Vaping Likely to Cause Lung and Oral Cancer 01/04/2026 Kerry Cullinan A new review links vaping to oral and lung cancer. Vaping is likely to cause oral and lung cancer, according to a comprehensive review of over 100 studies of the effects of nicotine-based e-cigarettes, published this week in the journal, Carcinogenesis. Carcinogenicity was evident in human studies that monitored biomarkers of harm, including DNA damage, oxidative stress, and “epigenetic change and inflammation in oral and respiratory tissue”, according to the researchers, who hail from a range of Australian universities. Meanwhile, studies on mice showed that they developed lung tumours after exposure to vape aerosols. The researchers focused on studies from 2017 of people who only used nicotine-based e-cigarettes or on studies that compared smokers and vapers, and excluded studies that involved people who used both tobacco and e-cigarettes. “Though direct epidemiological evidence of cancer causation takes time to accumulate, carcinogenicity of e-cigarettes is evident from different types of investigation,” the study concluded. “To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” according to co-author Bernard Stewart from the University of New South Wales. In a commentary published alongside the research, Stewart and co-author Freddy Sitas note that it took a long time before the harms of smoking were recognised. The first study to report a link between smoking and tuberculosis was published in 1886, yet smoking was only definitively linked to lung cancer in 1964. “Though smoking was once given the benefit of doubt, the same should not now be accorded to vaping given the strength of relevant carcinogenicity data,” they write. The tobacco industry has promoted vaping as a tool to help smokers to quit, while promoting e-cigarettes to young people who have never smoked. Image Credits: pixabay. Two-Speed Multilateralism: Breaking the Deadlock on Climate and Health 31/03/2026 Felix Sassmannshausen Panellists Diarmid Campbell-Lendrum (WHO, stage centre), Miguel Ruiz Botero (Colombian UN Mission, right), Margarita Gutierrez (IISD, left), Ömer Öztürk (Türkiye Min. of Environment, screen right), and Gül Mersinlioğlu Serin (Türkiye Minister of Health, screen centre) discussing two-speed multilateralism in Geneva. From stalled Pathogen Access and Benefit Sharing (PABS) negotiations to failing consensus in global climate policies, United Nations structures face a profound crisis. Diplomats are currently being forced to explore alternative governance models to bridge the disconnect between sluggish, power-driven diplomacy and the rapid, equitable action required in health and climate crises. This institutional rupture and the resulting emergence of two-speed multilateralism took centre stage during a critical panel hosted by the Global Health Centre in Geneva on 30 March. Professor Suerie Moon delivers opening remarks at the event. “The world order and the postwar institutions that were created to address global problems are at a unique moment of rupture, possibly collapse or transformation, depending on where we go from here,” said Professor Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute, during her opening remarks of the expert panel discussion. The event was co-hosted by the Centre’s International Geneva Global Health Platform, alongside the World Health Organization (WHO), the International Institute for Sustainable Development (IISD) and the Geneva Environment Network. There was clear unity among the expert panellists – ranging from global health researchers and climate adaptation advisors to international diplomats – that when traditional, consensus-based multilateralism stagnates, the international community must pragmatically turn to alternative, faster diplomatic channels. Two-speed multilateralism: agile coalitions accelerate implementation, while universal consensus provides global legal legitimacy. This “two-speed multilateralism” combines the universal legitimacy of consensus-based UN negotiations with the rapid implementation capabilities of smaller, highly ambitious “coalitions of the willing”, aiming at preventing single nations from vetoing desperately needed progress on environmental and public health protections. Miguel Ruiz Botero argues for the need of two-speed multilateralism because some nations weaponize consensus to obstruct global progress. “Consensus has been, in essence, weaponised by a few countries to obstruct progress,” said Miguel Ruiz Botero, second secretary at the Permanent Mission of Colombia to the UN in Geneva, during the panel discussion. For example, as global temperatures reach record levels, experts argue that traditional structures are simply not mobilising political action fast enough to protect vulnerable populations affected by climate change. To bypass this gridlock, Colombia is hosting the Santa Marta Conference on 28-29 April , which will serve as a prime example of this accelerated diplomatic speed. Co-hosted by the Netherlands, the summit aims to establish a clear pathway for transitioning away from fossil fuels outside the traditional UN architecture. This parallel track aims to establish a strict division of diplomatic labour, as COP30 President André Aranha Corrêa do Lago recently outlined. While the “first tier” ensures universal legitimacy and sets the collective legal direction, the “second tier,” or fast track tier, focusses exclusively on rapid implementation by mobilising finance and deploying solutions at scale without reopening debates already settled by consensus. WHO support for two-speed approach Diarmid Campbell-Lendrum (WHO) argues that health-based fossil fuel transitions offer immense, self-financing benefits. Notably, the WHO voiced clear support for this parallel approach. “If a certain subset of parties or countries can take a part of the agenda that moves things in a positive way, then you know that has to be supported,” said Dr Diarmid Campbell-Lendrum, WHO head of the climate change, energy and air quality. He noted that the health gains from reducing air pollution would effectively cover the costs of transitioning away from fossil fuels, making a compelling, evidence-based case for this accelerated track. Key Moments for Climate and Health Diplomacy in 2026 This decisive backing for initiatives outside the formal UN architecture is unusual for an agency traditionally restrained by universal consensus. However, in private discussions following the event, experts observed that the WHO is navigating new political dynamics. Following the US exit, the institution may be experiencing reduced diplomatic pressure, inadvertently allowing it to embrace more pragmatic, parallel agreements without its usual hesitation. This momentum will continue at the upcoming 79th World Health Assembly in May. While the WHO will not formally report on its “Global Action Plan on Climate Change and Health” during the main agenda, Türkiye and Brazil are set to co-host a high-level side event to fill the gap and strengthen the integration of the health and climate dossiers ahead of the COP31 summit in November 2026. Bypassing slow paced consensus is not new The panellists discussed that while two-speed multilateralism is an old tool, the 2026 rupture makes it a necessity. The strategy of utilizing alternative diplomatic pathways to bypass institutional gridlock is not a novel invention. “Two-speed multilateralism is certainly not a new phenomenon,” said Moon. “Ever since the UN was founded 80 years ago, there have been parallel bilateral and minilateral processes that work alongside global multilateral processes.” In recent decades, parallel negotiations and smaller alliances have historically operated alongside universal frameworks to influence broader international arenas. When traditional consensus rules made a UN-based landmine convention impossible in the late 1990s, Canada and a group of progressive nations moved negotiations outside the formal architecture to create the Ottawa Process. This historical success, alongside the eventual adoption of the Arms Trade Treaty by the UN General Assembly, demonstrates how coalitions of the willing can effectively force meaningful international agreements when broad consensus fails, explained Colombia’s representative Botero. The upcoming Santa Marta conference will act as the first major testing ground for establishing this diplomatic strategy in climate policies. Unlike exclusive diplomatic clubs where powerful nations make decisions behind closed doors, this approach remains open to states ready to act. Integrating health into climate action Ultimately, these efforts aim to create a push-pull dynamic that elevates the baseline ambition of the entire international community. Gül Mersinlioğlu Serin from the Ministry of Health, Türkiye highlights the synergy between UN legitimacy and voluntary coalitions. “We see value in both tracks, the inclusiveness and legitimacy of the UN system alongside the dynamism of the coalition of voluntary initiatives that can accelerate progress,” said Dr Gül Mersinlioğlu Serin, a health expert at the Turkish Ministry of Health. However, securing these baseline commitments – and breaking down two decades of silos between climate and health negotiations – remains challenging. Despite these hurdles, the recent COP30 summit in Belém, Brazil, delivered clear progress by finalising the Baku Adaptation Roadmap and establishing 59 voluntary indicators for the Global Goal on Adaptation. This allows the international community to measure climate impacts through human health metrics, such as heat-related mortality and local health system resilience, explained Ömer Öztürk, head of adaptation to climate change and local policies at the Turkish Ministry of Environment, Urbanization and Climate Change. Expanding action through local health WHO Director-General Dr Tedros Adhanom Ghebreyesus speaking at COP30 in Belém, which launched he Belém Health Action Plan. The Belém Health Action Plan established a critical framework for building low-carbon, climate-resilient health systems, effectively translating slow-moving global agreements into on-the-ground implementation. By targeting surveillance, capacity-building, and digital innovation, the plan ensures adaptation measures actively address severe health inequities. To successfully execute these measures at an accelerated pace, experts argue that broad climate goals must be communicated in terms that specific sectoral ministries understand. Margarita Gutierrez (IISD) emphasizes the need to translate climate goals into health-specific language. “This is a translation, this is different language and this happens with all the sectors,” said Margarita Gutierrez, policy advisor for Friends of Climate and Health at the International Institute for Sustainable Development, emphasising that mainstreaming climate considerations into everyday sectoral policies provides a crucial opportunity to coordinate joint actions. However, Gutierrez warned that unless countries actively integrate these health metrics into their formal UN commitments – such as Nationally Determined Contributions (NDCs) – securing health’s relevance and funding on future global agendas will remain incredibly difficult. But as amending these universal UN agreements is a years-long bureaucratic process, experts argue that fast-track, parallel coalitions are urgently needed to bypass the gridlock and deploy health solutions immediately. Rebuilding trust through equitable cooperation Small developing island states are highly vulnerable to the effects of climate change and rely on universal diplomatic processes to ensure they hold equal weight to major global powers. However, building on two-speed multilateralism and operating outside universal frameworks carries significant risks, prompting debates about fragmentation and the potential exclusion of smaller developing nations. “Considering, for example, that small island developing states are some of the most vulnerable to climate change, it’s really important that they have the equal weight to be able to stop the process,” said WHO’s Campbell-Lendrum, arguing that universal forums allow vulnerable nations to demand the same attention as major powers. Margot Morris highlights Australia’s commitment to supporting climate-health cooperation with Pacific island nations. To ensure these frontline voices are not lost, diplomats are actively elevating regional priorities. Highlighting this effort, Australia, presiding over the negotiations at the COP31 summit, announced that it is cooperating with Pacific islands to support a pre-COP31 gathering. “We are working hand in hand with Pacific Island Forum members and regional organisations to shine a global spotlight on our region,” said Margot Morris, counsellor at the Permanent Mission of Australia to the UN. As the Geneva event concluded with characteristic sober pragmatism, the underlying message was clear: by ensuring rapid progress does not come at the expense of equity, two-speed multilateralism could help counter the climate crisis and stabilise the deeply fractured international order. Image Credits: Felix Sassmannshausen/HPW, WHO/PAHO/Karina Zambrana , Unsplash/Ernests Vaga. New Open Source AI Platform Aims to Accelerate Malaria Drug Discovery 31/03/2026 Kerry Cullinan A health worker examines a child with suspected malaria. Scientists working on new malaria drugs now have access to an open-access artificial intelligence (AI)-powered platform aimed at accelerating drug discovery, thanks to a partnership between Medicines for Malaria Venture (MMV) and deepmirror. Drug Design for Global Health (dd4gh) uses “both predictive and generative AI to give researchers, especially those in the most resource-limited settings, access to cutting-edge technology that would otherwise be out of reach”, according to a media release from MMV. The dd4gh platform was developed using input gathered during co‑creation workshops in Ghana and Switzerland with global drug discovery researchers. Its AI models are trained on data sets from a wide range of studies conducted by global health researchers, enabling scientists to benefit from insights generated across multiple research efforts. “At a time when the global health sector is facing significant constraints, dd4gh demonstrates the power of partnership,” said MMV CEO Dr Martin Fitchet. “By giving scientists in low and middle-income countries (LMICs) free access to advanced AI tools, we can accelerate the discovery of lifesaving medicines led by the people closest to the diseases we are trying to defeat.” The platform implements active learning, a technique that allows AI and machine learning (ML) to continuously improve its predictions by learning from new data. It analyses large data sets and proposes the most promising compounds to explore in the lab. Shorter timelines, reduced costs These technologies have the potential to dramatically shorten timelines and reduce costs for drug discovery, allowing scientists to focus their time and resources on what is more likely to work, enabling faster discovery of treatments for diseases that pose significant global health challenges. “Africa is disproportionately affected by many infectious and non-infectious diseases, yet African-led solutions are limited. Tools like dd4gh can have a transformative impact on the continent’s capacity for drug discovery research,” said Prof Richard Amewu, lead of the drug innovation group at the University of Ghana, which tested the platform. Dr Godwin Dziwornu, senior investigator in medicinal chemistry at the University of Cape Town’s (UCT) H3D, said that the platform is “easy to access and user-friendly”. Dziwornu added: “I’ve found it very useful in two main areas: generating new compound designs and the models available to assess compound properties and predict their drug likeness to solve a particular liability, for example, absorption, distribution, metabolism and excretion. This helps me guide my decisions to synthesise high-quality compounds, saving me precious time and resources.” Caroline Maina, a UCT PhD candidate and participant in a co-creation workshop, said there are other AI tools that can help with drug discovery “but being in a resource-limited setting makes purchasing a license prohibitive”. “Making dd4gh open access for researchers in global health means more of us can explore new ideas and apply AI to finding treatments for diseases that are part of our everyday realities,” said Maina. Dr Max Jakobs, co-founder and CEO of deepmirror, said the free platform aims to strengthen “a more inclusive global scientific ecosystem” as “access to advanced AI should not depend on where a scientist works or their laboratory’s resources”. deepmirror builds chemistry-based foundation models for biopharma and research organisations to support active drug discovery programmes. It integrates predictive and generative AI directly into research workflows, combining “proprietary data with models trained on larger, curated datasets, which are continuously updated and strengthened over time”. MMV is a not-for-profit product development partnership working to discover, develop and deliver medicines to treat, prevent and eliminate malaria. Since 1999, its co-developed medicines have helped 1.3 billion people. Image Credits: Tommy Trenchard/ Global Fund, Damien Schumann / MMV. More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist 30/03/2026 Stefan Anderson First global survey of 93 nations shows two-thirds include these populations in health plans, but none provide equal access to undocumented migrants. More than 60 countries now include refugees and migrants in their national health policies, according to a new World Health Organization (WHO) report tracking progress on commitments first set out by the World Health Assembly in 2019. The finding, drawn from a survey of 93 member states, is the first systematic count of how countries are implementing a resolution that called on governments to ensure refugees and migrants have access to health services, are included in national health planning, and are counted in health data systems. “Many countries have begun integrating refugee and migrant health into national strategies,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Yet gaps remain, particularly in collecting and using migration-related health data, ensuring participation of refugees and migrants in decision-making, and guaranteeing access to care for all, regardless of legal status.” “Like anyone else, refugees and migrants need uninterrupted, affordable and equitable access to health services wherever they are,” Tedros said. While WHO called the findings “encouraging,” the picture the report paints is difficult to read clearly. What “inclusion in a national health policy” actually means for care access for migrants and refugees varies widely – and the report does not name which countries fall where. Two-thirds of the 93 surveyed countries said they include refugees and migrants in their health policies. When asked what level of access different groups receive, 16 countries said refugees can access services on a par with the host population, 14 extended that standard to documented migrant workers, and 11 to asylum seekers. No country surveyed reported providing equal access to migrants in irregular situations – those living without legal status or formal documentation. The positive examples the report does name – from Belgium to Chile – are presented as case studies. Only 37% of countries routinely collect and disseminate migration-related health data. Fewer than 40% train health workers in culturally responsive care. Just 30% have run campaigns to counter misinformation or discrimination, the report found. The report is the first systematic quantification of these indicators, further blurring the picture of progress, as there is no baseline to compare against. The data is also entirely drawn from a voluntary survey completed by member states with no independent verification, meaning the results are unvetted self-assessments. The report explicitly does not rank countries on the success, impact or implementation of their policies, and “did not assess the level of implementation or impact of any given initiative,” meaning real-world outcomes “cannot be evaluated,” it said. The survey also contains no questions about financing, meaning a country can report including refugees in its national health policy while allocating no dedicated budget to deliver on it. “Rather than ranking countries on their progress,” the report notes, it seeks to identify how key gaps can be addressed going forward. The report comes as conflict, climate change and economic insecurity displace more people than ever before. More than one billion people live as refugees or migrants worldwide, though over 800 million remain within their own borders. There are 405 million international migrants, 36.8 million refugees, 8.4 million asylum seekers and 83.4 million internally displaced people. Dr Santino Severoni, head of WHO’s Special Initiative on Health and Migration and lead author of the report, said it was intended as a roadmap for coordinated action across governments, UN agencies, civil society, academia and migrant communities themselves. “The health of refugees and migrants is not a marginal concern: it is a defining issue of our time,” Severoni said. “By acting now, countries can ensure that refugees and migrants are not left behind, and that health systems are stronger, fairer and more prepared for the future.” Data ’emergency’, exclusion from emergency plans Progress roadmap for the World Health Assembly Resolution on migrant and refugee health. The new report follows a first edition published in 2022, which was a literature review of around 82,000 documents that established the scale of health disparities facing refugees and migrants worldwide. Two further progress checks are planned for 2027 and 2029, ahead of the 2030 deadline set by WHA member states for full implementation. The 2022 report identified fragmented data collection as the central structural obstacle to effective policy. That remains unresolved. Severoni described the situation as “almost an emergency.” “It’s not because data is not collected, but because they are collected in a very fragmented way, which makes it very, very difficult for us to have a full picture,” he said. Just 42% of countries include refugees and migrants in emergency preparedness or disaster risk reduction plans. Irregular migrants – those without legal residency status – are entirely absent from those frameworks, even as the crises that drive displacement, from war to climate-related disasters, intensify. “We cannot talk about refugee and migrant health without also addressing emergencies,” said Dr Chikwe Ihekweazu, WHO’s executive director for health emergencies. “Whether it’s a conflict, a climate-related crisis or an epidemic that forces movement, these crises expose the fragility of health systems and magnify the vulnerabilities of all those already at risk.” Population groups among refugees and migrants included in national health policies,legislation, strategies or plans. “This is not only an equity issue — it is a global health security risk,” he added. Excluding displaced populations from health systems, he said, weakens the collective capacity to detect and respond to outbreaks and crises. “Health does not begin and end at borders.” WHO is calling on governments to strengthen disaggregated health data collection, tailor policies to specific migrant groups including those in irregular situations, involve refugees and migrants in health governance, train health workers in culturally responsive care, and protect and expand financing. “The phenomena of displacement is unfortunately happening more frequently in countries with fragile systems, fragile economies and limited domestic resources,” Severoni said. “There is almost no mention of irregular migrants in those emergency plans and response or in disease risk reductions, there is no systematic approach in assessing the system to see how their system is really functioning, how efficient and effective it is.” “This is really a call for action to keep the promise of sharing a bit of responsibility in managing those emergencies,” he added. Political wave washes away progress Political sentiment in many wealthy nations has turned against expanding access for migrants, refugees and asylees. The report highlights progress in some countries. Chile has embedded migrant community representatives in municipal health councils, with direct input into maternal and mental health priorities. Belgium has run a national intercultural mediation programme since 1999; as of late 2024, 113 trained mediators were working across 76 hospitals and community health centres. Yet the report’s release comes as several wealthy nations move to restrict refugee and migrant healthcare, driven by economic pressures and political campaigns questioning whether asylum seekers and refugees should be entitled to publicly funded care. In the United States, legislation passed in 2025 changed the definition of “eligible alien” for Medicaid eligibility, cutting coverage for many lawfully present immigrants, asylees, refugees, and trafficking and domestic violence survivors. On 1 May, its northern neighbour Canada will start requiring refugees and asylum seekers to pay out of pocket for essential health services previously covered under its Interim Federal Health Program. The programme “has provided basic health coverage to people fleeing war, genocide, torture, and persecution since 1957,” according to the Migrant Rights Network. Services affected include medications, dental care, mental health, vision and physiotherapy. Across the Atlantic, Germany extended to 36 months the period in which asylum seekers are restricted to emergency-only care, doubling the previous threshold of 18 months. In France, a similar fight is playing out over the future of its Aide Médicale de l’État programme, which provides medical care to undocumented migrants. Critics say the programme encourages migration and is an undue cost to taxpayers, though it accounts for just 0.5% of national public health spending. International funding for refugee health has also fallen sharply. UNHCR’s 2025 budget stands at $10.6 billion, of which only 23% had been secured at mid-year. The agency has warned that up to 12.8 million displaced people could be left without life-saving health interventions this year. “Around the world, more than one billion people are on the move, seeking safety, opportunity and dignity,” Tedros said. “Investing in refugee and migrant health is both ethically essential and strategically beneficial. Supporting their health and inclusion strengthens health systems and benefits everyone.” Image Credits: Wikipedia Commons. Pandemic Agreement Talks Get Five More Negotiating Days 30/03/2026 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening. With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations. Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May. The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics. Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted. “At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.” Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks. “This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.” However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. After some tension during the closed session, member states accepted this position. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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Two-Speed Multilateralism: Breaking the Deadlock on Climate and Health 31/03/2026 Felix Sassmannshausen Panellists Diarmid Campbell-Lendrum (WHO, stage centre), Miguel Ruiz Botero (Colombian UN Mission, right), Margarita Gutierrez (IISD, left), Ömer Öztürk (Türkiye Min. of Environment, screen right), and Gül Mersinlioğlu Serin (Türkiye Minister of Health, screen centre) discussing two-speed multilateralism in Geneva. From stalled Pathogen Access and Benefit Sharing (PABS) negotiations to failing consensus in global climate policies, United Nations structures face a profound crisis. Diplomats are currently being forced to explore alternative governance models to bridge the disconnect between sluggish, power-driven diplomacy and the rapid, equitable action required in health and climate crises. This institutional rupture and the resulting emergence of two-speed multilateralism took centre stage during a critical panel hosted by the Global Health Centre in Geneva on 30 March. Professor Suerie Moon delivers opening remarks at the event. “The world order and the postwar institutions that were created to address global problems are at a unique moment of rupture, possibly collapse or transformation, depending on where we go from here,” said Professor Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute, during her opening remarks of the expert panel discussion. The event was co-hosted by the Centre’s International Geneva Global Health Platform, alongside the World Health Organization (WHO), the International Institute for Sustainable Development (IISD) and the Geneva Environment Network. There was clear unity among the expert panellists – ranging from global health researchers and climate adaptation advisors to international diplomats – that when traditional, consensus-based multilateralism stagnates, the international community must pragmatically turn to alternative, faster diplomatic channels. Two-speed multilateralism: agile coalitions accelerate implementation, while universal consensus provides global legal legitimacy. This “two-speed multilateralism” combines the universal legitimacy of consensus-based UN negotiations with the rapid implementation capabilities of smaller, highly ambitious “coalitions of the willing”, aiming at preventing single nations from vetoing desperately needed progress on environmental and public health protections. Miguel Ruiz Botero argues for the need of two-speed multilateralism because some nations weaponize consensus to obstruct global progress. “Consensus has been, in essence, weaponised by a few countries to obstruct progress,” said Miguel Ruiz Botero, second secretary at the Permanent Mission of Colombia to the UN in Geneva, during the panel discussion. For example, as global temperatures reach record levels, experts argue that traditional structures are simply not mobilising political action fast enough to protect vulnerable populations affected by climate change. To bypass this gridlock, Colombia is hosting the Santa Marta Conference on 28-29 April , which will serve as a prime example of this accelerated diplomatic speed. Co-hosted by the Netherlands, the summit aims to establish a clear pathway for transitioning away from fossil fuels outside the traditional UN architecture. This parallel track aims to establish a strict division of diplomatic labour, as COP30 President André Aranha Corrêa do Lago recently outlined. While the “first tier” ensures universal legitimacy and sets the collective legal direction, the “second tier,” or fast track tier, focusses exclusively on rapid implementation by mobilising finance and deploying solutions at scale without reopening debates already settled by consensus. WHO support for two-speed approach Diarmid Campbell-Lendrum (WHO) argues that health-based fossil fuel transitions offer immense, self-financing benefits. Notably, the WHO voiced clear support for this parallel approach. “If a certain subset of parties or countries can take a part of the agenda that moves things in a positive way, then you know that has to be supported,” said Dr Diarmid Campbell-Lendrum, WHO head of the climate change, energy and air quality. He noted that the health gains from reducing air pollution would effectively cover the costs of transitioning away from fossil fuels, making a compelling, evidence-based case for this accelerated track. Key Moments for Climate and Health Diplomacy in 2026 This decisive backing for initiatives outside the formal UN architecture is unusual for an agency traditionally restrained by universal consensus. However, in private discussions following the event, experts observed that the WHO is navigating new political dynamics. Following the US exit, the institution may be experiencing reduced diplomatic pressure, inadvertently allowing it to embrace more pragmatic, parallel agreements without its usual hesitation. This momentum will continue at the upcoming 79th World Health Assembly in May. While the WHO will not formally report on its “Global Action Plan on Climate Change and Health” during the main agenda, Türkiye and Brazil are set to co-host a high-level side event to fill the gap and strengthen the integration of the health and climate dossiers ahead of the COP31 summit in November 2026. Bypassing slow paced consensus is not new The panellists discussed that while two-speed multilateralism is an old tool, the 2026 rupture makes it a necessity. The strategy of utilizing alternative diplomatic pathways to bypass institutional gridlock is not a novel invention. “Two-speed multilateralism is certainly not a new phenomenon,” said Moon. “Ever since the UN was founded 80 years ago, there have been parallel bilateral and minilateral processes that work alongside global multilateral processes.” In recent decades, parallel negotiations and smaller alliances have historically operated alongside universal frameworks to influence broader international arenas. When traditional consensus rules made a UN-based landmine convention impossible in the late 1990s, Canada and a group of progressive nations moved negotiations outside the formal architecture to create the Ottawa Process. This historical success, alongside the eventual adoption of the Arms Trade Treaty by the UN General Assembly, demonstrates how coalitions of the willing can effectively force meaningful international agreements when broad consensus fails, explained Colombia’s representative Botero. The upcoming Santa Marta conference will act as the first major testing ground for establishing this diplomatic strategy in climate policies. Unlike exclusive diplomatic clubs where powerful nations make decisions behind closed doors, this approach remains open to states ready to act. Integrating health into climate action Ultimately, these efforts aim to create a push-pull dynamic that elevates the baseline ambition of the entire international community. Gül Mersinlioğlu Serin from the Ministry of Health, Türkiye highlights the synergy between UN legitimacy and voluntary coalitions. “We see value in both tracks, the inclusiveness and legitimacy of the UN system alongside the dynamism of the coalition of voluntary initiatives that can accelerate progress,” said Dr Gül Mersinlioğlu Serin, a health expert at the Turkish Ministry of Health. However, securing these baseline commitments – and breaking down two decades of silos between climate and health negotiations – remains challenging. Despite these hurdles, the recent COP30 summit in Belém, Brazil, delivered clear progress by finalising the Baku Adaptation Roadmap and establishing 59 voluntary indicators for the Global Goal on Adaptation. This allows the international community to measure climate impacts through human health metrics, such as heat-related mortality and local health system resilience, explained Ömer Öztürk, head of adaptation to climate change and local policies at the Turkish Ministry of Environment, Urbanization and Climate Change. Expanding action through local health WHO Director-General Dr Tedros Adhanom Ghebreyesus speaking at COP30 in Belém, which launched he Belém Health Action Plan. The Belém Health Action Plan established a critical framework for building low-carbon, climate-resilient health systems, effectively translating slow-moving global agreements into on-the-ground implementation. By targeting surveillance, capacity-building, and digital innovation, the plan ensures adaptation measures actively address severe health inequities. To successfully execute these measures at an accelerated pace, experts argue that broad climate goals must be communicated in terms that specific sectoral ministries understand. Margarita Gutierrez (IISD) emphasizes the need to translate climate goals into health-specific language. “This is a translation, this is different language and this happens with all the sectors,” said Margarita Gutierrez, policy advisor for Friends of Climate and Health at the International Institute for Sustainable Development, emphasising that mainstreaming climate considerations into everyday sectoral policies provides a crucial opportunity to coordinate joint actions. However, Gutierrez warned that unless countries actively integrate these health metrics into their formal UN commitments – such as Nationally Determined Contributions (NDCs) – securing health’s relevance and funding on future global agendas will remain incredibly difficult. But as amending these universal UN agreements is a years-long bureaucratic process, experts argue that fast-track, parallel coalitions are urgently needed to bypass the gridlock and deploy health solutions immediately. Rebuilding trust through equitable cooperation Small developing island states are highly vulnerable to the effects of climate change and rely on universal diplomatic processes to ensure they hold equal weight to major global powers. However, building on two-speed multilateralism and operating outside universal frameworks carries significant risks, prompting debates about fragmentation and the potential exclusion of smaller developing nations. “Considering, for example, that small island developing states are some of the most vulnerable to climate change, it’s really important that they have the equal weight to be able to stop the process,” said WHO’s Campbell-Lendrum, arguing that universal forums allow vulnerable nations to demand the same attention as major powers. Margot Morris highlights Australia’s commitment to supporting climate-health cooperation with Pacific island nations. To ensure these frontline voices are not lost, diplomats are actively elevating regional priorities. Highlighting this effort, Australia, presiding over the negotiations at the COP31 summit, announced that it is cooperating with Pacific islands to support a pre-COP31 gathering. “We are working hand in hand with Pacific Island Forum members and regional organisations to shine a global spotlight on our region,” said Margot Morris, counsellor at the Permanent Mission of Australia to the UN. As the Geneva event concluded with characteristic sober pragmatism, the underlying message was clear: by ensuring rapid progress does not come at the expense of equity, two-speed multilateralism could help counter the climate crisis and stabilise the deeply fractured international order. Image Credits: Felix Sassmannshausen/HPW, WHO/PAHO/Karina Zambrana , Unsplash/Ernests Vaga. New Open Source AI Platform Aims to Accelerate Malaria Drug Discovery 31/03/2026 Kerry Cullinan A health worker examines a child with suspected malaria. Scientists working on new malaria drugs now have access to an open-access artificial intelligence (AI)-powered platform aimed at accelerating drug discovery, thanks to a partnership between Medicines for Malaria Venture (MMV) and deepmirror. Drug Design for Global Health (dd4gh) uses “both predictive and generative AI to give researchers, especially those in the most resource-limited settings, access to cutting-edge technology that would otherwise be out of reach”, according to a media release from MMV. The dd4gh platform was developed using input gathered during co‑creation workshops in Ghana and Switzerland with global drug discovery researchers. Its AI models are trained on data sets from a wide range of studies conducted by global health researchers, enabling scientists to benefit from insights generated across multiple research efforts. “At a time when the global health sector is facing significant constraints, dd4gh demonstrates the power of partnership,” said MMV CEO Dr Martin Fitchet. “By giving scientists in low and middle-income countries (LMICs) free access to advanced AI tools, we can accelerate the discovery of lifesaving medicines led by the people closest to the diseases we are trying to defeat.” The platform implements active learning, a technique that allows AI and machine learning (ML) to continuously improve its predictions by learning from new data. It analyses large data sets and proposes the most promising compounds to explore in the lab. Shorter timelines, reduced costs These technologies have the potential to dramatically shorten timelines and reduce costs for drug discovery, allowing scientists to focus their time and resources on what is more likely to work, enabling faster discovery of treatments for diseases that pose significant global health challenges. “Africa is disproportionately affected by many infectious and non-infectious diseases, yet African-led solutions are limited. Tools like dd4gh can have a transformative impact on the continent’s capacity for drug discovery research,” said Prof Richard Amewu, lead of the drug innovation group at the University of Ghana, which tested the platform. Dr Godwin Dziwornu, senior investigator in medicinal chemistry at the University of Cape Town’s (UCT) H3D, said that the platform is “easy to access and user-friendly”. Dziwornu added: “I’ve found it very useful in two main areas: generating new compound designs and the models available to assess compound properties and predict their drug likeness to solve a particular liability, for example, absorption, distribution, metabolism and excretion. This helps me guide my decisions to synthesise high-quality compounds, saving me precious time and resources.” Caroline Maina, a UCT PhD candidate and participant in a co-creation workshop, said there are other AI tools that can help with drug discovery “but being in a resource-limited setting makes purchasing a license prohibitive”. “Making dd4gh open access for researchers in global health means more of us can explore new ideas and apply AI to finding treatments for diseases that are part of our everyday realities,” said Maina. Dr Max Jakobs, co-founder and CEO of deepmirror, said the free platform aims to strengthen “a more inclusive global scientific ecosystem” as “access to advanced AI should not depend on where a scientist works or their laboratory’s resources”. deepmirror builds chemistry-based foundation models for biopharma and research organisations to support active drug discovery programmes. It integrates predictive and generative AI directly into research workflows, combining “proprietary data with models trained on larger, curated datasets, which are continuously updated and strengthened over time”. MMV is a not-for-profit product development partnership working to discover, develop and deliver medicines to treat, prevent and eliminate malaria. Since 1999, its co-developed medicines have helped 1.3 billion people. Image Credits: Tommy Trenchard/ Global Fund, Damien Schumann / MMV. More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist 30/03/2026 Stefan Anderson First global survey of 93 nations shows two-thirds include these populations in health plans, but none provide equal access to undocumented migrants. More than 60 countries now include refugees and migrants in their national health policies, according to a new World Health Organization (WHO) report tracking progress on commitments first set out by the World Health Assembly in 2019. The finding, drawn from a survey of 93 member states, is the first systematic count of how countries are implementing a resolution that called on governments to ensure refugees and migrants have access to health services, are included in national health planning, and are counted in health data systems. “Many countries have begun integrating refugee and migrant health into national strategies,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Yet gaps remain, particularly in collecting and using migration-related health data, ensuring participation of refugees and migrants in decision-making, and guaranteeing access to care for all, regardless of legal status.” “Like anyone else, refugees and migrants need uninterrupted, affordable and equitable access to health services wherever they are,” Tedros said. While WHO called the findings “encouraging,” the picture the report paints is difficult to read clearly. What “inclusion in a national health policy” actually means for care access for migrants and refugees varies widely – and the report does not name which countries fall where. Two-thirds of the 93 surveyed countries said they include refugees and migrants in their health policies. When asked what level of access different groups receive, 16 countries said refugees can access services on a par with the host population, 14 extended that standard to documented migrant workers, and 11 to asylum seekers. No country surveyed reported providing equal access to migrants in irregular situations – those living without legal status or formal documentation. The positive examples the report does name – from Belgium to Chile – are presented as case studies. Only 37% of countries routinely collect and disseminate migration-related health data. Fewer than 40% train health workers in culturally responsive care. Just 30% have run campaigns to counter misinformation or discrimination, the report found. The report is the first systematic quantification of these indicators, further blurring the picture of progress, as there is no baseline to compare against. The data is also entirely drawn from a voluntary survey completed by member states with no independent verification, meaning the results are unvetted self-assessments. The report explicitly does not rank countries on the success, impact or implementation of their policies, and “did not assess the level of implementation or impact of any given initiative,” meaning real-world outcomes “cannot be evaluated,” it said. The survey also contains no questions about financing, meaning a country can report including refugees in its national health policy while allocating no dedicated budget to deliver on it. “Rather than ranking countries on their progress,” the report notes, it seeks to identify how key gaps can be addressed going forward. The report comes as conflict, climate change and economic insecurity displace more people than ever before. More than one billion people live as refugees or migrants worldwide, though over 800 million remain within their own borders. There are 405 million international migrants, 36.8 million refugees, 8.4 million asylum seekers and 83.4 million internally displaced people. Dr Santino Severoni, head of WHO’s Special Initiative on Health and Migration and lead author of the report, said it was intended as a roadmap for coordinated action across governments, UN agencies, civil society, academia and migrant communities themselves. “The health of refugees and migrants is not a marginal concern: it is a defining issue of our time,” Severoni said. “By acting now, countries can ensure that refugees and migrants are not left behind, and that health systems are stronger, fairer and more prepared for the future.” Data ’emergency’, exclusion from emergency plans Progress roadmap for the World Health Assembly Resolution on migrant and refugee health. The new report follows a first edition published in 2022, which was a literature review of around 82,000 documents that established the scale of health disparities facing refugees and migrants worldwide. Two further progress checks are planned for 2027 and 2029, ahead of the 2030 deadline set by WHA member states for full implementation. The 2022 report identified fragmented data collection as the central structural obstacle to effective policy. That remains unresolved. Severoni described the situation as “almost an emergency.” “It’s not because data is not collected, but because they are collected in a very fragmented way, which makes it very, very difficult for us to have a full picture,” he said. Just 42% of countries include refugees and migrants in emergency preparedness or disaster risk reduction plans. Irregular migrants – those without legal residency status – are entirely absent from those frameworks, even as the crises that drive displacement, from war to climate-related disasters, intensify. “We cannot talk about refugee and migrant health without also addressing emergencies,” said Dr Chikwe Ihekweazu, WHO’s executive director for health emergencies. “Whether it’s a conflict, a climate-related crisis or an epidemic that forces movement, these crises expose the fragility of health systems and magnify the vulnerabilities of all those already at risk.” Population groups among refugees and migrants included in national health policies,legislation, strategies or plans. “This is not only an equity issue — it is a global health security risk,” he added. Excluding displaced populations from health systems, he said, weakens the collective capacity to detect and respond to outbreaks and crises. “Health does not begin and end at borders.” WHO is calling on governments to strengthen disaggregated health data collection, tailor policies to specific migrant groups including those in irregular situations, involve refugees and migrants in health governance, train health workers in culturally responsive care, and protect and expand financing. “The phenomena of displacement is unfortunately happening more frequently in countries with fragile systems, fragile economies and limited domestic resources,” Severoni said. “There is almost no mention of irregular migrants in those emergency plans and response or in disease risk reductions, there is no systematic approach in assessing the system to see how their system is really functioning, how efficient and effective it is.” “This is really a call for action to keep the promise of sharing a bit of responsibility in managing those emergencies,” he added. Political wave washes away progress Political sentiment in many wealthy nations has turned against expanding access for migrants, refugees and asylees. The report highlights progress in some countries. Chile has embedded migrant community representatives in municipal health councils, with direct input into maternal and mental health priorities. Belgium has run a national intercultural mediation programme since 1999; as of late 2024, 113 trained mediators were working across 76 hospitals and community health centres. Yet the report’s release comes as several wealthy nations move to restrict refugee and migrant healthcare, driven by economic pressures and political campaigns questioning whether asylum seekers and refugees should be entitled to publicly funded care. In the United States, legislation passed in 2025 changed the definition of “eligible alien” for Medicaid eligibility, cutting coverage for many lawfully present immigrants, asylees, refugees, and trafficking and domestic violence survivors. On 1 May, its northern neighbour Canada will start requiring refugees and asylum seekers to pay out of pocket for essential health services previously covered under its Interim Federal Health Program. The programme “has provided basic health coverage to people fleeing war, genocide, torture, and persecution since 1957,” according to the Migrant Rights Network. Services affected include medications, dental care, mental health, vision and physiotherapy. Across the Atlantic, Germany extended to 36 months the period in which asylum seekers are restricted to emergency-only care, doubling the previous threshold of 18 months. In France, a similar fight is playing out over the future of its Aide Médicale de l’État programme, which provides medical care to undocumented migrants. Critics say the programme encourages migration and is an undue cost to taxpayers, though it accounts for just 0.5% of national public health spending. International funding for refugee health has also fallen sharply. UNHCR’s 2025 budget stands at $10.6 billion, of which only 23% had been secured at mid-year. The agency has warned that up to 12.8 million displaced people could be left without life-saving health interventions this year. “Around the world, more than one billion people are on the move, seeking safety, opportunity and dignity,” Tedros said. “Investing in refugee and migrant health is both ethically essential and strategically beneficial. Supporting their health and inclusion strengthens health systems and benefits everyone.” Image Credits: Wikipedia Commons. Pandemic Agreement Talks Get Five More Negotiating Days 30/03/2026 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening. With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations. Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May. The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics. Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted. “At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.” Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks. “This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.” However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. After some tension during the closed session, member states accepted this position. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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New Open Source AI Platform Aims to Accelerate Malaria Drug Discovery 31/03/2026 Kerry Cullinan A health worker examines a child with suspected malaria. Scientists working on new malaria drugs now have access to an open-access artificial intelligence (AI)-powered platform aimed at accelerating drug discovery, thanks to a partnership between Medicines for Malaria Venture (MMV) and deepmirror. Drug Design for Global Health (dd4gh) uses “both predictive and generative AI to give researchers, especially those in the most resource-limited settings, access to cutting-edge technology that would otherwise be out of reach”, according to a media release from MMV. The dd4gh platform was developed using input gathered during co‑creation workshops in Ghana and Switzerland with global drug discovery researchers. Its AI models are trained on data sets from a wide range of studies conducted by global health researchers, enabling scientists to benefit from insights generated across multiple research efforts. “At a time when the global health sector is facing significant constraints, dd4gh demonstrates the power of partnership,” said MMV CEO Dr Martin Fitchet. “By giving scientists in low and middle-income countries (LMICs) free access to advanced AI tools, we can accelerate the discovery of lifesaving medicines led by the people closest to the diseases we are trying to defeat.” The platform implements active learning, a technique that allows AI and machine learning (ML) to continuously improve its predictions by learning from new data. It analyses large data sets and proposes the most promising compounds to explore in the lab. Shorter timelines, reduced costs These technologies have the potential to dramatically shorten timelines and reduce costs for drug discovery, allowing scientists to focus their time and resources on what is more likely to work, enabling faster discovery of treatments for diseases that pose significant global health challenges. “Africa is disproportionately affected by many infectious and non-infectious diseases, yet African-led solutions are limited. Tools like dd4gh can have a transformative impact on the continent’s capacity for drug discovery research,” said Prof Richard Amewu, lead of the drug innovation group at the University of Ghana, which tested the platform. Dr Godwin Dziwornu, senior investigator in medicinal chemistry at the University of Cape Town’s (UCT) H3D, said that the platform is “easy to access and user-friendly”. Dziwornu added: “I’ve found it very useful in two main areas: generating new compound designs and the models available to assess compound properties and predict their drug likeness to solve a particular liability, for example, absorption, distribution, metabolism and excretion. This helps me guide my decisions to synthesise high-quality compounds, saving me precious time and resources.” Caroline Maina, a UCT PhD candidate and participant in a co-creation workshop, said there are other AI tools that can help with drug discovery “but being in a resource-limited setting makes purchasing a license prohibitive”. “Making dd4gh open access for researchers in global health means more of us can explore new ideas and apply AI to finding treatments for diseases that are part of our everyday realities,” said Maina. Dr Max Jakobs, co-founder and CEO of deepmirror, said the free platform aims to strengthen “a more inclusive global scientific ecosystem” as “access to advanced AI should not depend on where a scientist works or their laboratory’s resources”. deepmirror builds chemistry-based foundation models for biopharma and research organisations to support active drug discovery programmes. It integrates predictive and generative AI directly into research workflows, combining “proprietary data with models trained on larger, curated datasets, which are continuously updated and strengthened over time”. MMV is a not-for-profit product development partnership working to discover, develop and deliver medicines to treat, prevent and eliminate malaria. Since 1999, its co-developed medicines have helped 1.3 billion people. Image Credits: Tommy Trenchard/ Global Fund, Damien Schumann / MMV. More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist 30/03/2026 Stefan Anderson First global survey of 93 nations shows two-thirds include these populations in health plans, but none provide equal access to undocumented migrants. More than 60 countries now include refugees and migrants in their national health policies, according to a new World Health Organization (WHO) report tracking progress on commitments first set out by the World Health Assembly in 2019. The finding, drawn from a survey of 93 member states, is the first systematic count of how countries are implementing a resolution that called on governments to ensure refugees and migrants have access to health services, are included in national health planning, and are counted in health data systems. “Many countries have begun integrating refugee and migrant health into national strategies,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Yet gaps remain, particularly in collecting and using migration-related health data, ensuring participation of refugees and migrants in decision-making, and guaranteeing access to care for all, regardless of legal status.” “Like anyone else, refugees and migrants need uninterrupted, affordable and equitable access to health services wherever they are,” Tedros said. While WHO called the findings “encouraging,” the picture the report paints is difficult to read clearly. What “inclusion in a national health policy” actually means for care access for migrants and refugees varies widely – and the report does not name which countries fall where. Two-thirds of the 93 surveyed countries said they include refugees and migrants in their health policies. When asked what level of access different groups receive, 16 countries said refugees can access services on a par with the host population, 14 extended that standard to documented migrant workers, and 11 to asylum seekers. No country surveyed reported providing equal access to migrants in irregular situations – those living without legal status or formal documentation. The positive examples the report does name – from Belgium to Chile – are presented as case studies. Only 37% of countries routinely collect and disseminate migration-related health data. Fewer than 40% train health workers in culturally responsive care. Just 30% have run campaigns to counter misinformation or discrimination, the report found. The report is the first systematic quantification of these indicators, further blurring the picture of progress, as there is no baseline to compare against. The data is also entirely drawn from a voluntary survey completed by member states with no independent verification, meaning the results are unvetted self-assessments. The report explicitly does not rank countries on the success, impact or implementation of their policies, and “did not assess the level of implementation or impact of any given initiative,” meaning real-world outcomes “cannot be evaluated,” it said. The survey also contains no questions about financing, meaning a country can report including refugees in its national health policy while allocating no dedicated budget to deliver on it. “Rather than ranking countries on their progress,” the report notes, it seeks to identify how key gaps can be addressed going forward. The report comes as conflict, climate change and economic insecurity displace more people than ever before. More than one billion people live as refugees or migrants worldwide, though over 800 million remain within their own borders. There are 405 million international migrants, 36.8 million refugees, 8.4 million asylum seekers and 83.4 million internally displaced people. Dr Santino Severoni, head of WHO’s Special Initiative on Health and Migration and lead author of the report, said it was intended as a roadmap for coordinated action across governments, UN agencies, civil society, academia and migrant communities themselves. “The health of refugees and migrants is not a marginal concern: it is a defining issue of our time,” Severoni said. “By acting now, countries can ensure that refugees and migrants are not left behind, and that health systems are stronger, fairer and more prepared for the future.” Data ’emergency’, exclusion from emergency plans Progress roadmap for the World Health Assembly Resolution on migrant and refugee health. The new report follows a first edition published in 2022, which was a literature review of around 82,000 documents that established the scale of health disparities facing refugees and migrants worldwide. Two further progress checks are planned for 2027 and 2029, ahead of the 2030 deadline set by WHA member states for full implementation. The 2022 report identified fragmented data collection as the central structural obstacle to effective policy. That remains unresolved. Severoni described the situation as “almost an emergency.” “It’s not because data is not collected, but because they are collected in a very fragmented way, which makes it very, very difficult for us to have a full picture,” he said. Just 42% of countries include refugees and migrants in emergency preparedness or disaster risk reduction plans. Irregular migrants – those without legal residency status – are entirely absent from those frameworks, even as the crises that drive displacement, from war to climate-related disasters, intensify. “We cannot talk about refugee and migrant health without also addressing emergencies,” said Dr Chikwe Ihekweazu, WHO’s executive director for health emergencies. “Whether it’s a conflict, a climate-related crisis or an epidemic that forces movement, these crises expose the fragility of health systems and magnify the vulnerabilities of all those already at risk.” Population groups among refugees and migrants included in national health policies,legislation, strategies or plans. “This is not only an equity issue — it is a global health security risk,” he added. Excluding displaced populations from health systems, he said, weakens the collective capacity to detect and respond to outbreaks and crises. “Health does not begin and end at borders.” WHO is calling on governments to strengthen disaggregated health data collection, tailor policies to specific migrant groups including those in irregular situations, involve refugees and migrants in health governance, train health workers in culturally responsive care, and protect and expand financing. “The phenomena of displacement is unfortunately happening more frequently in countries with fragile systems, fragile economies and limited domestic resources,” Severoni said. “There is almost no mention of irregular migrants in those emergency plans and response or in disease risk reductions, there is no systematic approach in assessing the system to see how their system is really functioning, how efficient and effective it is.” “This is really a call for action to keep the promise of sharing a bit of responsibility in managing those emergencies,” he added. Political wave washes away progress Political sentiment in many wealthy nations has turned against expanding access for migrants, refugees and asylees. The report highlights progress in some countries. Chile has embedded migrant community representatives in municipal health councils, with direct input into maternal and mental health priorities. Belgium has run a national intercultural mediation programme since 1999; as of late 2024, 113 trained mediators were working across 76 hospitals and community health centres. Yet the report’s release comes as several wealthy nations move to restrict refugee and migrant healthcare, driven by economic pressures and political campaigns questioning whether asylum seekers and refugees should be entitled to publicly funded care. In the United States, legislation passed in 2025 changed the definition of “eligible alien” for Medicaid eligibility, cutting coverage for many lawfully present immigrants, asylees, refugees, and trafficking and domestic violence survivors. On 1 May, its northern neighbour Canada will start requiring refugees and asylum seekers to pay out of pocket for essential health services previously covered under its Interim Federal Health Program. The programme “has provided basic health coverage to people fleeing war, genocide, torture, and persecution since 1957,” according to the Migrant Rights Network. Services affected include medications, dental care, mental health, vision and physiotherapy. Across the Atlantic, Germany extended to 36 months the period in which asylum seekers are restricted to emergency-only care, doubling the previous threshold of 18 months. In France, a similar fight is playing out over the future of its Aide Médicale de l’État programme, which provides medical care to undocumented migrants. Critics say the programme encourages migration and is an undue cost to taxpayers, though it accounts for just 0.5% of national public health spending. International funding for refugee health has also fallen sharply. UNHCR’s 2025 budget stands at $10.6 billion, of which only 23% had been secured at mid-year. The agency has warned that up to 12.8 million displaced people could be left without life-saving health interventions this year. “Around the world, more than one billion people are on the move, seeking safety, opportunity and dignity,” Tedros said. “Investing in refugee and migrant health is both ethically essential and strategically beneficial. Supporting their health and inclusion strengthens health systems and benefits everyone.” Image Credits: Wikipedia Commons. Pandemic Agreement Talks Get Five More Negotiating Days 30/03/2026 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening. With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations. Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May. The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics. Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted. “At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.” Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks. “This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.” However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. After some tension during the closed session, member states accepted this position. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist 30/03/2026 Stefan Anderson First global survey of 93 nations shows two-thirds include these populations in health plans, but none provide equal access to undocumented migrants. More than 60 countries now include refugees and migrants in their national health policies, according to a new World Health Organization (WHO) report tracking progress on commitments first set out by the World Health Assembly in 2019. The finding, drawn from a survey of 93 member states, is the first systematic count of how countries are implementing a resolution that called on governments to ensure refugees and migrants have access to health services, are included in national health planning, and are counted in health data systems. “Many countries have begun integrating refugee and migrant health into national strategies,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Yet gaps remain, particularly in collecting and using migration-related health data, ensuring participation of refugees and migrants in decision-making, and guaranteeing access to care for all, regardless of legal status.” “Like anyone else, refugees and migrants need uninterrupted, affordable and equitable access to health services wherever they are,” Tedros said. While WHO called the findings “encouraging,” the picture the report paints is difficult to read clearly. What “inclusion in a national health policy” actually means for care access for migrants and refugees varies widely – and the report does not name which countries fall where. Two-thirds of the 93 surveyed countries said they include refugees and migrants in their health policies. When asked what level of access different groups receive, 16 countries said refugees can access services on a par with the host population, 14 extended that standard to documented migrant workers, and 11 to asylum seekers. No country surveyed reported providing equal access to migrants in irregular situations – those living without legal status or formal documentation. The positive examples the report does name – from Belgium to Chile – are presented as case studies. Only 37% of countries routinely collect and disseminate migration-related health data. Fewer than 40% train health workers in culturally responsive care. Just 30% have run campaigns to counter misinformation or discrimination, the report found. The report is the first systematic quantification of these indicators, further blurring the picture of progress, as there is no baseline to compare against. The data is also entirely drawn from a voluntary survey completed by member states with no independent verification, meaning the results are unvetted self-assessments. The report explicitly does not rank countries on the success, impact or implementation of their policies, and “did not assess the level of implementation or impact of any given initiative,” meaning real-world outcomes “cannot be evaluated,” it said. The survey also contains no questions about financing, meaning a country can report including refugees in its national health policy while allocating no dedicated budget to deliver on it. “Rather than ranking countries on their progress,” the report notes, it seeks to identify how key gaps can be addressed going forward. The report comes as conflict, climate change and economic insecurity displace more people than ever before. More than one billion people live as refugees or migrants worldwide, though over 800 million remain within their own borders. There are 405 million international migrants, 36.8 million refugees, 8.4 million asylum seekers and 83.4 million internally displaced people. Dr Santino Severoni, head of WHO’s Special Initiative on Health and Migration and lead author of the report, said it was intended as a roadmap for coordinated action across governments, UN agencies, civil society, academia and migrant communities themselves. “The health of refugees and migrants is not a marginal concern: it is a defining issue of our time,” Severoni said. “By acting now, countries can ensure that refugees and migrants are not left behind, and that health systems are stronger, fairer and more prepared for the future.” Data ’emergency’, exclusion from emergency plans Progress roadmap for the World Health Assembly Resolution on migrant and refugee health. The new report follows a first edition published in 2022, which was a literature review of around 82,000 documents that established the scale of health disparities facing refugees and migrants worldwide. Two further progress checks are planned for 2027 and 2029, ahead of the 2030 deadline set by WHA member states for full implementation. The 2022 report identified fragmented data collection as the central structural obstacle to effective policy. That remains unresolved. Severoni described the situation as “almost an emergency.” “It’s not because data is not collected, but because they are collected in a very fragmented way, which makes it very, very difficult for us to have a full picture,” he said. Just 42% of countries include refugees and migrants in emergency preparedness or disaster risk reduction plans. Irregular migrants – those without legal residency status – are entirely absent from those frameworks, even as the crises that drive displacement, from war to climate-related disasters, intensify. “We cannot talk about refugee and migrant health without also addressing emergencies,” said Dr Chikwe Ihekweazu, WHO’s executive director for health emergencies. “Whether it’s a conflict, a climate-related crisis or an epidemic that forces movement, these crises expose the fragility of health systems and magnify the vulnerabilities of all those already at risk.” Population groups among refugees and migrants included in national health policies,legislation, strategies or plans. “This is not only an equity issue — it is a global health security risk,” he added. Excluding displaced populations from health systems, he said, weakens the collective capacity to detect and respond to outbreaks and crises. “Health does not begin and end at borders.” WHO is calling on governments to strengthen disaggregated health data collection, tailor policies to specific migrant groups including those in irregular situations, involve refugees and migrants in health governance, train health workers in culturally responsive care, and protect and expand financing. “The phenomena of displacement is unfortunately happening more frequently in countries with fragile systems, fragile economies and limited domestic resources,” Severoni said. “There is almost no mention of irregular migrants in those emergency plans and response or in disease risk reductions, there is no systematic approach in assessing the system to see how their system is really functioning, how efficient and effective it is.” “This is really a call for action to keep the promise of sharing a bit of responsibility in managing those emergencies,” he added. Political wave washes away progress Political sentiment in many wealthy nations has turned against expanding access for migrants, refugees and asylees. The report highlights progress in some countries. Chile has embedded migrant community representatives in municipal health councils, with direct input into maternal and mental health priorities. Belgium has run a national intercultural mediation programme since 1999; as of late 2024, 113 trained mediators were working across 76 hospitals and community health centres. Yet the report’s release comes as several wealthy nations move to restrict refugee and migrant healthcare, driven by economic pressures and political campaigns questioning whether asylum seekers and refugees should be entitled to publicly funded care. In the United States, legislation passed in 2025 changed the definition of “eligible alien” for Medicaid eligibility, cutting coverage for many lawfully present immigrants, asylees, refugees, and trafficking and domestic violence survivors. On 1 May, its northern neighbour Canada will start requiring refugees and asylum seekers to pay out of pocket for essential health services previously covered under its Interim Federal Health Program. The programme “has provided basic health coverage to people fleeing war, genocide, torture, and persecution since 1957,” according to the Migrant Rights Network. Services affected include medications, dental care, mental health, vision and physiotherapy. Across the Atlantic, Germany extended to 36 months the period in which asylum seekers are restricted to emergency-only care, doubling the previous threshold of 18 months. In France, a similar fight is playing out over the future of its Aide Médicale de l’État programme, which provides medical care to undocumented migrants. Critics say the programme encourages migration and is an undue cost to taxpayers, though it accounts for just 0.5% of national public health spending. International funding for refugee health has also fallen sharply. UNHCR’s 2025 budget stands at $10.6 billion, of which only 23% had been secured at mid-year. The agency has warned that up to 12.8 million displaced people could be left without life-saving health interventions this year. “Around the world, more than one billion people are on the move, seeking safety, opportunity and dignity,” Tedros said. “Investing in refugee and migrant health is both ethically essential and strategically beneficial. Supporting their health and inclusion strengthens health systems and benefits everyone.” Image Credits: Wikipedia Commons. Pandemic Agreement Talks Get Five More Negotiating Days 30/03/2026 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening. With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations. Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May. The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics. Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted. “At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.” Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks. “This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.” However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. After some tension during the closed session, member states accepted this position. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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Pandemic Agreement Talks Get Five More Negotiating Days 30/03/2026 Kerry Cullinan Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening. With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations. Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May. The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics. Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted. “At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.” Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks. “This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.” However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. After some tension during the closed session, member states accepted this position. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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New Funding Models Needed as Global Health Faces Growing Financial Strain 28/03/2026 Health Policy Watch Christoph Benn (left) and Patrick Silborn Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care. On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems. Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns. “It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said. Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes. Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding. Both experts stressed that private-sector engagement requires a clear understanding of incentives. “Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes. Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility. “It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution. Listen to the full episode >> Read more about Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. Posts navigation Older posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Global Health Needs Rethink as Systems Fall Behind 28/03/2026 Health Policy Watch Dr Garry Aslanyan and Axel R. Pries Global health leaders say the world needs to rethink how it approaches health, arguing that outdated systems, narrow thinking, and lack of coordination are slowing progress at a time of growing challenges. Speaking on the Global Health Matters podcast, Axel Pries, president of the World Health Summit, told host Dr Gary Aslanyan that improving health outcomes will require broader cooperation across sectors, stronger communication, and a shift toward prevention. Listen to the full episode >> Pries said it was “clear that we needed politics, civil society and also the private sector.” He argued that global health can no longer be driven by governments and medical professionals alone, and that progress depends on open collaboration between actors with different interests. While concerns remain, especially around the private sector, he said these partnerships are key to turning research into real-world results. He also pointed to shifting global power, saying institutions created after World War II need to adapt to a more multipolar world. Countries like India, Brazil, and those across Africa should have a bigger role in shaping global health. At the same time, he said core values, especially a shared commitment to health equity, must stay the same. Pries also highlighted challenges in how global health is communicated. Too often, the term is misunderstood as a niche issue affecting distant regions, rather than something that directly impacts everyday life. “It’s everything, everywhere. It’s at our doorstep,” Pries said. Looking ahead, he called for greater engagement from finance and political leaders, and a stronger focus on prevention rather than crisis response.Without that shift, he warned, health systems will remain reactive rather than resilient. Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters podcast. US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. Posts navigation Older posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
US Withdrawal of Global Health Funding is ‘Public Health Emergency of International Concern’ 26/03/2026 Kerry Cullinan US President Donald Trump shocked partners when he announced an immediate freezing of all international health aid shortly after assuming power in January 2025. The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week. According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. “Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK. The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”. If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030. Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue. “If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note. Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.” Mobilise resources In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions. They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” “The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge. While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”. They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”. However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.” Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. 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Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote? 25/03/2026 Kerry Cullinan Civil society organisations held a protest outside the European Parliament in Brussels last week, urging the EU to support a fair and equitable PABS Annex. A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock. Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar. At the opening session, African countries rejected the latest draft text proposed by the IGWG Bureau, and a closed session of the meeting finally agreed to revert to the text of IGWG 5, reported Professor Lauren Paremoer, a member of the People’s Health Movement. Member states are negotiating the one outstanding piece of the Pandemic Agreement – the Pathogen Access and Benefit Sharing (PABS) system, which will govern how dangerous pathogens should be shared and how any benefits that accrue from this information are also shared. Numerous countries, particularly in Africa, want the assurance that if they share pathogen information, they will be able to benefit from any vaccines, therapeutics or diagnostics (VTD) that are developed as a result. They also want the PABS Annex to include standard contracts with pharmaceutical companies, setting out the terms of access and benefit-sharing. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. They are also against set contracts, giving companies “a lot of wriggle room” to negotiate terms of benefit-sharing, said Gopakumar. Some European countries also favour allowing parties to use pathogen information without registration as a PABS user – something that the civil society representatives said would enable them to bypass any obligations to share benefits. There is also a dispute over when countries will receive a share of the benefits. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by the pharmaceutical companies that sign up to PABS during a pandemic only, not a public health emergency of international concern (PHEIC). Voting to break deadlock? Pedro Villardi, representing Public Services International – a trade union federation with over 30 million members, more than half of whom are health and care workers – warned that a binding benefit-sharing system is essential to protect frontline health workers. “If we don’t have a benefit-sharing system that truly works with binding commitments, the risk is that, when we face the next pandemic, frontline workers will not receive priority access to [VTDs] and we will have the same tragedy that we had during the COVID-19 pandemic.” “Some delegations are framing the non-conclusion of these negotiations as a failure of multilateralism,” said Villardi. But he warned that a weak PABS system would undermine the global solidarity that multilateralism was supposed to build. “So if we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations.” Villardi said that voting had happened on other issues, including a recent vote at the WHO Executive Board meeting in February on an Israeli proposal on Palestine. Although Villardi initially told the briefing that the WHO Essential Medicines List was created through a vote, he later qualified this, saying that member states had voted on a resolution to give the WHO a mandate to set up an expert group on essential medicines. “In the 1970s, the WHO was highly polarised, both in terms of East and West, and developed ‘versus’ developing nations. Developed countries [termed First World at the time] opposed the concept of essential medicines, and the creation of a WHO Essential Medicines list itself,” Villardi explained. “Developing nations did not back down because the First World countries wouldn’t agree with the WHO working on an equity-driven agenda. In other words, developing countries and the WHO itself took the agenda forward even without consensus. So consensus cannot be used as a veto power. The WHO did important things, such as the essential medicines list, even without consensus. And since developing countries are the majority, why not vote?” Civil society briefing (clockwise from top left): Rajnia Rodrigues, Lauren Paremoer, Alessandra Tisi, Guilherme Faviero, KM Gopakumar and Pedro Villardi. Pressure to adopt ‘stripped down’ Annex Guilherme Faviero, director of the AIDS Healthcare Foundation Global Public Health Institute, warned that member states are under mounting pressure to “accept a stripped-down annex that is devoid of meaningful benefit-sharing provisions and adequate legal guarantees”. However, the PABS Annex is supposed to address the “deep structural inequities within the global health system” exposed by the COVID-19 pandemic, said Faviero. “Pathogen samples and genomics sequence data moved quickly across borders, but life-saving technology did not and this is precisely what this Annex must solve,” said Faviero. “Despite months of good faith efforts by delegations to advance text-based negotiations, the European bloc and key developed countries have been resistant to commonsense proposals to operationalise equity and ensure that these commitments, that are set forth in Article 12 of the Pandemic Agreement can be implemented successfully on an equal footing.” He blamed the “delaying tactics of the European bloc” for the current impasse, adding that “civil society organisations have coalesced around very clear principles that should be reflected in the agreement”. ‘Europe to blame’ Alessandra Tisi, executive secretary of the Geneva Global Health Hub (G2H2), agreed: “The biggest threat to the successful outcome of this negotiation is the position of the European Union and other developed countries. Basically, they just keep rejecting key proposals from developing countries, and we have now arrived at this deadlock.” Tisi said that some of the positions of the European Union contradicted its own internal regulations and other international agreements. “The European Union was a very vocal, if not the main proponent, of the creation of a WHO Pandemic Agreement back in 2020. So it’s very hard to understand why, rather than advancing health for all and trying to build a more equitable and resilient healthcare architecture, it actually reinforces the very same status quo which has caused the pandemic in the first place.” This article was updated with a new quote from Villardi. Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. Posts navigation Older posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text 23/03/2026 Kerry Cullinan Namibia, speaking for the Africa region, at IGWG6. Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft PABS Annex text. Pakistan also asserted that an agreement on the Pathogen Access and Benefit-sharing (PABS) annex should not be rushed simply to “manufacture a multilateral success”. The World Health Organization’s (WHO) Intergovernmental Working Group (IGWG) aims to conclude talks on how to share information about dangerous pathogens – and any vaccines, therapeutics and diagnostics that are developed as a result – by Saturday night. This would enable the PABS annex to be presented to the World Health Assembly (WHA) in May for ratification. But while IGWG’s agenda for the final six days of talks runs until 11pm each night, this may not be enough time given the lack of trust and an unwillingness to compromise that was evident at the opening session. The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information. Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries. Return to earlier draft? IGWG co-chairs, Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Matthew Harpur. Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February. African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported. But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”. “We will obviously proceed to use all of the contributions that have been put forward, including the [IGWG 5] text,” said Tovar. “We cannot say that we will only use that [IGWG 5] text because we have so many enriching contributions, including, for example, the contracts that were put forward, including the terms of reference for labs and database that were produced by the secretariat. “So I think there, we are not allowed to impoverish our deliberations by just promising that we will solely see and focus on one text,” he asserted, later asking Namibia if it mistrusted the process. Eventually, Namibia proposed retaining the Bureau’s version as a “reference” while using the IGWG5 text for actual negotiations. Meanwhile, Nigeria said that the IGWG5 text is “contested”, reflecting “genuine disagreement between delegations on fundamental questions about sovereignty, about binding obligations, about who bears the cost of pandemic equity and who receives its benefits”. “That disagreement is real, and this session must resolve its honesty, rather than paper over it with language that creates an appearance of agreement while delivering on none of its substance.” Nigeria proposed prioritising key issues during the negotiations: sovereignty safeguards during public health emergencies; legal accountability for laboratories and sequence databases, and technology transfer that “directly enables African pharmaceutical manufacturing”. Changing the status quo Indonesia at IGWG 6, speaking for the Group for Equity Indonesia, speaking on behalf of the regionally diverse Group for Equity, asserted that “multilateralism is not simply about reaching an outcome. It is about producing an outcome that significantly changes the status quo”. Indonesia said that some “multilateral outcomes may appear to show progress on paper, but underlying inequities remain insufficiently addressed. “We are asking for a higher standard. We recognize the pressure of the timeline, but some of the sticky issues are not about time but the willingness to find meaningful solutions. The time pressure alone should not lead us toward weak design, diluted commitments, or lowered expectations,” said Indonesia. Pakistan, which is also part of the Group for Equity, said: “The PABS Annex must not be turned into a face-saving exercise for a strained multilateral system. A weak or unbalanced outcome will not strengthen the system; it will undermine it.” Pakistan warned IGWG6 not to adopt a symbolic agreement that won’t ensure equity. The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”. “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states. He stressed the need for “an open, collaborative and multilateral approach for pandemic prevention, preparedness and response”. and called on all delegations to “muster the necessary result to overcome our remaining differences in the time we have left for this process”. More time won’t bring agreement WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus, warned member states that more time will not buy more agreement. However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”. He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.” Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.” Tedros also warned: “The conflict in the Middle East and crises elsewhere in our world are reminders that health emergencies can erupt suddenly and affect multiple countries, increasing the risk of disease outbreaks. “A commitment to upholding international law, multilateral solutions and strong international collaboration to shared threats has never been more needed.” Civil society questions WHO commitment Over 100 civil society organisations wrote to Tedros before the meeting, raising the need for the WHO to adher to “access and benefit-sharing (ABS) principles”. Research indicates that “there are at least 15 WHO coordinated networks engaged in pathogen sample or digital sequence information sharing” without any regard for ABS, they noted, “facilitating biopiracy, including digital biopiracy and increasing biosecurity risks”. “Critically, WHO has failed to mandate user registration, identity verification, and data access agreements as baseline requirements,” they added. Anonymous access “means that genetic resources originating in developing countries can be accessed, commercialised, and exploited with complete impunity, and with WHO’s implicit endorsement”, they noted. Meanwhile, a range of non-state actors addressed the PABS 6 opening, stressing issues such as the need for equitable access to pandemic countermeasures, enforceable benefit-sharing terms, transparency and legally binding obligations. Pharma calls for ‘precise parameters’ The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) appealed for a “workable PABS”. “Companies need clear, science-based definitions of scope that should focus on pandemic emergencies. If inclusion depends on broad or evolving interpretations rather than precise parameters, it risks capturing routine research operations and creating uncertainty that could negatively impact R&D efforts. “Experience shows that voluntary, collaborative approaches deliver the strongest outcomes. PABS should support open scientific exchange, rather than condition access to pathogens on contractual arrangements that may limit collaboration. “In this regard, treating pathogens as sovereign or monetizable resources, or linking access to financial obligations, risks creating barriers to rapid sharing that are inconsistent with global health security objectives,” the IFPMA warned. Posts navigation Older posts