The member states of the G20, an economic forum for the world’s largest economies, included in its joint statement on Tuesday a provision in support of the World Health Organization’s (W.H.O.) “central coordinating role” and for the implementation of a global agreement on pandemics.

W.H.O. Director-General Tedros Adhanom Ghebreyesus attended and addressed the summit on Monday, seeking contributions from member states for a fundraising campaign seeking $7 billion.

Led and hosted this year by Brazil, G20 diplomats reportedly struggled to come to agreements on many of the most pressing issues on the international stage, including the conflicts in Ukraine and Gaza, censorship of political dissidents on the internet, the alleged climate crisis, and global wealth redistribution. Looming over the conversations behind the scenes, multiple reports citing anonymous diplomats present relayed, is the return of President-elect Donald Trump to the White House, which is expected to dramatically overhaul many of the policies of outgoing President Joe Biden.

Biden was present at the G20 but barely a factor, excluded from a “family photo” of attendees and failing to make any prominent statements or demands of the group.

The Biden administration has been consistently supportive of the W.H.O. leadership and the proposed pandemic accord, despite its poor record of responding to public health emergencies. Tedros has faced widespread criticism for his handling of a variety of emergencies, most prominently the Wuhan coronavirus pandemic, during which the W.H.O. opposed countries imposing travel restrictions and disregarded critical intelligence shared by the nation of Taiwan. The W.H.O. staged an investigation into the origins of the novel coronavirus, published in 2021, that offered no conclusive evidence and was reportedly significantly hindered by Chinese government interference.

While the G20 statement avoided taking definitive stances on many issues, it was categorical in its support for the W.H.O. and the deliberations intended to bring about the imposition of an international legal document governing pandemic response.

“We reiterate the central coordinating role of the World Health Organization (WHO) in the global health architecture, supported by adequate, predictable, transparent, flexible and sustainable financing,” the joint statement read.

“We remain committed to building more resilient, equitable, sustainable, and inclusive health systems for the provision of integrated people-centered health services,” the statement continued. “We also reaffirm our commitment to ending the epidemics of AIDS, tuberculosis, malaria, and for polio eradication.”

On the pandemic accord, the statement read, “We support the conclusion of the ongoing negotiations to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response.”

The G20 parties added that they support the document so long as it recognizes the “full respect for sovereignty of individual States.”

“We reiterate our commitment to an instrument that is ambitious, balanced, effective and fit-for-purpose, including equitable access to medical countermeasures during pandemics,” it concluded.

Tedros, the W.H.O. chief, has for years advocated for an international legal document governing pandemics. The negotiations to draft one have been contentious, so much so that the parties cannot agree on whether it should be a formal treaty or another kind of international legal document, such as a convention of covenant. The W.H.O. refers to the document as the “W.H.O. convention, agreement or other international instrument on pandemic prevention, preparedness and response,” or “WHO CA+.”

Negotiations over the provisions in the WHO CA+ failed to result in the creation of a draft that all members of the U.N. health agency could agree on during this year’s World Health Assembly in May. The drafters failed to agree on a document to submit in time for a vote by member states and extended the negotiation time in the hope of coming to some consensus, but failed.

Among the most controversial issues proposed in the pandemic accord are calls for the suspension of some intellectual property laws to allow the rapid and inexpensive distribution of new drugs and vaccine products in the event of a pandemic. The accord as initially drafted would also mandate countries share medical supplies and “facilitate or incentivize the transfer of technology and know-how for pandemic-related health products.”

The WHO CA+ initially called for the implementation of “common but differentiated responsibilities,” meaning wealthier nations would have to bear more of the costs of responding to a pandemic. It also would have significantly expanded the W.H.O.’s oversight power over member states, threatening their sovereignty by granting the agency authority over how to manage responses.

“The United States is committed to the Pandemic Accord, to form a major component of the global health architecture for generations to come,” Pamela Hamamoto, the Biden administration representative at the WHO CA+ talks, said in March 2023, as negotiations intensified. “Shared commitment, shared aspirations and shared responsibilities will vastly improve our system for preventing, preparing for, and responding to future pandemic emergencies.”

Biden’s commitment to the accord alarmed many in the United States, who feared it would grant the W.H.O. too much authority over the sovereign actions of the United States.

In March 2023, Rep. Tom Tiffany (R-WI) introduced a bill in Congress that would mandate Biden bring whatever final form the WHO CA+ took to a vote in the Senate before signing on to it. The Senate has constitutional approval power over treaties, but the possibility exists of the White House describing the document vaguely as an international agreement outside of the scope of Senate oversight.

“The United Nations-linked World Health Organization is a corrupt organization that President Trump got us out of, but President Biden disgracefully rejoined,” Rep. Tiffany said at the time.

“The United States should be in charge of our own pandemic policy; we should never outsource that power to an international bureaucracy that behaves like a puppet of Communist China,” he continued. “This legislation puts congressional oversight and transparency into what otherwise could be bad medicine for America’s public health.”

In February, as the W.H.O. prepared for new negotiations on the draft pandemic document, Rep. Chris Smith (R-NJ) denounced the WHO CA+ and its supporters in the Biden administration, asserting, “far too little scrutiny has been given, far too few questions asked as to what this legally binding agreement or treaty means to health policy in the United States and elsewhere.”

Rep. Smith noted that the document as it existed at the time could result in American taxpayers funding abortions – the W.H.O. lists abortions as an “essential health care service” – and observed the WHO CA+ contained provisions to “combat false, misleading, misinformation or disinformation” that could be abused to censor dissenting voices.

Advocating for the pandemic accord in February, an exasperated Tedros claimed the document “affirms national sovereignty” and described concerns about the WHO CA+ as a “litany of lies and conspiracy theories about the agreement.”

“W.H.O. will not even be a party to the agreement. The parties are governments and governments alone,” Tedros asserted. “Far from ceding sovereignty, the agreement actually affirms national sovereignty and national responsibility in its foundational principles. Indeed, the agreement is itself an exercise of sovereignty.”

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