COVID-19 starkly exposed the systemic frailties of global health governance, particularly concerning the functioning and utility of the International Health Regulations (IHR). Multiple independent reviews declared that the existing framework was designed to constrain rapid global action, and recommended concrete transformational reforms for the global health legal regime. 1 Most notably they recommended the negotiation of a new instrument to govern future pandemic prevention, preparedness, and response (PPPR). The appetite for a new instrument was cemented by a statement of support from twenty-six other world leaders and the director-general of World Health Organization (WHO). 2 From the start, there was a lack of clear unified vision for what a new treaty ought to achieve. This ideological rift generally fell along the North–South divide, something that continued throughout the negotiations of the treaty. Low- and middle-income countries (LMICs), suffering from the stark inequalities in vaccine access during the COVID-19 pandemic demanded embedding equitable distribution of life-saving health products into legally binding commitments. Meanwhile high-income countries (HICs) sought greater prevention and surveillance activities, determined to prevent spillover events from occurring and spreading in the first place.
Eccleston-Turner et al. (Thu,) studied this question.