The World Health Organization adopted the pandemic agreement in May 2025, aimed at making the world better prepared for the next global health crisis — but countries were only able to get the votes because they agreed to kick the can on finalizing the most contentious details.
That can kicking has continued for the past year and half. Countries met last week for the eighth round of negotiations in Geneva, but there was little to show for it.
"The pandemic agreement is really in a state of continued limbo," says Suerie Moon, co-director of the global health center at the Geneva Graduate Institute. "The mood is somber, I think a lot of countries know we have to make progress, and yet the path forward is not obvious."
At the center of the debate is access and equity — whether countries should be obligated to share data on new pathogens with the international community quickly, and what obligations countries have to share the vaccines, drugs or tests developed from those data.
"There was staggering inequity during COVID-19, where rich countries had access to vaccines almost immediately, and were able to procure it multiple times over for their population," while lower-income countries got scraps, says Sangeeta Shashikant, a legal adviser for the Third World Network, a nonprofit. "The pandemic agreement is an attempt to bridge that gap."
In principle, countries have agreed to these obligations. And they see them as crucial to having a system in place that allows for rapid response to the next pandemic in a more equitable way.
But countries haven't been able to agree on what that system, known as the Pathogen Access and Benefit Sharing annex (PABS), would actually look like.
At the UN General Assembly on Friday, WHO Director-General Tedros Adhanom Ghebreyesus urged countries to come together.
"Although differences remain, I am confident that countries will find common ground, just as they did with the agreement itself," he said. "So today, I leave you with just one request, just one: get [it] done, as soon as possible. Further delays are not just delays in procedure or process. They are delays that cost all countries dearly when the next pandemic arrives."
Global north versus global south
In broad strokes, negotiations are generally between the global north and the global south, or wealthy countries and lower-income countries, says Moon.
"The global north is concerned about setting up a system that would allow for the continued, very rapid development of new products," she says. Such a system would involve a database where countries quickly upload new pathogen data, and scientists around the world can easily use it.
COVID-19 demonstrated why that's valuable.
In early January 2020, Chinese scientists uploaded the SARS-CoV-2 genome to a publicly available database. That early access was part of why scientists were able to develop a vaccine so quickly, says David Reddy, director general of the International Federation of Pharmaceutical Manufacturers and Associations. "It worked incredibly well."
Lower-income countries see it differently. "I think they have very bitter memories of what happened during COVID-19," says Moon. "Countries in the global south want ironclad guarantees that if they share a sample or a data today, tomorrow they will get the drugs or vaccines and diagnostics that are developed with them."
These countries want to tie strings to accessing the database, as a kind of leverage.
Who wants what
Those strings could come in a variety of forms. Some countries are arguing to put all of this pathogen data in a closed database, available only to parties who register and sign contracts with WHO.
Such contracts might require a share of any resulting products to be provided to WHO at reduced cost for distribution to lower-income countries. WHO's pandemic influenza preparedness network works something like this: Countries submit virus samples in exchange for more equitable vaccine access.
Wealthy countries have already agreed that 20% of vaccines produced in a pandemic emergency would go to WHO. Yet they're not in favor of these strings as a condition of being able to use data. They argue it will slow science down at precisely the time it needs to be most nimble.
A researcher may want to study how a new virus enters human cells, for instance, to figure out how to stop it. That would require analyzing the virus's genetic data, but also data on human proteins, says Amber Sholz, head of science policy at the Leibniz Institute.
Putting boxes around some of that data creates "a huge amount of friction that leaves us not super prepared for understanding pathogen biology," she says.
Middle ground
Right now, the two sides still seem far apart in negotiations. But there are some proposals for a middle ground.
One involves attaching strings not to the data itself but to any products generated from the data. James Love, director of Knowledge Ecology International, a nonprofit, has been advocating this idea.
In this framework, scientists and companies would have access to pathogen data and develop a product from it. But to sell that product in a given country, they'd need to sign some kind contract that guarantees a degree of equity, he says. "Our proposal gives you the best on equity and the best on open science."
Not everyone agrees. Shashikant argues if manufacturers haven't agreed to terms and conditions upon the point of accessing data, lower-income countries have lost their bargaining edge. "If you have WHO chasing a company five years later, trying to get a contract, they can just say no," she says.
Negotiations are set to continue up until May of 2027, when WHO member states will come together again for the World Health Assembly.
"It does seem that countries are coming to the table with good faith efforts to try to find a resolution," says Alexandra Phelan, global health law expert at Johns Hopkins University. But she worries that good faith could erode over time. She views next May as a deadline for reaching a deal.
The United States is another wildcard. Since leaving WHO last year, the U.S. hasn't been part of the negotiations. But it is signing bilateral health aid agreements with individual countries outside of this framework — such as deals to exchange pathogen data for health aid, says Moon. She believes that could undermine the pathogen access and benefit sharing system.
"They're like termites in the wood of the house that we're trying to build," says Moon. If those termites keep eating away before negotiators reach a deal, she worries that the house could collapse. "We need a breakthrough if we're going to cross the finish line by next May."
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