Global pandemic treaty nears adoption, but key obstacle remains

A global agreement aimed at preparing for and responding to future pandemics is expected to be adopted May 20 at the annual meeting of the World Health Assembly, the main decision-making body of the World Health Organization, in Geneva. Countries are still discussing a key element of the treaty that allows for pathogen data to be exchanged with the pharmaceutical industry for therapeutics.

After more than 1,200 days of negotiations, Precious Matsoso, the South African cochair of the treaty’s Intergovernmental Negotiating Body, sees the consensus achieved in April for the pandemic treaty as an important achievement. “Today, the world has in its hands an agreement that was member state designed and led, reflecting their desire and commitment to make the world safer for pandemics,” she told journalists at WHO headquarters earlier this month.

“The principles of state sovereignty, human rights, international humanitarian law, equity, solidarity and of basing public health decisions on science and evidence are integral to the agreement,” said Tedros Adhanom Ghebreyesus, WHO director general. “The pandemic agreement shows that multilateralism is alive and well.”

With one issue in the agreement requiring further deliberation—that of pathogen access and benefit sharing (PABS)—the agreement will be “frozen in time” after its adoption on May 20, says Suerie Moon, codirector of the Global Health Centre in Geneva. According to the protocol, the treaty will be able to move forward for signature and ratification only after a yet-to-be-agreed annex on PABS is adopted by May 2026.

Treaty compromises emerge

In early 2021, when the European Union first proposed the bold idea of getting countries to work together to prevent future health emergencies, COVID-19 had already infected over 100 million people globally, and more than 2 million people had died from the virus SARS-CoV-2.

“Irrespective of the level of development, every country faced access issues,” says K. M. Gopakumar, senior researcher and legal adviser for the Third World Network, a Malaysia-based advocacy group. Yet inequities emerged. The US was angered by China’s lack of transparency regarding the origins of the virus, which had slowed the response, while lower-income countries called for “something in return” for providing pathogen data after experiencing delayed delivery of vaccines, he says. Lower-income countries wanted “to build a system based on mutual trust and cooperation. That is what is missing, and we need to fix it,” Gopakumar says.

But divisions soon emerged in the treaty negotiations. Richer countries stood firm on their position that any sharing of intellectual property for products such as vaccines be on a voluntary basis, while poorer countries felt that those terms did not amount to much.

In the end, member states found a compromise, affirming national sovereignty in public health decisions. On the divisive issue of the transfer of technology and know-how needed to produce pandemic-related health products, states agreed on a text allowing for the moves to be on “mutually agreed” terms, after higher-income countries rejected calls that transfers be mandatory.

Countries also recognized a whole-of-society, One Health approach in preparing for and tackling pandemics, understanding the connectedness between the environment, living species, and pandemics, including the risks of zoonotic spillovers from animals to humans.

But the trickiest issue of all in the talks was the PABS system, a platform allowing for pathogen data to be quickly shared with pharmaceutical companies, with the understanding that the resulting treatments, or benefits, would be shared with the countries providing the information. Lower-income countries had worried that giving access to the pathogens risked forfeiting their ability to receive vaccines and other treatments.

The agreement states that if the WHO declares a pandemic, the organization would be provided “real-time access” to 20% of the pandemic-health products made by industry, including 10% as a donation and 10% at affordable prices. The products, specifically designed or used to address a health crisis—such as vaccines, medications, and diagnostic tools—would then be distributed fairly and equitably.

According to Steven Solomon, the WHO’s principal legal officer, if member states adopt the PABS annex at the 2026 World Health Assembly, it may be another “year to year and a half” for the treaty to receive the required 60 ratifications by member states and come into force. For now, negotiators “really want to maintain momentum on this process and start quickly and effectively” to finalize the annex, he tells C&EN.

Tough access talks expected

But experts are expecting negotiations on the PABS annex to be challenging.

Gopakumar says the pharmaceutical industry has been “very inflexible,” and he expects it will continue to safeguard its interests—for example, by minimizing what benefits they share.

The pharmaceutical industry had feared that overregulation in an agreement could stifle innovation and hinder its ability to create the medicines and vaccines needed when a pandemic strikes. Responding in an email to questions on whether the industry was now satisfied with the agreement, David Reddy, director general of the International Federation of Pharmaceutical Manufacturers and Associations, the sector’s global lobbying group in Geneva, says, “It is essential that the experience of these companies is drawn upon so that their expertise can be mobilized.”

Industry know-how “includes how the Pathogen Access and Benefit System will work, where we must make sure that companies are able to access the pathogens and sequence information conditions to do so,” Reddy says. “Intellectual property protection and legal certainty are essential for the innovative-based pharmaceutical industry to invest in high-risk R&D and enable voluntary partnerships that we will need in the next pandemic.”

Gopakumar says more-robust guarantees were also needed to ensure the timely sharing of pandemic-related products with lower-income countries lacking local production. It wasn’t until 2 years after the WHO first declared mpox cases in Africa a public health emergency of international concern that the WHO was able to begin distributing to the continent a first batch of vaccines, which individual donor countries had already made available to 70 higher-income countries elsewhere.

Trump effect

Meanwhile, the US and its increasing pullback from international commitments is expected to loom over future pandemic response and preparedness more generally. Even before Donald J. Trump’s announcement to withdraw from the WHO, few expected the US, which in 2024 had contributed over $12 billion to global health initiatives, to ratify the pandemic treaty given its refusal to adopt a number of other recent international conventions. Related to the cutback in US support, Ghebreyesus announced last week that the organization is reducing its top leadership team from 10 to 4 in an effort to trim spending.

Tom Frieden, a former director of the US Centers for Disease Control and Prevention (CDC) and current president and CEO of health nongovernmental organization Resolve to Save Lives, says the US withdrawal from the WHO “would forfeit our seat at the negotiating table.”

Moon says, however, that even with the US exiting the WHO, “the possibility remains open” for nonstate actors such as US pharmaceutical companies and universities to access pathogen data under the treaty’s PABS principles. Theoretically, she said, private contracts may be signed through the WHO that fulfill the obligations, including fair pricing to lower-income nations. “It gets legally complicated but remains a possibility.”

But the recent decision by the US to ban the CDC from communicating with the WHO, as well as the pressure the Trump administration could put on private universities to not cooperate internationally, may “complicate” any such cooperation, Moon warned.

A first step

Even as international aid funding from the US and other donors drops, Moon underscores the pandemic treaty’s requirement that countries increase, or at least maintain, pandemic preparedness investment domestically. “They cannot move backwards, in terms of national investment,” she says. “That’s a great thing.”

With work still required before countries begin to ratify the treaty, Gopakumar says flexibility among the parties will be key. “Who will blink first? You need to work a lot to translate this into something concretely deliverable.”

Matsoso, the treaty’s negotiation cochair, agrees: “This is only the beginning, a first step, but a very important step. We only claim victory when we know that we are better prepared, and then we can prevent infectious diseases from spreading.”