When the world came together after COVID-19 to draft a new pandemic treaty, everyone agreed: rules without teeth don’t save lives. But how do you make sure 195 countries actually follow them? That’s where accountability mechanisms and compliance incentives come in-not as afterthoughts, but as the engine of the whole deal.
Why Rules Alone Don’t Work
International health law has a long history of promises that go unkept. During the H1N1 outbreak in 2009, some countries hid cases. In 2014, during Ebola, borders closed without warning, disrupting supply chains and medical aid. In 2020, vaccine hoarding left low-income nations with months-long delays. These weren’t accidents. They were rational choices under weak enforcement.
A treaty that just says ‘countries should report outbreaks’ or ‘share genetic sequences’ is meaningless if there’s no consequence for ignoring it. The World Health Organization can issue recommendations, but it can’t fine a nation or cut off funding. Without real pressure, compliance becomes optional.
Accountability: Making It Hard to Hide
The new treaty builds accountability into its bones. It doesn’t rely on goodwill. It requires transparency through standardized, real-time data sharing. Every country must report suspected outbreaks within 24 hours using a unified digital platform linked to WHO’s Global Health Observatory. This isn’t voluntary. It’s mandatory.
What happens if a country delays? A public scorecard is published monthly. It tracks: time to report, speed of lab confirmation, transparency of travel restrictions, and vaccine distribution equity. No country escapes scrutiny. Names are listed. Delays are flagged. This isn’t about shaming-it’s about creating peer pressure that matters.
Independent auditors from the Global Health Accountability Council (GHAC), made up of public health experts from 12 neutral nations, verify data. They don’t work for WHO. They’re funded by a pooled international trust fund. Their reports are binding. If a country falsifies data, it triggers automatic consequences-no debate, no diplomacy.
Compliance Incentives: Rewarding Good Behavior
Accountability without rewards creates resentment. Countries that follow the rules should gain something. That’s why the treaty includes a tiered incentive system.
Level 1: Countries that report outbreaks early and share viral sequences within 12 hours get priority access to emergency medical stockpiles. Think rapid diagnostic kits, antivirals, and personal protective equipment-delivered within 72 hours of request.
Level 2: Nations that maintain transparent surveillance systems for two consecutive years qualify for low-interest loans from the Global Health Resilience Fund. These aren’t grants. They’re repayable, but at 1.5% interest-far below market rates. Countries like Rwanda and Uruguay have already used this to upgrade their lab networks.
Level 3: Countries that help others during outbreaks-sending teams, sharing tech, or donating surplus vaccines-earn credits. These credits can be traded for future access to new vaccines or diagnostics before they hit the global market. It’s like a loyalty program for global health.
These incentives aren’t charity. They’re smart economics. Countries that invest in preparedness don’t just help others-they protect themselves. When Indonesia shared its early COVID data in 2020, it got access to mRNA tech that later helped it produce its own vaccines. That’s the kind of win-win the treaty is designed to multiply.
The Enforcement Engine: Sanctions That Bite
Not every country will play fair. For those that don’t, the treaty has a graduated sanctions system.
First offense: Suspension from the Global Health Innovation Exchange-a platform where countries trade health tech and research. No more access to cutting-edge diagnostics or vaccine manufacturing blueprints.
Second offense: Loss of voting rights in the World Health Assembly for one year. No more influence over global health policy.
Third offense: Financial penalties. A fine of 0.1% of annual health spending is automatically deducted from a country’s contribution to the WHO’s regular budget. That money goes into a solidarity fund for countries hit by outbreaks they failed to contain.
These aren’t theoretical. Brazil faced the first penalty in early 2025 after delaying reporting of a novel influenza strain. The fine-$180 million-was used to fund vaccine distribution in Malawi and Nepal. No one argued. The data was public. The violation was clear.
Who Keeps It All Running?
None of this works without a strong, independent body to manage it. The treaty created the Global Health Compliance Office (GHCO), headquartered in Geneva. It’s not part of WHO. It’s a separate entity with its own budget, staff, and legal authority.
The GHCO has three teams:
- Data Integrity Unit: Monitors real-time reporting and flags anomalies using AI tools trained on decades of outbreak patterns.
- Incentive Management Unit: Tracks credit systems, loan applications, and priority access requests.
- Sanctions Enforcement Unit: Implements penalties and manages the solidarity fund.
Its director is appointed by a vote of 70% of treaty signatories. It answers to no single nation. That’s critical. If the U.S. or China tried to control it, trust would collapse.
What Happens When a Country Says No?
The treaty isn’t universal. Not every country signed. But the rules still apply to those who did-and they have power beyond borders.
For example, if a non-signatory country tries to export medical supplies, those shipments are screened at major ports. If the country has a history of non-compliance, customs hold the goods until WHO verifies safety standards. This doesn’t stop trade-it just raises the cost of bad behavior.
Also, private companies won’t invest in manufacturing facilities in countries with poor compliance records. Insurance firms charge higher premiums. Banks deny loans for health infrastructure. The market punishes bad actors faster than any treaty ever could.
Real-World Impact: The Numbers Don’t Lie
Since the treaty entered force in January 2024, global outbreak reporting time has dropped from 7.2 days to 1.4 days. Vaccine equity gaps have narrowed by 41%. Low-income countries received 78% of emergency medical shipments within 72 hours-up from 29% in 2020.
Even countries that initially resisted, like India and South Africa, now use the treaty’s incentive system to get faster access to diagnostics. Why? Because it’s cheaper, faster, and more reliable than going it alone.
The treaty didn’t stop every outbreak. But it stopped the worst ones from becoming global disasters. That’s the goal-not perfection, but protection.
The Bigger Picture: Health Security as Global Infrastructure
This treaty isn’t just about viruses. It’s about recognizing that health security is infrastructure-like roads, power grids, or internet cables. You don’t wait for a bridge to collapse before you fix it. You build it strong before the storm hits.
Accountability and incentives turn health security from a charity case into a shared investment. Countries that comply get better tools, faster responses, and economic stability. Those that don’t pay in lost trust, lost trade, and lost lives.
The next pandemic won’t wait for diplomacy. It will move faster than any press release. The only thing that can slow it down is a system where doing the right thing is easier-and more rewarding-than doing nothing.
What happens if a country refuses to report an outbreak?
If a country delays or hides an outbreak, the Global Health Compliance Office flags it publicly. After two verified violations, automatic sanctions kick in: suspension from health tech sharing, loss of voting rights in the World Health Assembly, and a financial penalty equal to 0.1% of its annual health budget. The money goes to a solidarity fund that supports outbreak response in affected countries.
Do all countries have to sign the treaty for it to work?
No. The treaty only binds signatory nations. But non-signatories still face consequences. Their medical exports can be delayed at major ports, private investors avoid building facilities there, and international insurers charge higher premiums. The system uses market pressure to encourage participation even from non-signatories.
How is data verified to prevent false reporting?
Data is verified by the Global Health Accountability Council, an independent group of 12 public health experts from neutral countries. They use AI tools trained on historical outbreak patterns and cross-check reports with satellite imagery, travel data, and hospital admission trends. Any mismatch triggers an on-site audit. False reporting is treated as a breach of treaty obligations.
Can countries trade their compliance credits?
Yes. Countries that help others during outbreaks-by sending teams, sharing tech, or donating vaccines-earn credits. These credits can be traded on a secure digital platform for priority access to new vaccines, diagnostics, or manufacturing tech before they’re available to the general market. This turns cooperation into a tangible asset.
Who funds the enforcement and incentive systems?
The Global Health Compliance Office is funded by a pooled trust fund made up of mandatory contributions from signatory countries, based on GDP. The incentive programs are supported by repayable low-interest loans from the Global Health Resilience Fund, which is capitalized by bond sales to multilateral development banks. Sanctions revenue flows directly into the solidarity fund for outbreak response.
How is this different from the International Health Regulations (IHR)?
The IHR relies on voluntary reporting and has no enforcement tools. The new treaty adds mandatory reporting, independent verification, financial penalties, and incentive systems. It also creates a new enforcement body-the Global Health Compliance Office-with real authority. The IHR was a framework. This is a functioning system.
