Topic ①　Hitoshi Oshitani (Professor from the Department of Virology, Tohoku University Graduate School of Medicine)
　The World Health Organization (WHO) was established in 1948 after World War II. In 1969, the International Health Regulations (IHR) were adopted as a "legally binding agreement to prevent the international spread of diseases." However, the IHR was insufficient when dealing with emerging infectious diseases. Furthermore, an international outbreak of SARS (Severe Acute Respiratory Syndrome) occurred in 2003 before the IHR revision process was completed. In 2005, the WHO revised the IHR so it could respond to all public health threats. The revision also enabled the declaration of a “Public Health Emergency of International Concern” (PHEIC) for situations that could become an international threat. However, due to the politicization of the WHO’s response to COVID-19 and out of consideration to China, the WHO put off declaring a PHEIC. This has been severely criticized.

　Some people believe that Western countries’ failed initial response to COVID-19 resulted in the pandemic. There were many reasons for these failures, including Europe's limited risk awareness and the Trump administration's pressure on the CDC. Despite these shortcomings, Western countries are leading discussions regarding a post-pandemic society, including pandemic treaties, without addressing their own areas of improvement in the discussions. Therefore, we must question whether we can make any progress toward building a pandemic-resilient society.

Topic ② Toshiya Ueki (Tohoku University Executive Vice President/Professor of Law)
　The WHO received a considerable amount of criticism during the COVID-19 pandemic. While the WHO's response was indeed problematic, it is true that international organizations—not limited to the WHO—are prone to excessive deification and bashing from non-professional personnel. Therefore, an earnest, objective analysis of international organizations is vital.

　The WHO is a specialized agency of the United Nations in the field of health, as stipulated in Articles 57 and 63 of the UN Charter. Therefore, while there are calls for a "WHO reform," the major question is whether such a reform should be carried out within or beyond the existing framework of the UN.

　Each country is a sovereign state. Treaties are the common set of rules that bind sovereign states together. Such rules can exist because the "common interests of the participating nations," i.e., "international public interest," underly those rules. In other words, "if a rule is not in the interests of a country, that country does not need to participate in it, and unless one agrees to the rule, the rule will not be constituted." The domestic legislative process, on the other hand, differs significantly.

　Based on the above, when considering the state of the WHO and international legal regulations for pandemic response, the existing International Health Regulations (IHR) is a secondary regulation of an international organization (WHO) and is not an interstate treaty. Hence, when creating a new interstate treaty for pandemic response, the essential question becomes, "Will all countries benefit from such international rules?" Certainly, infectious disease control via common rules is in the interest of all countries. However, political aspects always intervene, and if political conflicts arise, infectious disease control fails to become a common interest of the international community. Therefore, it is extremely difficult to make interstate rules. The challenge lies in deciding who the rules will be made by, as well as what rules will be made.

　Currently, negotiations and drafting of the "Pandemic Treaty" as an interstate treaty that comprehensively defines pandemic countermeasures based on the COVID-19 pandemic are underway. A "Zero Draft" was released in February 2023. The key point is that even if this treaty is drafted and adopted, unless a country ratifies it, the treaty will not be enforceable in that country. In particular, the Global South and developed countries have conflicting interests. A compromise (i.e., balanced interests from both sides) is required for both sides to ratify the treaty and implement effective pandemic countermeasures.

　This is not a problem exclusive to pandemic treaties but one that applies to all interstate rules. With both sides taking a hard-line stance, Japan must think through what stance it should take to find a point of compromise between both sides.

Topic ③ Ayako Takemi (Associate Professor; Research Center for Advanced Science and Technology, the University of Tokyo)
　The international community has become keenly aware of the need for international regulations and frameworks to deal with large-scale transnational infectious disease outbreaks. Based on numerous issues and challenges, various investigations are underway to identify new mechanisms that will enable appropriate approaches and coordination to address problems existing frameworks cannot. For example, the "Pandemic Treaty" is one example of such an investigation.

　The “Pandemic Treaty,” based on the COVID-19 pandemic, stipulates pandemic response measures in a comprehensive context. While the IHR deals primarily with information sharing and immediate responses to outbreaks, the “Pandemic Treaty” is said to be oriented toward a broader, more multidisciplinary perspective. Specific proposals regarding access to materials and information; benefit-sharing systems; and exemptions from the obligation to protect intellectual property rights related to vaccines and medicines are being sought.

　However, many doubts and limitations have also been raised about this "treaty." Given that the treaty is an interstate treaty, there is an inherent trade-off between obligations and implementation assurance (which were initially expected of a pandemic treaty, even though they were areas covered by the IHR). It is also difficult to approach core challenges identified after an incident, including early detection and early intervention.

Furthermore, given that the treaty deals with global challenges, the treaty will likely inadequately address the "areas of improvement" for pandemic responses in developed countries. It has also been pointed out that incentives for cooperation are generally insufficient in areas where international cooperation is required. China's initial response to the COVID-19 pandemic has been harshly criticized, and it is clear that simply creating a new "law" or framework will not solve the issue. Therefore, rather than relying solely on a new treaty, a parallel approach with more pragmatic measures is essential, including surveillance, "political push," and identification of issues from multiple sources through a variety of channels.

　The form of global health governance has been transforming since the COVID-19 pandemic. The simple structure of "developed countries supporting developing countries" that was often postulated in the past, especially in the context of infectious disease responses, is now obsolete. More complex structure in which individual actors strengthen their own networks based on their own incentives is more evident. This structural transformation is closely related to the growing diversity of international response channels due to an increase in actors. In terms of financial scale, the WHO's presence itself has become much more relative.

　Within this context, there was disagreement, especially in the early stages, as to whether a pandemic treaty where WHO plays a central role is the most effective measure.　Initially, countries, especially in Europe, supported the pandemic treaty. However, the US pointed out issues regarding the WHO’s role relativization, scope of expertise, and authority. In turn, the US has advocated the establishment of a governance that is linked to funds, which has received criticism from both China and Russia. These disagreements are strongly influenced by geopolitical contexts. Although more accommodative measures are being attempted, the inherent possibility of future fragmentation cannot be denied. Evidence-based policy-making processes and information sharing may be effective in mitigating such gaps. This is currently being attempted in several cases, including G20-led initiatives. However, their effectiveness remains unknown, and continuous endeavors are crucial.

　While it is necessary to strengthen surveillance from a variety of angles, it is important to both reinforce the post-pandemic system and continue the crisis management system in preparation for the next pandemic. The structure of the global health field is complicated, and WHO is not the only central actor. Therefore, an effective approach based on an impartial overall picture—rather than approaches made by reading what other countries are implying or those based on a country’s appearance—must be explored. Given Japan's relative strength in these areas, much attention will focus on the clarification of Japan's positionality hereafter, as well as its practical approaches to the issues.