After three years of negotiations, the Pandemic Agreement has been adopted by the World Health Assembly – a step on the road to ratification by World Health Organization (WHO) member states. This should be cause for celebration, and credit must be given to the host of diplomats and public health officials that have worked tirelessly to get to this consensus text. Indeed, the director of the WHO said it was a ‘victory for public health, science and multilateral action’.
Yet the final text steers away from binding commitments on all the most critical and contested issues: equitable access to medical countermeasures like vaccines, diagnostic equipment and protective gear; sustainable financing for pandemic preparedness and response; and enforceable accountability mechanisms.
Instead, the agreement is an outcome that colleagues and I feared: the agreement fails to confront or correct the underlying inequalities and inefficiencies that defined the global response to COVID-19. The text offers few concrete obligations that would meaningfully shift the structural dynamics of global health inequity, relying instead on political rhetoric and aspirational language.
Governments’ national security priorities have outweighed the clear need for improved global health cooperation, leaving an agreement that gestures towards equity, solidarity and cooperation, but stops short of demanding it.
Failing on equitable access
The negotiation process leading up to the agreement has required a considerable investment of time, technical expertise, diplomatic effort, and financial resources – a conservative estimate would put this over $200 million.
This has included years of consultations, drafting, and negotiations involving experts, national delegations, and (to a lesser extent) civil society. Yet despite these substantial inputs, the output falls far short of the transformational ambition initially set out.
Equity, positioned early in the process as a guiding principle of the treaty, has been severely diluted. The clearest example is the treatment of pathogen access and benefit-sharing (PABS) – one of the most politically fraught elements of the negotiations.
PABS involves establishing a mechanism to share pathogens, and the countermeasures (for example, vaccines) developed from them. Such a mechanism was a central topic of discussion throughout, pushed by Global South countries seeking a more secure route to access affordable health products in future pandemics. Many such countries are still suffering the impact of vaccine inequalities during COVID-19.
But the final agreement fails to enshrine clear or binding guarantees. Instead, key provisions on PABS have been deferred to a future annex, which is to be negotiated over the next year: many believe it will take substantially longer.
This delays critical decisions for several more years, and introduces substantial uncertainty: the agreement will not be open for signatories or ratification until the annex is agreed, effectively placing the fate of the entire agreement, and three years of work, in limbo.
Loss of momentum on ratification
Even in its flawed condition, ratification of the agreement by 60 signatory countries – needed for it to have any effect – also seems far off. When the process for negotiating the agreement began, COVID-19 was still ravaging populations across the world, and a policy window to agree meaningful international cooperation seemed open. Since then, however, political enthusiasm has waned. Geopolitical tensions, along with domestic political constraints, particularly associated with the rise of populism, may stall momentum.
In many countries, elected officials are reluctant to reopen discussions around pandemic policy, which remains unpopular with constituents who are eager to move on. Moreover, the negotiations have been subject to significant lobbying by the pharmaceutical industry, something which will surely continue during the annex process, and ratification. As a result, some governments are minimally engaged with the process, leaving it to bureaucrats. It remains to be seen who is willing to expend political capital to advance ratification, and how this might change over time.
Implementation
Even if the agreement does eventually enter into force, significant questions remain about its implementation. There has been little public or expert discourse about what countries will be required to do in practical terms to comply with the treaty.
Given the vagaries of the legal text, obligations are also subject to significant interpretation by each potential signatory country. Without a clear and coordinated implementation plan, the agreement risks becoming symbolic rather than substantive.
Many of the operational requirements are politically sensitive and expensive: these include One Health – collaboration across animal, health and environmental sectors to prevent disease spill-over; developing geographically diverse capacity for research and development; and building resilient health systems. In the absence of serious planning or budget commitments, it is difficult to imagine how the agreement’s provisions would translate into meaningful change at the national level.
