48 Scientific American, March 2022Michael Nagle/Redux Picturesand its partners designed the Access to COVID19 Tools
(ACT) Accelerator to hasten the development and pro
duction of, and equitable access to, COVID resources.
Yet COVAX (the ACT Accelerator’s vaccine pillar) has
badly underperformed. About 10 percent of Africa was
fully vaccinated as of midJanuary, compared with
roughly 63 percent of the U.S. (the European Union
had achieved even better coverage). COVAX could be
transformative if it were properly funded and re
sourced and if its distribution channels were strength
ened so that vaccines could be stored, transported and
administered with speed and without waste.
President Biden has announced the investment of
billions of dollars to expand mRNAvaccine manufac
turing, aiming for 100 million doses a month for
domestic and global use. Yet this charitabledonation
model is deeply flawed because donations always
seem to come too little, too late. Any new internation
al agreement must go beyond donations to plan forBeyond funding, the WHO must have enhanced
powers to ensure governments work cooperatively in
responding to global health emergencies. Yet the goal
of enhancing the agency’s powers involves several chal
lenges. Most countries frowned on Trump’s withdrawal
from the WHO, but many agreed that he had a legiti
mate grievance. China’s early reporting of COVID cases
was disingenuous, causing a delay of weeks before the
world was alerted, and the country later blocked an in
dependent investigation of SARSCoV2’s proximal ori
gins. But what national leaders did not realize is that
the WHO has no power to verify a nation’s reports or
gain entry to a state’s territory for scientific investiga
tions. These two structural weaknesses—and many
more—are the subject of intense global negotiations to
create a bold new pandemic treaty, perhaps taking ad
vantage of the WHO’s power to adopt broadbased, le
gally defined commitments such as the Framework
Convention on Tobacco Control.
With crisis comes opportunity, and the new pan
demic treaty has the potential to be transformative.
It should introduce momentous reforms even beyond
giving the WHO power to conduct independent inves
tigations. These provisions should include adopting
a “One Health” strategy (a collaborative and transdisci
plinary approach to achieving optimal health out
comes) that recognizes the interconnection among
people, animals, plants and their shared environments.
The most likely origin of SARSCoV2 is a natural zoo
notic spillover, the source of more than 60 percent of
emerging diseases. Separating animal and human pop
ulations could prevent spillovers—a step that could be
achieved through land management, reforestation and
regulation of wild animal trade and markets.
Although SARSCoV2 most likely reached humans
through natural means, a laboratory leak at the Wuhan
Institute of Virology has been posed as an alternative
theory for COVID’s origins. Rigorous regulation and
inspection of lab safety, as well as gainoffunction re
search, could help prevent the unintentional or delib
erate release of novel pathogens.
Undoubtedly the rapid development of vaccines
and therapeutics, including innovative messenger
RNA technologies, was the greatest technological suc
cess in responding to the pandemic. But open access
and sharing of data and tools, such as realtime virus
samples, genomic sequencing, and results from clini
cal trials and other research, were often lacking. A
new legal instrument negotiated under the auspices
of the WHO’s constitution could provide a pipeline for
channeling significant research funding to where it is
needed while promoting publicprivate partnerships
and scientific cooperation.
Perhaps most important, the COVID pandemic re
vealed massive divides based on race, ethnicity, sex,
disability and socioeconomic status at both interna
tional and national levels. Highincome countries dom
inated global markets in diagnostics, protective equip
ment, therapeutics and, especially, vaccines. The WHO