The Pandemic Pact

The gruelling race up to the WHO Pandemic Agreement kicked off in late 2021, when Member States agreed to draft and negotiate an international instrument to strengthen global pandemic prevention, preparedness and response. At its core, this agreement intends to help the world respond to the next pandemic in a more effective and equitable way, learning some of the lessons from 2020.

The WHO has introduced a similar agreement only once before in the WHO Framework Convention on Tobacco Control, adopted in 2003 to tackle smoking in the context of global public health.

The process of drafting and negotiating a new legally-binding WHO agreement is essentially the pinnacle of health diplomacy, something akin to the Olympics. Member States have put forward their best and brightest to take on the challenge as part of the Intergovernmental Negotiating Body (INB) – a team of negotiators from all regions of the world, putting years of training and networking to the ultimate test.

So how are our athletes doing? Since the establishment of the INB, we’ve seen Substantive Elements, a Working Draft, a Conceptual Zero Draft, a Zero Draft and countless revisions to the negotiating text of the WHO Pandemic Agreement. If that isn’t dizzying enough, add to the mix 100+ global leaders publicly calling for “urgent agreement”; 58 charities and health experts calling out EU and US politicians for “patent hypocrisy”; and countless far-right influencers and conspiracy theorists claiming the WHO is trying to control our bodies and privacy.

Despite down-to-the-wire negotiations, the INB failed to deliver the Agreement at the 77th WHA in May, where Member States were hoping to review and vote on it. The INB’s mandate has therefore been extended for up to a year, meaning negotiations can continue until the next WHA in May 2025, kicking the decision into the long grass.

This agreement intends to help the world respond to the next pandemic in a more effective and equitable way.

One hurdle in the negotiating process is the false narrative that the Agreement would give the WHO the power to control the actions of Member States. More than 100 influential global leaders (including Ban Ki-moon and Sir Tony Blair) signed a public letter addressed to Member States, taking a swipe at the false claims, outlining that “countries themselves have proposed this instrument, countries are negotiating it, and only countries will ultimately be responsible for its requirements and its success or failure”. This has done little to quell misinformation, with large, coordinated protests against the Agreement taking place outside of this year’s WHA.

Other hurdles include the disagreements over R&D (Article 9), the transfer of technology and know-how (Article 11) and pathogen access and benefit sharing (Article 12). This is where we see the greatest clashes between the Global North (countries like the US, Japan and EU Member States) and Global South (countries like South Africa, the Philippines and Brazil). The former is fiercely protecting Intellectual Property Rights for pandemic-related diagnostics, vaccines and medicines, while the latter is pushing for greater transparency, affordability and access to innovation in low- and middle-income countries (LMICs).

The proposed Pathogen Access and BenefitSharing (PABS) system is a major pressure point. During the pandemic, many LMICs shared pathogen samples and genetic sequence data, which helped companies in the Global North develop vaccines, medicines and other products to tackle the pandemic. Access to these products was delayed in many of countries that initially shared pathogen data, in part because supply was bought up by Global North countries. The PABS system would offer a potential solution, acting as a global platform to share data on new pandemic pathogens and fairly distribute any resulting innovation. It would be managed by the WHO and populated by Member States.

For LMICs and civil society groups, the PABS system is a non-negotiable pillar of health equity. In their eyes, it’ll make sure that Global South countries receive the benefits of collecting and sharing pathogen data that helps the rest of the world. Many high-income countries – which typically have a strong life sciences sector – have opposed the proposal. They feel that setting up a brand-new system to upload and share pathogen data will slow down the development of new treatments. From their perspective, data-sharing mechanisms already exist, and the Agreement should focus instead on ways to ringfence and deliver new treatments to LMICs.

Critics of the current draft Agreement worry that it won’t deliver on its promises – language has been dialled down, provisions have been removed or made voluntary, and monitoring and accountability structures remain unclear. With the pandemic now four years ago and no global agreement in place, experts fear that we will fall back into a pattern of “every country for themselves”, disproportionately favouring those with the money and power to respond to a future pathogen.

Critics of the current draft agreement worry it won't deliver on its promises.

Where will we land in the coming year? The INB faces some difficult compromises in the road ahead. The optimist hopes that they find middle ground, emerging with a joint gold in the health diplomacy Olympics. Without compromise, they are at high risk of missing the podium altogether.