Background: Limitations of current global health governance revealed during the COVID-19 pandemic can inform the ongoing deliberations for an international treaty on pandemics.

Objectives: To report on World Health Organization (WHO) definitions for governance and the enforcement of treaties in the context of a proposed international treaty on pandemics.

Sources: This narrative review was based on keyword searches related to public health, global health governance and enforcement in PubMed/Medline and Google Scholar. Snowballing for additional articles followed the keyword search review.

Content: WHO lacks a consistent definition of global health governance. And, in its current state, the proposed international treaty on pandemics lacks clearly articulated compliance, accountability or enforcement mechanisms. Findings reveal that humanitarian treaties often fail to achieve their aims absent clear enforcement mechanisms. The proposed international treaty on public health is garnering a range of perspectives. Decision makers should evaluate whether a globally aligned definition of global health governance is needed. Decision makers should also consider whether the proposed international treaty on pandemics should be opposed if it lacks sufficiently clear compliance, accountability and enforcement mechanisms.

Implications: This narrative review is believed to be the first of its kind searching scientific-oriented databases regarding governance and international pandemic treaties. The review includes several findings that advance the literature. These findings, in turn, reveal two key implications for decision makers. First, whether an aligned definition for governance addressing compliance, accountability and enforcement mechanisms is needed. Second, whether a draft treaty lacking enforcement mechanisms should be approved.