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Scholars have identified a set of distinct and recurrent cooperation problems81 that states face (regardless of the substantive issue over which they are cooperating) either in isolation or, more typically, in various combinations when they attempt to work together to solve problems and/or realize joint gains.

• Enforcement problems are common in situations featuring public goods or problems of the “commons” and arise when some actors have individual incentives to defect from agreements to cooperate while others cooperate. While all states benefit from clean air and water, for instance, each state would prefer not to incur the costs required to achieve this good and instead free ride off others’ contributions.
• Commitment problems are a product of changing incentives over time, such that an actor’s agreement to behave in a particular way in some future period may not be perceived as optimal when that future period arrives. Bilateral investment treaties, for example, are characterized by problems of commitment: circumstances in a country may evolve to the point that nationalizing a foreign investment provides lucrative and irresistible short-term gains, thereby creating incentives to renege on a previous agreement.
• Distribution/bargaining problems feature in situations where actors have divergent preferences over the substantive terms of an agreement, which in turn affect the distribution of costs and benefits of a potential cooperative arrangement. In trade negotiations, for example, states often disagree over which tariffs to lower, by how much, and over what time period, as a result of the different distributional effects of a trade agreement.
• Coordination problems arise when actors must coordinate on one precise outcome to reap the gains from cooperation. The more damaging it is to “miss” this specific solution, the more severe the coordination problem. Agreements that govern airline traffic are an example of a cooperative endeavor characterized by significant coordination problems.
• Problems of uncertainty are of two main kinds. In the first case—uncertainty about behavior—actors are uncertain or lack information about how other actors will behave, thereby complicating efforts to detect whether an actor is in conformity with or “cheating” on the agreed terms of cooperation. In the domain of chemical weapons, for example, any cooperative agreement must take into account the ease of hiding the production of chemical weapons in an otherwise nonthreatening pharmaceutical plant. In the second case—uncertainty about the state of the world—actors are uncertain about the consequences of cooperation, given the potential for intervening developments (scientific or technological) or particular shocks to alter the benefits and costs of cooperation. For example, a cooperative arrangement over disputed territory could be affected by uncertainty over the future value of oil or mineral deposits located there.
• Norm exportation problems arise when a state (or group of states) seeks to diffuse particular norms or standards to other states through a cooperative arrangement, but where such exportation is either contested or difficult to achieve. With some human rights treaties, for example, participating liberal democratic states have been less concerned with their own capacity to comply with the standards in the treaty and more concerned with changing the behavior of other states over time.

The academic research on cooperation problems has generated two principal insights. First, cooperative arrangements are more likely to be reached if states fully understand the type and structure of the cooperation problem(s) they face. Second, these arrangements are more likely to be successful if they incorporate the right “design features,” including, in some cases, procedural provisions, to confront the underlying cooperation problem(s). These institutional features succeed in enabling cooperation when they are “incentive compatible,” such that actors adhere to them because doing so is in their reciprocal interest.82

For example, cooperative efforts in nuclear arms control, chemical weapons, and human rights have frequently been characterized by uncertainty about behavior. When states cannot easily observe the cooperation or noncooperation of their partners, they will seek to incorporate effective monitoring and verification provisions. This was the case in arms control treaties between the superpowers during the Cold War. The United States and the Soviet Union would have preferred not to cooperate at all than to cooperate without verification of the other’s activities. The monitoring provisions within their agreements thus made superpower cooperation a stable outcome to which each state had an incentive to adhere. Alternatively, in fields such as trade and the environment, cooperative arrangements have often entailed overcoming distribution problems, particularly for developing countries. They have therefore featured compensation mechanisms (frequently in a financial form) or “differential duties” to help those who incur disproportionate costs through their agreement to participate. Finally, to address uncertainties about the future, international treaty law anticipates future problems by containing a rule that allows a state party to a treaty to claim “unforeseen circumstances” as a reason for not complying with a treaty rule.
 

Cooperation in the field of pandemic preparedness and response is particularly complex because it entails a large number of participants, takes place over a long period of time, and is multifaceted in its scope.83 Moreover, the need to base pandemic preparedness and response on a common scientific and epidemiological foundation intensifies this complexity, as well as the severity of key cooperation problems.
 

5.2.1 Rethinking the Problem of Free Riding
 

Inequities in state capacity and vulnerability shape states’ priorities for cooperation on global health security. Low-income countries, for example, have experienced the benefit of a surveillance system differently, given their lower capacity to prepare and react to pandemics. This suggests that global information on disease outbreaks is of far less importance as a public good when states lack the means to respond effectively. These states also define the essential public goods in global health security as extending well beyond effective early warning, which has long been the main priority of developed countries. Prior to COVID-19, low-income countries had therefore grown increasingly frustrated with a regime geared toward ensuring the free flow of information to richer countries but that did not transfer to low-income countries resources to enable them to act on that surveillance, to participate meaningfully in policy coordination, or to gain access to essential vaccines and drugs.

In this context, the global public goods problem of free riding fades in significance. Low-income countries might be benefiting from the same disease outbreak information without expending the same financial resources as high-income countries—technically an instance of free riding—but this situation does not deliver the former the kinds of benefits they really seek. Nor does it directly threaten the interests of high-income countries in the same way that such behavior might in other policy domains, such as climate change. There, for example, increasing greenhouse gas emissions from low-income countries can effectively negate emissions reductions by high-income countries, since CO₂ has the same effect whether it is produced in a low-income country or a high-income country. Low-income countries can therefore free ride on the sacrifices of high-income countries and undermine the latter’s mitigation efforts, with every country being worse off as aggregate CO₂ levels are not reduced.

In the realm of infectious disease, the dynamics are different, and the search for cooperative solutions requires us to acknowledge, understand, and respond to them. Weaknesses in the health systems of low-income countries do not necessarily present the same kinds of challenges to high-income countries, for at least three reasons. First, as COVID-19 reveals, serious outbreaks can occur anywhere—including in high-income and high-capability countries. This suggests that surveillance and alert systems must be global and focused on all states. Second, many disease outbreaks in low-income countries will involve pathogens, such as Ebola, that will not generate the equivalent kind of crisis in high-income countries. Third, armed with a regular and timely flow of good surveillance information, high-income countries can and will take steps to protect themselves—including through practices such as “vaccine nationalism”—regardless of what low-income countries do, or can do, in their domestic policy.84
 

5.2.2 Managing Issues of Distribution, Commitment, and Uncertainty
 

Rather than focusing on the collective action problem of free riding, the analysis here identifies three main cooperation problems in the realm of pandemic preparedness: distribution, commitment, and uncertainty about behavior.

The first and most important problem is a distributive one, which arises from differences in the capacities and vulnerabilities of states. These inequalities shape government responses to health risks in ways that do not always incentivize cooperative behavior and create negative “externalities” for other states.85 When in 2005 the IHR expanded its scope to include obligations on states to develop national core surveillance and response capacities—on top of complying with all the other obligations in the revised regime—it was recognized that these requirements imposed significant demands on developing countries. Yet the IHR included no accompanying compensation mechanism to assist with compliance.86 Instead, assistance has come from outside the WHO framework through more ad hoc and voluntary initiatives (such as the Global Health Security Agenda) and has fallen well short of what is required. Consequently, current deliberations surrounding the pandemic treaty are encountering pushback from developing-country representatives worried about creating more obligations without corresponding financial mechanisms to enable their fulfillment.

Second, earlier versions of the IHR suffered from a lack of commitment as states routinely violated the core provisions (rather than taking the conscious step of withdrawing from the treaty) and failed to revise the cooperative regime to address mounting global health problems. What paved the way for state agreement on the revised IHR (2005) was a set of global health crises, including HIV/AIDS and SARS. Even so, noncompliance with the “core capacity” requirement of the 2005 IHR has continued to undermine the effectiveness of cooperative efforts to improve pandemic preparedness and response—in large part because of distribution issues. Less clear is whether the key issue during the early phases of the COVID-19 pandemic, particularly in China, was a lack of commitment to key provisions of the IHR. China did comply with the IHR by responding to the WHO’s request to verify the Wuhan outbreak and continued to attend to its ongoing obligations by sharing information with the WHO as the disease progressed.87 The WHO’s early assessment of China’s actions, which were predominantly positive, suggests the core problems lay elsewhere—notably, in the timing of China’s sharing of data about human-to-human transmission. On other problematic issues, such as the sharing of genetic sequencing data, China had no IHR obligations.

Finally, cooperation on pandemic preparedness and response has been affected, albeit to a lesser extent, by states’ uncertainty over how other states will behave, especially whether they will “defect” from negotiated provisions related to reporting and response. For example, states may underreport disease events to avoid others’ trade and travel sanctions. The IHR are partly designed, through the strengthened powers given to the WHO director-general, to address this temptation to defect. In other words, the IHR seek to overcome the “certainty” of defection with provisions to convince member states that, to further their own best interests, they should cooperate early and often with the WHO. Nevertheless, issues with information sharing around human-to-human transmission during the early months of COVID-19 reveal the persistence of this particular cooperation problem. Ultimately, addressing the potential for defection is made more challenging by the fact that pandemics operate at two levels: they are a transnational threat that requires some level of international cooperation (and thus the minimization of incentives to defect); and they are a national threat that requires the exercise of extensive sovereign powers, and this increases incentives to defect if compliance is perceived to pose excessive limits on sovereignty.88

Beyond these core cooperation problems of distribution, commitment, and uncertainty are additional issues related to coordination and norm exportation. To effectively coordinate their infectious disease responses, key state and nonstate actors need reliable scientific information about health risks and the most effective ways to address them. This requires a high degree of standardization in the way data and advice are presented. Furthermore, prior agreement is required on rules for triggering travel or trade restrictions to minimize ambiguity and uncertainty. While some reforms might still be required, the revised IHR (through Article 43) and the broader regime for global health security have generally been effective in assisting states in managing these kinds of coordination challenges. In the case of COVID-19, the problem was less about coordination around a particular rule on triggering travel restrictions and more about the content of the WHO’s initial advice, which subsequently proved problematic.

Generally speaking, norm exportation has not been a prominent feature in most efforts to enhance cooperation on pandemic preparedness and response. This is so for two reasons. First, the IHR’s embrace of the concept of “global health security” has been expansive enough to cope with interpretations of health risks that might lead individual countries to take different courses of action. Second, the successful functioning of the IHR does not depend on states accepting or spreading specific norms. The IHR make no explicit mention, for example, of the “right to health,” and any human rights provisions that are invoked are based on obligations that states have under existing human rights treaties. Some of the prescriptions that do feature in the 2005 IHR, such as the need to balance trade and travel interests with health interests, are long-standing ones in international cooperative efforts on global health and have not given rise to significant backlash. Provisions that might appear to be more contentious or to “smuggle in” particular normative agendas—such as allowing the WHO to use nongovernmental sources of information in global surveillance—have not been a frequent source of serious collective action problems. While this provision has normative content, in that it empowers an international organization vis-à-vis its sovereign state members, it is primarily designed to incentivize states to operate within the IHR framework. Where norm exportation does have the potential to affect the prospects for multilateral cooperation is with respect to more contested values such as “transparency” and “health equity.” If one set of states is seen to be using cooperative frameworks to bring about greater openness in closed societies or to advance particular redistributive goals, this could affect the willingness of other states to accept binding provisions that might improve pandemic preparedness and response. Similarly, in current discussions about the design of a “pandemic treaty,” the proposal to articulate a set of human rights norms that states should respect in the design of their pandemic strategies89 could generate significant pushback.

Similarly, uncertainty about the future “state of the world”—in this case, about the nature of future pathogens—has not been a particularly salient barrier to cooperation on pandemics. The scope of cooperation within international health organizations, such as the WHO, has been sufficiently broad to allow member states to adjust to new health challenges that might arise in different contexts. Particularly with the revision of the IHR in 2005, states dramatically expanded the reach of the cooperative regime to capture any disease event that might have the potential to constitute a public health emergency of international concern—including both existing diseases and pathogens not yet known. The need to prepare for future unknown pathogens was an incentive, not an impediment, to revising the existing arrangements. At the same time, the new approach in the revised IHR was already based on a sophisticated epidemiological understanding of the types of pathogens most likely to cause serious international disease outbreaks—i.e., influenza and coronaviruses. As a result, even though the IHR do not specifically identify strains of influenza or coronavirus that might emerge, its cooperative framework was already primed to respond to these “known unknowns.”90
 

Given the cooperation problems defined above, the ideal cooperative arrangements to meet the challenge of infectious disease would include norms and systems through which states could share the burdens and benefits of effective pandemic preparedness and response.91 They would also make more space for actors beyond governments by incorporating both impartial and independent regulators with full access to various sources of information that could be freely shared, as well as expert bodies with the authority to assess states’ interpretations of their obligations under the IHR and their approaches to managing competing obligations across regimes related to health, trade, and human rights.92 Finally, the international institutions at the core of pandemic governance would ideally strike the right balance between ensuring accountability and responsiveness to the member states that created them and maintaining enough insulation from political pressures to act impartially and effectively to deliver on public goods.93 But reality falls short of these ideals. As diplomats and global health experts debate what reforms are desirable and achievable, what lessons can they draw from efforts to craft solutions to cooperation problems in other policy domains? The comparative research on institutional design points to several considerations.
 

5.3.1 The Distribution of Power
 

While the global distribution of power matters for cooperation, power functions in a variety of ways within institutional arrangements. Evidence from different cooperative regimes suggests that strong states do not always get their way. In institutional settings that require broad adherence to the rules for the benefits of cooperation to be realized, defection by even the smallest states can undermine the goals of the agreement, thereby amplifying their power. The international accords on the ozone layer, for example, would not have had much effect without the participation of major developing states. They leveraged this position to call for a special fund—created by the United States and other large industrial states that were most concerned with protecting the ozone layer—to reimburse them the full cost of compliance.94

That said, power asymmetries can and do shape cooperative arrangements by producing outcomes more amenable to powerful countries. This is particularly so where more informal practices, which are not specified in the text of an agreement, allow powerful states to influence how an agreement is applied.95 A prime example is the way in which such states have managed alleged violations of the Nuclear Non-Proliferation Treaty (NPT). Powerful countries have also played a pivotal role in either inducing or preventing cooperation. For instance, the United States and the Soviet Union negotiated a Bilateral Destruction Agreement in 1990 that then provided momentum for the creation of the multilateral Chemical Weapons Convention two years later. This example also underscores how it is often easier to engage in cooperative endeavors when they are codifying agreements that powerful actors are already incentivized to accept.

The different ways in which power configurations can affect cooperative arrangements have clear implications for improving pandemic preparedness and response. First, COVID-19’s clear demonstration of deep interdependence among countries presents opportunities for low-income countries—who might be considered “weak”—to elevate a solidarity logic in negotiations for global health reform and bargain for the kind of assistance they have long been demanding from high-income countries. This could take the form of efforts to link progress on sharing data on disease outbreaks with a permanent platform to ensure equitable access to vital countermeasures.

Second, past instances where great-power rivals have jointly addressed a common threat indicate that the escalating competition between China and the United States does not necessarily foreclose cooperative arrangements in pandemic preparedness and response. However, it does suggest that finding alternative and perhaps more informal mechanisms for dialogue will be critical prior to (or alongside) any broader multilateral process. It also suggests that the current infusion of global health and pandemic management by a U.S.-China rivalry—as evidenced, for example, in the U.S.-led effort to conduct another investigation of the origins of COVID-19—will make ongoing efforts at global cooperation (as opposed to collaboration within smaller groupings of states) more difficult.
 

5.3.2 Membership and “Variable Geometry”
 

The comparative research on international institutions suggests that universal membership is not essential for successful international institutions or cooperative arrangements. Instead, membership should be considered as a “strategic choice” in the design of such arrangements. A more restrictive membership (at least initially) may prove more effective, because a larger, more heterogeneous group of participants can make compromises harder to achieve and strong compliance less likely.96 As the benefits from cooperation and the capability of international institutions grow, membership can then be expanded to other states. In their work on climate change, for example, Robert Keohane and David Victor advocate for states to engage in deep forms of cooperation where they can, often in small groupings; to coordinate on issues where cooperation is harder or where universal participation is important; and to “probe experimentally” when seeking to expand the boundaries of feasible cooperation.97

The limited-membership model of cooperation found in settings such as the G7 and G20 has proven highly effective when responding to pressing challenges or crises such as the 2008 financial crisis. But this approach has also gained in prominence in discussions of other challenges, such as cyber security and vaccine production and distribution, where scholars foresee states with common interests forming “global clubs”98 to share the burdens and costs of a variety of goods, especially in a context of growing rivalry between democratic and authoritarian states.

In the domain of pandemic preparedness and response, it is tempting to lead with the argument that only universal membership in a cooperative arrangement can address a threat that—theoretically—can affect all states. But several examples suggest that smaller groupings of states can assume leadership in addressing certain health risks or developing particular funding solutions. In the current context, a strong case can be made that a set of advanced liberal democratic states (whether through the G7, the G20, or the EU) could and should take the lead in creating and financing a more effective platform for ensuring equitable access to key “goods” such as treatments and vaccines. This case rests not only on their economic capacity but on the fact that their reputations have been damaged by protectionist practices and “vaccine nationalism.”
 

5.3.3 Monitoring and Verification
 

The institutional design literature suggests that international agreements are more likely to include formal monitoring provisions for the implementation of obligations when the number of states involved in a cooperative endeavor is large.99 Moreover, when an issue area is complex or when the extent of damage from a threat is uncertain, monitoring by technical experts—whose judgments are perceived as apolitical and confidential—has proven vital to effective cooperation. This has been the case in the field of chemical weapons, where member states have relied heavily on the Technical Secretariat of the Office for the Prohibition of Chemical Weapons to design and implement the verification mechanism for the Chemical Weapons Convention—including the conduct of inspections—and to foster international cooperation in chemistry for peaceful purposes.

However, the monitoring of state commitments can take many forms and does not necessarily need to rely on international third-party actors. Among agreements that have formally delegated monitoring provisions, researchers have found that more than 70 percent are also informally monitored by NGOs, who are less constrained in the timing and scope of their activities. For example, Greenpeace is free to engage in monitoring activity outside the international agreement on whaling, whereas the activities of the International Whaling Commission must align with the provisions of the treaty.100 At the same time, when formal delegated monitoring is absent from a cooperative arrangement, the incidence of informal NGO monitoring also decreases substantially.101 This suggests that informal information gathering and verification work best as a complement to, rather than a substitute for, a treaty or institutional arrangement.

In some policy domains, actors below the state level, working across borders, have also created monitoring arrangements to prevent or mitigate crisis. After the Three Mile Island incident in the United States, for example, organizations in the nuclear industry recognized that they were all “hostages of each other,”102 and thus they created a voluntary and confidential system of peer evaluation—the Institute of Nuclear Power Operations—to “sniff out” bad performance, elevate safety standards, and thus maintain the viability of the industry as a whole. The World Association of Nuclear Operators now operates on a similar kind of model, below the formal intergovernmental level, through site visits, mutual support, the exchange of information, and the emulation of best practices.

In the realm of infectious disease, monitoring and information sharing cannot operate without governments, given their central role and power in instituting public health measures. Furthermore, monitoring is in many respects already “layered” and conducted at multiple levels by both state and nonstate actors. For example, the joint external evaluations of the IHR’s “core capacity” requirements involve both governments and NGOs. Where potential progress could still be made is in creating a more comprehensive web of surveillance that links medical facilities and frontline medical personnel around the world in order to detect disease events earlier and more often. Although this proposal does not address the challenge of authoritarian governments, which are unlikely to grant formal permission for their facilities to share data directly with such a web, it does leave space for public health “whistleblowers” to act on their professional ethics and incentives and to leverage existing transnational networks.103

The importance of impartial inspections continues to be highlighted in several task force reports on pandemic preparedness and response—including the most recent report from the WHA’s independent panel. However, a key takeaway from other policy domains is that schemes for expert inspection can be more or less insulated from political pressure—depending on how they are designed—but can never be fully independent if they are connected to intergovernmental organizations and the states that create them. In the case of the WHO investigation of COVID-19, expectations were created that ultimately could not be met: the investigation was labeled “independent” but was conducted under the auspices of the WHO and thus could not in practice be fully independent of the organization’s member states.104
 

5.3.4 Domestic Actors and Factors
 

The IR literature has long argued for the importance of domestic or micro-level factors in explaining international outcomes.105 Academic research illustrates that, in almost every policy area, domestic interest groups have been instrumental in creating a virtuous dynamic that leads from more limited forms of coordination to stronger forms of international cooperation. As shown in the field of international trade, for example, such groups not only create internal political forces that help to promote deeper forms of cooperation, but they also gain leverage through their participation in international institutions.106 This latter dynamic can also be seen in the realm of human rights, where the international human rights regime has strengthened the ability of domestic civil society actors to push for improved rights protection at home. These actors are particularly crucial in the “naming and shaming” processes that have, in some cases, produced tangible improvements in compliance with human rights standards.107

Much less benign dynamics, however, are becoming increasingly apparent in many policy domains, with domestic politics acting as a break on, rather than a catalyst for, multilateral cooperation. Such dynamics are especially apparent in the various forms of backlash against the EU—including during the 2016 Brexit debate—but have also been prominent in opposition to multilateral agreements associated with trade and migration108 and in populist critiques of the UN system.109 As the academic literature over the past decade has shown, populist sentiment—whether expressed by leaders or the general public—constrains states from delegating national sovereignty in ways that enable international cooperation and makes it more likely that states will resist guidance or assistance from “foreign” actors.110

This combination of virtuous and problematic dynamics is also evident in the realm of infectious disease. Certain domestic actors—whether governmental (in the case of health ministries) or nongovernmental (in the case of scientific researchers)—have been crucial in not only advocating for but also implementing deeper forms of global cooperation that now form part of the regime of global health security. In addition, the capacities and strengths of private-sector organizations can be harnessed in the service of better pandemic preparedness and response, including by providing technical input into strengthening health systems, reinforcing critical supply chains, and developing new manufacturing capacity. Pressure from companies in industries heavily affected by pandemics can also be exerted on governments to tighten international agreements and to find better ways to develop and implement public health recommendations.

Nevertheless, as COVID-19 has revealed, some domestic actors—whether through their opposition to public health measures, peddling of misinformation, or efforts to challenge scientific guidance or the advice of international civil servants—have been significant obstacles to the implementation of solutions identified at a global level. Populist leaders and politicians, along with their supporters, regularly questioned the competence and legitimacy of multilateral institutions such as the WHO—employing labels like “technocratic” and “elitist”—and denounced the advice of the “epistemic communities” of scientists and medical professionals. Beyond the direct effects of this kind of populist skepticism, scholars have suggested that anti-elitism can have a dampening effect on “naming and shaming” efforts. Because populists discount or ignore information from so-called elitist organizations, “news that their own country’s policies are not in line with the expectations of other member states will be unlikely to ruffle a populist’s feathers” and may even serve as a “badge of honour.”111

Within advanced democracies, the populist penchant for anti-elitist and anti-expert views has been particularly consequential—not only for efforts to combat the pandemic but also for the broader global standing of democracy. A year and a half on from the outbreak of COVID-19, the “suboptimal performance” of leading democratic states had, according to one global health scholar, seriously “undercut the proposition that democratic governance is good for global health.”112
 

5.3.5 Inclusive Structures and Peer-to-Peer Dialogue
 

Lastly, the IR literature highlights how the politics of inclusion and exclusion can shape possibilities for cooperation. While the NPT created clear “haves” and “have nots” and thus institutionalized forms of hierarchy in proliferation governance, other cooperative arrangements to address common challenges have created more egalitarian structures to generate buy-in. The Chemical Weapons Convention, for example, requires all members to give up their programs and to maintain “chemical defenses” that provide protection assistance to any member facing chemical weapons threats. These provisions have enabled greater participation and arguably enhanced the normative power of the convention. Similarly, the Universal Periodic Review (UPR) process for human rights requires all countries (including advanced liberal democratic states) to submit to peer review and to self-report on progress. The process’s highly public form of information sharing among states, which occurs during interactive dialogue sessions in Geneva, has had the effect of catalyzing more extensive deliberation among a variety of stakeholders across the human rights system, “both in the run-up to and in the backwash of the UPR process.”113 The design features of inclusivity and peer-to-peer deliberation have evoked cooperative responses from many countries—even those with poor human rights records—and helps to mitigate against the charge that human rights protection and promotion is a “Western-inspired” project.

The global health security regime shares key aspects of this more inclusive model through the obligations set out for all states under the IHR. Reforms to the IHR in 2005 also served to demonopolize states as the key suppliers of information on infectious disease, much like the Geneva-based human rights mechanisms mandate the participation of a range of stakeholders beyond sovereign governments.114 Nonetheless, the review committee tasked with reporting on the functioning of the IHR during the COVID-19 pandemic recommended that the WHO work more actively with countries to establish a UPR process—akin to a pandemic preparedness and response “report card”—that could more routinely assess the level of implementation of the IHR and encourage a more collaborative approach to ensuring a whole-of-government response to disease outbreaks.

Such a system would not, and could not, be completely immune from politicization, but its focus on assessing capacities for gathering information about emerging pathogens and broader public health infrastructure could arguably make it less susceptible to the deep political divisions that have at times undermined the human rights UPR process. More important, such a system would enable countries to review their pandemic preparedness and response capacity together with others, to make the results public, and to support one another as peers, thereby contributing to a common accountability framework.115
 

In addition to identifying ways that institutional arrangements can be tailored to different kinds of cooperation problems, the comparative research on institutional design raises key questions about the viability of some of the proposals that have been advanced to improve global pandemic preparedness and response.
 

5.4.1 Binding Versus Nonbinding Arrangements
 

This research reveals that, although binding agreements (for example, specific treaty commitments) are frequently argued to be the optimal solution to collective action problems—given the need for states to be confident of one another’s reliability—such arrangements may capture only a limited level of coordination and represent the lowest common denominator of agreement. In practice, they often lead to few actions beyond what countries would have done on their own.116 Many international arrangements—particularly in the environmental domain—therefore adopt more flexible and nonbinding approaches.

This is also true for infectious disease, where many parts of the regime complex for global health security are nonbinding. Those parts of the regime that are covered by binding regulations—such as the IHR (2005)—were agreed upon in a much more favorable international context, when there was a broad commitment to globalization and collective action in the face of growing transnational threats and less ideological and geopolitical competition. Yet even here the two factors that have been relied upon to generate compliance with the IHR—the “technocratic legitimacy” of the WHO and the convergence of state interests—have not always been sufficient.117 Thus, a key question facing proponents of a new legal instrument for pandemic preparedness and response is how ongoing issues of noncompliance with an existing binding agreement could be addressed by negotiating another treaty.

Current diplomatic discussions around such an instrument suggest that the preferred approach is the negotiation of an overarching framework convention, which would then be accompanied by more specific protocols. However, as some legal analysts have noted, previous conventions on protection of the ozone layer and tobacco control illustrate that the combination of framework and protocols works best when confronting a specific problem for which proven policy or technological solutions exist—as they did in these domains—and when additional permissive conditions are present. Thus, high-income countries in the Global North were strongly supportive of a binding agreement on the ozone layer, given the direct threat that ozone depletion posed to their societies, and had strong incentives to transfer resources to low-income countries to address any noncompliance problems.118 In the case of the Framework Convention on Tobacco Control, agreement was made easier by the fact that noncompliance by individual countries “posed no systemic threat” and that the convention could mobilize assistance from the WHO, NGOs, and high-income states to transfer proven tobacco-control policies to low- and middle-income countries.119 By contrast, framework conventions and protocols have been much less effective in the face of multidimensional transnational problems—such as global warming or biodiversity loss—where technological solutions are more complex and where policy solutions are both more costly and entail unequal effects. The policy domain of pandemic preparedness and response shares many of these more challenging background conditions.
 

5.4.2 The Lack of Incentives for Enforcement
 

Though recent commentary on global health and infectious disease has often featured calls for stronger sanctions—or punishment—when states fail to meet formal commitments, comparative research indicates that such punishment provisions in international institutions exist in only a small minority of situations.120 Global trade agreements—where dispute resolution mechanisms authorize a decentralized application of countermeasures by states—and investment treaties are much more the exception than the rule. Even within the realm of nuclear weapons, where punishment might be thought to be more robust, formal enforcement measures are largely absent from the nonproliferation regime, and states can withdraw from the NPT with ninety days’ notice. The assessment of a violation of the treaty is centralized in the UN Security Council, but actual enforcement is decentralized and left to UN member states. The latter can and do respond to alleged violations unilaterally and sometimes through unofficial means (for example, Israel attacked nuclear facilities in Syria in 2007 and more recently in Iran).

In the case of infectious disease, the enforcement of treaty provisions has not been a feature of either international law or state practice, dating back to the mid-nineteenth century—this notwithstanding the fact that infectious disease treaties, including the IHR, often have a dispute resolution provision and that states have always been able to use countermeasures to respond to treaty violations under customary international law and the principle of state responsibility. The reason states have not invoked such measures, including in the case of COVID-19,121 ties back to incentives. Pathogens with pandemic potential can originate anywhere. For example, the H1N1 virus that led to the 2009 influenza pandemic was first detected in the United States. This reality, in the words of global health expert David Fidler, “creates a shared interest among states not to litigate disease notification issues.”122 Similarly, though a state experiencing an outbreak might protest against questionable trade or travel measures imposed by other countries, that state also knows that in the future it could be in a situation where it might wish to implement similar measures. In other words, states have reciprocal interests not to seek reparations for violating treaty rules on trade and travel measures. Hence, despite calls to give the IHR more “teeth” (for example, in the form of “sanctions”), states are unlikely to agree to such measures.

More generally, analysts of international cooperation are increasingly arguing that the core issue with transnational threats like climate change is really about addressing distributional conflict rather than achieving more effective forms of enforcement.123 While scholarship on global warming has been influenced by the collective action paradigm, which views free riding as the main constraint on effective climate action,124 analysis of climate policy-making indicates that governments implement climate policies regardless of what other countries do and irrespective of whether a climate treaty dealing with free riding is in place.125 Instead, states’ actions reflect the fact that climate policies create “new economic winners and losers”—across and within countries—and are thus shaped by conflicts between “pro- and anti-climate reform interests.”126 This suggests that, before—or rather than—seeking more transparent and verifiable commitments as a means to increase compliance, those advocating stronger action on climate change should attend to the distributive conflicts that act as the biggest drag on cross-national climate policy. Pandemic preparedness and response can also be seen primarily as a distribution problem that demands greater attention to how benefits and costs can be equitably shared.

Within the context of distributive conflict, key states can play a “catalytic” role by investing enough to reduce the costs to so-called second movers and by empowering constituencies that will advocate for further reform.127 The key contribution international institutions can make has less to do with addressing free riding and more to do with helping to create the initial incentive to act cooperatively—by strengthening coalitions of actors that can help to secure the necessary initial investments and by helping to catalyze and coordinate the constituencies that favor change.
 

5.4.3 The Challenge of Transparency
 

The question of incentives is also relevant to a final proposal featuring in discussions about the reform of pandemic preparedness and response: enhanced powers for the WHO to investigate pathogens with pandemic potential. In the report of the WHA’s independent panel, this entails the potential investigation of all countries on short notice, with full access for investigators to relevant sites and samples and standing visas for epidemic experts on the model of the International Atomic Energy Agency (IAEA) system.128 But how can states be incentivized to agree to this intrusion into their sovereign jurisdiction?

In the domain of nuclear nonproliferation, a solution was found in the careful language and the interlocking bargain(s) of the initial NPT. Under the agreement, states have an inalienable right to develop nuclear energy for peaceful purposes—a specific and meaningful sovereign right. However, this right is contingent upon compliance with the treaty and its provisions on third-party monitoring. That is, states gain something substantial in exchange for consenting to limitations on sovereignty.129 In the case of the Chemical Weapons Convention, states agreed to infringements on sovereignty—in the form of both declarations of possession of chemicals and routine and so-called challenge inspections—in exchange for a net gain in security. A mix of incentives was at play. First, many states lacked adequate defenses against the devastation that would ensue from chemical weapons use and thus saw the costs of transparency as tolerable. Second, the convention created a level playing field among all 193 member states, wherein all were required to destroy any chemical arsenals they possessed along with any dedicated production facilities (monitored by inspectors associated with the Office for the Prohibition of Chemical Weapons). Finally, the convention contained a provision pledging all members to assist any other member threatened with or attacked by chemical weapons. Together, these factors incentivized many states (including China) to accept routine inspection.130

As promising as these analogies might initially appear, the degree to which similar solutions could be applied to pandemic preparedness and response is more limited. This is so for at least two reasons:

• The nature of the threat. The perception of the use of nuclear weapons as a common existential threat helped to facilitate cooperation between the United States and the Soviet Union in arms control and crisis management and among a wider set of states concerned about nuclear weapons proliferation. Even here, however, views differed on the likelihood of a threat materializing, and most states recognized that the effects of nuclear weapons use would likely be uneven (for example, South Korea and Japan would be much more affected by nuclear proliferation in North Korea than would countries in Europe or North America). Similarly, small island countries may view sea level rise as an existential threat, whereas landlocked countries will likely perceive this threat as less severe. Such perceptual variations are likely to be even more pronounced in how countries view infectious disease—with significant implications for whether and how cooperation can be fostered. While a shared perception of vulnerability is likely to have been enhanced by the experience of COVID-19—since the pandemic has devastated both developed and less-developed societies—levels of national resilience and capacity are highly uneven, shaping not only the degree to which countries believe that high levels of global cooperation are vital to their ability to cope with a significant disease event but also the key things they want from that cooperation.
  
  In addition, it is important to recognize the differences between threats which manifest quickly, and those which move more slowly. Whereas the effects of a chemical weapons or nuclear attack are felt immediately, other threats—including the threat of a pandemic—do not affect all countries simultaneously or in the same way. The distribution of costs and benefits thus varies over time, and states can adjust their capacity to meet the challenges they face (some more effectively than others). States may also differ in how they weigh the “costs” of agreeing to transparency against the benefit of “gains” in security.
  
  Finally, the actions required to address certain threats may be confined to a small set of actors and decision-makers or may require the engagement of multiple constituencies. During the Cold War, the field of nuclear arms control was dominated by scientific experts and skilled diplomats, and the implementation of intergovernmental agreements required a relatively small set of decision-makers to undertake specific commitments and actions. Containing a pandemic, by contrast, arguably requires a “whole-of-society” approach, with many private and public actors implicated in implementing the necessary steps.
• The nature of geopolitical competition. The intensity of today’s geopolitical competition between the United States and China, which—unlike in the Cold War period—has directly affected the domain of pandemic preparedness and response, also makes it unlikely that new multilateral agreements on more-demanding levels of transparency and inspection will be forthcoming.131 The outcome of the WHA meeting in May 2021 confirms this sober assessment of the prospects for strengthening the WHO’s investigatory capacity, despite the level of devastation caused by the COVID-19 pandemic. In subsequent diplomatic discussions over a “pandemic treaty,” recalcitrant states could find themselves increasingly isolated in negotiations, initiating concerns about reputation that could make them amenable to side deals that incentivize their cooperation; however, the particular provision of robust inspection is unlikely to form a core part of that “zone of agreement.” It is also possible that an agreement among a smaller set of countries could still facilitate some advancements in global cooperation, but at present this kind of approach—for example, within the G7—is not prioritizing measures related to inspections. Indeed, no Western state has publicly declared its willingness to commit, ahead of any treaty negotiations, to allowing any form of “challenge” inspections by the WHO.
   

While it is sometimes assumed that the severity of a collective action problem will automatically generate an institutional solution, one of the central lessons of the IR literature is that optimal institutions or arrangements often fail to emerge, even when there is potential for large gains from their creation.132 This is most obvious today in the diplomacy surrounding responses to climate change. Instead, conscious strategies to build those institutions are required, based on a clear understanding of the interests of national governments and the political dynamics among them, as well as the incentives under which states are operating.
 

5.5.1 Understand the Incentives
 

A central task in improving global cooperation on pandemics going forward will be to uncover and understand the current incentives for states to engage in collaborative efforts to better prepare for, detect, and respond to pandemics. Some of the analysis of the current pandemic has too quickly assumed a “harmony of interests” among states, when the landscape of interests may be more complex. The WHA’s independent panel suggested that the incentives for global cooperation in pandemic preparedness and response currently appear to be too weak to ensure the systematic and timely engagement of states.133 This observation reinforces the idea that a number of factors (alone or in combination) could be working against global cooperation: key government representatives are not convinced that certain forms of global cooperation offer a reliable solution to better pandemic preparedness and response and therefore do not see the need to cooperate; the costs and benefits of better pandemic preparedness and response remain unevenly distributed and are therefore diluting the power of the imperative to cooperate; and domestic political calculations in many states appear to point away from global cooperation.

The last factor is particularly important to unpack when evaluating proposals for the reform of pandemic preparedness and response. Given a lack of certainty around where the next infectious disease with pandemic potential may arise, all states do have an interest in a system of rapid information sharing, based on credible scientific and epidemiological standards, that will reveal whether an outbreak is unfolding in another country and that will lead to timely and coherent recommendations to countries on measures to prevent further spread. However, two further dynamics are also at work, related to the costs of cooperative action:

• Some governments have incentives to defect from schemes requiring transparency if they believe that providing information about an infectious disease outbreak or agreeing to outside scrutiny could compromise their national security, destabilize their political or social order, or cause widespread economic damage.
• While pandemic preparedness and response is a concern for all states, it is not the primary health priority for all. For states that require significant investments in public health infrastructure to meet more basic health needs or that are engaged in battles with noncommunicable diseases that are endangering their populations, the call to prioritize pandemic preparedness from the developed world fails to acknowledge their most pressing challenges.

This structure of incentives will need to be fully appreciated in any process designed to reform or create cooperative arrangements on pandemic preparedness and response.
 

5.5.2 Understand and Engage with Political Dynamics
 

Some of the assessments of pandemic preparedness and response have emphasized the need for cooperation in global health to be, at best, “depoliticized” or, at least, insulated from prevailing political pressures. But although institutional design can in some cases mitigate or redirect political forces, the IR literature suggests that such forces can never be eliminated. Much like other domains, global health policy—including for infectious disease—is both dynamic and heavily mediated by domestic and international politics. The goals, priorities, and even conceptual frames are increasingly contested.134 This has been particularly true since the denouement of the so-called golden age of global health governance and diplomacy (from the late 1990s to the 2008 financial crisis), during which health outcomes improved dramatically and substantial resources were dedicated to global health objectives in development assistance budgets. Rather than wish the politics away, initiatives for change in pandemic preparedness and response need to understand those political dynamics and potentially channel them in more productive ways.

Today’s political trends thus entail that we attend not just to technical policy choices but to deeper questions of governance, including what mechanisms exist for negotiation and how contestation can be mediated.135 One critical area of focus should be the politics between high-income and low-income countries and how the interests of the latter could be addressed through current negotiations over pandemic preparedness and response. The report of the G20’s expert panel, for example, calls for substantial new investment not only in global-level pandemic governance functions but also in strengthening the public health systems of low- and middle-income countries over the next five years.136 This may prove to be the moment when developing countries have greater political leverage in efforts to prioritize global health solidarity and not just security from immediate global health threats.

The other area of focus should be the political priorities and strategies of the two largest powers, the United States and China. While the United States, under President Biden, has been lauded for its “return” to the WHO, both past and present U.S. behavior does not indicate that Washington necessarily prioritizes this particular intergovernmental forum for the realization of its global health priorities. Previous signature U.S. initiatives in global health, such as the 2003 President’s Emergency Plan for AIDS Relief, were bilateral rather than multilateral initiatives. Similarly, the United States has continued to favor voluntary contributions rather than mandated funding as the revenue source for the WHO. Finally, recent months have made clear that COVID-19’s “agitation of the US-China rivalry”137 has affected how Washington engages on global health issues, with the Biden administration concerned to demonstrate the capacity and competence of liberal democratic states—as part of an ideological competition with China—and its broader ambition to maximize U.S. power and influence in different institutions and diplomatic processes.

Whereas the first decades of the twenty-first century were geopolitically conducive to concerted action on pandemics (such as SARS and H1N1), the relationships among great powers today are transforming in ways that adversely affect global health cooperation. Still, history has shown that high-profile events, and particularly moments of failure, can serve as the political impetus for new forms of cooperation, even between competing great powers. China’s 1964 nuclear weapons test constituted this kind of pivotal event in the development of the NPT, as it forced the United States and Soviet Union to recognize that countries they did not want to acquire nuclear weapons could (one day) do so. Politically, however, it was easier to convince a broad set of countries to sign on to a global framework than it was to impose threats on specific states of concern.

Despite the widespread effects of COVID-19, it has yet to serve as such a catalyst for collaboration between the United States and China. The impact of their growing rivalry is rippling through global health governance and diplomacy, as well as, increasingly, the transnational scientific community. Greater attention thus needs to be paid to how the two leading powers can identify “islands of agreement” that will enable other, broader forms of multilateral negotiation to succeed. Efforts to bring the United States and China together in collaborative ways prior to the recent Glasgow Climate Change Conference had mixed success. Thus, one of the most urgent diplomatic priorities for improving pandemic preparedness and response is to launch and sustain a form of “global health détente” between the United States and China, combining both official and so-called Track II mechanisms to provide the political support necessary for reformed or new cooperative arrangements. Well-placed “middle powers,” both Western and non-Western, should spare no diplomatic effort in finding ways to facilitate and support such a process.
 

5.5.3 Take the Long View
 

A final lesson from the IR literature is that various political and institutional changes can, over time, influence the effectiveness of cooperative agreements. The nuclear nonproliferation regime has grown and evolved into its present composition as different layers of legal obligation and different capacities for enforcement and inspection have developed. For example, IAEA inspections—which were highly contentious when the NPT was signed—became more robust following the 1991 Gulf War and the discovery of uranium enrichment programs in Iraq. The special inspections regime that was elaborated in the Additional Protocol enabled the IAEA to verify, in all sites associated with the nuclear fuel cycle, the non-diversion of declared nuclear material and the absence of undeclared nuclear materials and activities. At present, 137 states have ratified this more demanding protocol.138

It is worth remembering that many prominent diplomatic regimes that foster cooperation took several years to be negotiated and often experienced ratification delays that impacted their entry into force. Cooperation itself takes time. As a consequence, it often manifests not in perfectly designed institutions or agreements but in layers of collective action that may overlap to create a complex but evolutionary regime.