WHO member states seal historic pandemic treaty

For the first time since the landmark Framework Convention on Tobacco Control in 2003, the World Health Organization (WHO) has agreed to a new legally-binding treaty. On May 20th, the 78th World Health Assembly (WHA) adopted the WHO Pandemic Agreement, a blueprint meant to prevent another Covid-scale catastrophe and to correct the inequities that marred the last one.

WHO Director-General Tedros Adhanom Ghebreyesus addresses the 78th World Health Assembly in Geneva, Switzerland.

How we got here

Negotiations began in December 2021, during the peak of the variant Omicron, when governments convened a special WHA to plug the gaps exposed by Covid-19. Over 13 formal negotiating rounds, many of them overnight marathons, delegates hammered out text that was approved in Committee A yesterday (124 in favour, 0 against, 11 abstentions) and sailed through plenary this morning.

The United States, whose new administration stepped back from the talks three months ago, neither opposed nor participated in today’s vote. That absence, however, did little to slow momentum as 173 countries queued to speak in support, from South Africa to Switzerland.

Why it matters

Covid-19 killed more than seven million people and erased an estimated $10 trillion from the global economy. “It seems somebody switched the price tags on what is truly valuable,” WHO director-general Tedros Adhanom Ghebreyesus told ministers, noting that WHO’s entire biennial core budget, US$4.2 billion, is less than the world spends on defense every eight hours.

“The agreement is a victory for public health, science and multilateral action.”
— Dr Tedros Adhanom Ghebreyesus, WHO director-general

Whether the treaty can correct that imbalance depends on the months ahead: high income countries must resist protecting pharmaceutical monopolies; low- and middle-income countries (LMICs) must invest in labs, supply chains and data-sharing. And the United States, still the world’s largest research funder, will eventually have to decide whether to join or watch from the sidelines.

Even with these caveats, global health veterans deemed Tuesday’s vote a watershed. “The next pandemic is not a question of if but when,” said Namibia’s health minister Esperance Luvindao, who chaired the committee vote. “This accord gives us a fighting chance.”

“For the Americas this means no more oxygen shortages and no more vaccine queues dictated by wealth.”
— Jamaica, on behalf of 22 Latin American and Caribbean states

Experts at the London School of Hygiene & Tropical Medicine have warned that the treaty includes “no firm commitments to new, long-term funding streams,” raising concerns that LMICs may be left to foot the bill. Civil society networks, including the Pandemic Action Network, are urging governments to proactively communicate the treaty’s benefits and counter disinformation campaigns, many of them originating in the United States, that portray the accord as a power grab by the WHO.

What the treaty does

Countries commit to beefing up primary care, protecting healthcare workers and shoring up surveillance that links human, animal and environmental health, the first One Health obligation ever written into an international treaty. The treaty outlines several foundational commitments designed to strengthen preparedness, improve equity and ensure faster and more effective responses to future pandemics.

Equitable access and countermeasures

The Pathogen Access and Benefit Sharing (PABS) system aims to establish a mechanism ensuring that countries sharing information on potentially pandemic-causing pathogens receive fair benefits if pharmaceutical products, such as vaccines or treatments, are developed as a result. Under the new PABS scheme, manufacturers will be required to reserve 20% of their real-time production of vaccines, diagnostics, and therapeutics for WHO allocation during a pandemic, half as donations, and half to be sold at affordable prices. While the principle has been agreed upon, the detailed annex outlining how the system will work must still be negotiated by May 2026. “Time-bound waivers or other flexibilities” on intellectual property barriers aiming at moving know-how and production facilities to regional hubs in Africa and Latin America will probably encounter resistance from the pharmaceutical industry.

Global supply chain and logistics (GSCL) network

The WHO will establish a network to move raw materials and finished pandemic-related products, vaccines, diagnostics, and therapeutics quickly and equitably across borders, removing trade and regulatory bottlenecks. The concept builds on the emergency air-bridge the WHO ran for PPE in 2020, but with a broader mandate and a standing structure.

Funding pledges

States pledge to “mobilise additional financial resources” and to establish a coordinating financial mechanism without providing details on the amount needed. Critics warn that without dedicated funding the treaty risks becoming “an unfunded mandate”.

Respect for sovereignty

To counter a wave of misinformation, Article 3 spells out that nothing in the agreement empowers the WHO to order lockdowns, vaccine mandates or border closures. “No country, however powerful, can address a global health crisis alone,” said France’s ambassador Anne-Claire Amprou.

Who pushed it across the line

The Africa Group, led by South Africa’s health minister Aaron Motsoaledi, called the 20% access guarantee “a positive first step” toward redressing past injustices, such as South Africa’s early sharing of Covid-19 sequence data only to face travel bans and slow vaccine deliveries.

Even countries with strong pharmaceutical interests like Germany and Switzerland wanted tougher language on prevention but ultimately backed the deal with Bern emphasising the text’s “pragmatic, voluntary approach” for industry.

The European Union lauded the agreement for embedding One Health and urged members to carry the same “political will” into the PABS annex negotiations. Surprisingly, Hungary, which has been aligned with Washington in the international arena, also voted yes, as it didn’t see the treaty jeopardizing its sovereignty.

Memories of oxygen shortages and overwhelmed hospitals, had small island and Caribbean states arguing for faster regional manufacturing capacity.

What happens next

An intergovernmental working group (IGWG) will draft rules for sharing pathogen samples and distributing the benefits. Observers expect lengthy negotiations, especially over intellectual property terms and how to assign value to genomic data.

Once the annex is adopted, the treaty will open for signature. It will enter into force after 60 countries ratify it, with additional countries able to join later through accession.

The IGWG will also be responsible for launching the GSCL network and designing the coordinating financial mechanism. Legal teams will draft procedures for the Conference of the Parties, including budgets and compliance reporting. Still under discussion is the creation of an independent body to monitor and enforce obligations.