On December 16, 2021, the Council of Councils (CoC) convened its fourth virtual conference to discuss the COVID-19 pandemic at the end of its second year, what multilateral diplomacy achieved in 2021 on preparing the world for future pandemics, and the challenges COVID-19 creates for 2022. This policy brief summarizes issues that representatives of CoC members discussed on these topics during the conference.

Overall, CoC participants agreed that states had made too little progress in 2021 against COVID-19, especially in failing to make vaccines more globally available and in reforming pandemic governance. As a result, combating COVID-19 and strengthening pandemic governance remain daunting challenges in 2022—made more difficult by diminished confidence in multilateralism, no consensus on pandemic governance reforms, and the global spread of the highly transmissible omicron variant.

The COVID-19 Pandemic: Current Situation and Challenges for 2022

COVID-19 remained dangerous and deadly throughout 2021. As noted during the conference, COVID-19 infected over 90 million people worldwide and killed more than 1.65 million since the Independent Panel on Pandemic Preparedness and Response released its report in May—a total of more than 325 million people infected and 5.5 million killed since the pandemic began. Vaccination campaigns in countries with vaccine access mitigated the pandemic’s impact and facilitated economic recovery. The impact of the delta variant, however, coupled with the slow pace of vaccine donations, the perceived need for vaccine boosters, and resistance to vaccination created domestic and international problems. For low- and middle-income countries (LMICs), nonpharmaceutical interventions were unsustainable, access to vaccines was inadequate, vaccine distribution and administration were challenging, and economic recovery was weak.

For conference participants, inequitable access to vaccines stood out as the most significant failure in the global fight against COVID-19 during 2021 and as the most pressing challenge for 2022. The conference noted that COVAX (COVID-19 Vaccines Global Access)—the multi-stakeholder mechanism designed to increase global vaccine access—would not distribute its 2021 target of two billion doses. Donations to COVAX were declining as 2021 ended because of the demand for booster shots in high-income countries. In addition, the gap between vaccine donations pledged by high-income countries and vaccines delivered to LMICs remained considerable across 2021. Inequitable vaccine access throughout 2021 represented a failure of global solidarity, exacerbated the damage that COVID-19 inflicts in LMICs, and contributed to the risk that new coronavirus strains would emerge to threaten all countries.

The conference convened three weeks after South Africa identified the omicron variant. Omicron’s emergence and global spread underscored the problem of global vaccine inequity, heightened interest in boosters in high-income countries, and triggered more controversial travel measures. Since the conference, epidemiological surveillance and preliminary scientific studies have demonstrated omicron’s transmissibility, generated information about its virulence, and raised questions about the efficacy of existing vaccines against this strain.

In terms of mitigating global vaccine inequity in 2022, conference discussions focused on the proposal in the World Trade Organization (WTO) to waive patents on COVID-19 vaccines. The WTO was to consider the proposal again in early December but postponed the meeting because of omicron. The CoC’s deliberations replayed the disagreements during 2021 on whether a patent waiver would meaningfully increase global vaccine access during 2022.

Skepticism about the waiver identified several problems, including the reality that vaccines are made using many patents and advanced technological know-how, the lack of vaccine production capacity in LMICs, and vaccine distribution problems in many low-income countries. Pro-waiver arguments emphasized how much support the proposal has gained, asserted that complexity in implementation is no reason to reject a waiver, and stressed that LMIC production capacity is underestimated and can be built.

Beyond COVID-19: High-Level Diplomacy on Future Pandemic Preparedness and Response

The conference’s proceedings reflect consensus that multilateral diplomacy on improving governance for future pandemics failed to make progress in 2021. This failure was not from a lack of proposed reforms or diplomatic opportunities to discuss them. But no proposals—such as adopting a pandemic treaty, establishing a pandemic financing mechanism, creating a global health threats council, or strengthening the World Health Organization (WHO)—advanced beyond countries’ agreeing to continue to talk about them in 2022. The conference likewise revealed no agreement among CoC participants on what reforms governments should support and did not discuss new policy prescriptions for 2022.   

Although COVAX fell short of its 2021 distribution target, conference participants identified it as a qualified multilateral achievement. Its creation, governance, and operation encountered problems, but global vaccine inequity would have been worse without it. CoC representatives expected COVAX to remain important in 2022, even with the challenges that omicron might create for vaccines. The conference discussions were less clear about whether participants thought COVAX—or a similar multi-stakeholder mechanism—should form part of pandemic governance beyond COVID-19.

Conference participants observed that bilateral and—in some parts of the world—regional diplomacy has proved more robust than multilateralism. The practice of “vaccine diplomacy” indicates that some countries have favored sales and donations that align more with foreign policy interests than global health imperatives. The need for improved bilateral cooperation between leading powers was raised, a step that could open possibilities for better regional and multilateral cooperation on COVID-19 and future pandemics.

Regionally, COVID-19 prompted the European Union (EU) to transform how it responds to health threats. These measures include developing an EU “health union” anchored in EU law, establishing a European Health Emergency Preparedness and Response Agency, strengthening the European Medicines Agency and the European Centers for Disease Control, and crafting an industrial policy to create more EU supply-chain autonomy for critical health goods. However, such commitment to governance reform was not apparent in other regions. Conference participants heard that responses from regional organizations in Latin America did not improve the ability of countries to respond to COVID-19 or prepare for future pandemics. The multilateral difficulties experienced during COVID-19 might encourage some regional organizations, such as the African Union, to strengthen their capacities and become more autonomous to avoid dependence on high-income countries and multilateralism during future pandemics.

Omicron also heightens concerns about the prospects for pandemic governance reform in 2022. The omicron wave again highlights the vulnerability of all countries to a transnational spread of disease. This vulnerability reinforces the imperative for governments to treat serious outbreaks as security threats and protect their own populations first and foremost. The travel measures imposed on southern African countries reflected this imperative and underscored the difficulty of getting states to follow a risk-based, coordinated approach to restrictions on international traffic during future pandemics.

The omicron surge is making efforts to reduce global vaccine inequity more difficult. Omicron has caused the use of boosters in high-income countries to increase, created confusion about the effectiveness of existing vaccines, and produced more challenges for vaccination campaigns in LMICs. Omicron and the emergence of more variants also might make it more difficult for countries to reach consensus on pandemic governance reform, such as concluding a pandemic treaty or instrument, building vaccine production capacity in LMICs, or resolving controversies over vaccine patents.

Into the Pandemic’s Third Year

Omicron’s global spread could change the pandemic in 2022 by, for example, affecting what vaccines are effective, causing less morbidity and mortality than earlier strains, and increasing natural immunity within populations from widespread infection. The availability of antiviral drugs will give countries another pharmaceutical tool, assuming that the drugs work against omicron. The willingness of the companies that created the drugs to make them globally available might prevent “antiviral apartheid” from developing. Access to therapies could help countries mitigate omicron’s impact on vaccines, health-care systems, and economic activity.

The lack of progress in multilateral diplomacy in 2021 means that the agenda for pandemic governance reform remains crowded but that no proposals have any momentum. How omicron will affect national interests on pandemic governance reform is not clear. However, governments face decisions in 2022 that will shape the future of pandemic governance, including whether to

• create a global health threats council after the UN General Assembly reconvenes in January,
• waive patent rights on COVID-19 vaccines at the rescheduled WTO meeting in March,
• pursue a binding or nonbinding pandemic agreement at WHO negotiations in March and August,
• begin the process of revising the International Health Regulations (2005) at the World Health Assembly meeting in May, and
• establish a pandemic financing mechanism during Indonesia’s presidency of the Group of Twenty before or during the Bali Summit in October.

The world enters year three of COVID-19 with little indication that it has learned the tough lessons of the pandemic. Opportunities remain, however, to strengthen international cooperation to fight COVID-19 and prevent and prepare for future pandemics.