An international draft treaty aimed at bolstering readiness for the next pandemic enters a final round of scheduled negotiations Monday, with key disagreements remaining about how much knowledge and product drugmakers must share with the world.

Why it matters: COVID-19 laid bare global health inequities — and exacerbated them, as low- and middle-income countries received vaccines far later than other countries despite global sharing efforts hatched during the crisis.

• That led to hundreds of thousands of deaths that could have been averted, and the inequity reverberated around the hyperconnected planet as variants arose and spread through an uneven patchwork of vaccine access.
• An estimated one-quarter of the world's population still hasn't received a single dose of COVID vaccine.

"There's a need for a new international legal instrument to capture political momentum to prevent this from happening again and to recognize and rectify gaps that existed even before COVID," said Alexandra Phelan, a global health lawyer and associate professor at Johns Hopkins Bloomberg School of Public Health.

Catch up quick: The world's first pandemic treaty aims to "strengthen pandemic prevention, preparedness and response" with "equity as the goal and outcome."

• The draft negotiating text covers a number of issues, including pathogen surveillance, health care workforce capacity, supply chain and logistics, and tech transfer to support production of vaccines, diagnostic tests and treatments.

A key sticking point is whether countries must provide viral specimens or genome sequences to a global repository managed by the World Health Organization, which would enable others to use that information to create vaccines, diagnostic tests and treatments.

• Drugmakers, who'd have to pay into the system, would in exchange contribute diagnostics, treatments or vaccines in real time to a network coordinated by WHO — 10% free of charge to countries and 10% at not-for-profit prices, with some flexibility based on availability.
• The draft text "serves the interests of developed countries and their biotech industries by forcing developing countries to share biological materials and information without adequate legal certainty of benefit sharing," Nithin Ramakrishnan of the Third World Network, an international research and advocacy group, told Axios.

But drugmakers say mandatory sharing rules would undermine valuable intellectual property rights and chill the incentive to develop treatments and vaccines. Some Republican lawmakers have also argued the treaty will cost American taxpayers and threaten U.S. intellectual property rights.

• The mRNA platform that Pfizer and Moderna used to create COVID vaccines was already three decades in development. That may not be the case in a future pandemic, which could require considerably more research and development.
• "The biopharmaceutical industry is committed to equitable access to vaccines and treatments, which is not possible unless we protect the innovation ecosystem," said Larry Kerr, global health deputy vice president for lobbying group PhRMA.
• The draft text states IP protection is "important for the development of new medical products," while also saying it also does not prevent countries from "taking measures to protect public health."
• The U.S. "supports an access and benefits sharing system that pairs strong commitments to share information, pathogen samples, and genetic sequence data before and during a pandemic; and contractual commitments from manufacturers participating in the system to set aside a dedicated percentage of production for equitable distribution during pandemics," a National Security Council spokesperson said in a statement to Axios, adding it also supports stronger systems of voluntary technology transfer.

Yes, but: Pharmaceutical companies could benefit from the treaty by having guaranteed demand for their product "beyond the high-income market they're already in," said Raj Panjabi, a former White House official who oversaw the U.S. global response to COVID.

• Its difficult to predict whether a pathogen will disappear as quickly as it emerges like the first SARS virus in 2003, or take hold around the world like SARS-CoV-2.

Between the lines: There is no guarantee the U.S. would be the first country to develop a vaccine or treatment in the next pandemic.

• China, the UK and other countries are investing heavily in their ability to quickly develop vaccines.
• "If another nation develops a pandemic vaccine or therapeutic before the U.S., the U.S., like any other country, will be guaranteed access to that network of vaccines, therapeutics and tests," Panjabi said.
• The agreement says it will take special interest in developing countries, "but nowhere does it say U.S. and rich countries won't have access," he said.
• "It is the smarter thing to do because it buys down risk, the right thing to do because it provides access to those in highest need, and the safer thing to do because it meets the highest need at the beginning of a pandemic and decreases the chance of future variants affecting Americans," he said.

What's next: The current round of negotiations in Geneva ends March 28, with a goal of reaching a consensus decision by the World Health Assembly at the end of May.

• Some officials have expressed concern the deadline won't be met, the Financial Times reports, but Phelan, the Johns Hopkins associate professor, is more optimistic and said countries could choose to extend negotiations.
• "There is an extremely high level of good faith to meet this deadline," said Phelan, who was involved in negotiations around the High Seas Treaty.
• "It always feel precarious until it's done," she said.