1. Introduction
In May 2025 at the 78th World Health Assembly (WHA), Member States of the World Health Organization (WHO) approved a new international treaty to address pandemic prevention, preparedness and response: the WHO Pandemic Agreement.Footnote 1 The adoption of the Pandemic Agreement, which is only the second international instrument ever to be adopted under Article 19 of the WHO Constitution’s formal treaty-making powers,Footnote 2 was the culmination of some three years of intergovernmental negotiations which began during the COVID-19 pandemic. The instrument is comprised of 35 articles divided into three chapters, with topics including supply chain logistics, health system resilience, how pathogens with pandemic potential will be shared and sustainable financing. A central premise of the new instrument is that it requires States Parties to adopt a ‘One Health’ approach to pandemic prevention, preparedness and response (PPPR) in recognition of the fact most new diseases to infect humans are zoonotic in origin.
The historical foundations of the concept of One Health remain somewhat contested.Footnote 3 Importantly, however, in May 2021 the WHO, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (WOAH, formerly the Office International des Epizooties (OIE)) and the United Nations Environment Programme (UNEP), together forming the Quadripartite Collaboration for One Health, established the One Health High-Level Expert Panel (OHHLEP) to provide scientific and technical advice on One Health. In executing their mandate, the independent panel of technical experts defined One Health as:
an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.Footnote 4
This definition was subsequently embraced by all four intergovernmental organisations that form the Quadripartite (i.e. WHO, FAO, WOAH and UNEP) and currently serves as the definitional benchmark informing international policy development.Footnote 5
The purpose of this article is to examine the practical and legal obligations under the Pandemic Agreement for States Parties in adopting a One Health approach towards PPPR. The analysis proceeds in four distinct parts. Section 2 examines definitional matters, comparing and contrasting the definition of One Health used in the Pandemic Agreement to the widely accepted definition of One Health that was developed by the OHHLEP. In so doing, attention is given to shared definitional elements, the areas where distinctions exist and the implications that emerge therefrom. Section 3 examines the One Health provisions as they relate to disease surveillance contained within Article 4 as well as the legal weight of the qualifications that were inserted during the Intergovernmental Negotiating Body (INB) process. Section 4 considers the Article 5 requirement for States Parties to foster a One Health approach and the positive obligations to address the drivers of human-animal disease transmission. Section 5 then considers the legal and practical effects for States Parties that ratify the Pandemic Agreement, including the need for the treaty’s Conference of the Parties (COP) to develop a robust implementation monitoring framework, as well as the development of new technical capacities alongside major domestic policy and legislative reforms. The article concludes by reflecting on the progress made to date, and what this suggests about multilateral treaty negotiation in a highly divided world.
2. The Pandemic Agreement’s definition of a ‘One Health approach’
Prior to weighing the significance of the Pandemic Agreement’s emphasis on One Health, consideration must first be given to the object and purpose of the instrument. This is most clearly articulated in Article 2, which declares that ‘[t]he objective of the WHO Pandemic Agreement, guided by equity and the principles set forth herein, is to prevent, prepare for and respond to pandemics’ and ‘[i]n furtherance of this objective, the provisions of the WHO Pandemic Agreement apply both during and between pandemics, unless otherwise specified’.Footnote 6 The premise underlying the instrument’s purpose is that pandemics are an inexorable feature of human life.Footnote 7 To that end, the Pandemic Agreement establishes a framework by which States Parties may better use the intervening years between pandemics to build, strengthen and maintain their domestic capacity to respond more efficiently and effectively to future public health crises when they do arise (i.e. pandemic prevention and preparedness), as well as establishing a series of new protocols, norms and expectations around how the international community will respond collectively when the next pandemic occurs (i.e. the pandemic response phase). In this respect, the Pandemic Agreement might be interpreted as having a dual purpose—i.e. prevention/preparedness and response—and as such, it aims to disrupt the ‘cycle of panic and neglect’ that has permeated global pandemic mitigation efforts.Footnote 8
To more fully understand these distinctions, it is important to appreciate the broader context in which the Pandemic Agreement might take effect. Specifically, while the Pandemic Agreement imposes new, wide-ranging obligations on States Parties to strengthen their efforts in pandemic prevention and preparedness prior to another global health emergency, several of the instrument’s new pandemic response provisions are only enacted when a ‘pandemic emergency’ is declared pursuant to Article 12 of the 2005 International Health Regulations (IHR 2005), as amended in 2024.Footnote 9 The declaration of a pandemic emergency under the IHR 2005 is made by the WHO Director-General upon the advice of an independent technical advisory body, the IHR Emergency Committee. Moreover, it is a second-order declaration in that a pandemic emergency is only declared where a public health emergency of international concern (PHEIC), which is an ‘extraordinary event’ that constitutes ‘a public health risk to other States through the international spread of disease’ and which will ‘potentially require a coordinated international response’,Footnote 10 meets certain additional substantive criteria. These include that the PHEIC is ‘caused by a communicable disease’ which:
-
(i) has, or is at high risk of having, wide geographical spread to and within multiple States; and
-
(ii) is exceeding, or is at high risk of exceeding, the capacity of health systems to respond in those States; and
-
(iii) is causing, or is at high risk of causing, substantial social and/or economic disruption, including disruption to international traffic and trade; and
-
(iv) requires rapid, equitable and enhanced coordinated international action, with whole-of-government and whole-of-society approaches.Footnote 11
If these criteria are met, the WHO Director-General may upgrade the PHEIC declaration to that of a pandemic emergency, at which point several of the new instrument’s provisions take effect, to enable greater knowledge and technology transfers, the production and distribution of pandemic-related health products and equipment, and expedited supply chain mechanisms. Undergirding the overarching approach to PPPR within the instrument, however, is the obligation to adopt a ‘One Health approach’.
Pursuant to Article 1 of the new treaty, the negotiating parties defined the ‘One Health approach’ as ‘an integrated multisectoral and transdisciplinary approach to pandemic prevention, preparedness and response, which contributes to sustainable development in an equitable manner’ and which seeks to achieve ‘a sustainable balance’.Footnote 12 The premise underlying this approach ‘recognizes the health of humans is closely linked and interdependent with the health of domestic and wild animals, as well as plants and the wider environment (including ecosystems)’.Footnote 13 This latter element is further reinforced in Article 5 which stresses that ‘the health of people is interconnected with animal health and the environment’ before extrapolating that a One Health approach ‘is coherent, integrated, coordinated and collaborative among all relevant organizations, sectors and actors, as appropriate’.Footnote 14
It is important to note that the language in this definition replicates to a large degree the definition of One Health developed by the OHHLEP that was published in December 2021. Both definitions, for instance, emphasise the close interconnection between human, animal and environmental/ecosystem health. Further, both definitions underline the need to sustainably balance those health needs, and the necessity for ensuring that measures reflect integrated, multisectoral collaboration. These similarities are expected, to some extent, given that early drafts of the treaty explicitly referenced the OHHLEP definition, and both the FAO and WOAH repeatedly encouraged the negotiating parties to adopt the OHHLEP definition as the instrument’s definition of One Health.Footnote 15
At the fourth informal consultation on 14 October 2022, for example, the then WOAH Director-General, Dr Monique Eloit, explicitly argued that:
the pandemic instrument should include the definition of one health, developed by OHHLEP … and agreed by the Quadripartite as it emphasizes the crucial multisectoral and multidisciplinary approach needed to tackle health threats and promote sustainable development.Footnote 16
In a written submission ahead of the 7th INB, the Quadripartite commended the inclusion of the OHHLEP definition in draft Article 1.Footnote 17 Following changes made to the definition during the negotiations, however, ahead of the 12th INB the FAO submitted a written statement independently of the Quadripartite as follows:
First, we call for the inclusion of the full definition of One Health in Article 1(b). The One Health definition was developed by OHHLEP and welcomed by the Quadripartite, bringing much needed consistency to a concept that previously had over 40 different published definitions. Introducing a new definition in the Pandemic Agreement on One Health for the purpose of the Pandemic Agreement would undermine global efforts to provide clear guidance on One Health implementation, leading to potential misunderstanding regarding its content, scope, and implementation.Footnote 18
This position, which sought to emphasise the risk of creating unnecessary confusion by diverging from the OHHLEP definition, was reiterated again by the FAO in its written submission for the 13th INB but ultimately rejected by the negotiating parties,Footnote 19 who opted instead for a similar but distinct definition.
It should be acknowledged, of course, that there are very good reasons why the definition adopted in an international treaty would diverge from that developed by an expert group. Treaty negotiations invariably require compromise, and definitional divergences may simply reflect the iterative bargaining through which consensus-based treaty text is concluded, even if this occasionally leads to unintended consequences.Footnote 20 It is also the case that the OHHLEP definition was developed to inform policy,Footnote 21 not generate legal obligations that States Parties must implement, and it is perhaps unfair to expect coterminous alignment given that the normative functions each definition serves are fundamentally distinct—one guiding scientific and policy coordination, the other delimiting enforceable State conduct in a narrower field of PPPR. Finally, as the product of an advisory panel constituted under a memorandum of understanding between international organisations, the OHHLEP definition carries no binding force and cannot as a matter of international law constrain how States choose to define their obligations under a binding treaty. The negotiating States were therefore entitled to make independent definitional choices calibrated to their agreed upon objectives.
Noting this, the Pandemic Agreement’s definition of One Health involves some important departures from the OHHLEP definition. For example, the Pandemic Agreement utilises the adjective ‘transdisciplinary’ to describe a One Health approach while also emphasising the importance of equity—elements that are not explicitly included in the OHHLEP definition but which were identified by the expert panel as foundational principles.Footnote 22 More specifically, the term ‘transdisciplinary’, which was included in an early draft, removed and then reinserted into the definition sometime between September 2024 and April 2025,Footnote 23 appears only once in the entire instrument—in Article 1—and is not explained, clarified or contextualised further. While the Oxford English Dictionary has defined transdisciplinary as ‘[o]f or pertaining to more than one discipline or branch of learning; interdisciplinary’,Footnote 24 scholars have highlighted that while ‘interdisciplinary’ and ‘transdisciplinary’ are frequently used interchangeably, their conflation is unhelpful on account of the fact that whereas interdisciplinary involves a ‘blurring of professional [disciplinary] boundaries’,Footnote 25 transdisciplinary approaches are those ‘that integrate the natural, social and health sciences in a humanities context, and in so doing transcend each of their traditional boundaries’.Footnote 26 The implication is that transdisciplinary represents an evolutionary development beyond disciplines working alongside each other, thereby suggesting a higher order of collaboration.
One term that appears both within the Article 1 definition of a ‘One Health approach’ and frequently throughout the Pandemic Agreement is ‘multisectoral’. While the instrument does not define this term, the Oxford English Dictionary defines multisectoral as ‘[c]oncerning or involving more than one sector of an industry, economy, etc’.Footnote 27 Whereas the need for multisectoral collaboration is implied within the OHHLEP definition,Footnote 28 the negotiators of the Pandemic Agreement opted to make the expectation of multisectoral collaboration explicit by stipulating that a One Health approach ‘uses an integrated multisectoral and transdisciplinary approach to pandemic prevention, preparedness and response’.Footnote 29 The emphasis on multisectoral collaboration that spans several disciplines and fields of practice is arguably consistent with the foundational premise of One Health given the concept’s focus on the interdependence between human-animal-environmental health.Footnote 30 Of further note, however, is that the term ‘multisectoral’ appears in the instrument’s preamble, and also provisions relating to pandemic prevention and surveillance (Article 4)Footnote 31 and whole-of-government and whole-of-society approaches to PPPR (Article 15).Footnote 32 Accordingly, it may be inferred that States Parties are obligated to pursue multisectoral collaboration in promoting and implementing a One Health approach to PPPR. Consistent with the principles articulated in Article 31 of the Vienna Convention on the Law of Treaties, this would necessitate—at the minimum—cooperation between government departments responsible for human, animal and environmental health; however, multisectoral collaboration is distinct from whole-of-government and whole-of-society approaches to PPPR, though it may be deemed a subset of either. The importance of these distinctions will be revisited and discussed further in Section 5.
3. One Health disease surveillance obligations (Article 4)
Consistent with the instrument’s intended purpose in enhancing prevention and preparedness efforts, Article 4 establishes new obligations on States Parties to strengthen their existing domestic disease surveillance capacities using a One Health approach. In addition, several provisions have been included that ostensibly require governments to take active steps in reducing the risks of cross-species disease transmission. For example, Article 4.2(a) stipulates that States Parties take steps to prevent ‘emerging and re-emerging infectious diseases, by taking measures to promote collaboration across relevant sectors to identify and address drivers of infectious disease at the human-animal-environmental interface, with the aim of early prevention of pandemics’.Footnote 33 Article 4.2(b) expands this obligation further by requiring States Parties to prevent ‘infectious disease transmission between animals and humans, including, inter alia, zoonotic disease spill-over, by taking measures to identify and reduce pandemic risks associated with human-animal interactions, and relevant settings, as well as measures aimed at prevention at source’.Footnote 34 Additional Article 4 clauses clarify how these measures might be accomplished, such as conducting ‘coordinated multisectoral surveillance to detect and conduct risk assessment of emerging or re-emerging pathogens with pandemic potential’,Footnote 35 and by implementing ‘early detection and control measures at the community level’.Footnote 36
In many respects, the obligations contained within these provisions reflect international consensus on the type of measures required to prevent, or at the very least minimise, the risk of future pandemics using a One Health approach. In 2018, for example, the World Bank advanced the business and economic case for increased investment in priority zoonotic disease/pathogen detection alongside standard (human) disease surveillance to facilitate early detection and timely intervention, highlighting the need for indicator-based and event-based surveillance and verification ‘core capacities’.Footnote 37 This report was followed in 2019 with the release of the Tripartite Zoonoses Guide that was jointly developed by the WHO, FAO and WOAH, which encouraged governments to ‘establish a coordinated national surveillance system for early detection of zoonotic disease events, and timely, routine data sharing among all relevant sectors with responsibility for zoonotic disease’.Footnote 38 To give effect to this framework, the Tripartite (now Quadripartite) produced a series of additional guidelines in 2022 such as the Tripartite Surveillance and Information Sharing Operational Tool (SIS OT) to help countries take actionable steps to enhance their disease surveillance capabilities using a One Health approach.Footnote 39 That same year following the joining of UNEP, the newly-formed Quadripartite released the One Health Joint Plan of Action (2022–2026) which encourages governments to develop sustainable disease detection capacities at human-animal-environmental interfaces that will enable early warning and prompt intervention, outlining a series of deliverables that countries were encouraged to achieve within a five-year timeframe.Footnote 40 In short, therefore, the Pandemic Agreement’s obligations replicate and reinforce what international organisations charged with advancing One Health had already endorsed.
Noting the above, there are several significant and important caveats that conceivably delimit the scope of measures which States Parties might be expected to take. The first and most prominent is the inclusion of the phrase ‘consistent with the International Health Regulations (2005)’, which appears in three of the six paragraphs of Article 4.Footnote 41 While on the one hand the explicit, repeated references to the IHR 2005 may be interpreted as reinforcing the synergistic relationship between the two instruments, at the same time, the condition that the development and implementation of any new capacities, measures or actions must be consistent with the IHR 2005—an exclusively human health instrument—anthropomorphises the application of the One Health approach in the instrument and raises a question as to whether the new animal and environmental health obligations are subordinate to human disease surveillance capacity building—a position at odds with the concept of One Health.Footnote 42 Put differently, the use of this specific phrase might be interpreted by some States Parties as trivialising the need for them to expand substantively upon their existing obligations under the IHR 2005 to build, strengthen and maintain (human) public health core capacities for disease detection and verification to address the animal and environmental obligations under the Pandemic Agreement.
The potential constraining import of this phrase is further strengthened by additional language in Article 4, including qualifications such as ‘taking into account national capacities’,Footnote 43 ‘taking into account its national circumstances’,Footnote 44 ‘subject to the availability of resources’,Footnote 45 ‘take into account its public health priorities’Footnote 46 and ‘with full consideration of the national circumstances and the different capacities and capabilities of Parties’.Footnote 47 In a similar vein to the IHR 2005 reference, whilst the introduction of these caveats might be seen as giving due regard to the complexity and diversity of States Parties’ existing disease threat spectrum (i.e. wildlife, endemic pathogen populations etc) and capacities, the result of these various provisos—when viewed collectively—is that governments enjoy considerable latitude to determine the nature, extent and even sustainability of any new disease detection, verification and/or prevention measures.
In this context, it is perhaps unsurprising that commentators have noted that the obligations contained within Article 4 of the Pandemic Agreement—while commendable for advancing One Health approaches in disease surveillance and pandemic prevention—could nevertheless benefit from greater precision.Footnote 48 Entities such as the diplomatic and foreign affairs division of the European Union (EU) and the European External Action Service (EEAS) have even gone so far as to call for an entirely new and separate international instrument on pandemic prevention to better articulate what and how applying a One Health approach in PPPR would entail.Footnote 49 At least for now, however, there appears to be no consensus for pursuing another international instrument; and given the extent of the qualifications available under Article 4, it will be comparatively effortless for States Parties to (at least provisionally) circumvent their obligations, simply by declaring either resource constraints or ‘national capacity’ considerations.
4. Advancing a One Health approach for PPPR (Article 5)
The central provision affirming States Parties’ obligations in pursuing a One Health approach in PPPR is contained in Article 5. Consisting of three paragraphs and two subparagraphs, the article establishes the requirement for States Parties to ‘promote a One Health approach’ while taking measures ‘as appropriate’ and ‘subject to the availability of resources’ to identify and address ‘the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface’.Footnote 50 To give effect to these actions, a State Party is required to ‘take measures that it considers appropriate’, which include ‘developing, implementing and reviewing relevant national policies and strategies’ with particular attention to be given to ‘Indigenous Peoples’ and ‘people in vulnerable situations’Footnote 51 and ‘promoting or establishing joint training and continuing education programmes for the workforce at the human-animal-environment interface’.Footnote 52
As with the new Article 4 responsibilities on strengthening One Health disease surveillance capacities, the obligations outlined in Article 5 are consistent with contemporary international expectations. For instance, the Tripartite Zoonoses Guide encouraged governments to institute mechanisms to facilitate joint risk assessments of zoonotic diseases with pandemic potential,Footnote 53 as well as risk reduction measures,Footnote 54 effectively calling on countries to identify and then address the drivers of zoonotic spillover events. Likewise, the rationale for the Quadripartite’s One Health Joint Plan of Action advocates that countries adopt ‘a systems approach to support the health of humans, animals, plants and ecosystems, while identifying and addressing the factors underlying disease emergence, spread and persistence’.Footnote 55 The text of Article 5 thus extrapolates and codifies what has emerged as the neoteric wisdom for contemporary global disease outbreak alert and control efforts.
Even so, the Pandemic Agreement’s emphasis on addressing the underlying preconditions facilitating zoonotic spillover to prevent future pandemics is a comparatively recent and remarkable phenomenon, both with respect to global public health generally and its related legal instruments specifically. To be more precise, while the health promotion movement (which has long advocated disease prevention) has permeated public health discourse for decades, prevention and early intervention has historically remained a secondary or even tertiary consideration to primary health care service models—on average receiving two-thirds less funding than curative care allocations.Footnote 56 Amongst Organisation for Economic Co-operation and Development (OECD) countries, spending on disease prevention averaged only 2.8 per cent of total healthcare spending.Footnote 57 While the adage ‘prevention is better than cure’ may resonate rationally with government decision-makers, even where there may be growing evidence of economic benefits,Footnote 58 prevention measures are habitually viewed as being in competition with curative health spending.Footnote 59 For this reason, policymakers have historically prioritised pandemic response over investments in pandemic prevention.
This same ethos and generalised lack of attention to pandemic prevention is also reflected in global health law instruments such as the IHR 2005. For example, the original 1951 framework and its subsequent 1969 and 1981 revisions were primarily focused on describing which measures governments could take to prevent diseases entering their respective territories.Footnote 60 These instruments were not concerned with addressing the underlying factors that might give rise to a new pandemic; only in halting the importation of disease into their jurisdiction. The 2005 revision was more concerned with outbreak containment and response than prevention, and essentially reversed the onus of responsibility on WHO Member States so that, instead of impeding the introduction of disease into their territory, governments were required to build, strengthen and maintain core public health capacities to detect, verify and contain diseases from spreading internationally. The Pandemic Agreement’s requirement on States Parties to proactively address the drivers of disease events with pandemic potential thus represents a fundamental shift in traditional PPPR efforts.
Despite this rather significant modification, like its predecessor, Article 5 contains several qualifications of note. For instance, as indicated in Section 3, the provisions in Article 5.1 which require States Parties to ‘promote a One Health approach’ to PPPR include several caveats such as ‘as appropriate, in accordance with national and/or domestic law’, and ‘taking into account national circumstances’.Footnote 61 Similarly, Article 5.3 requires States Parties to develop, implement and review national PPPR plans and undertake training and education initiatives for frontline workers ‘subject to the availability of resources’.Footnote 62 While, again, these provisos may be designed to provide sufficient scope for countries to implement One Health policies and measures germane to their unique contexts, the legal effect of these qualifications is to severely diminish the underlying obligations and, by default, the overall object and purpose of the treaty.
In this same context, it is interesting to note the integration of these various obligations (and their respective qualifications) within one article stands in contrast to the initial proposed outline of the international instrument when it was first envisaged. Indeed, in June 2022 the concept of One Health featured much more prominently in the proposed framework for the treaty, extending from a raft of general obligations addressing multisectoral and whole-of-government engagement, surveillance and laboratory capacity, through to and including an entire section on One Health financing.Footnote 63 This emphasis persisted into December 2022 with One Health being listed as a core guiding principle of the treaty as well as being integrated into draft articles on strengthening health systems’ resilience and an expansive article on One Health that addressed not only PPPR, but also pandemic recovery.Footnote 64
The initial significance given to One Health was, in large part, due to the advocacy of a collective of WHO Member States that identified themselves as the ‘Group of Friends of One Health’ that comprised 22 countries and the EU.Footnote 65 In addition, the INB Bureau had held an informal consultation on the inclusion of One Health in the instrument with several leading experts including WOAH’s Director-General, Deputy Director-General and two members of OHHLEP, who advocated not only that the OHHLEP definition of One Health should be adopted in its entirety as the instrument’s definition,Footnote 66 but also that the One Health Joint Plan of Action should serve as ‘guidance for the provisions on One Health in the future instrument’.Footnote 67 Public consultations conducted by this same body also highlighted the importance of ensuring the new instrument adopted a One Health approach.Footnote 68
In response to these proposals and written submissions from the Quadripartite, negotiators had inserted a range of provisions designed to strengthen States Parties’ commitments to the One Health approach to PPPR following the 5th INB in April 2023.Footnote 69 These provisions, which were included in the draft text for the resumption of the 5th INB meeting in June of that same year, included measures such as ‘harmonization of surveillance and management of environmental antimicrobial run-off’ to mitigate future pandemic threats that were also microbially resistant to existing treatments,Footnote 70 optimisation of ‘antimicrobial consumption’ and strengthening ‘sanitation and biosecurity in livestock farms’.Footnote 71 By late 2023, however, the weight given to One Health had been progressively pared back to its inclusion in just two articles—Articles 4 and 5—with multiple caveats and qualifications inserted.Footnote 72 As one commentator noted at the time, ‘[i]nstead of deeply anchoring One Health in this instrument, what we have been seeing at negotiation tables in Geneva is One Health being used as a bargaining chip, even running danger of being carved out of the Pandemic Agreement altogether’.Footnote 73 Similarly, others highlighted what they identified as ‘a significant shift in strategy’ on One Health when, in September 2024, the 11th INB meeting deleted a provisionFootnote 74 for a separate, dedicated international instrument on the ‘modalities, terms and conditions and operational dimensions of a One Health approach’ to explicate States Parties’ One Health obligations under the Pandemic Agreement.Footnote 75
The oscillation on incorporating One Health obligations appear to have had three possible causes. The first was a growing frustration amongst low- and middle-income countries (LMICs) that high-income countries (HICs) were not taking their demands for equitable approaches and solutions seriously. As one delegate at the 7th INB remarked:
Regarding the core equity articles in the text, articles 9-13, we welcome the retention of key text on intellectual property rights and transfer of technology and know-how. However, we note with concern the weak legal language and qualifiers used. In contrast, for example, to more legally binding language in Article 4 in pandemic prevention and public health surveillance.Footnote 76
The second basis for reticence was related to the logistical, technical and financial burdens that any additional obligations would place on LMICs, which had already struggled unsuccessfully to meet their obligations on building, strengthening and maintaining core public health capacities under the IHR 2005.Footnote 77 Concerns centred particularly around the scope and cost of the proposed One Health capacity requirements, including the potential strain on emerging economies’ agricultural sectors.Footnote 78 This reticence subsequently culminated in a concession whereby, at least with respect to the formerly envisaged One Health obligations, in lieu of an additional international instrument it was ultimately agreed the treaty’s COP would only ‘develop and adopt guidelines, recommendations and other non-binding measures as necessary … as appropriate’ in pursuit of a One Health approach.Footnote 79
A third element appears to have been the WHO’s anthropomorphisation of the One Health concept and the marginalisation of other stakeholders’ voices. While the UN was provisionally considered a more appropriate forum in which to negotiate a new international treaty given the evident system-wide impacts of pandemics and the international organisation’s track record in successfully adopting multisectoral agreements,Footnote 80 the WHO Director-General advocated strongly for his agency to own the intergovernmental negotiations.Footnote 81 In securing authorisation for the WHO to move ahead with forming the INB,Footnote 82 the ability of other international organisations—and, specifically, the FAO, WOAH and UNEP which were actively campaigning for One Health to become the guiding principle of the new instrumentFootnote 83—were effectively sidelined once the formal negotiation process commenced. Efforts to introduce treaty obligations compelling the WHO to consult other Quadripartite members on forming technical guidance to States Parties in relation to the implementation of One Health PPPR measures also failed.Footnote 84 The result, as highlighted in Section 3, culminated in aligning the new legally binding One Health obligations in the Pandemic Agreement with the IHR 2005 and the WHO’s (human) health mandate as opposed to a wider, more holistic One Health approach to PPPR.
5. Discussion and implications for States Parties
As may be discerned, the compromise language in the Pandemic Agreement provides States Parties with extensive latitude in how they will interpret and notionally fulfil their new One Health PPPR obligations. Given that no additional international instrument is planned to supplement or elaborate upon how States Parties are to meet their One Health commitments, and the COP will only produce non-binding guidelines, governments are effectively empowered to decide which elements they will comply with and which they will not. While it is acknowledged that non-binding guidelines can and do influence State practice,Footnote 85 where States Parties do elect the latter course of action they theoretically need only cite, for example, Article 4.2 or Article 5.1, 5.2 and/or 5.3 provisions such as ‘taking into account its national circumstances’ and ‘subject to the availability of resources’ to effectively circumvent their obligations and avoid implementation.Footnote 86
At the same time, the Pandemic Agreement creates several new positive obligations on States Parties with respect to taking a One Health approach to PPPR. By their nature, ‘[a] positive international obligation is an obligation “to do” something, and it requires that its bearer(s) engage in some form of positive action’Footnote 87 in pursuit of either specific conduct or an outcome. Clauses like ‘[e]ach Party shall progressively strengthen measures and capacities’,Footnote 88 and ‘taking measures to identify and reduce pandemic risks associated with human-animal interactions’,Footnote 89 are clear examples of positive obligations within the Pandemic Agreement, and States Parties will be expected to demonstrate progress in relation to them. Even with the various qualifications that were inserted to accommodate the diversity of country conditions and risk factors for zoonotic spillover, the ability for States Parties to ‘do nothing’ will be challenging over the longer term. While governments may initially cite ‘national circumstances’ or ‘resource constraints’ as impeding their ability to immediately meet their international One Health PPPR obligations, under the COP reporting requirements in Article 21 they will nevertheless be expected to demonstrate at least some progress over time or risk being considered in breach of their international obligations.Footnote 90
As others have noted, while once largely confined to the field of international environmental law, since the turn of the century there has been a discernible preference to include a COP mechanism in all new international treaty arrangements.Footnote 91 The purpose of these mechanisms is to help encourage compliance with the instrument’s implementation,Footnote 92 traditionally either via facilitative methods (i.e. technical assistance, financial aid, information and data exchange etc) or enforcement measures (i.e. sanctions),Footnote 93 although research has shown that usually a combination of both approaches is most effective.Footnote 94 The Pandemic Agreement contains no enforcement provisions, explicitly stating the COP shall ‘be facilitative in nature, and function in a manner that is transparent, cooperative, non-adversarial, non-punitive and cognizant of respective national circumstances’.Footnote 95 This approach is similar to other international instruments, such as the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal, which rely on facilitative methods to encourage compliance;Footnote 96 and in empowering the COP with the authority to meet regularly to ‘take stock of the implementation of the WHO Pandemic Agreement’ and ‘take the decisions necessary to promote its effective implementation’,Footnote 97 as well as the means to create subsidiary bodies and ‘a mechanism to facilitate and strengthen effective implementation of the provisions of the WHO Pandemic Agreement’,Footnote 98 it is also apparent WHO Member States intend for the COP to monitor and encourage compliance with the treaty’s implementation.
However, it should be acknowledged the COP associated with the WHO’s other Article 19 treaty—the Framework Convention on Tobacco Control (FCTC)—has had a mixed record in ensuring implementation of that instrument’s obligations. One of the early challenges that arose was States Parties’ unwillingness to adopt a strong implementation monitoring system.Footnote 99 As a result, reports submitted to the COP secretariat consistently offered little insight into how countries were progressing with meeting their treaty obligations,Footnote 100 which was compounded further by the fact that the secretariat lacked the authority to ensure the submitted reports contained accurate information.Footnote 101 A second issue has been its limited ability to publicly call out States Parties that are failing to meet their obligations,Footnote 102 while a third challenge is that many of the FCTC obligations require actions to be taken that are outside the purview of ministries of health.Footnote 103 As may be readily appreciated, these are all problems that, whilst not assured, are highly likely to impact the implementation of the Pandemic Agreement. Given the possibility that there will be some States Parties that are less committed to and/or active in implementing their obligations than others, there will be a need for a concerted effort by a coalition of States Parties to ensure that the COP establishes a robust oversight framework to monitor implementation of the instrument’s positive obligations during its initial meetings.Footnote 104
For example, as per Article 5, States Parties, ‘shall promote a One Health approach for pandemic prevention, preparedness and response’.Footnote 105 The insertion of the modal verb ‘shall’ establishes the positive obligation that action is required, limiting the scope for noncompliance. The obligation continues, stipulating that the action(s) to be taken by governments need to be ‘coherent, integrated, coordinated and collaborative among all relevant organizations, sectors and actors’.Footnote 106 This particular provision reinforces the premise of the ‘One Health approach’ as defined in Article 1, which instructs States Parties to use ‘an integrated multisectoral and transdisciplinary approach’.Footnote 107 When applied to the obligation of ‘promoting’ a One Health approach, as noted in Section 2, the implication of the adjectives ‘multisectoral’ and ‘transdisciplinary’ underline and delineate the obligations on States Parties in two notable ways.
The first, as noted in Section 2, is that there is a distinction drawn in the treaty between ‘multisectoral’ and ‘whole-of-government’ or ‘whole-of-society’. Whereas ‘whole-of-government’ collaboration is understood to mean involving all government ministries, departments and agencies working together in a unified way towards a clear objective or set of objectives, ‘whole-of-society’ entails an even broader approach that both includes and coopts non-governmental stakeholders (i.e. industry, civil society etc).Footnote 108 In the context of the latter phrase, ‘whole-of-society’ has been defined within the treaty as entailing ‘effective and meaningful engagement of Indigenous Peoples, communities, including local communities as appropriate, and relevant stakeholders, including through social participation’.Footnote 109 Multisectoral collaboration, by contrast, can be considered a smaller subset of whole-of-government and whole-of-society collaboration, involving ‘collaborative efforts by individuals, stakeholders, and/or organizations from different sectors working together on a medium- to long-term basis to achieve some end, often perceived as best achieved through collaboration’.Footnote 110 When applied to Article 5, this may be interpreted to mean that States Parties are required to ensure multisectoral collaboration to further the One Health PPPR objectives, but they are exempted from pursuing a whole-of-government and whole-of-society approach.Footnote 111
In saying this, as explored in Section 2, the concept of ‘transdisciplinary’ necessitates a higher order of collaboration beyond having traditionally siloed government departments work alongside each other. Applied to Article 5, it means that pursuing multisectoral collaboration may involve entities and individuals as well as government departments; any collaboration must be more than perfunctory; and members must strive to transcend their traditional boundaries, putting aside professional or disciplinary biases, to achieve something that otherwise would be out of their respective reach. At the practical level, what this means is that States Parties will need to pinpoint those stakeholders relevant to their national context that can assist with detecting and addressing the drivers of pandemics as well as the emergence/re-emergence of infectious diseases at the human-animal-environment interface, bringing them together in an advisory capacity or taskforce that is empowered to make recommendations designed to affect meaningful change across a suite of areas and topics. It is to these areas and topics that the discussion now turns.
5.1. Implications of the new One Health disease surveillance capacities
Accepting this broader context and the instrument’s legal plasticity, the Pandemic Agreement has established new obligations to build, strengthen and maintain One Health disease surveillance capacities as part of its larger pandemic prevention objective. Pursuant to Article 4, for instance, States Parties are required to develop new multisectoral disease surveillance capacities to identify pathogens with pandemic potential as well as ‘those pathogens that may present significant risks of zoonotic spillover’.Footnote 112 In practical terms, this provision effectively translates to governments either building and/or then merging human, animal and environmental disease surveillance systems into an integrated surveillance mechanism. Notably, integrated surveillance systems are identified as a core recommendation of the One Health Joint Plan of Action, critical for identifying endemic zoonotic, neglected tropical and vector-borne diseases and implementing ‘risk-based solutions’.Footnote 113
In saying this, while integrated disease surveillance systems are theoretically possible, they are arguably difficult and resource-intensive to develop and maintain in practice—at least if pursuing a comprehensive One Health approach to PPPR. For example, as Roy and Rana have argued, there are three distinct objectives that any disease surveillance system must be able to fulfil: (i) maintenance, where the objective of a system is to detect and/or maintain freedom from disease; (ii) investigative, in which the aim is to discover more about endemic or epidemic disease; and (iii) implementation, where surveillance is used for evidentiary purposes to inform mitigation measures.Footnote 114 Moreover, there are different levels, types and methods of surveillance, including active surveillance (a system designed to detect every instance or case of a disease), passive (a system that analyses disease incidence on reported data), sentinel (a system that relies on data relating to specific diseases being submitted by preselected reporters), syndromic (a system that identifies disease incidence based on case definitions), event-based (involves identifying cases and disease outbreaks via official and informal reporting platforms), population-based (captures all reported cases within a defined geographic location), laboratory-based (a system that relies on laboratory diagnosis), wastewater (involving non-invasive sampling of sewage wastewater) and integrated (which combines laboratory, environmental etc).Footnote 115
Adding further to this complexity is the fact that animals, which continue to serve as the point of origin for approximately two-thirds of new infectious diseases affecting humans,Footnote 116 are broadly categorised as companion animals, livestock or wildlife, each with separate surveillance approaches.Footnote 117 Traditionally, governments have often displayed considerable reluctance to report outbreaks, particularly in livestock, due to other countries’ reactions in imposing trade-related sanctions.Footnote 118 Despite this, between 2019 and 2023 some 150 of WOAH’s 183 Member States (82 per cent) reported over 68 million cases of disease in domestic animals (including livestock) via weekly reports and six-monthly consolidated summaries.Footnote 119 However, only a small proportion of those countries—and almost exclusively high-income countries—maintain adequate systems to prevent, detect and respond to zoonotic disease events.Footnote 120 A recent study by the WOAH revealed ‘high heterogeneity around the needs, capacity level and organisation of wildlife disease surveillance systems’ with extensive gaps in geographic areas known to be hotspots for zoonotic spillover.Footnote 121 Some two-thirds of respondents also noted that they regularly experienced impediments related to the collection, handling, transportation and diagnostic testing of wildlife disease samples.Footnote 122 Accordingly, during those same years (i.e. 2019–2023), in contrast to over 68 million reports of disease in domestic animals, less than 200,000 cases of disease in wildlife were reported by WOAH Member States.Footnote 123 These results suggest that while some progress has been made in strengthening animal disease surveillance systems globally, immense financial and human resource investments will be needed to strengthen holistic One Health PPPR capacities.
Similar levels of investment will also conceivably be required to enhance environmental surveillance capacities to meet the Pandemic Agreement’s One Health requirements, specifically with respect to addressing the drivers of pandemics. This is complicated, however, by the fact that international collaboration on plant diseases and on human-animal diseases with pandemic potential currently operate through largely separate frameworks—a distinction rooted in the fact that, unlike human-animal pathogens, plant diseases do not presently cross the species barrier in ways that could trigger a human pandemic.Footnote 124 While there remains speculation that our changing climate may lead to genetic shifts in fungal species, heightening their thermotolerance and ability to infect humans which may generate new pandemic risks,Footnote 125 at least for now the etiological agents responsible for causing plant-based diseases do not pose a pandemic threat to humans. The investment implications arising from the Pandemic Agreement’s environmental surveillance obligations therefore differ somewhat from the human-animal surveillance obligations, and integrating these into a coherent One Health surveillance architecture raises its own set of challenges. As OHHLEP has itself acknowledged:
an integrated surveillance approach that includes ecological monitoring is challenging due to a range of issues including: i) historic silos of expertise and sectors; ii) limited surveillance capacity; iii) problems with access to, and quality of, One Health data and information; iv) logistical challenges such as lack of resources, personnel and legal basis for integrated surveillance across different domains (environmental, animal, human health systems), and v) the number of disciplines that need to be involved, including partners currently not routinely involved in disease surveillance (e.g., environmental agencies, ecologists, conservation biologists, social scientists).Footnote 126
Accordingly, the amount of time, effort and resources—human, technological and financial—that are required to meet even the surveillance-related obligations of the WHO Pandemic Agreement are significant moving forward.
5.2. Addressing the drivers of zoonotic disease emergence
Beyond the disease surveillance provisions, there are also substantial packages of work that States Parties are now obligated to undertake to actively prevent potential pandemic threats from arising. More specifically, pursuant to Article 4.2(a)–(b) and Article 5.2, States Parties are obliged to identify and then take measures to address the drivers of disease emergence and zoonotic spillover ‘at the human-animal-environment interface, with the aim of early prevention of pandemics’.Footnote 127 This will require States Parties to contend with a variety of factors and areas of public (domestic) policy, extending from food production and food security to the illicit trade of wildlife, environmental degradation, habitat destruction and encroachment of development into wildlife habitats—all factors that not only have major impacts on cross-species disease transmission dynamics, but also major economic and development consequences.
For example, even prior to the COVID-19 pandemic in which a wet market in Wuhan, China, was implicated as the coronavirus’ point of origin,Footnote 128 wet markets (also described as ‘live animal markets’) have long been identified as conducive environments for cross-species disease transmission.Footnote 129 In many parts of the world wet markets remain entirely unregulated (if not illegal), adhering to minimal hygiene or sanitary standards.Footnote 130 In some locations, these commercial environments also enable and cultivate the illicit wildlife trade (i.e. the poaching, capture and smuggling of protected species).Footnote 131 Although some governments have sought to increase their oversight of these markets, even closing them temporarily to aid outbreak control efforts,Footnote 132 the permanent abolition of wet markets has often been met with resistance from both local consumers and animal sellers.Footnote 133 There have also been cases where market closures have inadvertently contributed to new disease outbreaks as vendors sought new avenues for their merchandise.Footnote 134 This suggests that even though wet markets continue to pose significant risks in facilitating zoonotic spillover, local economic considerations including access to food and food security mean that, rather than elimination, wet markets need to be better regulated to manage the risks they pose. Under the terms of the Pandemic Agreement, governments will now need to isolate and investigate environments such as wet markets, bush meat retailers and the like, which pose an elevated risk of cross-species disease transmission, and take measures to mitigate and/or eliminate those risks as much as possible. Implementing such measures will require the allocation of human and financial resources to conduct inspections, renovate buildings to improve hygiene and sanitation, improve food safety standards etc. In addition, the introduction of such measures will need to be accompanied by widespread community education campaigns, and the development, adoption and application of new laws in those jurisdictions that currently lack such regulatory frameworks.Footnote 135 All these measures will likely take those States Parties willing to meet their One Health PPPR obligations several years, if not decades, to accomplish.
Similarly, to meet their obligations under the WHO Pandemic Agreement, governments may additionally need to reconsider their current land use practices, food production and farming methods. Alongside wet markets, intensive animal farming practices—and, specifically, ‘confined animal feeding operations’ (CAFOs)—have been identified as one of several high-risk activities contributing to the emergence of pathogens with pandemic potential.Footnote 136 While industry stakeholders have often argued that CAFOs limit risks because they are ‘spatially self-contained, closed-system production’ arrangements that are often situated on the outskirts of major metropolitan areas, as others have highlighted, ‘[t]his framing of production neglects the footprint, overflows and inevitable leakages’ that typify contemporary intensified animal rearing, whether it is from the massive (external) animal feed production and transport needs, water and sewage run-off, antimicrobial use to maintain animal health and/or growth promotion or even the land clearing associated with their construction.Footnote 137 Despite the risks these practices perpetuate for human-animal disease evolution, mutation and transmission, most industrialised countries have elected to look past these hazards in an effort to meet the low-cost protein demands of their citizenry. Under the Pandemic Agreement, however, States Parties are obligated to seek out and address the anthropogenic drivers of zoonoses emergence and, as such, CAFOs and related intensified food production methods will—at the very minimum—need to be scrutinised with a view to taking remedial risk mitigation measures.
5.3. Mitigating environmental risk factors
Intimately tied to intensified food production has been humanity’s ever-increasing encroachment into wildlife habitats. This phenomenon has several root causes extending from nutritional demands as discussed in Section 5.2, to population growth (i.e. urban expansion, construction of new infrastructure such as roads, dams etc), resource extraction (i.e. mining, deforestation etc) and even ecotourism,Footnote 138 but the consequences arising from land use changes have often disrupted ecosystem equilibrium. This, in turn, has frequently led to humans becoming exposed to animals and the pathogens they carry, some of which are novel and have pandemic potential.Footnote 139 As per the Pandemic Agreement, States Parties are now mandated to consider the wider ecosystem impacts of human behaviour, how these may foreseeably contribute to zoonotic spillover and take corrective measures to prevent pandemic threats emerging. Of course, precisely how governments are to accomplish this and the lengths to which they will be expected to go to prevent future pandemics remains the key issue, although some have already suggested as a first step requiring any new development proposal to include environmental impact studies that assess disease emergence risks.Footnote 140 As per Article 4, the COP is tasked with providing further guidance on the One Health approach implications to PPPR which States Parties will be able to adapt and mould to their national circumstances and diverging capacities.Footnote 141 As may be readily appreciated, however, while the COP’s task will be formidable it is ultimately the measures which governments take (or fail to take) that will have the greatest impact on reducing the risk of future pandemics.
To that end and pursuant to Articles 4 and 5, States Parties to the Pandemic Agreement will have willingly and knowingly committed themselves to work towards the elimination of both pathogens with pandemic potential as well as the environments that facilitate zoonotic spillover within their respective jurisdictions. The positive obligations contained within the treaty also extend to building, strengthening and maintaining additional domestic disease surveillance capacities capable of detecting, verifying, containing and/or eliminating those pathogens that pose a specific threat to human health. Consistent with Article 1 provisions, States Parties are also directed on how they are to conduct themselves to accomplish these outcomes: namely, via sustainable, multisectoral, transdisciplinary collaboration.
5.4. Entry into force, reservations and implementation
In saying this, there are three further considerations that warrant highlighting. The first and foremost is that while the Pandemic Agreement was officially adopted by the 78th WHA in May 2025, subject to Article 31 the instrument will not open for signature until intergovernmental negotiations on an annex to the treaty have been concluded.Footnote 142 More specifically, as per Article 12, WHO Member States are required to agree on a new annex entitled the Pathogen Access and Benefit Sharing (PABS) Instrument which will detail the ‘provisions governing the PABS System, including definitions of pathogens with pandemic potential and PABS Materials and Sequence Information, modalities, legal nature, terms and conditions, and operational dimensions’.Footnote 143 Given deliberations around the pathogen access and related benefits sharing proved particularly controversial during the full three years of the INB proceedings, speculation has already emerged over how long or even whether consensus on the PABS Instrument can be achieved.Footnote 144 Certainly, LMICs consider securing increased access to the vaccines, diagnostics and therapeutics that would be developed during a pandemic as essential to the instrument’s purpose, with some even describing Article 12 as ‘the backbone to the whole instrument’.Footnote 145 Unless and until such time as consensus can be reached on the PABS annex therefore, the instrument’s One Health PPPR obligations—not to mention the treaty itself—are moot.
In fact, given the perceived centrality of the PABS Instrument to the overall operation and functioning of the Pandemic Agreement, reaching consensus on the specifics of how the PABS System will function is likely to have a significant impact on States Parties’ willingness to ultimately sign and ratify the treaty. Unlike instruments adopted under Article 21 of the WHO Constitution which, pursuant to Article 22, become automatically binding on WHO Member States ‘after due notice has been given of their adoption by the Health Assembly’ (unless a State explicitly opts out),Footnote 146 conventions or agreements adopted under Article 19 are subject to the standard two-stage process of signature and ratification. Moreover, the treaty will not officially enter into force until 60 WHO Member States have ratified the instrument, meaning that approximately a full third of the organisation’s membership must be prepared to abide by the final version of the instrument that will include the PABS Instrument.Footnote 147
While the Pandemic Agreement does not specifically address whether States Parties can lodge a reservation to the PABS Instrument/annex,Footnote 148 a general right to lodge reservations to any part of the treaty has been provided for in Article 25, though with the qualification that such reservations may not be incompatible with the object and purpose of the Agreement.Footnote 149 Given that annexes form an integral part of the treaty, this general right would appear to extend to any annexes developed before or after the treaty has entered into force.Footnote 150 In this context, whereas countries entered into negotiations on the PABS Instrument in good faith, it is not inconceivable that some may be unsatisfied and/or unwilling to agree to the requirements outlined in the PABS annex given that it need only be adopted by a two-thirds majority of the WHA,Footnote 151 and may thus elect to sign the Pandemic Agreement while lodging a reservation to the PABS Instrument either in full or in part. It is likely that any State Party objecting to all or part of the PABS annex might be expected to justify their reservation before the WHA. However, despite the possibility of reservations, the hurdles to the treaty’s entry into force which would give effect to the instrument’s One Health PPPR obligations, remain sizeable.
The second factor of note is that the Pandemic Agreement remains anthropogenically highly selective, arguably to the detriment of its broader purpose. While the human-centricity of the instrument might be anticipated given that it was negotiated under the auspices of the WHO that has an exclusively human health mandate, the instrument’s limitation in only being concerned with those pathogens that are a direct, acute threat to human health largely nullifies a genuinely One Health approach to PPPR. For example, African Swine Fever (ASF)—a highly contagious disease with a fatality rate of up to 100 per cent—is currently spreading globally, decimating pig populations worldwide.Footnote 152 Pork meat remains one of the most consumed forms of animal protein in the world with an estimated 32.5 per cent of the world’s population consuming pork in 2021;Footnote 153 and while pork production declined temporarily between 2021 and 2022, the outlook is that it is expected to increase by 0.4 per cent per annum until 2033 to meet growing demand.Footnote 154 The decimation of the global pork industry by ASF, an animal pandemic, represents an indirect threat to human health given both the economic harms and nutritional impacts. It is also very likely that farms impacted by ASF have inadequate biosecurity measures in place, making them highly susceptible to other zoonotic diseases that do have human pandemic potential (e.g. highly pathogenic avian influenza).Footnote 155 The restriction of the treaty’s focus to those diseases of immediate, direct risk to humans thus overlooks the interconnectedness that can exist at the human-animal-environment interface, which the One Health approach ultimately seeks to promote.Footnote 156
This narrow, human-centric approach to One Health, now enshrined in a legally binding instrument, may additionally generate new, unintended implementation problems requiring careful attention. Specifically, as noted by the FAO in written submissions to the INB, adopting a new definition of One Health that diverges from the OHHLEP definition endorsed by the Quadripartite risks inadvertently undermining efforts to provide States Parties with clear guidance on implementing a One Health approach to PPPR.Footnote 157 Given that the FAO and WOAH were relegated to a relatively minor advisory role during the INB compared to the WHO,Footnote 158 and the WHO Secretariat will also now serve as the Pandemic Agreement’s secretariat,Footnote 159 there will be an ongoing temptation for the WHO to take the lead in providing technical advice to States Parties on how they should interpret and apply their new One Health PPPR obligations. The associated risk is that Quadripartite members, in seeking to assist States Parties in meeting their new international obligations, may provide conflicting or contradictory guidance, particularly where consultation and coordination is inadequate. Moreover, by embedding the human-centred conception of One Health PPPR, the Pandemic Agreement may inadvertently undermine the authority of other non-WHO international organisations with related responsibilities given the treaty has legal status whereas technical guidelines do not.
The third element is that, even without adopting a more holistic One Health approach to PPPR, the costs associated with meeting the treaty’s existing, more narrowly defined obligations are significant and transformational. Previous attempts at requiring States Parties to build, strengthen and maintain core public (human) health capacities in disease surveillance, detection, verification and response proved unsuccessful, given that two-thirds of the world’s countries had failed to meet their obligations by the mutually agreed, self-imposed deadlines under the IHR 2005.Footnote 160 As discussed in Section 3, developing and maintaining the core capacities required to detect, verify and contain zoonotic pathogens with pandemic potential via integrated disease surveillance systems will require sizeable new human, technical and financial investments. Likewise, instituting new inspection and regulatory systems to monitor, oversee and reform high-risk zoonotic spillover environments, such as wet markets, CAFOs, bush meat retailers etc, will incur considerable new costs, both human and economic. Indeed, some of these industries may need to be shuttered entirely or radically reorganised if States Parties are to take their One Health PPPR obligations under the Pandemic Agreement seriously.
6. Concluding remarks
The One Health approach to PPPR, encapsulated in the WHO Pandemic Agreement, represents a notable milestone in multilateral, multisectoral efforts to strengthen global health security. As argued in Section 2, the instrument’s incorporation of the core elements of the OHHLEP definition of One Health—albeit with some principled distinctions—indicates that the concept of One Health has gained hitherto unprecedented international consensus on how to systematically prevent, prepare for and respond to future health crises. Certainly, the extent of the recognition of the need to consider more carefully the intersections between human-animal-ecosystem health, made compellingly clear by the tragedy of the COVID-19 pandemic, is an outcome worth cautiously celebrating.
It should be further acknowledged that the very conclusion of the INB process for the Pandemic Agreement represents a major achievement for contemporary multilateralism. While the work in ensuring that the world is better prepared for the next pandemic is far from complete, the fact that a new framework was able to be concluded during heightened geopolitical tensions brought about by Russia’s unprovoked invasion of Ukraine, the Israel-Hamas war and multiple civil conflicts in Sudan, Ethiopia and Myanmar just to name a few, is remarkable. The fact that the new international instrument also contains far-reaching obligations on addressing the drivers of pandemics and the emergence and re-emergence of infectious diseases at the human-animal-environment interface offers some promise that the associated human morbidity and mortality and the social and economic consequences of future pandemics may be more efficiently mitigated.
Despite this, there is no question that the challenges confronting States Parties to meet their international One Health PPPR obligations under the treaty are substantial. Arguably the most significant challenge remains the extent to which States Parties may seek to circumvent their obligations given the abundance of qualifiers and caveats inserted into the instrument’s provisions. While the risk of noncompliance may be mitigated to a degree via the requirement for States Parties to regularly report on their progress to the COP, as highlighted in Section 5, much will depend upon the authority of the treaty’s implementation monitoring system that is adopted. If that system is to be effective, it will require a coalition of States Parties maintaining pressure on those less enthusiastic for a more equitable set of outcomes than what the world witnessed during COVID-19.
Beyond the political, there are also significant hurdles at the practical level. Encouraging cooperation between sectors that have traditionally operated independently in professional siloes whilst simultaneously building integrated disease surveillance systems capable of detecting pathogens with pandemic potential is very complex, as demonstrated by the experience of building, strengthening and maintaining core public health capacities under the IHR 2005. Moreover, accomplishing these tasks will take considerable time and resources, as will the measures to reduce and ideally eliminate zoonotic spillover risks now required of States Parties. Alongside these efforts, as noted in Section 5.2, governments will need to embark on extensive education and training to help professional communities and the general public—who are still exhausted and suffering ‘pandemic fatigue’—understand the regulatory and practical changes underway.
Beyond the day-to-day technical measures that States Parties may be expected to implement to reduce and/or mitigate the emergence of pathogens with (human) pandemic potential, the Pandemic Agreement’s focus on addressing the drivers of pandemics raises broader questions about human activity and the role it plays in fomenting infectious disease emergence and spread. Fundamentally, it is human behaviour—whether from food production methods, ever-increasing urbanisation, global trade and travel or the warming of the planet via heavy industrialisation—which is directly contributing to and elevating the threat of further pandemics. The psychological propensity to quickly move past traumatic events such as the COVID-19 pandemic, perpetuating the cycle of pandemic ‘panic and neglect’, combined with the lack of willingness to adequately invest in healthcare systems, services and infrastructure, exacerbate the consequences of these events when they do arise. The Pandemic Agreement’s obligation to address the drivers of pandemics will ideally compel a broader, humanity-wide philosophical conversation about modernity and the type of future society desired. While that is probably unlikely to transpire, at the very least the Pandemic Agreement will prompt reflective deliberations in government meetings, board rooms, industry and professional communities on how, collectively, society can work towards minimising future pandemic risks. In this, only one thing is certain: the next pandemic is not a matter of if, but when.
Acknowledgements
The author would like to thank Cummings Foundation for enabling this research. The author would also like to thank the editorial team and the two anonymous reviewers for their helpful comments and suggestions. All errors and omissions remain those of the author.
Open access
