The adoption of the Pandemic Agreement at the 78^th World Health Assembly marks a historic milestone in global health governance. It expands the scope for how member states of the World Health Organization (WHO) will address pandemics moving forward. The agreement complements the International Health Regulations and includes language on building health system capacities, the manufacturing of pandemic-related health products, international collaboration, financing, and governance. Beyond emergency preparedness and response, it also includes a new and forward-looking focus: prevention at the human-animal-environment interface through a “One Health” approach.

There is broad consensus that the drivers of disease outbreaks must be tackled at the earliest possible stage before a health emergency arises. With more than 70% of emerging infectious diseases in humans originating in animals, this requires focusing on prevention at the human-animal-environment interface. Yet prevention at the source was not sufficiently captured in the international legal architecture that existed prior to the Pandemic Agreement.

Prevention made its way into the pandemic negotiations gradually. In May 2021, during the 74^th World Health Assembly, WHO member states recognized that, for the purpose of preparing and responding to health emergencies, they needed to rely on the One Health approach, recognizing that the health of humans, animals, and the environment is interconnected. Nonetheless, they did not initially focus on prevention, deciding to schedule a special session to consider developing an international instrument on “pandemic preparedness and response.” In December 2021, when WHO member states agreed to establish the Intergovernmental Negotiating Body (INB) to draft an international agreement under the WHO constitution, they more explicitly added “prevention” to the scope, agreeing to “strengthen pandemic prevention, preparedness and response.”

Before the negotiations, there was limited focus on prevention at the source and the One Health approach, both within the WHO’s program and the broader public health ecosystem. It therefore emerged as a contentious topic when the negotiations began during the first half of 2022, and negotiators faced challenges incorporating prevention and One Health into the scope of the pandemic agreement. While some of these challenges have been resolved and agreed in the legal text, the agreement’s success will ultimately depend on addressing them concretely during the implementation stages.

Prevention and One Health: Going Beyond Emergency Preparedness and Response

Even though prevention was included in the scope of the negotiations, it was not a priority for many member states. Most states were focused on the biggest, most obvious post-outbreak challenges, which were not related to the drivers of outbreaks but rather to the emergency response. The majority of member states, especially those that faced the biggest resource gaps during the pandemic, were keen to agree on steps to tackle the adversities faced during the pandemic. These included strengthening health systems and workforces and developing medical countermeasures to protect the most vulnerable during a public health emergency.

This focus was reinforced during the negotiations, as Geneva-based diplomats mainly received guidance from their public health institutions, which historically focused on emergency preparedness and response. Not all countries had One Health coordination mechanisms in place, and those that did were not receiving instructions on prevention from those multi-sectoral mechanisms. This meant that delegates had clearer instructions on preparedness and response, and only a few had clear instructions and were vocal on prevention and One Health in the earlier stages of the negotiations.

This lack of guidance on prevention reflects the traditionally siloed approach to international and national policymaking. One of the first remarks by a bigger developing country member state in the early stages of the INB negotiations was that it was not the job of the WHO to tackle disease drivers. While these drivers are addressed in multilateral environmental agreements, including on biodiversity, climate, trade in endangered species, and wetlands, those agreements are not designed for preventing disease outbreaks and protecting human health.

In early 2022 as the Pandemic Agreement negotiations kicked off, civil society organizations also advocated to expand the scope of multilateral environmental agreements to ensure they include measures specifically aimed at reducing disease emergence, but such efforts were not met with broad support by member states. For example, some organizations proposed expanding the scope of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) to also require monitoring of species that are likely to carry pathogens that have the potential to spill over from animals to humans. However, some of the parties to CITES expressed concerns about overstretching the convention’s mandate. They argued that if the purpose of the proposed provisions was to protect human health, then those provisions should be placed in a public health instrument. This was only one example that illustrated how the global policy architecture had clear gaps in scientifically grounded prevention measures. A mechanism to identify and fill those gaps was needed.

These challenges were exacerbated by fault lines that emerged among member states. Developed countries, which already had the resources they needed to prepare for and respond to pandemics, were the most vocal in pushing for strong provisions on prevention and One Health. Developing countries, by contrast, did not express their support for One Health early in the negotiations, even though their efforts on One Health were more advanced. Instead, they used the articles on prevention and One Health as bargaining chips to advance negotiations on their priorities of preparedness and response, making developed countries even less willing to show flexibility on those provisions.

Nonetheless, consensus was ultimately reached due to the collective efforts of loose cross-regional groups of bridge-building member states, as well as NGOs, academic institutions, think tanks, and intergovernmental organizations. These efforts brought in more evidence on the gaps the agreement could fill and the pioneering One Health efforts of developing countries and facilitated dialogue and trust building on all issues of contention. The final agreement emerged from acts of solidarity and diplomacy we witnessed from all sides, which are all the more remarkable considering the volatile geopolitical environment.

What Was Agreed on Prevention and One Health

The Pandemic Agreement’s Article 4 on “pandemic prevention and surveillance” and Article 5 on a “One Health Approach for pandemic prevention, preparedness and response” capture the core of member states’ commitments to tackle pandemics at the earliest possible stages. Additional provisions throughout various articles in the agreement reinforce that purpose. At the same time, the agreement also includes weak language and caveats, especially tied to the availability of resources and national laws and circumstances. To illustrate, using examples relevant to these specific articles, although pandemic prevention costs a fraction of response, developing prevention plans and taking measures “aimed at promoting human, animal and environmental health” is “subject to the availability of resources,” and while addressing disease drivers is the essence of prevention, governments “shall endeavour to consider” factors that increase risks of pandemics. Despite this weak language, if the agreement’s commitments are enabled and its implementation is supported, it includes several “essentials” that will help governments and regions protect their citizens, animals, and the environment at the earliest stages.

The Pandemic Agreement is the first legally binding instrument to operationalize One Health. It significantly expands the scope of international health policy and the international legal architecture by tackling the root causes of outbreaks rather than just focusing on controlling them through emergency preparedness and response. The One Health High-Level Expert Panel’s definition was slightly adapted but captured in Article 1. The agreement’s concrete provisions on prevention at the source show that member states have learned from COVID-19 and are committed to implementing early preventive interventions before humans and animals suffer.

To prevent pandemics via the One Health approach, member states committed to several measures at the national level, including strengthening coordination across sectors and multisectoral surveillance and developing comprehensive multisectoral national prevention strategies via the One Health approach. Multisectoral surveillance and risk assessments will enable member states to identify and prioritize the highest-risk settings in their strategies and surveillance efforts. Multisectoral surveillance will not only enable real time data sharing for early detection but also inform member states on what is driving outbreaks so that they can develop more effective plans.

Language on empowering communities to detect and prevent outbreaks ensures that the promise of equity is honored not just during preparedness and response but also during prevention. Prevention starts with communities at the frontlines of an outbreak, and the provisions within the agreement require involving them in the development of strategies, which would mean that they would contribute to designing measures that actually work in their settings, thus protecting themselves, their livelihoods, and animals before an outbreak.

Prevention via One Health strategies would vary among countries, where each would prioritize their respective high-risk practices and design measures that address the root causes of diseases and prevent disease transmission at the source while also safeguarding communities’ livelihoods and food security and enhancing their capacity to prevent unusual health events. For example, to reduce spread of the Nipah virus from bats and after identifying transmission routes, Bangladesh implemented measures as simple as covering palm tree trunks and sap, which reduced human exposure to bat saliva and excrements. In Indonesian Borneo, the government reduced illegal logging by engaging with communities to understand their needs and supporting them with access to local health care services and offering alternative livelihood programs.

These provisions on national-level prevention are coupled with commitments on international cooperation and support for implementation, especially for developing countries, including technical assistance, capacity building, research collaboration, access to tools and technologies, and financial assistance. Relevant intergovernmental organizations with expertise on prevention and One Health may, upon their request, offer support to governments in designing and implementing their strategies. Member states also agreed to develop clear guidelines and recommendations that would inform not only their collective efforts but also the support provided by intergovernmental organizations and financial institutions after the agreement enters into force. While the Pandemic Agreement does not create a dedicated fund to support its implementation, it establishes a Coordinating Financial Mechanism that will match the activities member states need funding for with relevant existing funds and conduct a needs and gaps assessment every five years to inform the Conference of the Parties on measures that were supported or that need support in the future.

Member states also recognized and aimed to fill gaps in the international legal architecture for pandemic prevention, preparedness, and response by committing to strengthen and enhance cooperation among legal instruments, frameworks, organizations, and stakeholders. This creates a hook for more concrete measures toward that end once the Conference of the Parties convenes.

Anchoring the One Health approach into a legally binding agreement, adding prevention at scope to how governments tackle pandemics, and ensuring support for implementation demonstrates that governments are moving beyond symptom-control, which will lead to more effective strategies and transform the way many countries will collaborate nationally and with others. Despite legal caveats, WHO member states have agreed to a future-ready foundation, which, when successfully implemented, will help prevent pandemics and achieve health for all.

Nina Jamal is the International Head of Pandemics & Campaign Strategies at FOUR PAWS International. Nina and the FOUR PAWS team led advocacy efforts, supporting member states in anchoring actionable provisions on prevention and One Health in collaboration with a broad coalition of animal welfare and conservation NGOs and experts.

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