United Nations, explained.
A US objection was not unanticipated (Daniel Torok/Official White House Photo)
A near-unanimous UN vote on pandemics masks a deeper fight over what counts as consensus in global health diplomacy.
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The United States has a new template for blocking global health consensusThe United States has a new template for blocking global health consensus
World leaders gathered at the United Nations on 25 September for the second High-Level Meeting on Pandemic Prevention, Preparedness and Response, the aim of which was to foster a multilateral approach (Opens in new window) to pandemics, grounded in solidarity. Months of negotiation produced a comprehensive, if aspirational, political declaration (Opens in new window) with wide ranging commitments on how to tackle health emergencies, which countries had decided would be “agreed in advance byconsensus (Opens in new window).” But when the moment arrived, it was never approved, despite representing what its drafters considered “the most balanced outcome achievable.”
The General Assembly’s President said that while the text had broad support, “some observations” still held – diplomatic parlance pointing chiefly to the objections of the United States. During the meeting, the United States said that it could not support the text because of “divisive ideologies that lack definitional consensus (Opens in new window)” and references to ongoing negotiations for pathogen access and benefit sharing (PABS). The ideologies that were so reprehensible? Equity, solidarity, and universal access to sexual and reproductive healthcare (Opens in new window).
Those ambitions aside, the declaration’s core commitments are hardly radical. They include:
These commitments are the floor and not the ceiling of what is required. If anything, the declaration contains few concrete, measurable or time-bound measures. Like all General Assembly resolutions, it is not legally binding, but that does not make it inconsequential. Political declarations assert the collective will of the world’s governments at the highest level.
Participants attending the High-level Meeting on Pandemic Prevention, Preparedness and Response (Mark Garten/UN Photo)
A US objection was not unanticipated. All week, rumours circulated that the United States would attempt to torpedo the process – the question was just how and when. By Friday, the declaration had been moved to the closing session to be “considered” rather than approved. Approval at a High-Level Meeting is largely ceremonial, but authorises a negotiated document to be put to the Assembly for formal adoption. Instead, the declaration went to a vote (Opens in new window) on Monday, 12 October, where the Assembly adopted it by 153 votes to three (the United States, Israel and Argentina voted against, while New Zealand and Paraguay abstained).
In plenary, the United States renewed its objections to sexual and reproductive health language and to what it termed “harmful gender ideology”. It also warned that references to the amended International Health Regulations and the Pandemic Agreement would commit states to instruments they have not joined. But the declaration’s language is considerably softer and expressly preserves states’ freedom to join or conclude international agreements. Other nations voiced objections to particular paragraphs, but maintained support for the text overall. Speaking for the EU (Opens in new window), Ireland praised the declaration’s overarching objective but dissociated EU members from “uncaveated references to technology transfer” which it argued could “only be undertaken on a voluntary basis.”
Inequitable access to health products, insufficient and fragmented financing, and persistent weaknesses in health system capacities endure.
After last year’s political declaration on non-communicable diseases followed a near-identical path (Opens in new window) (it also required consensus (Opens in new window), which the United States invoked (Opens in new window) at the eleventh hour forcing a vote), what emerges is a pattern indicating how we can expect the United States to approach multilateral engagement on global health – wielding consensus as another lever alongside its broader retreat from the UN and World Health Organisation (Opens in new window) (WHO). Diplomats are also now entitled to ask what consensus means if a powerful state can hold up what the overwhelming majority wants.
That crisis of confidence will follow negotiators into next year’s talks on universal health coverage which will proceed on the same modalities – “agreed in advance by consensus (Opens in new window)”. The greater risk is that this becomes a template for health diplomacy – particularly for crises like pandemics that require global solidarity.
The September High-Level Meeting arrived at a critical moment for health emergency governance. Inequitable access to health products, insufficient and fragmented financing, and persistent weaknesses in health system capacities endure. Covid-19 exposed the cost of failure: more than 7.1 million (Opens in new window) deaths were officially reported, though estimates exceed 22 million (Opens in new window). Now the Ebola Bundibugyo outbreak (Opens in new window) – the fastest-growing on record – has killed some 4,600 people (Opens in new window) and infected almost 10,000. Pathogens show no signs of letting up, making fracturing now particularly reckless.
The declaration is adopted, and nothing stops countries from acting on what most have agreed matters. The amended International Health Regulations have been in force since September 2025, and states bound by them can begin implementing them today. The Pandemic Agreement cannot open for signature until the PABS annex is finalised, and those negotiations remain entrenched – countries should conclude them without delay. But states can implement the agreement’s core elements (Opens in new window) now. The agreement’s adoption at WHO by consensus (Opens in new window) signalled that the world already agrees on what must be done. The UN’s October vote sent another: those who want stronger action on pandemics are the overwhelming majority.
About the author
Alexandra Finch
Alexandra Finch is an Adjunct Professor of Law at Georgetown University Law Centre.
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