International pandemic governance need not prioritize compliance and sanctions

In a Policy Forum, Mark Eccleston-Turner and colleagues argue that upcoming negotiations surrounding the World Health Organization (WHO) international pandemic treaty need not be overly focused on formal compliance mechanisms and sanctions. Instead, Eccleston-Turner et al. suggest that any efforts to ensure compliance should be part of broader efforts to ensure effective and equitable implementation across all member states. Member states of the World Health Organization (WHO) are preparing for ambitious governance reforms to global health policy to strengthen pandemic prevention, preparedness, and response through international law. The International Health Regulations (IHR) is the sole legal framework for ensuring a coordinated response to global health crises. However, across numerous outbreaks, including COVID-19, these regulations have been criticized as being ineffective, an outcome that has largely been blamed on failures of compliance and enforcement. As a result, a focus of negotiations on the new Pandemic Treaty and amendments to the IHR is how compliance by member states can be best achieved. Here, Eccleston-Turner et al. discuss how debates surrounding formal sanctioning power rely upon simplistic assumptions and one-size-fits-all solutions, which could, in turn, discourage compliance and best practice implementation. Instead of formal sanctions and the threat of punitive actions in response to noncompliance, the authors argue that a holistic approach to understanding and encouraging compliance and implementation must consider the overall legal, institutional, and political aspects of such as a total “package” that can generate trust and mutual reliance between member states.