By Suerie Moon
In May 2024, countries agreed on amendments to the World Health Organization (WHO) International Health Regulations (IHR). These legally binding rules govern how all member states address the threat of infectious disease outbreaks that may cross borders. This was a much-needed diplomatic success for weary negotiators in a polarised geopolitical context, and the amendments filled some gaps in the IHR that Covid-19 exposed. However, they also left unaddressed many critical and politically difficult issues that now fall under the Pandemic Agreement (PA). The PA was to cross the finish line side-by-side with the IHR, but countries could not reach a consensus, so negotiations were extended to the May 2025 World Health Assembly.
The Risk of the Next Global Pandemic
The devastating scale and speed of pandemics provide a strong rationale for getting these talks done this year. The threat of another pandemic has not waned since the COVID-19 crisis, although global political attention has. In August 2024, the international mpox outbreak was declared a continental and international health emergency by the Africa Centres for Disease Control and Prevention and WHO, respectively. Efforts to control mpox have been stymied by armed conflict and under-resourced health systems at national level, and delayed access to vaccines and other technologies at the international level, a stark reminder that structural weaknesses that hampered the COVID-19 response have not yet been fixed.
The threat of another pandemic has not waned since the COVID-19 crisis, although global political attention has.
Meanwhile, a highly-pathogenic form of avian influenza first detected in dairy cows in the US in March 2024 continues to spread among livestock and the people who work closely with them. This outbreak is a grim reminder that pathogens circulate between animals, people and the natural environment, raising various technical and political challenges. Efforts to get the human, animal and environmental health sectors to work more closely together at national and international levels – called the One Health approach – are creeping forward but have become a political hot potato in the Pandemic Agreement talks. One Health reflects how PA negotiations have fallen into age-old North-South divides.
Diverging approaches between higher- and lower-income countries
Some high-income countries, foremost among them the European Union, are pushing hard for new One Health commitments. They see such obligations as the most important gain beyond the status quo that they would achieve through the PA. On the other hand, many low- and middle-income countries (LMICs) are wary of the costs and potential trade disadvantages One Health commitments could entail, as they could require more extensive surveillance systems and have far-reaching implications for livestock rearing, wildlife and land use practices.
Meanwhile, the risk of turf wars is never far away. Some question whether legally binding international rules on One Health should fall under a WHO-managed treaty at all rather than the purview of all four international organisations that now work together through the quadripartite collaboration (i.e., the Food and Agriculture Organization, the United Nations Environment Programme, WHO, and the World Organisation for Animal Health).
Meanwhile, developing countries have prioritised measures that would provide more reliable access to products needed to combat pandemics, such as vaccines, drugs and diagnostics – framed as the “equity” issues. The draft PA includes some of the most detailed provisions in any international treaty for increased international cooperation on research and development, regionally diversified production, technology transfer, intellectual property management and strengthening supply chains for medicines.
Negotiation Roadblock
However, whether these provisions can be finalised depends on resolving a complex and difficult issue, known as Pathogen Access and Benefit-Sharing (PABS). In brief, tracking the spread and mutation of pathogens that could cause pandemics requires a global community of scientists to share pathogen samples and data rapidly and internationally, and scientists largely did so during the COVID-19 pandemic. Such sharing is also the starting ingredient that allows researchers to develop diagnostic tests, vaccines and drugs rapidly when a new outbreak is detected. However, currently, no international rule – including the recently amended IHR – requires governments to share pathogen samples and data internationally, and this gap in the legal architecture leaves every country at greater risk. Yet many LMICs hesitate to accept obligations to do so, as they fear they will not get access to the products developed from the samples and data they shared.
Currently, no international rule – including the recently amended IHR – requires governments to share pathogen samples and data internationally, and this gap in the legal architecture leaves every country at greater risk.
Complicating the picture further, another treaty already governs part of the equation: parties to the 1992 Convention on Biological Diversity (CBD) and its 2010 Nagoya Protocol have committed to sharing benefits in exchange for access to genetic resources (such as pathogen samples). However, agreements on access to genetic resources and benefits are usually the subject of lengthy bilateral negotiations, which are wholly unsuited for the urgency of sharing during a pandemic. The question of how to ensure fair benefit-sharing has become even more complicated with the rise of digital sequencing information (DSI), which can sometimes replace the need to share physical samples. CBD negotiations, which have been running in parallel to PA talks, have agreed that using DSI should result in benefit-sharing, and took steps to create a system for doing so, but important details remain unresolved.*
Why does this matter? Building a Multilateral System for Global Health
Health negotiators have been trying to construct a separate system, carved out from the CBD-Nagoya rules, tailor-made for pandemics: a multilateral system that would deliver fast sharing of samples and data and fair sharing of vaccines, drugs and diagnostics. Without agreement on the core elements of PABS, a Pandemic Agreement is unlikely. And all countries, whether global North or South, stand to benefit from a reliable, functional, equitable PABS system. However, the legal and technical complexities, and distributional consequences, have made progress difficult.
Health negotiators have been trying to construct a separate system tailor-made for pandemics: a multilateral system that would deliver fast sharing of samples and data and fair sharing of vaccines, drugs and diagnostics.
One path forward, supported by many countries, is to agree on the key pillars of a PABS system in the PA and leave negotiations on its implementation to future talks, for example, through a protocol or annex to the PA. However, agreement on this path seems to hinge on stronger commitments to One Health. Progress on One Health could be achieved, in theory, with reliable commitments to mobilise the international financing that could make the lowest-income developing countries more comfortable about taking on new obligations. Yet, most of the biggest traditional donor countries – e.g., the United Kingdom, Germany, and France – have recently cut their development assistance budgets, with pressure to spend more on defence and military aid. Funding would need to come from non-traditional sources, but so far, it is not clear who or what these might be. And development assistance is much less relevant for middle-income countries, who would likely bear new costs alone.
Adding a wild card into the mix is the 2024 election of Donald Trump as the next US president, which will likely increase fiscal pressures on Europe further. Members of Trump’s Republican Party have also openly attacked the PA as a threat to sovereignty. Trump’s 2020 withdrawal of US membership in the WHO (quickly reversed when Joe Biden came into office) looms over not just the treaty talks but also all of the WHO and the UN system in general, which would be financially hobbled if US funds were to stop flowing into the system. What remains to be seen is how WHO’s other 193 member states proceed, given that US ratification of a pandemic treaty has always been in serious doubt.
Countries have made painstaking but real progress towards a meaningful PA in 2024, but there remain several more delicate passages to navigate in 2025 amidst turbulent seas. But nature doesn’t wait. The world will be safer if governments agree on fair, effective rules to govern pandemics in 2025. Skilful diplomacy, careful compromise and strong governance arrangements for post-treaty implementation will all be needed to get there.
* At the 16th Conference of Parties to the CBD in Cali, Colombia, in November 2024, parties agreed to a multilateral mechanism for the sharing of DSI and related benefits, and established the Cali Fund, which would manage financial contributions calculated as a proportion of DSI users’ sales or profits. The decision is not legally binding on CBD parties, but parties may implement it in their national laws and in this way make it obligatory on users based in their territories.
About the author
Suerie Moon is Co-Director at the Global Health Centre and Professor of Practice for the Interdisciplinary Programmes and International Relations/Political Science Faculty at the Geneva Graduate Institute.
The opinions expressed in this publication are those of the authors. They do not purport to reflect the opinions or views of the Geneva Policy Outlook or its partner organisations.
