An enormous list of World Health Organization (WHO) member states, 173 in all, lined up to speak in favour of the pandemic agreement at the World Health Assembly (WHA) on Monday – an extraordinary demonstration of the breadth of support for the document.

But between the cheers were reminders that the talks are not yet done. An annex still needs to be negotiated to establish the mechanisms for a pathogen access and benefit-sharing (PABS) system – the most controversial aspect of the three-year talks.

The PABS system will develop a mechanism for how countries that share information about pathogens with pandemic potential may benefit if pharmaceutical products are developed as a result.

“As a country that has shared its pathogens, often without equitable returns, the PABS system is paramount in rectifying these imbalances and ensuring the realisation of genuine equity and equitable access,” said South African Health Minister Aaron Motsoaledi, speaking for the Africa region.

The Africa region sees the target of 20% of pandemic products being reserved for the WHO for distribution to low- and middle-income countries (LMICs) by manufacturers participating in PABS, with at least 10% as a donation, during future pandemics, as a “positive first step”, added Motsoaledi.

Speaker after speaker urged countries to maintain their political commitment to the PABS negotiations and reach an agreement on the annex before next year’s WHA.

Even Hungary, a staunch ally of United States President Donald Trump, welcomed the agreement – and stressed that it did not infringe on countries’ sovereignty, a key claim of disinformation about the pandemic.

Trump distanced the US from the pandemic agreement at the outset of his presidency in January, and many of his MAGA supporters claim it is a “power grab” by the WHO.

Only Iran and Paraguay said they could not support the current pandemic agreement draft – reserving support until after the PABS negotiations.

First ‘One Health’ agreement

Germany said it “would have welcomed stronger provisions, particularly regarding prevention,” but “recognise this agreement as a critical and timely step toward global solidarity and multilateralism”. 

“We urge all member states to engage in the upcoming annex negotiations with the same political will and unity that have brought us this far. Let us continue to invest in international cooperation and global solidarity, not only to protect our citizens, but also to lay the groundwork that future generations can benefit from,” said Germany.

Switzerland, which has sought to protect its pharmaceutical sector during talks, said it supports “a pragmatic, voluntary approach within existing frameworks, that take into account the advice and contributions from experts”. 

The European Union said that the agreement “marks an important accomplishment for global health security and cooperation” and “can bolster country capacities to prevent and prepare for pandemics using the One Health approach”.

Ireland added that “the commitment to [pandemic] prevention through a One Health approach is the first of its kind to recognise the interconnectedness of human, animal and environmental health in our response to emerging health trends”. 

“The establishment of a global supply chain and logistics network and a pathogen access and benefit sharing system will ensure that the response to future health threats will be faster, more effective and more equitable,” it added. 

China said the agreement “will contribute to the fair distribution of health products, relevant technologies and resources to help developing countries enhance their capacities for prevention, preparedness and response” – but that it needed “some follow-up mechanisms, as well as sustained investment and capacity building efforts from all countries” to be effective. 

Kazakhstan said that “this is not just a global legal document. It is our collective response to a future where everybody will be protected, regardless of their economic position or status. We must underscore that the success outcome will be defined not only by its content, but also by its ability the state’s ability to implement it.”

Jamaica, speaking for 22 countries in the Americas and Caribbean (excluding the USA), said the region was ready to do the work to finish the pandemic agreement.

“We remember too vividly the oxygen shortages, the overwhelmed hospitals and healthcare workers, and over seven million lives lost during the COVID-19 pandemic,” said Jamaica. “For the Americas,  this agreement means stronger commitments to regional manufacturing capacity, coordinated surveillance, research and development and transfer of technology, especially for developing countries.”

‘The worst of times’

Co-chairs of the Intergovernmental Negotiating Body (INB), South Africa’s Precious Matsoso and French Ambassador for Global Health Anne-Claire Amprou, also addressed the session, expressing appreciation to member states for their commitment.

Matsoso reminded the WHA that the special assembly called to establish the INB was convened “at a time when we all wore masks, we practised social distancing, and we had face-to-face meetings that were highly restricted”. 

“It was the worst of times, the season of despair, of tragic losses, immeasurable devastation – all associated with COVID-19,” said Matsoso.

She praised delegates for working through “13 formal rounds of negotiations, many of them extended, producing various iterations of draft pandemic agreement and proposals that have culminated into what we have before us as a consensus draft”.

Amprou, who took over as co-chair from Roland Driece of the Netherlands in July 2024, said that the process involved “three years of dialogue, of compromise, of debates, of sleepless nights, but above all, three years guided by a common conviction that health is a common good”.

“The COVID-19 pandemic was a shock for us all. It was a brutal reminder of the fact that viruses know no borders. No country, however powerful, can address a global health crisis on its own,” said Amprou.

Meanwhile, former co-chair Driece spoke for the Netherlands, expressed his appreciation that the long process had resulted in an agreement.

A resolution on the pandemic agreement is likely to be put to the WHA plenary on Tuesday.