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Two broad analytical lenses are useful for understanding the nature of global policy in a domain such as infectious disease. One is a “polycentric” lens, whereby multiple actors participate—to varying degrees—in global policy-making. These include national governments, private-sector actors, and nongovernmental organizations. The other is the more traditional “state-centric” lens, whereby policy develops from the interaction of representatives of politically independent sovereign states.11 Theoretically, a host of actors—including nonstate actors such as the Program for Monitoring Emerging Diseases (ProMED, a program of the International Society for Infectious Diseases,12) the Global Alliance for Vaccines and Immunization (GAVI), and the Coalition for Epidemic Preparedness Innovations (CEPI)—could have shaped policy-making on COVID-19, as they have played a role in the broader governance of global health over the past decades. Yet, despite the prevalence of public-private partnerships and other forms of polycentrism in global health governance, we found ourselves in the early phase of the pandemic operating in a largely state-centric world.

The crisis reasserted the importance and force of sovereign control. Populations became more acutely conscious of their nationality and citizenship and their reliance upon their governments to protect them from the spread of the virus. National governments themselves engaged in emblematic exercises of sovereign power, including the closing of borders and restrictions on air travel both out of and into their countries. At the same time, governments confronted demands to protect their citizens beyond their borders by dispatching planes to bring those citizens home. Finally, the pandemic made painfully clear—if it was not already so—that those who are displaced or “stateless” find themselves in a particularly vulnerable situation during transnational phenomena such as pandemics. So, too, do populations in societies where the state’s capacity to protect is underdeveloped or where the political legitimacy of state authorities is contested.

Notwithstanding the retreat inward, various forms of state interaction occurred during the COVID-19 outbreak, ranging along a spectrum according to density and formality.

At the furthest end of the spectrum was global policy competition, marked by only a minimal level of interaction among decision-makers in different countries to produce an effect on policy, as well as conscious efforts to privilege the well-being of a state’s own population and economy. This included a convergence on “beggar-thy-neighbor” policies, whereby countries competed to access scarce resources—in the form of protective and testing equipment—as well as the early effort by the Trump administration in the United States to gain first-mover advantage by acquiring exclusive access to a vaccine being developed for COVID-19. Despite the calls by global officials such as the UN secretary-general and the director-general of the WHO to collaborate in the sharing of epidemiological and clinical data and materials necessary for research and development, intergovernmental cooperation remained limited and ad hoc.

Another, subtler form of competition among states was more productive or even “virtuous” in its effects. A broad set of countries—though not all—experienced an evolutionary or almost Darwinian process whereby unsuccessful strategies to combat COVID-19 were “selected out” in favor of more stringent forms of social distancing.

In this second form of state interaction—what we might call global policy diffusion—the policies of one state did not so much produce negative externalities for others as they proved to be crucial sources of information for other governments in their own response to the pandemic. In other words, policy-makers became enmeshed in ad hoc processes of “policy transfer” or “policy borrowing,” whereby information about experiences in other countries was drawn upon to design or revamp policies within their own societies.

Here, the modes of interaction differed widely in intensity, regularity, and degree of formalization. At the most basic level were cases in which national officials learned about others’ approaches simply through publicly available sources, without much interaction with policy-makers from the countries where those experiences originated. This appears to have been the case with Western countries’ initial monitoring of the development of and response to the virus in South Korea—a country currently held up as a positive model of pandemic management. But “transnational epistemic communities” (networks of scientific professionals with deep expertise in pandemic prevention and response) also provided crucial information to policy-makers or were even directly involved in designing solutions. Examples include ProMED’s role in providing information (via ProMED-mail) about disease outbreaks to the WHO, the transnational collaboration of scientists and pharmaceutical companies to develop a vaccine, and the efforts of GAVI and CEPI to establish the COVAX scheme.

However, despite some conscious attempts to share best practices, the first six months of the pandemic broadly reflected a process of emulation rather than conscious coordination (let alone concerted cooperation) among states.13 Policy-makers in countries at an earlier point “along the curve” monitored developments in countries at the height of the virus, or those starting to descend to the other side, and put in place mechanisms—tailored to national circumstances—similar to those that were deemed effective. A key question left outstanding is whether this global policy diffusion created productive and sustainable processes of learning that will outlive this crisis and assist in a future pandemic.

A third form of interaction among states is what scholars refer to as global policy coordination, which is usually decentralized and may or may not be universal in scope.14 Here, states agree to take particular actions together—usually through agreement on a common rule or standard—in order to reap the gains from coordinated behavior. This kind of interaction emerged only later in the pandemic and was limited in scope and impact—despite the significant efforts, over three decades, to build an effective system of governance for global health. Prominent examples were the efforts at coordinated research into therapeutic treatments or vaccines for COVID-19 or—later in the pandemic—decisions by countries to commit to joint global targets on vaccine distribution.

This brings us to a final way that states can interact: global policy cooperation. This entails not only conscious and sustained technical coordination but also political cooperation to facilitate the development of reciprocal commitments and the harmonization of policies across countries.15 The goal of global policy cooperation has been to realize significant gains from joint action among states, whether financial (as in trade) or the reduction of threats (as in climate change) or to avoid the negative effects of unilateral action (as in nuclear proliferation). Such cooperation can take place either in groupings or “clubs” of states or through international institutions with (close to) universal membership.

The COVID-19 pandemic demanded, at a minimum, intergovernmental coordination to facilitate an adequate supply of health care and testing equipment; share treatment results; ensure transparent and dynamic information on the evolution of the virus; and amplify and synchronize fiscal action to address the economic effects of the crisis. On March 25, 2020—two months into the health emergency—a virtual ministerial meeting of the Group of Seven (G7) discussed the evolution of the COVID-19 pandemic and its impact. Yet, rather than providing an impetus for deeper global policy cooperation, the meeting showcased the deep divisions within the international community. Not only did the gathering not issue a final communiqué, but participants reportedly could not even agree on what to call the epidemic—with Trump administration officials demanding that it be called the “Wuhan virus.”16

The following week, the Group of Twenty (G20) also met virtually to address both the health and economic impacts of COVID-19. G20 countries represent 80 percent of global economic output and two thirds of the world’s population, and thus form a key piece of the global architecture available to address pressing collective action challenges. For example, the G20 was a lead actor in directing the response to the 2008 financial crisis and had already become part of the governance framework for global health. G20 leaders did issue a final statement on March 30, 2020, pledging their commitment to coordinate public health and financial measures and to support the work of the WHO.17 The statement refers to increased sharing of information and materials for research and development, financial resources for the new WHO Solidarity Response Fund, and efforts to address blockages and shortages of vital medical supplies—including new incentives to increase their production. G20 leaders also promised to inject, collectively, $5 trillion18 into the global economy to cushion the impact of COVID-19 and announced a future meeting of finance and health ministers that would launch a global initiative on pandemic preparation and response.

Two years later, however, national action—including the mobilization of financial resources—still dwarfs efforts in global cooperation. Furthermore, despite the pledge to facilitate trade, G20 countries in the crucial early months of the pandemic failed to call for an end to the export bans that many states—including Western democracies such as France and Germany—had placed on drugs and medical supplies. Elsewhere, supply chains backed up as airfreight capacity plummeted and companies faced not only shortages of truck drivers, freight containers, and shipping crews but also quarantines at ports.

The May 2021 Global Health Summit of the G20 in Rome—the first meeting of its kind—offered heads of state what some have called their “San Francisco moment” for setting clear goals and initiating bold collective action on pandemic preparedness and response.19 A full year of living with the pandemic had passed, and a series of recommendations had already been articulated (including by the WHA’s independent panel) for participating states to build upon. But although the final declaration acknowledged the need for stronger and sustained support for multilateral cooperation, it went only as far as to elaborate a set of sixteen guiding principles to improve collective action on pandemics and other broad global health objectives, emphasizing the “voluntary orientation” of state commitments.20 No specific targets, actions, or timeframes were set out.

The meeting of G7 leaders that followed in mid-June did see, in addition to calls to improve global surveillance of infectious disease and to support the WHO,21 ambitious pledges to “vaccinate the world” (through both the donation of vaccines and increased funding for distribution). These commitments marked the first significant departure from the “my country first” approach of 2020 and pointed to particular avenues for improved international cooperation. Nevertheless, they remained vague on the modalities for improving future pandemic preparedness and response. Moreover, even the most immediate priority—getting vaccines to the world, for which member states pledged 870 million doses over the next year—fell far short of the eleven billion doses estimated to be essential to ensuring that 70 percent of the world’s population is vaccinated against COVID-19 by the end of 2022.