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In Richard Horton's Offline,1 he raises two issues that can undermine the future success of the pandemic agreement being negotiated by the Intergovernmental Negotiating Body: WHO's resistance to an independent high-level council outside its governance structure and the absence of meaningful accountability in large-scale WHO initiatives. Why must a pandemic convention be housed outside WHO? Ministers of health (who comprise the World Health Assembly, the decision-making body of WHO) simply do not have the power to drive the whole of society, whole of government approach needed to prevent, prepare for, and respond to pandemics. A broader approach is needed because pandemics are not just a health issue but a problem that affects all layers of the economy and society. Moreover, a high-level council comprising heads of state and government must be outside of WHO because heads of state cannot report to their own ministers of health.

to pandemics. A broader approach is needed because pandemics are not just a health issue but a problem that affects all layers of the economy and society. Moreover, a high-level council comprising heads of state and government must be outside of WHO because heads of state cannot report to their own ministers of health. A body that is independent from WHO, such as the Global Health Threats Council envisioned by Helen Clark and Ellen Johnson Sirleaf, is also needed for compliance because WHO, as a technical adviser to countries, should not be placed in a position to evaluate and hold countries accountable for their obligations. Furthermore, because the absence of accountability and enforcement threatens the success of international treaties,2, 3 an accountability framework with incentives and disincentives for compliance is necessary for a pandemic convention to achieve its desired effect.4 Details of this framework must be agreed upon in advance to be binding for countries and not left for discussion until after the pandemic agreement is signed, as has been proposed in the Zero Draft.5 Failing to keep countries accountable for their obligations under the agreement would place the world at greater risk for another pandemic.