After three years of intense negotiations in the aftermath of Covid-19, the World Health Assembly this week adopted a historic Pandemic Agreement. The agreement, only the second of its kind adopted by WHO’s governing body, sets out a comprehensive package of obligations for states to prevent, prepare for, and equitably respond to pandemics. Its adoption is not only a significant achievement for global health but is a signal that multilateralism, despite all odds, is alive and well.
The negotiations were not without controversy. Distrust resulting from the inequitable sharing of resources during the pandemic meant that there were often gaps between rich and poor countries. And outside the negotiating room, a small but vocal group of objectors spread disinformation about the agreement’s contents, including falsely claiming it would usurp state sovereignty. What the agreement does contain, however, is a roadmap for fighting pandemics. Here are its core obligations.
Pandemic prevention
Most emerging diseases are zoonotic (diseases transmitted from animals to humans), and nearly all recent novel outbreaks such as Ebola, mpox, and likely Covid-19 originated from zoonotic spillovers. The agreement therefore introduces obligations to prevent pandemics at their source via a One Health approach. States must develop multisectoral national plans including measures to identify and address the drivers of disease at the human-animal-environment interface. They must conduct surveillance and risk assessment of pathogens with pandemic potential. Measures directly addressing the drivers of disease emergence (including deforestation and climate change) are outside the agreement’s scope, but parties agree to consider them as they formulate their national plans.
Health system capacities
Covid-19 brought health systems and workers to breaking point. To avoid a future collapse, states commit to building resilient health systems with a focus on primary care, including strengthening their laboratory capacities and ensuring patients have equitable access to clinical care and routine essential health services. Health workers would also gain priority access to vaccines in a pandemic and enjoy decent work, equal pay, and protection from harassment.
Pandemic response products
The treaty talks were fundamentally initiated to address gross inequities in global access to pandemic response products (including vaccines, tests, and treatments) that characterised the pandemic. The agreement introduces a series of obligations to transform the model for accessing these lifesaving products from one reliant on charity to an equitable end-to-end development and distribution ecosystem.
That ecosystem begins with commitments by states to strengthen their regulatory capacities to ensure product safety and efficacy and accelerate approvals. States agree to strengthen their research and development (R&D) capacities and, significantly, to include provisions in their publicly-funded R&D agreements with manufacturers that promote equitable access to those products – a policy which would ensure that millions spent in public funding for R&D result in public benefit. Vaccine manufacturers are mostly concentrated in high-income countries, but a growing number of low- and middle-income countries have invested in vaccine production infrastructure enabling them to produce vaccines in large volumes. Through the agreement, states commit to build up sustainable and geographically distributed manufacturing capacities which could be scaled in an emergency – creating regionally distributed pockets of resilience to pandemic threats.
Linked to these obligations are commitments to promote or incentivise technology transfer – sharing the recipe for vaccines. Technology transfer emerged as a flashpoint in the negotiations, and the resulting commitments are couched in discretionary language because some high-income countries were highly protective of their industries’ proprietary technology. But the text still preserves states’ use of flexibilities under the TRIPS Agreement and policy space for compulsory measures where voluntary negotiations for technology transfer fail.
One of the agreement’s core contributions, and a major hurdle in the negotiations, is a new system facilitating greater access to pathogens and sequence information and the equitable sharing of benefits (like vaccines) that flow from their use (a PABS System). During pandemics, participating manufacturers would aim to provide 20% of their real time production (at least 10% as a donation and the rest at affordable prices) to WHO, pursuant to legally binding contracts, to distribute based on public health need. Operational aspects of the PABS System still need to be negotiated in an additional annex, without which the agreement cannot open for signature – tying the fate of the whole agreement to the success of those negotiations. And to coordinate the equitable distribution of products, it establishes a WHO-led global supply chain and logistics network and introduces new state obligations to avoid stockpiling and supply chain disruptions.
Cooperation and financing
Linked to these obligations are commitments to promote or incentivise technology transfer – sharing the recipe for vaccines.
The agreement introduces both a general obligation on interstate cooperation, particularly to support developing countries, and a commitment on sustainable financing. Failure to invest made the world vulnerable to Covid-19. Therefore, the agreement establishes a Coordinating Financial Mechanism charged with conducting a needs and gaps analysis of agreement implementation, maintaining a dashboard of available funding sources, and leveraging voluntary contributions. It, however, falls short of establishing a distinct fund or requiring state contributions to the mechanism.
Governance arrangements
The agreement establishes a Conference of the Parties – like those under international agreements on biodiversity and climate change – to meet regularly, develop additional guidelines, recommendations and protocols, and review the agreement’s functioning. These structures are essential to expanding the agreement’s normative framework, accountability, and maintaining high-level political commitment. But the agreement, like so many other multilateral treaties, takes a non-adversarial approach to compliance – choosing to facilitate implementation with support via an implementation committee rather than enforcing parties’ commitments with penalties or universal review.
Next steps
Now that the agreement is adopted, WHO Member States will embark on a process to negotiate the PABS annex by May next year. That instrument’s adoption will open the whole agreement for signature by governments, and once 60 governments sign on, the agreement will enter into force. But in the meantime, states can and must begin to finance and build the capacities required under the agreement. While the text could have been more ambitious in many areas, it nonetheless provides a firm foundation for action on pandemics. Implementing the agreement will take enormous political will from governments and buy-in from non-state actors. But failing to do so will leave us vulnerable when the next pandemic emerges.
