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Unraveling the Knot: The Complex and Multi-Pronged Negotiations of Global Pandemic Response Reform

By guest contributor Yassen Tcholakov

The COVID-19 pandemic has exposed the vulnerabilities and shortcomings of the global health system. From strained healthcare infrastructures to inequitable vaccine distribution through a burned out workforce, the crisis has underscored the urgent need for comprehensive pandemic response reforms. In response to these challenges, the world has embarked on one of the most complex processes in recent history: a multi-pronged approach to pandemic response reforms. This approach comprises three key processes: the Intergovernmental Negotiating Body (INB) negotiations for a new Pandemic Treaty, the Working Group on Amendments to the International Health Regulations (WGIHR) working on targeted amendments to the existing regulations, and the United Nations’ High-Level Meeting (HLM) on Pandemic Prevention, Preparedness, and Response (PPR) fostering high-level discussions on pandemic response. This article aims to dissect these intricate negotiations, shedding light on the various facets of this endeavor.

While the focus of this post is on the governance aspects of pandemic response reforms, it’s important to acknowledge the crucial role of financing in this context. Initiatives like the Pandemic Fund are key components of the global strategy to enhance pandemic preparedness and they warrant a detailed discussion that goes beyond the scope of this piece.

The Intergovernmental Negotiating Body (INB)

One of the most discussed pieces of current pandemic negotiations is the Intergovernmental Negotiating Body (INB), which is spearheading the creation of a new Pandemic Treaty at the WHO by May 2024. The negotiations aim to create a legally binding instrument on pandemic prevention, preparedness, and response, a tool that could fundamentally reshape the global approach to pandemics. This instrument aims to address the shortcomings of the International Health Regulations 2005 (IHR), which proved insufficient for government compliance during COVID-19, leading to widespread contraventions and contributing to the global spread of the virus.

A key principle underscoring the pandemic instrument discussions has been equity, particularly in relation to access to and distribution of medical countermeasures, such as vaccines. The failures of the patent-based system and advance market commitments have undermined global public goods approaches like COVAX, leading to demands for equitable access and distribution to be included in the pandemic instrument.

The Working Group on Amendments to the International Health Regulations (WGIHR)

Running parallel to the INB is the Working Group on Amendments to the International Health Regulations (WGIHR). The WGIHR is tasked with considering proposed amendments to the International Health Regulations (2005), a legally binding agreement between 194 WHO Member States. The IHR‘s purpose is to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with public health risks and avoid unnecessary interference with international traffic and trade. Furthermore, the IHR are legally binding on all World Health Organization (WHO) member states, making them essentially an “opt-out” system. This means that all WHO member states are automatically bound by the IHR unless they explicitly reject them. In practice, this has resulted in near-universal acceptance of the IHR, with 196 countries (including all WHO member states) currently bound by them. This is in stark contrast a new pandemic treaty, which would likely be an “opt-in” system. This means that each country would need to individually decide to sign and ratify the treaty in order to be bound by its provisions. The WGIHR’s work builds on lessons learned from various review panels that examined the functioning of the IHR and the global health security architecture during the COVID-19 pandemic.

The United Nations’ High-level Meeting (HLM) on Pandemic Prevention, Preparedness, and Response (PPR)

Adding another layer to these negotiations is the United Nations’ High-level Meeting (HLM) on Pandemic Prevention, Preparedness, and Response (PPR), which will be held in September 2023. This meeting will bring together world leaders to commit to a global, whole-of-society approach to addressing pandemics. It is expected to be a key moment to drive political commitments and foster high-level discussions on pandemic response.

The current state of negotiations

The state of negotiations for the three instruments is a complex and evolving landscape. Progress at the INB has been challenging, with the first draft of the Pandemic Accord receiving criticism for its weaker language on innovation sharing, common but differentiated responsibility, and the role of WHO. At the sixth meeting of the INB in July 2023, the Bureau’s text was discussed, with in-depth consultations conducted on the topics of Research and Development, Access and Benefit-Sharing, and Supply Chain and Logistics.

The fourth meeting of the group in July 2023 focused on proposed amendments to various articles of the IHR, including those related to notification, verification, and information sharing by WHO about public health risks, determination of a public health emergency of international concern, and recommendations.

The INB and WG-IHR held a joint plenary session in July 2023, which served as a platform for the two groups to coordinate their efforts and ensure that their respective processes are aligned on issues that appear in both processes. There, the WHO Director-General Dr. Tedros Adhanom Ghebreyesus urged member states to deliver both the Pandemic Treaty and strong, effective amendments to the IHR by the deadline of May 2024 calling this a “generational commitment”. He also warned against the adoption of contradictory definitions and processes, highlighting the need for the two instruments to be complementary.

Finally, while there are also growing concerns that the current draft of the HLM on PPR political declaration is weak and proposes an over-reliance on the World Health Organization (WHO) to manage future pandemics, Dr. Tedros emphasized that the outcomes of the HLM should support the Member State-led processes in Geneva while calling for equity and solidarity to be the guiding principles in the efforts on PPR in all the related processes.


In conclusion, we are currently at a critical juncture in the world’s approach to managing global health emergencies. The complexity of these ongoing negotiations reflects the myriad challenges that must be addressed to prevent, prepare for, and respond to pandemics effectively. It is crucial that these reforms be guided by principles of equity and solidarity, ensuring that all countries, regardless of their resources, are equipped to protect the health of their populations and for the world. As we await the outcomes of the INB, WGIHR, and HLM on PPR, one thing is clear: the world cannot afford to wait for the next pandemic to act.

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About the author:

Yassen Tcholakov is a public health physician working as the lead in infectious diseases at the Nunavik Department of Public Health. He has been involved for over a decade in global health often representing health professional organizations and is currently serving as the Immediate Past Chairperson of the Junior Doctors Network of the World Medical Association. Yassen is passionate about epidemiology, global health, and planetary health all topics on which he teaches at the McGill University and the University of Montreal. He tweets at @yassentch

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