U.S. Global Response to COVID-19

The Biden-Harris Administration worked intensively to respond to the COVID-19 pandemic globally — as both a bilateral and multilateral partner. Critical areas of leadership were seen in its mobilization and distribution of vaccines throughout the world, as well as diagnostics and therapeutics; engagement in the Access to COVID-19 Tools Accelerator (ACT-A); support for the health workforce; efforts to combat mis- and dis-information; and collaboration to secure supply chains.

The United States was the world’s largest donor to ACT-A and provided global leadership to raise billions of additional dollars in critical funding through the U.S.-hosted and co-hosted Global COVID-19 Summits that brought together world leaders to advance a shared response to the COVID-19 crisis — and collaborate effectively to address future threats. ¹² The United States also led an international and coordinated effort to accelerate access to safe and effective vaccines to meet global needs. Between May 2021 and February 2024, the United States donated more than 693 million vaccine doses to 117 countries and economies, bilaterally and in partnership with the vaccines pillar of ACT-A (COVAX), the Caribbean Community (CARICOM), and the African Vaccine Acquisition Trust (AVAT). Action on vaccine access was just one part of broader Biden-Harris Administration efforts to increase availability of and access to key tools to address health emergencies and to improve health systems and global health security for the future. ¹³

World Health Organization Reforms

WHO has remained a key partner in global health security efforts. Given its central and necessary role guiding collective action and mobilizing joint resources for global health emergencies, the Biden-Harris Administration has been focused on strengthening WHO effectiveness and impact. The previous administration outlined a series of reforms that the Biden-Harris Administration expanded and focused on in our reengagement with WHO leadership and with other WHO Member States. HHS and the Department of State worked together closely on outlining critical reforms necessary for the United States to consider increased investment in the organization and continued confidence in its ability to carry out the essential health functions entrusted to it by all Member States. ¹⁴ Key areas have included critical reforms in budget and financial transparency and oversight; strengthened accountability across the organization; strengthened rules and policies for compliance, risk management, and ethics; human resources management; and a push for more meaningful engagement of Taiwanese health experts and stakeholders in relevant WHO programs and meetings. In 2022, a successful whole-of-government strategic dialogue ¹⁵ between the United States and WHO, hosted by U.S. HHS Secretary Xavier Becerra and WHO Director-General Tedros Adhanom Ghebreysus, served to strengthen communications on technical and governance priorities to advance public health.

Two-thirds of recommended U.S. reforms have been adopted by the organization over the past few years, consistent with ongoing governance discussions. These reforms have had a direct impact on WHO work in global health security, including the establishment of a new executive board committee on health emergencies that is poised to provide Member States with greater oversight of decision-making during outbreaks and pandemics: the Standing Committee on Health Emergency Prevention, Preparedness and Response (SCHEPPR). ¹⁶ Building from the COVID-19 response, SCHEPPR has demonstrated its value to convene, advise the Director-General, and serve as a conduit to Member State governments around the world on rapidly evolving health emergency circumstances and what is needed to combat them, as seen in the ongoing global mpox response.

Another major reform effort has sought to address the pervasive culture of sexual exploitation, abuse, and harassment at WHO by strengthening weak institutional controls, which became starkly evident following reporting out of the DRC of widespread misconduct during the Ebola virus disease outbreaks of 2018-19. ¹⁷ The United States worked with the WHO leadership and like-minded governments to insist on a comprehensive management plan to hold accountable those responsible, including those working in ethics and oversight, and to provide survivor benefits and support to staff to ensure a safe workplace environment for all, at all levels of the organization.

Amendments to the International Health Regulations (IHR)

The IHR are the international community’s main playbook for preparing for, detecting, and initially responding to health crises globally. They provide a legal framework that outlines states’ rights and obligations in managing public health events with potential cross-border impacts. The IHR were last substantially updated in 2005, nearly two decades ago, following the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak.

Starting in 2022, the United States led international efforts to amend the IHR over the course of almost four years of negotiations at WHO, first to conduct an assessment of the COVID-19 response and weaknesses and gaps in the system, and then to take forward clear recommendations that came forward to negotiate a package of targeted amendments to the IHR. The U.S. government ultimately delivered on this objective through the amended IHR package at WHO and through efforts across global health institutions to strengthen coordination and effective collaboration — from WHO to Gavi, UNICEF, the Global Fund, and beyond.

These amended IHR will help protect Americans, as well as people around the globe, by requiring countries to work domestically and to collaborate internationally to better prevent, prepare for, detect, report, and respond to future health security threats. The amendments to the IHR include, among other reforms: a tiered alert system that includes a new pandemic emergency declaration to trigger an escalated global response to pandemics; improved obligations to facilitate rapid sharing of information between WHO and states; an improved set of core capacities for countries to implement; a new accountability mechanism to encourage effective implementation of the IHR for health emergency prevention, preparedness, and response; a coordinating financial mechanism to help countries, especially developing countries, better identify and effectively utilize existing financial resources and promote efficiency by harmonizing existing funding sources; and greater emphasis on community and stakeholder engagement. U.S. leadership in these negotiations helped to ensure that all countries reduce the risk of outbreaks — with many arising outside of the United States — affecting American lives and livelihoods, and doing so in a way that protects national sovereignty on how the IHR are implemented in each country.

Pandemic Agreement

During the second-ever World Health Assembly Special Session in 2021, WHO Member States took the decision to launch the negotiation of a new international agreement on pandemic prevention, preparedness, and response. ¹⁸ While these “Pandemic Agreement” negotiations did not conclude in the initial two-year timeframe envisioned, the U.S. government remains proud of the progress made and the strong measures that will result if it is finalized and ultimately implemented by countries. These negotiations remain within reach if countries will set aside entrenched positions and work together for a safer, healthier, and fairer world that is better prepared for pandemics.

Regional Partnerships

This Biden-Harris Administration has also worked to diversify global partnerships through expanded regional cooperation throughout the world. These efforts have included working on a new Memorandum of Cooperation with the Africa Centres for Disease Control and Prevention (Africa CDC), ¹⁹ formalizing the relationship between the Association of Southeast Asian Nations (ASEAN) and the United States, ²⁰ and renewing support and engagement in PAHO, the regional public health body for the Americas. Through these regional partnerships, the United States and partners will continue to work together to advance a shared vision to strengthen public health systems and deliver improved health outcomes worldwide.

Financing for Pandemic Preparedness

NSM-1 also made clear that establishing long-term sustainable financing for pandemic prevention, preparedness, and response is essential to strengthening the health and safety of the American people. Building on the strong work of previous Administrations (including through the Global Health Security Agenda and its Sustainable Financing for Preparedness Action Package, as well as the G20 joint finance and health meetings established by Japan during its presidency in 2019), HHS worked closely with Treasury, State, and USAID colleagues to establish the Pandemic Fund. Established in November 2022 by G20 countries, this new Fund is housed at the World Bank with integral WHO participation. ^{21 , 22} With generous support from the U.S. Congress, the Pandemic Fund has enjoyed a successful launch. Although the crowded and diffuse global health financing landscape is challenging for any issue area to find success, early moves have shown that the Pandemic Fund can adapt to new challenges (like mpox) and become more responsive and transparent in its governance. Notably, U.S. investments in the Pandemic Fund follow a similar model to the Global Fund, which caps overall U.S. investment at 1/3 of total funding and incentivizes new and existing donors to step up to fund the shared responsibility for pandemic prevention, preparedness, and response.

Beyond the Pandemic Fund, HHS has also partnered closely with Treasury to foster and secure continued support within the G20 for the Finance and Health Task Force. Initially established in 2021 under Italy’s G20 Presidency, alongside the proposal for a Pandemic Fund, the Finance and Health Task Force has focused on bringing better cross-sectoral analysis, data, and focus on health and financing issues as they relate to health emergencies with high potential to disrupt national economies — as we saw during the COVID-19 pandemic. This enhanced collaboration between health and finance was also on full display during the IHR amendment negotiations, where U.S. negotiators were able to work across ideological and regional lines to develop and build support for the Coordinating Financing Mechanism (CFM). Rather than establishing another new fund that would likely struggle to mobilize resources, the new CFM will instead focus on better coordination of existing resources and efforts to mobilize bilateral, regional, and multilateral funding.