Amid geopolitical fragmentation and rising nationalist sentiment, the negotiations leading to the Pandemic Agreement—which was adopted on May 20, 2025 at the World Health Assembly—have shown that multilateral diplomacy is more difficult than ever—but also more vital. 

For decades, cooperation on global health was treated as self-evident. The shared logic was clear: pandemics, like the climate crisis, do not respect borders, and global public health demands a coordinated response. Institutions like the World Health Organization (WHO) were long viewed as technical bodies—operating above the political fray and tasked with delivering neutral, evidence-based guidance.

The COVID-19 pandemic fractured that perception. The trauma of the pandemic, which resulted in over 7 million deaths worldwide, initially appeared to strengthen the rationale for collective action. As states confronted overwhelmed health systems, supply chain collapses, and massive social and economic dislocation, there was a rhetorical agreement that a more robust, equitable, and coordinated international system was urgently needed.

But the pandemic also revealed the deeply political nature of global health governance. It laid bare structural injustices—in access to vaccines, therapeutics, health infrastructure, and financing—that had long been overlooked. The ideal of health cooperation as a neutral technical enterprise gave way to a reckoning with long-standing inequities underscored by the pandemic’s disproportionate toll on low- and middle-income countries. For many countries, especially those in the Global South, the pandemic confirmed not just the failures of the response to the pandemic, but the persistent asymmetries of the international system.

In 2021, against the backdrop of COVID-19’s devastation, WHO member states agreed at a rare Special Session of the World Health Assembly to initiate negotiations on a pandemic treaty. This marked only the second such session in WHO’s history.

The process that followed was ambitious. The Intergovernmental Negotiating Body (INB) was established to draft a binding pandemic instrument within just two years. Compared to the parallel process to amend the International Health Regulations, the INB started from scratch, soliciting proposals from states and civil society and aiming to deliver a transformative global health agreement.

Yet the initial ambition was quickly overshadowed by procedural and political deadlock. 

From the outset, the negotiation process was slow and sometimes frustrating for the delegates, beginning with the establishment of working methods and procedures, such as how to reflect the proposals of member states, how to conduct discussions, and the formats of meetings. It took a long time for discussions to focus on technical and substantive issues.

Even once discussions moved to substantive issues, plenary sessions remained largely performative, slow, and stagnant. Delegates often repeated entrenched positions rather than engaging in genuine, solution-oriented dialogue. The structure of the process encouraged states to negotiate primarily with the INB Bureau rather than with one another. This dynamic fostered monologues over conversation, with little incentive to explore compromises or mutual understanding. Regional blocs tended to negotiate inwardly, and although informal engagement outside the plenary is common practice in multilateral negotiations, in this case it was frequently met with skepticism and mistrust. This reflected the high levels of political sensitivity and low levels of trust that permeated much of the process.

Countries in the Global South—which tended to emphasize the “response” component of the treaty—advocated for enforceable commitments on technology transfer, local manufacturing, and benefit-sharing, viewing the agreement as an opportunity to address long-standing systemic imbalances. High-income countries, by contrast, were generally more reluctant to accept binding obligations in areas touching on intellectual property rights and benefit-sharing, in part due to pressure from private sector stakeholders. However, they strongly supported bolstering the “prevention” pillar, particularly through enhanced global surveillance and the adoption of a One Health approach, which integrates human, animal, and environmental health systems.

While these broad fault lines shaped much of the early negotiation dynamics—mirroring deeper geopolitical divides—they often obscured the more nuanced and multifaceted positions of individual member states, whose interests did not always align neatly along a North-South axis. The perseverance and proactive engagement of multiple delegates acting as bridge-builders were instrumental in laying the groundwork for more constructive dialogue on how to strike an acceptable and balanced agreement that meaningfully addresses all dimensions of pandemic prevention, preparedness, and response. Even delegates operating under tighter mandates from their capitals demonstrated leadership and pragmatism—often going beyond formal instructions to help build consensus—highlighting the significant influence that individual personalities and personal commitment can have on the outcome of multilateral negotiations.

The design of the plenary meeting format itself posed additional challenges. INB Drafting Group sessions were closed to the public but could be followed online by member states through a hybrid setup. While this allowed capitals and technical experts to remain closely involved, it also constrained the delegates’ flexibility. Under real-time scrutiny, some delegates became more rigid in defending their national positions, limiting space for negotiation.

Recognizing these constraints, a range of actors promoted informal discussion spaces to enable more candid, problem-solving exchanges. Among those were the Mont-Pèlerin retreats, convened regularly by the International Peace Institute (IPI) on the margins of INB sessions under the leadership of IPI President Zeid Ra’ad Al Hussein. These off-the-record, cross-regional dialogues created space to unpack red lines, explore compromise, and foster trust and collegiality—anchored in the shared goal of building a safer, healthier future for all.

These efforts outside the formal plenary room gradually translated into more consistent cross-regional dialogue among delegates seeking creative, mutually acceptable solutions to the most contentious issues—helping to build momentum and unlock progress in the final year of negotiations. Notwithstanding the growing dynamism and a more effective INB Bureau in the final phases of negotiations, delegates in Geneva still struggled to achieve substantial breakthroughs. This was in part due to the limited high-level political attention afforded to the process amid a crowded international agenda, including the wars in Ukraine and Gaza.

The prospect of a United States withdrawal from the WHO following Donald Trump’s reelection initially sent a demoralizing signal: if the world’s largest funder of global health was poised to walk away, was a treaty still worth pursuing? In many capitals—already strained by political fatigue and limited policy bandwidth—this development fueled doubts about the viability and value of continued engagement.

Yet in reality, the intensity of President Trump’s renewed assault on multilateralism—and on the WHO in particular—served as a jolt to the process. It crystallized what was truly at stake: not only the future of pandemic prevention, preparedness, and response, but the credibility and resilience of multilateral cooperation itself. This recognition helped reinvigorate political leadership and empowered cross-regional coalitions of the willing, determined to salvage the process and reaffirm the importance of collective action.

When the final INB session opened on April 7^th, many of the most contentious articles remained unresolved, and several delegations were openly skeptical about the prospects for consensus. But by the end of the week, momentum had shifted. Delegations reached agreement on the highly sensitive Article 12—establishing a system for access to pathogens and the fair sharing of benefits. The African Group accepted the INB Bureau’s proposed package on Articles 4 and 5 covering prevention and the One Health approach, and substantial progress was made on Article 11 concerning technology transfer. Negotiations stretched into the early hours, with Friday’s meeting continuing until 9:00am on Saturday. Talks resumed the following Tuesday, culminating in full agreement on the text shortly after 2:00am.

There were moments when the talks teetered on the brink—beset by deep mistrust, procedural gridlock, and entrenched political divides that threatened to derail the process. And yet, in an era of mounting skepticism toward global institutions, the agreement on pandemic prevention, preparedness, and response stands as a rare and hard-won example of sustained collective action—a testament to the enduring power of diplomacy, dialogue, and determination.

Emmanuelle Cousin works in the Executive Office of the IPI as Special Advisor to President Ra’ad Al Hussein, and served as the project lead for IPI’s mediation support to the INB negotiations on the Pandemic Agreement.

Ricardo Matute is an IPI consultant and a Policy Engagement Advisor with the Governing Pandemics Team at the Global Health Centre, Geneva Graduate Institute. Ricardo is a former negotiator for the Mission of Chile in Geneva and was involved in setting up the INB and negotiations for the Pandemic Agreement since the beginning.

See more articles in our GO series on the Pandemic Agreement.