Understanding the expectations, positions and ambitions of LMICs during pandemic treaty negotiations, and the factors contributing to them.

Global South countries account for two-thirds of WHO Member States and are a crucial voice in negotiating the 'pandemic treaty', which Member States agreed was necessary if the world was to avoid a repeat of the significant inequity that resulted during COVID-19. The negotiation of a pandemic treaty presents an opportunity to recalibrate global health systems and processes for pandemic prevention, preparedness and response. However, for this to eventuate through global solidarity, as many Global South countries have said they expect, then concessions by developed states on issues that they have long protected must occur. It remains to be seen whether the negotiations amount to a rebalancing of power and resources to substantially improve our capacity and capability to address global health threats. Further, while these issues have often been viewed through a dualistic lens between developing and developed countries, these negotiations also reflect the diversity of Global South Member States, some of which are strong voices in, and for, coalitions. Drawing on content analysis techniques, this research describes how Global South countries articulate their expectations, positions and ambitions during treaty negotiations in the lead up to the World Health Assembly in 2024 and discusses exogenous and endogenous factors that contribute to these positions. The analysis found that the pursuit of equity is galvanising for Global South countries, as are their ambitions for the multilateral system not to drive further inequity through the asymmetry of power and influence exercised by developed states. Well-coordinated collective positions from Global South countries in negotiations to date have resulted in traction on contested issues such as technology transfer, production capability, and access and benefits. Additionally, some Global South countries have also used these negotiations to pursue national interests whilst maintaining collective positions in pursuit of equity and global solidarity.