEIC means an extraordinary event which is determined (i) to constitute a public health risk to other States through the international spread of disease; and (ii) to potentially require a coordinated international response;
2. being of communicable disease nature;
3. having or at risk of having wide demographical;
4. exceeding, or is at high risk of exceeding, the capacity of health systems;
5. causing, or is at high risk of causing, substantial social and/or economic disruption etc.; and
6. requires rapid, equitable and enhanced coordinated international action etc.

None. The outcome document developed by the Intergovernmental Negotiating Body (INB) and presented to the Seventy-seventh World Health Assembly reaffirms “the principle of the sovereignty of States in addressing public health matters.”

Article 24, paragraph 2, of the draft agreement goes onto say that “Nothing in the WHO Pandemic Agreement shall be interpreted as providing the WHO Secretariat, including the WHO Director-General, any authority to direct, order, alter or otherwise prescribe the national and/or domestic laws, as appropriate, or policies of any Party, or to mandate or otherwise impose any requirements that Parties take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns.”

A guiding principle of the draft agreement is the “full respect for the dignity, human rights and fundamental freedoms of persons.”

As with all international instruments, any new accord, if and when agreed by Member States, would be determined by governments themselves, who would take any action while considering their own national laws and regulations.

Member States will decide the terms of the accord, including whether any of its provisions will be legally binding on Member States as a matter of international law.

It is expected that such an accord would aim to help prevent future disease outbreaks from impinging on people’s freedom to travel, work, seek education and, above all, lead a healthy life free of avoidable disease, as called for by another global accord, the WHO Constitution.

This would be a decision of WHO’s Member States, working through the intergovernmental negotiating body. It would be expected that a new accord would be open to the participation of all countries, who would be able to participate if they so wished. In line with the example provided by the WHO Framework Convention on Tobacco Control, the new accord could, possibly, be open to regional economic integration organizations.

It would be up to Member States to decide if and what compliance mechanisms would be included in the new accord on pandemic preparedness and response. It is a general principle of international law that once an international law instrument is in force, it would be binding on the parties to it, and would have to be performed by those parties in “good faith.”