The COVID-19 pandemic and the development of global health law: managing crises or achieving structural changes?

The COVID-19 pandemic has been a global crisis with multiple causes, effects and consequences going beyond its immediate health impact. On the one hand, environmental drivers may have facilitated the spillover of the virus to humans, while on the other the pandemic has affected most areas of international relations and revealed a troubling lack of equity and solidarity within and among countries. However, what was the real crisis? Framing COVID-19 as a health crisis brought the negotiation of a new pandemic agreement into WHO as a crisis measure to fill the gaps left by the International Health Regulations and reduce the risk of future pandemics. International law has been defined as a “discipline of crisis”, evolving through responses to violent shocks, and COVID-19 seems to confirm this view. However, international law has also been shaped by a counternarrative highlighting the structural causes of crises and addressing them rather than the symptoms. This historical tension has negatively affected the negotiation of the pandemic agreement, with Global South countries moving beyond a crisis approach and demanding “equity” through structural changes to the pharmaceutical market, support for self-reliance in pharmaceutical manufacturing and guarantees of financing. This fault line also has consequences for global health law in general, in particular because the scarcity of dedicated global health instruments and the limited mandate of WHO questions what issues can be regulated through that organisation and which will require the interplay of different institutions and regimes, pointing to regime complexity as the appropriate conceptual tool to undertake that analysis.