Pandemic treaty textual analysis: ethics and public health implications.

Background: The World Health Organization's convention, agreement or other international instrument on pandemic prevention, preparedness, and response, often referred to as the 'pandemic treaty', was established with principles to guide implementation. The treaty's underlying ethic was cosmopolitan in intent, emphasizing equal value of all people with obligations stemming from shared humanity.

Methods: The principles of the working draft of 13 July 2022 and the proposed agreement of 22 April 2024 were compared by textual analysis for content and sequence. Changes were analysed using the ethical framework of cosmopolitanism and associated public health implications identified.

Results: Compared with the working draft, the proposed agreement consolidated principles such as solidarity and reduced specific obligations, weakening ethical demands. Sovereignty was elevated to the cardinal principle, while obligations tied to equity and human rights were less specific, reflecting a shift from cosmopolitan intentions and a reduced emphasis on cooperation for shared public health goals.

Conclusions: Changes made through the pandemic treaty negotiation process suggest ethical amnesia, undermining global equity, justice, and solidarity with consequences for public health and pandemic preparedness. Strengthening obligations in the treaty text is essential to embed a collective motivation for cooperation necessary for effective public health before the next pandemic.