World Health Day 2031 marks a little over 11 years since the beginning of the COVID pandemic, and a year since it has been possible to finally imagine a return to normal (RTN). A decade ago it already seemed like the RTN was at hand: vaccination campaigns forged ahead as the Second Wave of the pandemic abated. This optimism did not take into account a simple, biological fact: as long as transmission continued, variants that could escape the immune response of those vaccinated would gradually gain the upper hand.

In 2021, the World Health Organization (WHO) and other organisations launched a campaign for vaccine equity but vaccines had only been secured for 20% of the population in low- and middle-income countries (LMICs). This fact did not gain much attention in high-income countries, where much of the discussion was focused on vaccine delivery bottlenecks and vaccination delays.

By mid-2022 escape variants initially identified in Switzerland, Venezuela and the DRC had combined into a strain to which everyone was susceptible, even those vaccinated. This led to a massive global Third Wave. There was no short-term hope for RTN.  

Although one of the vaccines seemed to offer some protection, it had been linked to a rare but deadly clotting disorder. This led to anguished public debates as it became clear that should the general population be vaccinated, it would lead to a small but significant number of deaths from cerebral haemorrhages in young people.

Luckily, the new mRNA vaccine platforms allowed vaccines to be rapidly adapted, and by then industrial production had been ramped up, also in some LMICs. When global vaccination campaigns finally began in earnest, after the initial deliveries through COVAX, in 2023 a RTN seemed imminent. But the very unequal patchwork of vaccination remained worldwide, also because no agreement on a patent waver could be achieved at the World Trade Organization (WTO).

As a result, escape variants re-appeared in 2024 and 2025. By then countries tried to control the epidemic through tighter border controls, however national successes were short-lived as only very few countries – mainly island states – were able to completely seal off their borders. China and the United States, whose size and industrial policies allowed them to be largely self-sufficient, were able to enforce draconian controls on goods and people entering the country. This proved much more difficult for the EU and many of the Asian countries highly dependent on trade.

The Fourth and Fifth Waves accelerated talks around a Global Pandemic Treaty that had stalled since an initial move by over 20 heads of state back in 2021. Most countries shied away from the accountability mechanisms proposed, with many leaders fearing personal consequences.

As talks in 2027 finally closed in on a treaty focusing on enforced surveillance, notification and accountability mechanisms, a Sixth Wave of a new escape recombinant was already underway. The new recombinant strain was worrisome: in those immunised, it could lead to a massive deadly pathological immune response, particularly in the young.

By then the machine for rolling out new adapted vaccines was well oiled for the wealthy and some LMICs, but vaccinating a pandemic-weary younger population was a new challenge. Despite near universal testing and vaccination centres, hospitals were once again overwhelmed and the death toll in the young surged, leaving the high-income world shell-shocked. In LMICs, lower vaccination rates paradoxically helped them weather the Seventh Wave: there, the escape variants were less prevalent and the “classical” and by now less deadly strains kept the newer variants from gaining a toehold. By 2028, it had become clear that nationalist approaches were doomed to fail in a world inhabited by one interconnected species.

Ironically, commentators would later remark that the strongest factor in the emergence of a new global approach to pandemics was not the Sixth Wave but the series of cataclysmic ecological disasters that struck Australia, California, India and Southern Europe in 2028 and a cascade of humanitarian crises that overwhelmed national Red Crosses, the ICRC and the international humanitarian response.

The crises ushered into power a new generation of leaders who rejected traditional political cleavages. They no longer saw national solutions – and the multilateral approaches of old – as able to address existential, planetary threats. Many of the existing multilateral organisations no longer seemed fit to respond to the systemic threats. In 2029, as a result, a robust global treaty was signed in Geneva.

The Entente de Genève combined WHO, the United Nations Environment Program (UNEP), the World Organisation for Animal Health (OIE) and the Food ad Agriculture Organisation (FAO) to form a new Planetary Health Agency. This was funded not by states, but by a global digital tax that had been introduced in 2025 through agreements at the Organisation for Economic Co-operation and Development (OECD).

The Agency’s long-term funding would be ensured through a new currency, the health-coin, issued against health and environmental gains achieved. Its operations division is now fully equipped and trained, and armed if necessary, to tackle emerging planetary health risks, while its powerful economics division has the financial sway to influence central banks to address the social inequalities that threatened human health across the globe and build a wellbeing economy.

It is today, on World Health Day 2031, that the new Planetary Health Agency begins operations.