Six years ago, the World Health Organization sounded its highest alarm for COVID-19, a disease that would kill over 7 million people by official counts and likely more than 20 million when including excess deaths. The question now: Is the world any better prepared for the next pandemic?
The WHO's answer: 'Yes and no.' On paper, significant progress has been made—a historic Pandemic Agreement adopted in May 2025, amended International Health Regulations in force since September 2025, over $1.2 billion distributed through the Pandemic Fund, and mRNA technology transfer hubs operating across 15 countries. But these gains are fragile. The United States, once the WHO's largest funder, completed its withdrawal in January 2026. Eleven countries have rejected the new health regulations. And the estimated $10-15 billion per year needed for preparedness remains far out of reach.
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People Involved
Tedros Adhanom Ghebreyesus
WHO Director-General (Serving second term (reelected 2022))
Helen Clark
Co-Chair, Independent Panel for Pandemic Preparedness and Response (Former Prime Minister of New Zealand)
Organizations Involved
WO
World Health Organization (WHO)
International Organization
Status: Leading global pandemic preparedness coordination despite US withdrawal
The UN agency responsible for international public health, coordinating global disease surveillance and emergency response.
PA
Pandemic Fund
Multilateral Financing Mechanism
Status: Distributing grants across three funding rounds
The first multilateral fund dedicated exclusively to strengthening pandemic prevention, preparedness, and response in low- and middle-income countries.
AF
Afrigen Biologics
Biopharmaceutical Company
Status: Operating WHO mRNA technology transfer hub
South African biotech firm serving as the hub for WHO's mRNA technology transfer program, enabling vaccine manufacturing across 14 countries.
Timeline
WHO Marks Six Years Since COVID-19 PHEIC
Assessment
WHO issued statement assessing pandemic preparedness as 'yes and no'—progress made but gains remain 'fragile and uneven.'
US Completes WHO Withdrawal
Political
United States formally exited WHO after required one-year notice period, terminating all funding and recalling US personnel.
Amended IHR Enter Into Force
Legal Framework
The 2024 International Health Regulations amendments entered into force for countries that accepted them, establishing new equity provisions and financing commitments.
US Formally Rejects IHR Amendments
Political
HHS Secretary Kennedy and Secretary of State Rubio issued joint statement rejecting the 2024 International Health Regulations amendments.
WHO Pandemic Agreement Adopted
Legal Framework
World Health Assembly adopted historic Pandemic Agreement by consensus after three years of negotiations—only the second legally binding health treaty in WHO's 77-year history.
Trump Signs Executive Order to Withdraw from WHO
Political
President Trump signed executive order initiating US withdrawal from WHO, citing failures in COVID-19 response and reform refusal.
World Health Assembly Adopts IHR Amendments
Legal Framework
Member states reached consensus on amendments to International Health Regulations, including equity provisions and new financing mechanisms.
COVID-19 PHEIC Status Ends
Declaration
WHO Director-General declared the end of COVID-19 as a Public Health Emergency of International Concern after more than three years.
Pandemic Fund Launched
Financing
G20 launched the Pandemic Fund as the first multilateral financing mechanism dedicated to pandemic preparedness in low- and middle-income countries.
Pandemic Treaty Negotiations Begin
Negotiation
World Health Assembly launched intergovernmental process to draft a pandemic preparedness and response agreement.
WHO Launches mRNA Technology Transfer Hub
Capacity Building
WHO announced program to transfer mRNA vaccine technology to low- and middle-income countries, with Afrigen Biologics in South Africa as hub.
Independent Panel Calls for Pandemic Treaty
Recommendation
The Independent Panel for Pandemic Preparedness released 'COVID-19: Make it the Last Pandemic,' recommending a framework convention and major reforms.
COVID-19 Declared a Pandemic
Declaration
WHO characterized COVID-19 as a pandemic, signaling sustained global transmission across multiple continents.
WHO Declares COVID-19 a PHEIC
Declaration
Director-General Tedros declared the novel coronavirus outbreak a Public Health Emergency of International Concern with 7,818 confirmed cases globally across 19 countries.
H1N1 'Swine Flu' Pandemic Declared
Historical Precedent
First pandemic declared under revised IHR. The moderate severity revealed gaps in WHO's ability to calibrate response to threat level.
International Health Regulations Revised
Legal Framework
WHO member states adopted updated IHR, creating the Public Health Emergency of International Concern (PHEIC) declaration mechanism.
SARS Contained After 8,447 Cases
Historical Precedent
WHO declared SARS contained after coordinated global response. The outbreak killed 813 people but was stopped without a vaccine through surveillance, contact tracing, and quarantine.
Scenarios
1
Pandemic Agreement Takes Effect, Creates Durable System
Discussed by: WHO leadership, European Union officials, global health advocates
Following 60 ratifications, the Pandemic Agreement enters into force with the Pathogen Access and Benefit-Sharing system operational. Countries share pathogen samples and genomic data rapidly; vaccine and treatment access is more equitable than during COVID-19. The system proves its worth when the next outbreak emerges, with faster detection and more coordinated response. Remaining holdouts eventually join as benefits become clear.
2
Fragmented System Persists, Response Capacity Degrades
Discussed by: Global Preparedness Monitoring Board, International Pandemic Preparedness Secretariat, health policy analysts
Ratification stalls short of the required 60 countries. Without US participation and funding, WHO's operational capacity diminishes. The Pandemic Fund falls far short of the $10-15 billion annual need. When a new pathogen emerges, response mirrors COVID-19's early failures: delayed alerts, vaccine nationalism, and uncoordinated measures. Political fractures prevent the coordination that contained SARS in 2003.
3
Regional Blocs Build Parallel Preparedness Systems
Discussed by: African Union health officials, European Commission, bilateral health cooperation analysts
Facing global fragmentation, regional organizations build their own preparedness infrastructure. The Africa CDC and African Medicines Agency expand capacity. The EU deepens health security integration. China and Russia build separate networks with aligned countries. These systems work well within regions but struggle to coordinate across blocs when a pathogen crosses boundaries.
4
US Rejoins WHO Under New Administration
Discussed by: US public health officials, former WHO collaborators, Democratic Party health policy experts
A future US administration reverses the withdrawal decision, as happened after Trump's first-term withdrawal was halted by Biden in 2021. The US rejoins WHO, restores funding, and accepts the Pandemic Agreement and IHR amendments. American reentry catalyzes broader participation and restores funding levels, though rebuilding trust and capacity takes years.
Historical Context
SARS Outbreak (2003)
November 2002 - July 2003
What Happened
A novel coronavirus emerged in Guangdong Province, China, spreading to 29 countries before containment. The outbreak infected 8,447 people and killed 813 (9.6% mortality). WHO coordinated an unprecedented international response through its Global Outbreak Alert and Response Network, issuing its first-ever travel advisory.
Outcome
Short Term
SARS was contained in under four months without a vaccine, using surveillance, contact tracing, and quarantine. China's initial secrecy drew international criticism.
Long Term
Led directly to the 2005 revision of International Health Regulations, creating the PHEIC declaration mechanism used for COVID-19. China built new disease reporting infrastructure.
Why It's Relevant Today
SARS proved coordinated global response could stop a novel pathogen. COVID-19 showed the same tools fail when a virus spreads faster and governments delay action.
H1N1 'Swine Flu' Pandemic (2009-2010)
April 2009 - August 2010
What Happened
A novel influenza A virus emerged in Mexico, triggering the first pandemic declared under the revised IHR. The WHO declared a PHEIC in April 2009 and a pandemic in June. Estimates suggest 151,700-575,400 deaths globally in the first year, though severity was lower than feared.
Outcome
Short Term
Countries that had prepared for a severe pandemic struggled to calibrate response to moderate threat. Vaccine arrived after the peak wave in many countries.
Long Term
WHO revised its pandemic phases framework. Reviews found the international alert system was not calibrated for varying severity levels—a lesson partially applied to COVID-19.
Why It's Relevant Today
Demonstrated that pandemic planning based on worst-case scenarios creates rigidity. WHO's 'yes and no' assessment echoes 2009 lessons: preparedness exists on paper but translating it to appropriate response remains difficult.
Ebola West Africa Outbreak (2014-2016)
December 2013 - June 2016
What Happened
The largest Ebola outbreak in history spread across Guinea, Liberia, and Sierra Leone, eventually reaching seven more countries. Over 28,600 cases and 11,325 deaths occurred. WHO was criticized for delayed response, declaring a PHEIC only in August 2014 despite months of transmission.
Outcome
Short Term
International mobilization eventually contained the outbreak. The delay highlighted WHO's underfunding and limited surge capacity.
Long Term
WHO established the Health Emergencies Programme and created a Contingency Fund for Emergencies. The outbreak accelerated discussions that eventually led to the Pandemic Fund.
Why It's Relevant Today
Exposed how WHO's funding model—dependent on voluntary contributions—limited its ability to respond quickly. The same funding fragility now threatens post-COVID preparedness gains.
