Explainer: The Pandemic Treaty

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Explainer: The Pandemic Treaty

This EXPLAINER brings you up to speed on the WHO's "Pandemic Treaty" negotiations and outlines how unions need to engage.

This EXPLAINER provides key background info to get you up to speed on the WHO's "Pandemic Treaty" negotiations and outlines how unions need to engage.

Table of contents

This EXPLAINER provides key background info to get you up to speed on the WHO's "Pandemic Treaty" negotiations and outlines how unions need to engage.

The What, Why, How

What is the Pandemic Treaty?

Over the course of the COVID-19 pandemic, there has been significant discussions on the need to ‘build back better’ and to avoid the same mistakes seen in the global COVID-19 response. The most glaring of these mistakes being that of vaccine inequity, a problem that continues to persist. Other issues in the COVID-19 response have included unequal distribution and access to PPE, diagnostics, ventilators, and medicines distribution; unnecessary and unsafe exposure of healthcare workers to the virus; and weak health systems unable to provide necessary care to their patients. 

Keeping in mind the hugely inadequate response of the global health community to the COVID-19 pandemic and the large-scale health inequity (largely due to lack of cooperation among states) witnessed during the pandemic, a need was felt for an agreement among nations on directives and measures to effectively avoid and address any future health emergencies. As a result, at a special session of the World Health Assembly, held in November 2021 member states of the World Health Organisation (WHO) agreed to proceed with a new international instrument towards this. The instrument, informally known as the Pandemic Treaty, will set voluntary as well as legally binding norms and standards aimed at strengthening pandemic prevention, preparedness, and response. It will be drafted through formal negotiations through the Intergovernmental Negotiating Body (INB). The final instrument is expected to be adopted in 2024 at the 77th World Health Assembly (WHA)

Why is this Treaty Important?

This instrument is important as it can shape the ways in which health systems globally not only respond during a pandemic, but also ways for countries to address existing health inequities. 

This means that the treaty should ideally include clauses that secure and protect the interests of the health and care workforce of countries. We know that health systems are strong and resilient only when workers' interests are secured.

It is thus important that during the negotiations member states push for provisions that will ensure future cooperation and democratic processes that can strengthen health systems, ensure decent work conditions, and build resilience within the global health governance to respond to shocks such as a pandemic.

How will the Text of the Treaty be Developed?

Decisions made at the World Health Assembly are achieved through consensus between governments. In some rare cases decisions are made by vote if the topic is particularly sensitive and there’s lots of disagreement (for example on the health situation in Ukraine). All member states of the WHO can define the focus and text of the new pandemic agreement through the INB which is open for all governments to take part in.   

The INB consists of:

Co-Chairs: from South Africa and the Netherlands

Vice Chairs: from Thailand, Japan, Egypt, and Brazil

In addition to member states, United Nations and intergovernmental organizations, official observers and nongovernmental organisations in official relations with the WHO are also invited to attend and speak at INB meetings, workgroup meetings and contribute via an online platform. This engagement is extended to a further list of organisations selected by the INB. However, they only have a consultative role and are not part of the negotiations. 

PSI as a non-state actor in official relations with the WHO has been part of the process of the development of the treaty. Negotiations on the text of this instrument are currently underway. So far, the member states have agreed the new instrument will be legally binding but may also contain non-binding provisions.   

Brief Timeline

And Upcoming Important Dates



WHA Special session creates the INB to draft a Pandemic Treaty



First INB Meeting (INB 1) 

Held over four sessions

Outcome: Agreement on modalities of the work, timelines and composition of the INB

12-13 April

1st Public Hearing on the Pandemic Treaty

18-21 July 

Second INB Meeting (INB 2)

Outcome: Agreement on the legally binding nature of the treaty with some non-binding elements 

29-30 September 

2nd Public Hearing on the Pandemic Treaty

PSI affiliates shared their opinions through a video submission on the question: 

“Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics?”

Link: https://inb.who.int/home/public-hearings/second-round

5-7 December

Third INB Meeting (INB 3)

Outcome: Agreement on the next INB to start negotiations on the text to be called Zero Draft


1 February

Zero Draft released

27 February-3 March

Fourth Meeting of the INB (INB 4)

Closed room negotiations begin on the text of the treaty

Member states agree on keeping the negotiations closed to all. Comments on the text will be added without disclosing who proposed the changes

3-6 April 

Fifth Meeting of the INB (INB 5)

Outcome: The meeting was suspended with a decision to meet end June

21-30 May

76th World Health Assembly

Outcome: A version of the pandemic treaty text that includes country's inputs is leaked, revealing important additional proposals including on health and care workers rights, as well as harmful and diluted language on sharing of technology, knowledge and pathogens for research.

Link: Text INBPoliticoleak.pdf

12-16 June

Resumed Fifth Meeting of the INB (rINB5)

Outcome: PSI and other organisations denounce setbacks in the negotiations and the text published on 2 june 2023

Link: https://apps.who.int/gb/inb/pdf_files/inb5/A_INB5_6-en.pdf

17-21 July 

Sixth Meeting of the INB (INB 6)

4-6 December

Seventh Meeting of the INB (INB 7)


19 February-1 March

Eighth Meeting of the INB (INB 8)

18-29 March

Ninth and Final Meeting of the INB (INB 9)


77th World Health Assembly

What Does it Address?

The actual text of the new instrument on which negotiations have begun this year is the Zero Draft, published on 1 February 2023. This text has been developed after revisions of a Conceptual Zero Draft text on which both member-states as well as civil society and other interest groups had shared their comments. 

This Zero Draft has 38 articles that address the following issues:

  • Achieving equity in, for and through pandemic prevention, preparedness, response and recovery of health systems

  • Strengthening and sustaining capacities for pandemic prevention, preparedness, response and recovery of health systems

  • Coordination, collaboration and cooperation for pandemic prevention, preparedness, response and health system recovery

  • Financing for pandemic prevention, preparedness, response and recovery of health systems

  • Institutional arrangements

What is Missing?

While the draft has sections that cover all relevant concerns regarding a future pandemic as well as strengthening and sustaining the existing global health architecture, the clauses and provisions under many sections lack clear commitments from member-states. The language in many places fail to hold member-states accountable for crucial measures required to achieve the goal of robust, resilient health systems prepared for future health emergencies.

Specifically, it fails to: 

(Click title to learn more)

1. Uphold the Right to Decent Work for Health and Care Workers

Upholding the Decent Work Agenda for all health and care workers across workplaces is vital for quality public services and strong healthcare systems. Article 12, in the Zero Draft on "strengthening and sustaining a skilled and competent health workforce" remains grossly inadequate in addressing the rights of workers. It fails to recognise the essential role of health and care workers who despite the lack of Personal Protective Equipment (PPE) early in the pandemic risked their lives to ensure that elderly and disabled people were taken care of and reached out to vulnerable communities.   

Because of lack of secure employment and decent working conditions there is a drain of health and care workers from low-and-middle income countries to high-income countries. In most cases the mobile population of workers are not protected by any laws in the destination countries. During the pandemic this phenomenon was exacerbated due to the stressful conditions face by the health workforce. However, the current draft fails to address this phenomenon. It is imperative in the context of strengthening global health systems and regional cooperation for preparing for future pandemics, that the treaty addresses issues faced by both the migrant health workforce as well as the sending countries whose health systems are already overburdened and weak and face acute shortage of workforce

The following are the specific inclusions that PSI calls for in the Pandemic Treaty:

  • Labour and union rights for health and care workers both inter- and in pandemic times, to be explicitly included;  

  • The application of the precautionary principle in policies affecting health and care workers' exposure to risk, as an additional principle   

  • The inclusion of meaningful participation of unions and organisations of health and care workers in decision making in long term health and care policy as well as in crisis planning during a pandemic; 

  • An additional article in Chapter IV (ideally before the current Article 12) providing for measures to ensure decent work for health and care workers, with the explicit inclusion of improved working conditions, adequate health and care worker to patient ratios and the labour rights provided for in ILO recommendations and instruments, such as the 2017 ILO Tripartite Meeting on Improving Employment and Working Conditions in Health Services,  the 2016 Report of the Expert Group to the High level Commission on Health Employment and Economics and the Convention 149 on nursing personnel

  • The new instrument should explicitly include protective measures that secure rights of migrant health and care workers in destination countries. As well as adequate measures to ensure that sending nations do not face health workforce shortages

2. Ensure Public Financing of Health Goods

The Zero Draft includes clauses on compulsory obligation for manufacturers that receive public funding for R&D in pandemic countermeasures to disclose prices and contractual terms for public procurement in times of pandemic. This is included in Article 9 on "increasing research and development capacities” (Article 9.3.b). This inclusion is a valuable gain.  

However, to truly realise a robust global health systems architecture we believe that we must understand all health technologies as public goods. Governments must commit to invest in their development and distribution. 

It is therefore important that the instrument includes policies that guarantee that all health products, technologies, know-how, etc, that originate from public-funded research programs be kept in the public domain.

3. Waive off Patent Rights in all Cases of Public Health Emergencies

The TRIPS Waiver campaign for a suspension of intellectual property rights (IPR) on vaccines, therapeutic products and diagnostics as demanded by more than 100 countries at the World Trade Organisation (WTO) highlighted the restrictive role of trade rules in addressing people’s health concerns. 

Because of the international pressure created by the TRIPS Waiver campaign as well as continued discussions around the world on big pharma greed and its profiteering over the lives of people, the current pandemic treat text has included a provision for a time-bound waiver of intellectual property rights to accelerate and scale-up manufacturing of pandemic products.

However, this article needs to be strengthened in order for it to be effective. PSI therefore calls for the time-bound waiver to be automatically triggered with the announcement of a PHIEC, ie a public health emergency of international concern. A PHIEC is a WHO defined situation of emergency and covers a wider range of critical health emergencies, including a pandemic. 

Further, it should be specified that this waiver would apply to all parties willing to use it and not be left for each country to take measures within their borders unilaterally. The existing caveats in the TRIPS agreement of the WTO already enable countries to take such unilateral initiatives, which has proven to be a sub-optimal mechanism.

What Can Unions Do?

The negotiations are underway behind closed doors. It is therefore imperative that unions, especially those of health and care workers make their voices heard through any means possible. The Pandemic Treaty is an important opportunity to ensure not only a better global coordinated response to future pandemics but also for countries to invest in their public health systems and secure the interests of their health and care workforce. 

It is important to reiterate to the WHO and to member states that there can be no pandemic treaty without health workers in it. 

During the process of negotiations that will go on till the World Health Assembly (WHA) in 2024, unions can put pressure on their governments to push for their priorities and defend clauses in the treaty that speak to the interests of the health and care workers and uphold quality public health services.

You can do this by writing to your governments, request for meetings to discuss priorities, or plan and execute social media actions to spread awareness etc. 

PSI both globally and in the region is following the process of negotiations and is actively involved in inputs to the entire process. 

For more information on the Pandemic Treaty and how you can get involved, please contact:

Global Coordinator for Health Equity, Susana Barria susana.barria@world-psi.org

Useful Resources

Pandemic Treaty - Old Model Letter (for zero draft)

Letter for unions to send to their Health Ministry, building on our concerns and demands for the WHO Pandemic Treaty.


PSI's Submission to WHO Pandemic Treaty Talks

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