Countries cross the finish line on Pandemic Agreement, assess next steps

Written by Camden Malone, United Nations Foundation

Last updated April 23, 2025

 

 

After over three years of negotiations, Member States of the World Health Organization (WHO) defied expectations and reached consensus on a Pandemic Agreement. A legally binding instrument for countries that opt-in, the agreement will lay the bedrock for global cooperation to prevent, prepare for, and respond to future pandemic threats. But negotiations are not done yet.

Lessons learned, consensus earned

The new agreement is deeply rooted in the COVID-19 experience, which delivered excellence in science and innovation, but also unearthed deep inequities across global health, economic, and social structures. In December 2021, as the acute phase of the pandemic tapered, countries came together under the auspices of WHO to craft new solutions.

Member States formed an Intergovernmental Negotiating Body (INB) to draft and negotiate a legal instrument to improve the way countries collectively tackle pandemics. The INB navigated a diplomatic period marked by mistrust among nations in the aftermath of COVID-19, rising geopolitical tensions and declining political interest, rampant mis- and disinformation, the exit of the United States from the process, and protracted debate over key points of the text. Outside the negotiation room, emerging threats such as mpox, Marburg, and avian influenza reminded decision-makers of the fast-paced evolution of 21^st century global health crises. Member States persevered, however, and gradually built consensus on a legally binding framework for pandemic preparedness, prevention, and response.

At the final meeting of the INB, the Ethiopian delegate recounted INB’s genesis:

“We have started this process three years back with the lessons from the COVID-19 pandemic fresh in our memories… In line with the determination of the people of the United Nations to ‘save succeeding generations from the scourge of war,’ we are here at WHO, determined to save succeeding generations from the scourge of pandemics, which threaten to endanger humankind.”

Pillars of the Pandemic Agreement

The final text strikes a delicate balance between the views of all Member States that contributed to it. Through the agreement, countries commit to:

• Prevention. The Pandemic Agreement is the first legally-binding instrument to explicitly embed “One Health” in its provisions, recognizing the interconnectedness of human, animal, and environmental health. Acceptance of this concept is a critical step toward improved pandemic risk assessment, surveillance, and multisector collaboration to combat the risk of zoonotic spillovers, which is the predominant cause of emerging infectious diseases and the primary cause of recent pandemics.
• Preparedness. The agreement acknowledges that investment in public health infrastructure and service delivery, including mental health and psychosocial support, is the foundation of pandemic preparedness. Healthcare workers underpinned the COVID-19 response, and countries have committed to ensuring they remain well-prepared, equipped, and protected at all times.
• Response. At the heart of negotiations were efforts to ensure access to essential health medicines and technologies. Ambitions related to technology transfer – the process of sharing intellectual property (IP), know-how, and technology needed to diversify production and distribution – were met with compromise. While the final text encourages countries to promote technology transfer under “mutually agreed” terms, low-income countries fear the outcome will be ineffectual in helping their regions scale up manufacturing and supply of life-saving medical countermeasures (e.g. vaccines, therapeutics, and diagnostics). In further pursuit of equity, the text obligates countries to attach conditions for access to publicly funded research and development (R&D) contracts. It also establishes a Global Supply Chain and Logistics Network to coordinate resource allocation, reduce access barriers, and mitigate the practice of hoarding of pandemic products through shared stockpiles.

Pathogen Access and Benefit Sharing talks continue

Critical to the response pillar and the centerpiece of the agreement, a system for Pathogen Access and Benefit Sharing (PABS) has not yet been signed off by Member States. “The issue of pathogen access and benefit sharing strikes at the heart of international relations,” Ambassador John E. Lange, the UN Foundation’s Senior Fellow for Global Health Diplomacy, explains. “Governments are fundamentally responsible for the security of their own citizens, while global partnership is required in the face of a global pandemic, and fundamental humanity means the world’s poorest people should not be last in line to receive lifesaving medical countermeasures.” While Member States agree in principle to an outline of the PABS mechanism as articulated in the current agreement, further negotiation is expected.

At the World Health Assembly in May, countries are set to approve the Pandemic Agreement by consensus or a two-thirds majority vote. They will also decide on their approach to extended negotiations of the PABS instrument, potentially under the guidance of a new Intergovernmental Working Group. Agreement on the PABS instrument, which will be annexed to the main text, must be finalized before the whole agreement can be ratified by countries and reach the 60 signatures required for entry into force.

While a one-year timeline is envisaged for negotiating the PABS annex, history has shown that this technical subject matter can be vexing to negotiate. Access and benefit-sharing mechanisms are designed to promote fairness, transparency, and trust in the exchange of pathogens and their genetic sequence data between countries by ensuring equitable distribution of benefits, including both monetary gains and non-monetary advantages like medical countermeasures. Without a guarantee that pandemic-related health products will be available to their own populations, low- and middle-income countries have little incentive to share information with overseas R&D companies.

Through these negotiations, Member States have agreed in principle that, in the event of a pandemic outbreak, the PABS instrument will ensure at least 20% of essential pandemic products are set aside for equitable distribution based on risk and need (10% as a donation, and the remaining percent at affordable cost). The text also encourages alternative benefit-sharing approaches, such as capacity building, technology transfer, and non-exclusive licensing to manufacturers in low- and middle-income countries.

Experts warn that the agreement is an empty shell without the details of the PABS instrument being finalized. PABS is a missing link that is needed to bring the Pandemic Agreement into force and, according to low- and middle-income countries, also holds the greatest promise for making an impact on global health equity. At the same time, measures elsewhere in the agreement must be rigorously implemented in order to effectively operationalize the PABS system, including integrated surveillance, a robust R&D and innovation pipeline, and a reliable supply chain network. supply chain network.

The complex nature of PABS has proven difficult to codify. For instance, the Nagoya Protocol, a supplementary agreement to the Convention on Biological Diversity (1992), was agreed upon in 2010—after nearly two decades—to provide clear rules and procedures for access and benefit sharing of genetic resources. WHO’s Pandemic Influenza Preparedness (PIP) Framework also established non-binding access and benefit sharing arrangements for influenza viruses with pandemic potential, though contentious negotiations postponed the framework’s adoption for years.

Member States are seeking to conclude negotiations on the new PABS instrument swiftly, though it remains to be seen whether the historically prickly issues can be resolved on a shorter timeline. Ambassador Lange adds, “As the head of the U.S. delegation for the first two of four years of difficult negotiations on access and benefit sharing that led to the 2011 Pandemic Influenza Preparedness Framework, I was not surprised that the details of Pathogen Access and Benefit Sharing remain to be negotiated.  It’s now imperative that delegates reach agreement on the PABS mechanism.  COVID-19 was a wake-up call for the planet: the world needs a much better system to prevent, prepare for, and respond to future pandemics.”

Not a panacea but a prescription for global health security

The agreement, albeit imperfect and unfinished, represents a paradigm shift toward more cooperative and equitable global health governance. Its commitments reaffirm WHO’s role in safeguarding the normative and functional tools of global health, which will be essential to support implementation. And having achieved consensus in such an imperiled environment for global cooperation, the agreement signals the enduring strength of multilateralism, uplifting Geneva’s spirits before the World Health Assembly.

The agreement has passed a critical juncture and is now on a path toward entry into force. Time will tell whether it will succeed in instilling equity and solidarity among nations in the face of the next pandemic.

About the Author

Camden Malone advances the global health agenda through engagement with UN Member States on a wide range of health policy issues, including universal health coverage, antimicrobial resistance, and pandemic preparedness, prevention, and response. Prior to the United Nations Foundation, Camden worked at the Permanent Mission of Costa Rica to the UN, covering intergovernmental negotiations related to health and human rights. Camden holds a master’s degree in International Affairs from the Colin Powell School for Civic and Global Leadership at the City College of New York; and a bachelor’s degree in History and Political Science from the College of Saint Rose. 

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