News
By Karolin Seitz and Jens Martens
From May 19 to 27, 2025, States meet in Geneva for the 78th World Health Assembly (WHA). The central topic on the meeting’s agenda is the pandemic treaty. Governments want to use it to learn lessons from COVID-19 and be better equipped to prevent, prepare for, and respond to future pandemics. After three years of intensive negotiations, governments agreed on the draft text of the treaty on April 16, 2025. WHO Director-General Tedros Adhanom Ghebreyesus praised the agreement as a success of multilateralism and "historic" in the fight against pandemics.
However, it was not clearly communicated that the pandemic treaty would not be ready for signature and ratification after the 78th WHA. Although the governments were able to agree on a document comprising 37 articles and 32 pages, one key element is still missing: the system for regulating fair Pathogen Access and Benefit-Sharing (PABS). An agreement is urgently needed here to ensure that low-income countries are not once again left empty-handed when it comes to vaccine distribution in the event of a future pandemic or only receive delayed access to essential medical products such as vaccines, diagnostics, and therapeutics.
As governments have not yet been able to agree on the PABS system, the preliminary agreed text will be adopted at the WHA in May 2025 but will not be ready for ratification yet. An accompanying resolution sets out the modalities of the further negotiation process, including the establishment of a new intergovernmental working group (INB) and a timetable. Only once the States have reached a consensus on the PABS system will the current text be adopted by the WHA together with the annex as a complete package and then ratified by the contracting States. As soon as 60 States have ratified the agreement, it enters into force.
Right from the beginning, the timetable for the negotiations was ambitious in view of the very large divergence of interests and the complexity of the issue. Originally, the adoption of the agreement was already planned for the 77th WHA in May 2024, but had to be postponed due to a lack of consensus. Following the USA announcing its withdrawal from the WHO, the INB Co-Chairs and the WHO Secretariat urged the remaining 193 WHO Member States to quickly reach a provisional agreement. Estimates of how long further negotiations on the PABS system will take vary widely, ranging from six months to four years.
In parallel to the negotiations on a pandemic treaty, the International Health Regulations (IHR) were revised and, surprisingly, adopted during the 77th WHA. The IHR form the basis under international law for combating cross-border infectious diseases, but proved to be inadequate during the COVID-19 pandemic. In the absence of a pandemic treaty, the IHR are currently the only basis for action for international cooperation in the event of a pandemic. According to many health experts, the added value of a pandemic agreement compared to the IHR ought to lie in the fact that the agreement should go beyond the IHR in terms of its thematic scope and also address, for example, equitable access to medical products.
Is the world now better equipped against pandemics?
The central question following the provisional agreement on the treaty text is whether the world is better positioned than before to prevent and respond to future pandemics.
The actual effectiveness of the planned measures for responding to pandemics will ultimately be measured by the successful handling of a new pandemic. However, it would be better for a new pandemic not to occur in the first place. This would prove the planned prevention measures to be effective.
This is precisely where the agreement is not well positioned. After all, mandatory measures to combat the underlying causes of the development of zoonotic diseases would be the best way to prevent a pandemic. These include, for example, combating climate change, deforestation, and intensive mass animal farming, and promoting agroecology. After all, by taking the One Health approach into account for the first time in an international agreement, the understanding of prevention is not limited to "surveillance" of pandemics. The One Health approach looks at the entire ecosystem and calls for the interplay between human, animal, and environmental health to be taken into account. Even though the text of the agreement recognizes ecological, climatic, social, and economic factors as drivers of pandemics, it remains vague on how the One Health approach should be implemented in concrete terms.
Ensuring that all countries have timely and equitable access to the necessary vaccines, medicines and diagnostics would be the best way to contain an infectious agent at an early stage and prevent it from growing into a pandemic in the first place. But here, too, the agreement has major weaknesses. According to the Third World Network, it does not meet its core objective of preventing pandemics.
The countries of the Global North, including the EU in particular, insisted on their position of not suspending intellectual property rights in the event of a pandemic and not obliging pharmaceutical companies to provide timely and fair access to pandemic-related medical products. In doing so, they continue to prioritize the interests of the pharmaceutical industry over people's health.
Everything remains voluntary
Overall, the agreement provides for hardly any binding measures for the signatory States, neither when it comes to collecting and sharing scientific data and information on pathogens, a core demand of the countries of the Global North, nor where access to important medical products and technologies in the event of a pandemic, a core demand of the countries of the Global South, is concerned. Most of the requirements for countries have been weakened by additions such as "where appropriate", "in accordance with national law", or "subject to available resources and applicable law".
As mentioned, the transfer of technology and knowledge is also to be promoted primarily on a voluntary basis. In the final hours of negotiations in April 2025, the countries from the Global North, led by the EU, suddenly vehemently insisted that the new phrase "as mutually agreed" be inserted in every reference to technology transfer. A diplomat from a government in the Global South told the Geneva Health Files information portal: "It seems that the industry woke up and called the G7 countries over the weekend." The term "as mutually agreed" is defined in a footnote as: "For the purposes of this agreement, ‘as mutually agreed’ means willingly undertaken and on mutually agreed terms, without prejudice to the rights and obligations of the Parties under other international agreements". However, according to Ellen 't Hoen, a lawyer and expert on pharmaceutical and intellectual property rights, the footnote can be understood to mean that governments can take other measures to enable technology transfer if there is no willingness to "mutually agree".
The German government's wish to include the word "voluntary" in addition to the phrase "as mutually agreed" – a demand repeatedly voiced by the pharmaceutical lobby – did not prevail in the negotiations. Restricting technology transfer to purely voluntary agreements would possibly have meant that States would no longer have been able to use existing legal frameworks to require companies to transfer technology under certain conditions.
For example, the 2021 agreements of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) of the World Trade Organization (WTO) grant certain flexibilities in patent protection for the protection of public health. The text of the agreement requires the contracting States to respect these flexibilities of the TRIPS agreements. With this provision, however, the agreement is far from the demand of civil society groups and the countries of the Global South for a TRIPS waiver. Such a waiver would have made it possible to temporarily suspend patent protection for relevant vaccines, medicines, diagnostics, and medical devices in the event of a pandemic.
The only obligation for the signatory States is that they develop policies on provisions in publicly funded research and development projects with companies and public-private partnerships that promote timely and equitable access to pandemic-related medical supplies. Whether this should be made possible, for example through licensing to manufacturers in countries of the Global South, is left to the States.
A few regulations on the PABS system are already included in the current text of the agreement. For example, in the event of a pandemic, companies participating in the system will be obliged to make 20 percent of their pandemic-related medical products available to the WHO. Ten percent of this is to be donated to the WHO and, depending on the nature and capacity of the manufacturer, a further ten percent is to be offered at a reduced price. However, as participation in the PABS system is voluntary for companies, this requirement is ultimately only a voluntary commitment.
The countries of the Global South see the additional time for negotiations on the PABS system as an opportunity to focus on regulations that will guarantee timely and equitable access to medical goods.
A few positive elements
Civil society organizations, such as Médecins Sans Frontières, also see some positive achievements in the text of the agreement, including agreements on the protection of health workers, the prioritization of people in humanitarian emergencies, and the promotion of transparency in government procurement contracts with manufacturers of pandemic-related health goods. In addition, States should avoid excessive stockpiling of medicines and vaccines and make provisions for a portion of national procurement to support countries in the Global South. However, as mentioned, it is up to the States themselves to decide whether or not to implement these recommendations.
Another positive aspect the text of the agreement bears is the role assigned to healthcare systems. A separate article mentions that States should strengthen their healthcare systems and ensure their functioning in the event of a pandemic.
Finally, a Global Supply Chain and Logistics Network is to be created to replace the multi-stakeholder initiative Access to COVID-19 Tools Accelerator (ACT-A). ACT-A was set up during the COVID-19 pandemic to coordinate the distribution of vaccines, but fell far short of its distribution goals and was criticized for its governance, lack of transparency, and conflicts of interest. In contrast to ACT-A, the new network is to be developed and coordinated by the WHO in full consultation with the contracting parties.
Questions regarding the implementation of the agreement remain unanswered
The agreement will enter into force one month after 60 countries have ratified it. In order to monitor the implementation of the agreement and, if necessary, reach additional agreements, the contracting parties are to meet regularly at a Conference of the Parties (COP). The first COP is to take place one year after the agreement comes into force. However, it is still unclear what the relationship between the COP and the WHA should look like, for example with regard to reporting obligations, and how a further parallel structure can be avoided in the already highly fragmented global health governance. Furthermore, it has not yet been determined what role the WHO, including its emergency program, should play in the implementation of the agreement.
A Coordinating Financial Mechanism is planned to support financing the implementation of the agreement. The Board of the Pandemic Fund, which is based at the World Bank, had (successfully) urged that no further fund be created as part of the pandemic agreement and asked for it to serve as the financing mechanism for the agreement. The fund has been criticized for failing to involve the countries of the Global South, the dominance of large donors, and its lack of accountability to the WHA, among other things. Ultimately, the States agreed that the new financing mechanism should not raise its own funds, but only identify financing gaps and potential sources of funding and develop financing strategies. It is also intended to help leverage voluntary contributions for other financing instruments, such as the pandemic fund.
Massive WHO funding crisis overshadows agreement on pandemic treaty
The US government's announcement to withdraw from the WHO and to no longer pay its contributions for 2025 has led to a funding crisis at the WHO. The USA is the WHO's largest donor. It was responsible for financing more than 20 percent of the budget. In order to avert the WHO's insolvency, massive job cuts are currently being made, units are being merged, the budget is being cut from USD 5.3 billion to USD 4.2 billion, and relocations to more cheaper cities and a re-prioritization of functions are being considered.
Against this backdrop, the expected agreement of the remaining Member States during the 78th WHA to increase their assessed contributions to the WHO by 20% is only a small ray of hope. In order to ensure more predictable and flexible funding for the WHO, the governments had decided in 2022 to gradually increase the assessed contributions to a total of 50% of the WHO budget. However, this increase will by no means close the funding gap caused by the USA. Even if the USA is no longer involved, this will also overshadow the further negotiations on the PABS system yet to be agreed – and therefore also the final adoption of the pandemic treaty.
Link to the current text of the pandemic agreement (WHO Doc. A78/10)
