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COVID-19 presented a “once in a generation” challenge to all nation-states and their political leaders. The pandemic tested not only their public health infrastructures but also struck at the core of their economic and political systems and the roots of social cohesion. But while the multifaceted threat posed to societies called out for a coordinated response, the past two years have witnessed the devastating impact of a failure to address COVID-19 as a shared challenge and, to date, to design and implement effective forms of international cooperation. At the national level, governments retreated inward, competed for critical medical supplies, and raced unilaterally to secure vaccines. At the global level, power politics between the two major players, the United States and China, also undermined collective action on COVID-19, with “raw realpolitik” subordinating responses to global health threats to geopolitical interests.2

This dynamic, in turn, directly affected the capacity for international institutions to facilitate cooperation. The United Nations (UN) Security Council—wracked by geopolitical rivalry—took months just to pass a resolution on COVID-19 and was equally slow in responding to the UN secretary-general’s call for a global ceasefire to enable societies to focus on combatting the pandemic.3 Tensions also developed within the World Trade Organization (WTO), where high-income countries defied trade liberalization rules by placing export bans on key medical supplies early in the crisis and later defended the intellectual property rights of vaccine producers in ways that frustrated the goals of many middle- and lower-income countries. For its part, the World Health Organization (WHO) not only confronted the effects of member states’ continued lack of compliance with the International Health Regulations (IHR) but also succumbed to political pressures that constrained its capacity to act decisively on a pandemic declaration and to issue clear and timely guidance on pandemic response.

As one of the early task forces on COVID-19 thus observed, the pandemic saw a breakdown of coordination across states in a variety of “multilateral settings where an effective response both to the disease and its massive economic fall-out could have materialized.”4 Several reasons for this foundering of international cooperation have already been suggested in the academic and policy literature, including, inter alia, the intensification of geopolitical competition, weaknesses in institutional design, the unwillingness of states to share information in a timely fashion, populist trends that are challenging the authority of expert advice and guidance, and nationalist pressures to look inward rather than outward to the global commons.5 The member states of the World Health Assembly (WHA) also established an independent panel to provide recommendations on how to prevent and respond better to future pandemics—including through changes to global institutions and mechanisms. The panel’s final report, issued on May 12, 2021, echoes earlier studies of weaknesses in global health architecture and sets out detailed plans for reform.6 At the meeting of the WHA later that month to consider the report’s recommendations, member states passed a resolution calling upon the director-general of the WHO to convene a special session of the WHA in November 2021 to debate the benefits of developing an international framework convention (under WHO auspices) to strengthen pandemic preparedness and—if supported—to launch an international negotiation process.7 This was followed by the release of a high-level panel report from the G20 in June 2021 setting out an ambitious new financing framework to support some of the political and institutional recommendations emerging from the WHA’s process.8

As part of these ongoing deliberations, the American �����Ƶ of Arts and Sciences’ Rethinking the Humanitarian Health Response to Violent Conflict initiative sought to take stock of the findings from international relations (IR) research about the preconditions for and nature of effective cooperative solutions, as well as from more specialized fields—such as the environment and weapons of mass destruction (WMD)—that deal with common threats to humanity where cooperative mechanisms have been designed even in contexts of deep geopolitical competition. By convening experts from multiple domains,9 we aimed to spark creative discussion of what kind of cooperative arrangements have been designed before, why they have succeeded or failed, and how barriers to cooperation might be overcome.

The focus of our discussions, which were held in February and March 2021, was primarily on early warning and early action—namely, how to prevent instances of infectious disease from becoming global pandemics. As such, key topics included how to promote transparency and information sharing among sovereign states, how to establish legitimate and effective mechanisms for monitoring and verification, how to integrate scientific expertise into decision-making, whether and how sanctions for noncompliance have been built into cooperative mechanisms, how nonstate actors (including the private sector and civil society) can feature in both building and maintaining cooperative solutions, and how to incentivize the commitment of adequate resources to ensure that cooperative solutions are sustainable.

In the first meeting, we concentrated on extracting lessons from other policy domains that entail transnational threats—or what former UN Secretary-General Kofi Annan referred to as “problems without passports.”10 We asked participants to reflect upon particular agreements or institutions from their area of expertise (such as the Chemical Weapons Convention, the Montreal Protocol, or particular nuclear arms control agreements) but also to consider less formal mechanisms that have encouraged information sharing and productive forms of cooperation. The second meeting drew upon these insights to consider specific ideas and proposals for reform of and innovation in the global health architecture (including, but not limited to, reform of the WHO) and assessing how well they address barriers to cooperation against infectious disease. We also discussed how to develop and equitably share effective treatments and vaccines to address pandemics already underway.

This summary report begins by briefly reviewing the breakdown in international cooperation during the COVID-19 pandemic. It then takes a step back to examine the evolving “regime complex” for global health security, discussing earlier efforts to improve pandemic preparedness and response and the broader frameworks that shaped them. The main section of the report reviews the academic literature on the types of cooperation problems that can occur in global politics, analyzes those problems that were most acute in the case of the COVID-19 pandemic, and synthesizes what we learned about attempts in other domains to address common threats. It also builds on this analysis by examining the key reform proposals forwarded to improve pandemic preparedness and response and by identifying some of the preconditions for successful global cooperation. The report concludes with a broad set of recommendations for states and other actors as they engage in high-level diplomatic discussions on potential changes to our global health architecture to better meet the challenges of infectious disease.

Endnotes

• 2David P. Fidler, “,” Think Global Health, June 23, 2021.
• 3Relief Web, “,” May 19, 2020.
• 4Council on Foreign Relations, , Independent Task Force Report No. 78 (New York: Council on Foreign Relations, October 2020).
• 5Ibid. See also “,” International Organization 74 (S1) (December 2020); and Sophie Eisentraut, Luca Miehe, Laura Hartmann, and Juliane Kabus, (Munich: Munich Security Conference,November 2020).
• 6Independent Panel on Pandemic Preparedness and Response (IPPPR), (IPPPR, May 2021).
• 7The text of the resolution can be found . While the framework convention is being referred to as a “pandemic treaty,” member states have not converged on the idea of a legally binding treaty. Instead, they agreed in November 2021 to begin negotiations on a “new instrument,” which some are referring to as an “accord.”
• 8G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, (June 2021).
• 9See Appendix A for a list of participants. While these experts were consulted in the writing of the report, the views expressed—and any errors or omissions—are solely the responsibility of the author.
• 10Kofi Annan, “,” Foreign Policy (9) (November 2009).