Several times, talks nearly collapsed, as bold promises made by world leaders during the Covid-19 pandemic ran into longstanding divisions between high- and low-income countries. Worryingly, a year or two of hard wrangling still lies ahead.

The world scrambles to save global health policy from US President Donald Trump.

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Heartfelt applause greeted the adoption on May 20 of the World Health Organisation (WHO) Pandemic Agreement, a treaty that commits governments to be more responsible and less selfish when future pandemics emerge.

There was doubtless an edge of relief to the clapping. After three years of fierce argument, an overwhelming majority of health ministers and officials from more than 130 countries—but not America, which is leaving the WHO and boycotting the treaty—voted to approve the text.

To cheerleaders, this was hopeful applause. The WHO boss, Dr Tedros Adhanom Ghebreyesus, congratulated governments on a "victory for public health, science and multilateral action".

Opponents of the new pandemic agreement, who include the Trump administration but also populist politicians in Europe and elsewhere, might call those clapping sinister. An executive order issued on US President Donald Trump's first day in office announced America's withdrawal from the WHO and from negotiations to craft the new pandemic treaty.

The order added that America would not be bound by amendments to international health regulations agreed on in 2024. Those changes, which tighten virus-surveillance and reporting obligations on governments, were demanded by American negotiators during the Biden administration. Mr Trump accuses the WHO of mismanaging the Covid-19 pandemic under China's influence, and of demanding too much money from America.

The pandemic treaty has sparked wild if vague claims in several countries. In 2024, a fringe candidate for America's presidency called the pandemic agreement a power-grab by "international bureaucrats and their bosses at the billionaire boys club in Davos" that tramples Americans' constitutional rights.