The COVID-19 pandemic starkly highlighted shortcomings in the global health governance system, prompting urgent calls for reform. Central to these reforms is the development of robust and equitable global rules to better prepare for, prevent, and respond to future pandemics.
In late 2021, the World Health Organization’s (WHO) 194 Member States embarked on negotiations to draft a legally binding Pandemic Agreement to address the system's weaknesses and the global inequities that emerged during the pandemic.
Simultaneously, the same Member States began negotiating targeted amendments to the International Health Regulations (IHR). As the sole legally-binding global instrument for preventing and controlling the international spread of diseases, the IHR faced severe criticism, and alleged low compliance, during the COVID-19 pandemic. This parallel reform process sought to address key issues around outbreak reporting, equity measures, and stronger compliance.
The goal was to complete both processes by the 77th World Health Assembly (WHA) in May 2024. This timeline, however, proved overly ambitious.
Member states successfully adopted a number of amendments to the IHR. They are mainly technical in nature, with notable provisions on the recognition of the principle of equity and solidarity, the establishment of a state parties committee to facilitate implementation, and some light-touch duties on access to health products during emergencies. However, the WHA extended the Pandemic Agreement negotiations by one year.
This outcome reflects the inherent challenges of crafting a new and unprecedented instrument compared to amending an existing one.
From the onset, negotiations for the Pandemic Agreement were broad and ambitious , covering the entire spectrum of pandemic prevention, preparedness, and response (PPPR).
To add to the complexity, and as is expected in multilateral negotiations, the process has been characterised by political tensions that have slowed down the negotiations. These tensions are nuanced and cannot be oversimplified, but as an illustration, developing countries demand equity through broader, faster, fairer access to health products and technologies, more flexibilities on intellectual property rights, support for regional pharmaceutical manufacturing, and guarantees on financing. Developed countries have focused narrowly on health security, seeking reform in areas such as strengthening surveillance and information-sharing obligations. Additionally, they strongly support the inclusion of the One Health approach in the agreement, which acknowledges the interconnection between the health of people, animals, and ecosystems. This approach raises concerns for other negotiators worried about its regulatory burden, costs, and potential barriers to trade.
Over two years were spent laying the treaty's foundation, which now includes diverse provisions such as pandemic prevention and surveillance, health workforce protection, research and development, geographically diversified local production, technology transfer for health products, global supply chain strengthening, regulatory enhancements, and a system for the timely sharing of pathogens and related benefits.
Delegates negotiated tirelessly for months to meet the May 2024 deadline. However, at the WHA77, it became evident that despite these efforts, consensus remained elusive, with several key issues unresolved.
What obstacles stand in the way of finalising the agreement?
A significant unresolved issue is the Pathogen Access and Benefit Sharing System (PABS). This system aims to ensure the timely sharing of pathogen samples and genetic information through a network of laboratories and databases, alongside the equitable sharing of benefits arising from their utilization. This system is considered as critical for pandemic preparedness and access to health technologies during emergencies.
While negotiators agree on the necessity of such a system, key design elements remain contested: how do countries rapidly share pathogen samples and data internationally? What kind of benefits should they receive if they commit to doing so? What obligations loom over the pharmaceutical industry as it develops life-saving countermeasures from these pathogens?
Concerns regarding access to vaccines, drugs, and other health technologies continue to be highly contentious as well. This encompasses debates on the degree to which Member States are willing to mandate private companies to transfer potentially valuable technology, their flexibility regarding intellectual property protection, and the role they intend to delegate to the WHO and other international entities.
Considering these deep divides and other priorities demanding political attention, experts have warned that one additional year of work might not be enough to bring these discussions to a close. The coming months will reveal if these challenges are surmountable.