{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:53:37Z","timestamp":1789840417148,"version":"4.0.1"},"reference-count":63,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. Objective: To identify key challenges in global pandemic preparedness and health governance reported in the literature (2019\u20132024) through a systematic scoping review, and to evaluate how these challenges are addressed in the provisions of the WHO Pandemic Agreement via qualitative document analysis. Methods: Using Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we systematically identified and thematically analyzed 52 peer-reviewed studies published between 2020 and 2024. The thematic results informed a qualitative document analysis of the WHO Pandemic Agreement text to assess the extent to which its provisions address the identified challenges. Results: Persistent gaps in governance (limited enforceability, fragmented coordination), equity (inequitable access to medical countermeasures), capacity (technology transfer and financing), and accountability were identified. Health systems in low- and middle-income countries continue to face critical resource constraints and lack robust mechanisms to ensure accountability and continuous learning. Document analysis showed the WHO Pandemic Agreement addresses coordination and financing but offers limited advances in enforcement, technology transfer, and independent monitoring. Conclusion: The WHO Pandemic Agreement introduces important institutional and financing measures, but persistent gaps remain in enforcement, technology transfer, and inclusive implementation. Strengthening these domains is crucial to achieving equitable and resilient preparedness. By systematically linking evidence from the pandemic preparedness literature to Treaty provisions, this study offers a novel analytical framework for assessing how global health treaties respond to research-identified challenges.<\/jats:p>","DOI":"10.3390\/ijerph22121807","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T08:49:22Z","timestamp":1764665362000},"page":"1807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Global Health Governance and the WHO Pandemic Agreement: A Scoping Review of Challenges and Analysis of Reforms"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4996-4852","authenticated-orcid":false,"given":"Kadria Ali","family":"Abdel-Motaal","sequence":"first","affiliation":[{"name":"Institute of Global Health and Human Ecology, American University, New Cairo 11835, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9689-5667","authenticated-orcid":false,"given":"Wafa Abu","family":"El Kheir-Mataria","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Human Ecology, American University, New Cairo 11835, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8105-7062","authenticated-orcid":false,"given":"Sungsoo","family":"Chun","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Human Ecology, American University, New Cairo 11835, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1017\/S1744552321000288","article-title":"Casualties of preparedness: The Global Health Security Index and COVID-19","volume":"17","author":"Mahajan","year":"2021","journal-title":"Int. J. Law Context"},{"key":"ref_2","unstructured":"Global Health Security Index (2024, July 20). 2021 Global Health Security Index Report. Available online: https:\/\/www.ghsindex.org."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Maccaro, A., Audia, C., Stokes, K., Masud, H., Sekalala, S., Pecchia, L., and Piaggio, D. (2023). Pandemic preparedness: A scoping review of best and worst practices from COVID-19. Healthcare, 11.","DOI":"10.3390\/healthcare11182572"},{"key":"ref_4","unstructured":"Global Preparedness Monitoring Board (2020). A World in Disorder: Global Preparedness Monitoring Board Annual Report 2020, World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/351720."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S0140-6736(21)02344-8","article-title":"Governing the Access to COVID-19 Tools Accelerator: Towards Greater Participation, Transparency, and Accountability","volume":"399","author":"Moon","year":"2022","journal-title":"Lancet"},{"key":"ref_6","unstructured":"Federal Ministry of Education and Research (2024, July 20). Global Research Collaboration for Infectious Disease Preparedness (Glo-PID-R)\u2014BMBF Gesundheitsforschung, Available online: https:\/\/gesundheitsforschung-bmbf.de\/en\/global-research-collaboration-for-infectious-disease-preparedness-glopid-r-8689.php."},{"key":"ref_7","unstructured":"Coalition for Epidemic Preparedness Innovations (CEPI) (2024, July 20). Why We Exist. Available online: https:\/\/cepi.net\/why-we-exist."},{"key":"ref_8","unstructured":"World Health Organization (2019). Coronavirus Disease (COVID-19) Situation Reports, World Health Organization. Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/situation-reports."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"World Health Organization (2016). International Health Regulations (2005), World Health Organization. [3rd ed.]. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241580496.","DOI":"10.62454\/KA112E"},{"key":"ref_10","unstructured":"Balogun, B., and Butchard, P. (2024). What Is the Proposed WHO Pandemic Preparedness Treaty?, Parliament. Available online: https:\/\/commonslibrary.parliament.uk\/research-briefings\/cbp-9550\/."},{"key":"ref_11","unstructured":"World Health Organization (2025). Pandemic Prevention, Preparedness, and Response Accord, World Health Organization. Available online: https:\/\/www.who.int\/news-room\/questions-and-answers\/item\/pandemic-prevention--preparedness-and-response-accord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2471\/BLT.13.118596","article-title":"Global health diplomacy: Five years on","volume":"91","author":"Kickbusch","year":"2013","journal-title":"Bull. World Health Organ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/1468-0009.12186","article-title":"The International Health Regulations: The governing framework for global health security","volume":"94","author":"Gostin","year":"2016","journal-title":"Milbank Q."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3790\/gyil.64.1.41","article-title":"Do we need to protect the entire world population from health threats through one global biomedical surveillance and response system? A human rights-based comment on the proposed WHO Treaty on Pandemic Preparedness and Response","volume":"64","author":"Behrendt","year":"2022","journal-title":"Ger. Yearb. Int. Law"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e006392","DOI":"10.1136\/bmjgh-2021-006392","article-title":"Pandemic treaty needs to start with rethinking the paradigm of global health security","volume":"6","author":"Buss","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hosseini, M. (2024, August 03). Building Global Health Solidarity in a Permacrisis: Legal Impacts of a Pandemic Treaty. Available online: https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=4659766.","DOI":"10.1353\/isia.0.a915221"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1675","DOI":"10.1016\/S2214-109X(22)00341-2","article-title":"Pandemic preparedness and response: Exploring the role of universal health coverage within the global health security architecture","volume":"10","author":"Lal","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e012636","DOI":"10.1136\/bmjgh-2023-012636","article-title":"The WHO pandemic treaty: Where are we on our scepticism?","volume":"8","author":"Evaborhene","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e1200","DOI":"10.1016\/S2214-109X(24)00186-4","article-title":"Decolonising Global Health: Why the new pandemic agreement should have included the principle of subsidiarity","volume":"12","author":"Bosha","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_20","unstructured":"Bustamante, T.L., Lago, J.R., Magliolo, M., and Segal, L.J. (2021). A New Treaty on Pandemics: Some Key Issues from a Global South Perspective, South Centre. Available online: https:\/\/community.southsouth-galaxy.org\/topic\/new-treaty-pandemics-some-key-issues-global-south-perspective."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9","DOI":"10.34172\/hpp.42744","article-title":"Pandemic treaty as an instrument to strengthen global health security: Global health diplomacy at its crux","volume":"14","author":"Chattu","year":"2024","journal-title":"Health Promot. Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1126\/science.adq1055","article-title":"A pandemic agreement is within reach","volume":"384","author":"Cicero","year":"2024","journal-title":"Science"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1126\/science.abe2803","article-title":"An ethical framework for global vaccine allocation","volume":"369","author":"Emanuel","year":"2020","journal-title":"Science"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e069129","DOI":"10.1136\/bmj-2021-069129","article-title":"Can geopolitics derail the pandemic treaty?","volume":"375","author":"Kickbusch","year":"2021","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huang, Y., Jiang, S., and Kumah, E. (2024). China and the WHO pandemic treaty: A dive into stance, underpinnings, and implications. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1335751"},{"key":"ref_26","first-page":"1257","article-title":"An International Agreement on Pandemic Prevention and Preparedness","volume":"326","author":"Gostin","year":"2021","journal-title":"SSRN Electron. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12992-021-00779-0","article-title":"A pandemic treaty, revised international health regulations, or both?","volume":"17","author":"Wiktorowicz","year":"2021","journal-title":"Glob. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1017\/jme.2023.29","article-title":"Challenges and prospects for the intergovernmental negotiations to develop a new instrument on pandemic prevention, preparedness, and response","volume":"50","author":"Solomon","year":"2022","journal-title":"J. Law Med. Ethics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e357","DOI":"10.1016\/S2468-2667(21)00101-8","article-title":"Pandemic preparedness in the 21st century: Which way forward?","volume":"6","author":"Khor","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/S0140-6736(21)00948-X","article-title":"A global pandemic treaty should aim for deep prevention","volume":"397","author":"Vinuales","year":"2021","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5334\/aogh.3084","article-title":"Rethinking the COVID-19 pandemic: Back to public health","volume":"86","author":"Collins","year":"2020","journal-title":"Ann. Glob. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1007\/s44197-024-00233-5","article-title":"Navigating hurdles: A review of the obstacles facing the development of the pandemic treaty","volume":"14","author":"Sheerah","year":"2024","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e730","DOI":"10.1016\/S2468-2667(22)00192-X","article-title":"An effective pandemic treaty requires accountability","volume":"7","author":"Faviero","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/S0140-6736(24)00585-3","article-title":"Governance provisions in the WHO pandemic agreement draft","volume":"403","author":"Schwalbe","year":"2024","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/hast.1538","article-title":"Making the world safer and fairer in pandemics","volume":"53","author":"Gostin","year":"2023","journal-title":"Hastings Cent. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1017\/S0020589323000350","article-title":"Equity in the pandemic treaty: The false hope of \u2018access and benefit-sharing\u2019","volume":"72","author":"Hampton","year":"2023","journal-title":"Int. Comp. Law Q."},{"key":"ref_37","unstructured":"Berman, A., and Kantiana, I.D. (2024, July 01). The Pandemic Agreement: A Milestone in Global Health, but Will It Work?. EJIL:Talk!, Available online: https:\/\/www.ejiltalk.org\/the-pandemic-agreement-a-milestone-in-global-health-but-will-it-work\/."},{"key":"ref_38","unstructured":"World Health Organization (2025). WHO Pandemic Agreement: Adopted by the Seventy-Eighth World Health Assembly on 20 May 2025 (WHA78.1), WHO. Available online: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA78\/A78_R1-en.pdf."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1001\/jama.2020.6641","article-title":"The Equitable Distribution of COVID-19 Therapeutics and Vaccines","volume":"323","author":"Bollyky","year":"2020","journal-title":"JAMA"},{"key":"ref_40","first-page":"e230486pt","article-title":"Equal access to vaccines: Lessons learned and future perspectives","volume":"32","author":"Abreu","year":"2023","journal-title":"Saude Soc."},{"key":"ref_41","first-page":"1242","article-title":"Compulsory licensing of trade secrets: Ensuring access to COVID-19 vaccines via involuntary technology transfer","volume":"16","author":"Gurgula","year":"2021","journal-title":"J. Intellect. Prop. Law Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"35","DOI":"10.54648\/EERR2024003","article-title":"The EU\u2019s Vaccine Diplomacy in the WHO","volume":"29","author":"Horng","year":"2024","journal-title":"Eur. Foreign Aff. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/1468-0009.12494","article-title":"Allocating a COVID-19 vaccine: Balancing national and international responsibilities","volume":"99","author":"Lie","year":"2021","journal-title":"Milbank Q."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"105112","DOI":"10.1016\/j.healthpol.2024.105112","article-title":"The WHO pandemic agreement should be more specific about when and how to enable global access to technology","volume":"146","author":"Geiger","year":"2024","journal-title":"Health Policy"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e013348","DOI":"10.1136\/bmjgh-2023-013348","article-title":"Independent monitoring and the new pandemic agreement","volume":"8","author":"Hanbali","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Jiang, S., and Kumah, E. (2023). Strategizing Global Health Governance: Unpacking Opportunities and Challenges for Least Developed Nations within the WHO Pandemic Treaty Framework. Front. Public Health, 11, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/38026386\/.","DOI":"10.3389\/fpubh.2023.1321125"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12992-020-00645-5","article-title":"Assessing COVID-19 through the lens of health systems\u2019 preparedness: Time for a change","volume":"16","author":"Weishaar","year":"2020","journal-title":"Glob. Health"},{"key":"ref_48","first-page":"1","article-title":"From business as usual to health for the future: Challenging the intellectual property regime to address COVID-19 and future pandemics","volume":"41","author":"Baker","year":"2022","journal-title":"Boston Univ. Int. Law J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e445","DOI":"10.1017\/dmp.2023.99","article-title":"The WHO African Region initiative on engaging civil society organizations in responding to the COVID-19 pandemic: Best practices and lessons learned for a more effective engagement of communities in responding to public health emergencies","volume":"17","author":"Billaud","year":"2023","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/SIH.0000000000000515","article-title":"Simulation Innovation: A Novel Simulation Guide for Building Community Simulation Capacity in Pandemic Preparedness","volume":"15","author":"Drake","year":"2020","journal-title":"Simul. Healthc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/1758-5899.13217","article-title":"International negotiations for a pandemic treaty: A thematic evaluation of 43 member states","volume":"14","author":"Patel","year":"2023","journal-title":"Glob. Policy"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e012759","DOI":"10.1136\/bmjgh-2023-012759","article-title":"Is the Proposed Global Treaty an Answer for Public Health Emergencies?","volume":"8","author":"Gandhi","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1017\/S1049023X20000746","article-title":"50 States or 50 Countries: What Did We Miss and What Do We Do Now?","volume":"35","author":"Burkle","year":"2020","journal-title":"Prehospital Disaster Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e006297","DOI":"10.1136\/bmjgh-2021-006297","article-title":"Will a Global Preparedness Treaty Help or Hinder Pandemic Preparedness?","volume":"6","author":"Frieden","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1016\/S1473-3099(23)00364-X","article-title":"The importance of getting the ethics right in a pandemic treaty","volume":"23","author":"Schaefer","year":"2023","journal-title":"Lancet Infect Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"03031","DOI":"10.7189\/jogh.14.03031","article-title":"A roadmap to equity in pandemic preparedness, prevention, and response","volume":"14","author":"Walckiers","year":"2024","journal-title":"J. Glob. Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/S0140-6736(22)01585-9","article-title":"The Lancet Commission on Lessons for the Future from the COVID-19 Pandemic","volume":"400","author":"Sachs","year":"2022","journal-title":"Lancet"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13017-021-00393-w","article-title":"A pandemic recap: Lessons we have learned","volume":"16","author":"Coccolini","year":"2021","journal-title":"World J. Emerg. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"ii43","DOI":"10.1093\/jac\/dkad310","article-title":"Lessons Identified for a Future Pandemic","volume":"78","author":"Cunningham","year":"2023","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_60","first-page":"4","article-title":"COVID-19: Lost opportunities and lessons for the future","volume":"14","author":"Saqr","year":"2020","journal-title":"Int. J. Health Sci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S1473-3099(23)00354-7","article-title":"Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries","volume":"23","author":"Titanji","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12992-021-00786-1","article-title":"The Middle East and COVID-19: Time for collective action","volume":"17","author":"Fawcett","year":"2021","journal-title":"Glob. Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"100129","DOI":"10.1016\/j.pdisas.2020.100129","article-title":"COVID-19 and ASEAN responses: Comparative policy analysis","volume":"8","author":"Djalante","year":"2020","journal-title":"Prog. Disaster Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/12\/1807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:43:06Z","timestamp":1764679386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/12\/1807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,30]]},"references-count":63,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["ijerph22121807"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22121807","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,30]]}}}