At 3am on Wednesday 16th April 2025, after three years of intense negotiations, WHO member states (minus the United States) preliminarily consented to a final text of the so-called Pandemic Agreement. The text will now be considered for final adoption at the upcoming World Health Assembly meeting in May 2025, where – barring any major upsets – it is expected to be adopted. At a time when global news is replete with breakdowns in multilateralism and the ripping up of international law rulebooks, this decisive step towards a new accord on pandemic prevention and response has been hailed by the WHO Director-General as a reminder that “multilateralism is alive and well”, demonstrating that “in our divided world, nations can still work together to find common ground, and a shared response to shared threats”. This blog post provides some reflections on the ostensible achievements of the Pandemic Agreement and the main sticking points raised until the final hours of negotiation.
INB negotiations
The mandate of the Intergovernmental Negotiating Body (INB), set at a December 2021 special session of the World Health Assembly, was to “draft and negotiate a convention, agreement or other international instrument, under the WHO Constitution, to strength pandemic prevention, preparedness and response” (Decision SSA2(5), para. 1(1)). This was at the height of the COVID-19 pandemic, and whilst subsequent developments (such as the Russian invasion of Ukraine and the Israeli offensive in Gaza) somewhat overtook public attention, the INB continued to meet under an “inclusive Member State led process” in thirteen separate sessions from February 2022 to April 2025 to formulate a draft text.
Early working drafts, such as the July 2022 draft, already alluded to issues of common concern, including incorporating WHO accountability mechanisms, a ‘One Health’ approach that acknowledged human-animal interfaces, and the all-important question of equitable access and solidarity. The final text agreed by the INB contains several innovations, including provisions for the training of a “global health emergency workforce” (article 7), a new pathogen access and benefit sharing system (PABS, article 12) to promote timely development of vaccines, a logistics network for global supply chains around vaccines and related products (GSCL Network, article 13), and a financing facility that would respond to the needs of developing countries (article 20). Issues which have been recurring sticking points for decades, including pathogen sharing, but also technology transfer, continued to attract considerable debate during these negotiations and I discuss these as well as other notable aspects of the agreement below.
Key aspects of the Pandemic Agreement
The final text seeks to build on the existing global health architecture – notably the revised International Health Regulations (2005) and its most recent amendments from 2024. The WHA already noted in 2021 the “need for coherence and complementarity between the process of developing the new instrument and the ongoing work […] in regard to implementing and strengthening of the IHR (2005)” (Dec 2021 WHA res). The final text attempts to secure such coherence and complementarity in several ways. By article 2, the agreement’s objective “guided by equity and principles set further herein, is to prevent, prepare for and respond to pandemics”. This is to be achieved by a number of mechanisms, including the aforementioned PABS and health workforce. By article 4, parties are also to cooperate to “progressively strengthen pandemic prevention and surveillance measures and capacities” in line with the IHR (2005), whilst “taking into account national capacities and national and regional circumstances”.
The existing pandemic risk management architecture, already promoted in the amended IHR last year, was also to be further integrated through “coordinated multi-sectoral surveillance to detect and conduct risk assessment of emerging and re-emerging pathogens with pandemic potential” (article 4(2)(c)), including through early detection, immunization, laboratory management and “facilitating affordable and equitable access to antimicrobials” (article 4(2(j)).
Resilience measures also feature more prominently in the agreement than in previous global health instruments. This appears to respond to the wish to balance the focus on vertical health interventions such as immunization programs and building healthcare infrastructures domestically. Article 6 thus obliges each state “within the means and resources at its disposal [to] take appropriate measures to develop, strengthen and maintain a resilient health system, particularly primary health care, for pandemic prevention, preparedness and response”. A clear theme throughout the text is the reference to differential resources and circumstances among states, and whilst this is visible in the final wording, it also directed negotiations much as it had done in relation to the IHR amendment process and previous global health discussions around the PIP Framework.
Equity, solidarity and North/South fault-lines
UN organisations such as UNAIDS and other stakeholders welcomed the final text as “an agreement with human rights at its heart, prioritizing community engagement and whole-of-society and whole-of-government approaches to pandemic preparedness, prevention and response”. This is reflected in parties’ commitment to be guided by “full respect for the dignity, human rights and fundamental freedoms of all persons” (article 3(2)) as well as article 17 on integrated, multi-sectoral coordination at the domestic level. One clear win for developing states in this respect is that “participating manufacturers” will be obliged to donate 10% of their medical products (vaccines, but also therapeutics and diagnostics) to WHO in the event of a pandemic, with another 10% to be offered for purchase at “affordable prices” (article 12(6)(a)). This adopts (with some changes) a mechanism introduced by the ill-fated COVAX Facility during the COVID-19 pandemic and offers a developing countries more timely access to vaccines than was possible via COVAX, and at low cost.
Nevertheless, demands for equitable access largely fell along established North/South lines and further equity demands by developing countries were not met. This, despite the agreement’s acknowledgment of the “inequities at national and international level [vaccine-hoarding and PPE export bans] that hindered timely and equitable access to health products to address coronavirus disease” (specifically by developed states). In the final text, failure to live up to the equitable aspirations of the agreement were visible in the provisions on technology transfer. As in previous global health negotiations around this issue, this remained a bone of contention throughout negotiations and the final text “falls short of what developing countries called for” (see Becker Lorca (2023)). They had demanded that the transfer of technologies assisting in pandemic preparedness and response be compulsory for ‘technology holders’, i.e. developed states. By contrast, developed states, including Germany, argued that technology transfer should remain voluntary to incentivize private innovation and investment. The final text of article 11 requires that states “promote and otherwise facilitate or incentivize, transfer of technology as mutually agreed, including transfer of relevant knowledge, skills, technical expertise, and cooperation or any other related know-how for production of pandemic-related health products, in particular for the benefit of developing countries”. The term “as mutually agreed” was so controversial – effectively confirming the need for developing states’ consent – that it warranted a footnote defining the term as meaning “willingly undertaken and on mutually agreed terms, without prejudice to the rights and obligations of the Parties under other international agreements”. It is unclear whether such a provision, which embeds once more the uneasy balance between Global North and Global South states, will facilitate more local production of vaccines during any future pandemic. The agreement is careful to reaffirm existing intellectual property rights and parties’ “right to use, to the full, the TRIPS Agreement and the Doha Declaration” (article 11(4)) (on which previously, see Grosse-Ruse Khan 2020).
The drafters were also not unaware of the wider political reality of the negotiations. Despite offering an example of rare multilateralism, the agreement reiterates in its first preambular paragraph (and affirmed as a principle in article 3(1)) that “States bear the primary responsibility for the health and well-being of their peoples”. Already in 2021, WHO affirmed that “nothing in the draft agreement shall be interpreted as providing WHO any authority to direct, order, alter or prescribe national laws or policies, or mandate States to take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns”. This reassurance took on renewed significance after January 2025. On the day of his second inauguration, President Donald Trump withdrew the United States from WHO, reducing the annual budget by US $1 Billion and already giving rise to austerity proposals for the organisation amounting to $600 Million, putting WHO’s ongoing activities and future programmes of work at risk. This nod to state sovereignty might therefore be seen as an effort to forestall additional withdrawals or assuage the fears of governments sympathetic to Trump’s vision of world order (or disorder).
To be sure, formal adoption of the Agreement at the 78th WHA in May will not spell the end of discussions around the scope and implications of this new accord. There were many occasions on which negotiations seemed likely to break down entirely, particularly over the issue of technology transfer and pathogen access. That the INB was able to reach consensus on a final text at a time of such upheaval attests to the willingness of parties (particularly developing states) to accept certain clauses through gritted teeth. Only a future ‘pandemic emergency’ – hopefully a long way off – will be the true diagnostic tool for the feasibility and effectiveness of the new mechanisms built into the Pandemic Agreement.
The WHO Pandemic Agreement: Equity for Developing States or Business as Usual?
Written by Richard ClementsAt 3am on Wednesday 16th April 2025, after three years of intense negotiations, WHO member states (minus the United States) preliminarily consented to a final text of the so-called Pandemic Agreement. The text will now be considered for final adoption at the upcoming World Health Assembly meeting in May 2025, where – barring any major upsets – it is expected to be adopted. At a time when global news is replete with breakdowns in multilateralism and the ripping up of international law rulebooks, this decisive step towards a new accord on pandemic prevention and response has been hailed by the WHO Director-General as a reminder that “multilateralism is alive and well”, demonstrating that “in our divided world, nations can still work together to find common ground, and a shared response to shared threats”. This blog post provides some reflections on the ostensible achievements of the Pandemic Agreement and the main sticking points raised until the final hours of negotiation.
INB negotiations
The mandate of the Intergovernmental Negotiating Body (INB), set at a December 2021 special session of the World Health Assembly, was to “draft and negotiate a convention, agreement or other international instrument, under the WHO Constitution, to strength pandemic prevention, preparedness and response” (Decision SSA2(5), para. 1(1)). This was at the height of the COVID-19 pandemic, and whilst subsequent developments (such as the Russian invasion of Ukraine and the Israeli offensive in Gaza) somewhat overtook public attention, the INB continued to meet under an “inclusive Member State led process” in thirteen separate sessions from February 2022 to April 2025 to formulate a draft text.
Early working drafts, such as the July 2022 draft, already alluded to issues of common concern, including incorporating WHO accountability mechanisms, a ‘One Health’ approach that acknowledged human-animal interfaces, and the all-important question of equitable access and solidarity. The final text agreed by the INB contains several innovations, including provisions for the training of a “global health emergency workforce” (article 7), a new pathogen access and benefit sharing system (PABS, article 12) to promote timely development of vaccines, a logistics network for global supply chains around vaccines and related products (GSCL Network, article 13), and a financing facility that would respond to the needs of developing countries (article 20). Issues which have been recurring sticking points for decades, including pathogen sharing, but also technology transfer, continued to attract considerable debate during these negotiations and I discuss these as well as other notable aspects of the agreement below.
Key aspects of the Pandemic Agreement
The final text seeks to build on the existing global health architecture – notably the revised International Health Regulations (2005) and its most recent amendments from 2024. The WHA already noted in 2021 the “need for coherence and complementarity between the process of developing the new instrument and the ongoing work […] in regard to implementing and strengthening of the IHR (2005)” (Dec 2021 WHA res). The final text attempts to secure such coherence and complementarity in several ways. By article 2, the agreement’s objective “guided by equity and principles set further herein, is to prevent, prepare for and respond to pandemics”. This is to be achieved by a number of mechanisms, including the aforementioned PABS and health workforce. By article 4, parties are also to cooperate to “progressively strengthen pandemic prevention and surveillance measures and capacities” in line with the IHR (2005), whilst “taking into account national capacities and national and regional circumstances”.
The existing pandemic risk management architecture, already promoted in the amended IHR last year, was also to be further integrated through “coordinated multi-sectoral surveillance to detect and conduct risk assessment of emerging and re-emerging pathogens with pandemic potential” (article 4(2)(c)), including through early detection, immunization, laboratory management and “facilitating affordable and equitable access to antimicrobials” (article 4(2(j)).
Resilience measures also feature more prominently in the agreement than in previous global health instruments. This appears to respond to the wish to balance the focus on vertical health interventions such as immunization programs and building healthcare infrastructures domestically. Article 6 thus obliges each state “within the means and resources at its disposal [to] take appropriate measures to develop, strengthen and maintain a resilient health system, particularly primary health care, for pandemic prevention, preparedness and response”. A clear theme throughout the text is the reference to differential resources and circumstances among states, and whilst this is visible in the final wording, it also directed negotiations much as it had done in relation to the IHR amendment process and previous global health discussions around the PIP Framework.
Equity, solidarity and North/South fault-lines
UN organisations such as UNAIDS and other stakeholders welcomed the final text as “an agreement with human rights at its heart, prioritizing community engagement and whole-of-society and whole-of-government approaches to pandemic preparedness, prevention and response”. This is reflected in parties’ commitment to be guided by “full respect for the dignity, human rights and fundamental freedoms of all persons” (article 3(2)) as well as article 17 on integrated, multi-sectoral coordination at the domestic level. One clear win for developing states in this respect is that “participating manufacturers” will be obliged to donate 10% of their medical products (vaccines, but also therapeutics and diagnostics) to WHO in the event of a pandemic, with another 10% to be offered for purchase at “affordable prices” (article 12(6)(a)). This adopts (with some changes) a mechanism introduced by the ill-fated COVAX Facility during the COVID-19 pandemic and offers a developing countries more timely access to vaccines than was possible via COVAX, and at low cost.
Nevertheless, demands for equitable access largely fell along established North/South lines and further equity demands by developing countries were not met. This, despite the agreement’s acknowledgment of the “inequities at national and international level [vaccine-hoarding and PPE export bans] that hindered timely and equitable access to health products to address coronavirus disease” (specifically by developed states). In the final text, failure to live up to the equitable aspirations of the agreement were visible in the provisions on technology transfer. As in previous global health negotiations around this issue, this remained a bone of contention throughout negotiations and the final text “falls short of what developing countries called for” (see Becker Lorca (2023)). They had demanded that the transfer of technologies assisting in pandemic preparedness and response be compulsory for ‘technology holders’, i.e. developed states. By contrast, developed states, including Germany, argued that technology transfer should remain voluntary to incentivize private innovation and investment. The final text of article 11 requires that states “promote and otherwise facilitate or incentivize, transfer of technology as mutually agreed, including transfer of relevant knowledge, skills, technical expertise, and cooperation or any other related know-how for production of pandemic-related health products, in particular for the benefit of developing countries”. The term “as mutually agreed” was so controversial – effectively confirming the need for developing states’ consent – that it warranted a footnote defining the term as meaning “willingly undertaken and on mutually agreed terms, without prejudice to the rights and obligations of the Parties under other international agreements”. It is unclear whether such a provision, which embeds once more the uneasy balance between Global North and Global South states, will facilitate more local production of vaccines during any future pandemic. The agreement is careful to reaffirm existing intellectual property rights and parties’ “right to use, to the full, the TRIPS Agreement and the Doha Declaration” (article 11(4)) (on which previously, see Grosse-Ruse Khan 2020).
The drafters were also not unaware of the wider political reality of the negotiations. Despite offering an example of rare multilateralism, the agreement reiterates in its first preambular paragraph (and affirmed as a principle in article 3(1)) that “States bear the primary responsibility for the health and well-being of their peoples”. Already in 2021, WHO affirmed that “nothing in the draft agreement shall be interpreted as providing WHO any authority to direct, order, alter or prescribe national laws or policies, or mandate States to take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns”. This reassurance took on renewed significance after January 2025. On the day of his second inauguration, President Donald Trump withdrew the United States from WHO, reducing the annual budget by US $1 Billion and already giving rise to austerity proposals for the organisation amounting to $600 Million, putting WHO’s ongoing activities and future programmes of work at risk. This nod to state sovereignty might therefore be seen as an effort to forestall additional withdrawals or assuage the fears of governments sympathetic to Trump’s vision of world order (or disorder).
To be sure, formal adoption of the Agreement at the 78th WHA in May will not spell the end of discussions around the scope and implications of this new accord. There were many occasions on which negotiations seemed likely to break down entirely, particularly over the issue of technology transfer and pathogen access. That the INB was able to reach consensus on a final text at a time of such upheaval attests to the willingness of parties (particularly developing states) to accept certain clauses through gritted teeth. Only a future ‘pandemic emergency’ – hopefully a long way off – will be the true diagnostic tool for the feasibility and effectiveness of the new mechanisms built into the Pandemic Agreement.
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