More than 5 million lives worldwide have been lost to Covid-19, and the World Health Organization predicts that millions more could be lost in the months to come. The damage from the pandemic has been so catastrophic that, when the World Health Assembly meets, starting on November 29, its task is nothing less than preventing such a tragedy from reoccurring. The pandemic has been so ruinous that we now need an internationally binding agreement to prevent future outbreaks from becoming pandemics. A new agreement should be underpinned by a high-level commitment to health for all, grounded in equity and solidarity between nations. Not only should all people have fair access to what they need for their health, irrespective of their wealth or income, but the international community should ensure the equitable use and distribution of available medical resources. For that to happen, we need a fully functioning global surveillance system, fast tracking and sharing of support in emergencies, and predictable finance. Nothing illustrates this need more clearly than our collective failure to meet our promise to secure the equitable distribution of vaccines . Thanks to brilliant science and a strong manufacturing performance, we will have produced 12 billion vaccines by Christmas, enough to vaccinate every adult in the world. Even so, 95 per cent of people are still unprotected in low-income countries. This is perhaps the greatest public policy failure of our times. More than 80 countries are expected to miss the WHO’s adult vaccination target of 40 per cent by December. On current trends, it will take until at least Easter to get close to 40 per cent, and even then dozens of countries could miss out. Since June’s Group of 7 meeting, where leaders pledged that the whole world would be vaccinated by the end of 2022, the vaccine gap has only widened. Vaccination rates in high-income countries have risen from 40 per cent in June to 60 to 70 per cent now, but in low-income countries they have gone from 1 per cent to 5 per cent in that time. Six adults are receiving booster shots in middle- and high-income countries for every one adult now being inoculated each day in a low-income country, and 90 per cent of African health workers remain unprotected. Although important regional initiatives have taken steps to address the vaccine gap by purchasing doses, it is still not enough to meet the shortfall. This inequality is simply explained: the world’s richest countries have hoarded vaccines and retain control of most future deliveries. Promises of vaccines from the Global North have fallen short. Only around 20 per cent of donations promised by the United States have been sent, and Europe and Britain have performed even worse than that. The Covax Facility, which had hoped to distribute 2 billion vaccines by December, now expects to deliver just two-thirds of that amount. Such is the stockpile of vaccines in wealthy countries that health data research group Airfinity estimates 100 million unused doses in that stockpile will pass their expiration dates by the end of 2021 and be wasted. Wealthy countries hoarding life-saving vaccines is morally indefensible. To allow millions of doses to go to waste is an act of medical and social vandalism that should never be forgotten or forgiven. But the vaccine inequities show why more fundamental changes are needed in the architecture of health decision-making. Few international organisations have the freedom and independence to make decisions which national governments are obliged to follow. The discretion available to the World Trade Organization’s appeal court and the International Criminal Court are areas where an international organisation can overrule nation-states, and because of that they are under assault from a coalition of anti-internationalists. While there is a global health treaty focused on reducing the demand and supply of tobacco , as well as a 2011 agreement to ensure the WHO can commandeer supplies of flu vaccine when needed, a binding agreement to enable world health authorities to do more to prevent, detect, prepare for and control a pandemic still eludes us. First, our global health leaders must have more authority to develop and upgrade health surveillance . Second, we need to build on existing work to ensure equitable manufacturing and distribution of protective equipment, tests, treatments and vaccines so all countries can detect, respond to and protect against pandemics. Third, we need a global pandemic preparedness board. But all this will only work if we devise a sustainable financing mechanism to address the glaring global inequalities in health provision. Too often in times of global crises, we are reduced to passing round the begging bowl or convening “pledging” conferences more reminiscent of organising a whip-round at a charity fundraiser. Pandemic preparedness should be financed by a burden-sharing formula where the costs are shared between the countries with the greatest capacity to pay. Even now, though, less than 20 per cent of the WHO’s budget is covered in this way. Considering the estimated US$9 trillion of trade lost because of the pandemic, the US$10 billion annual budget for pandemic prevention and preparedness called for by the Group of 20 would offer one of the greatest returns on investment in history. We must act now, starting with the coming World Health Assembly, to be prepared for all future eventualities. Gordon Brown is a WHO Ambassador for Global Health Financing and is former prime minister of the United Kingdom