There are tensions between World Health Organization (WHO) member states about how to approach the final negotiations on the pandemic agreement – an annex on Pathogen Access and Benefit Sharing system (PABS), according to Precious Matsoso, who co-chaired the negotiations.

“There’s an argument about whether you invite experts to start working on a technical document and then invite member states to discuss the details and negotiate amongst themselves, or get member states to submit their inputs and discuss and only then would you invite experts,” Matsoso told on event at the Global Health Centre at the Geneva Graduate Institute on Tuesday.

The Intergovernmental Negotiating Body (INB), co-chaired by Matsoso of South Africa and French Global Health Ambassador Anne-Claire Amprou, hands the PABS talks to an  Intergovernmental Working Group (IGWG). 

The working group is supposed to conclude talks on annex by next year’s WHA and, once adopted, the pandemic agreement will then be open for signature and ratification. Once 60 countries have ratified it, the agreement will enter into force.

The IGWG will also begin to set up a Coordinating Financial Mechanism for pandemic prevention, preparedness and response, and the Global Supply Chain and Logistics Network (GSCL).

Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response, said the IGWG was expected to start work in September.

She flagged the 2026 United Nations High-Level Meeting on pandemic prevention, preparedness and response as an opportunity to “push for rapid ratification” – or agreement on the annex if it has not yet been passed.

“The message we could send out to countries is: start looking at your national procedures and doing your national tests, and be ready to run on ratification when the annex is actually agreed,” Clark told the Graduate School audience.

Clark added that while South Africa, as chair of the G20, was supportive of pandemic prevention, preparedness and response, the US was due to assume the chair in 2026.

“Will they take the chair next year, or will it pass to someone else? If they take the chair, what hope is there for any of this? That’s an open question. I’m not a diplomat, so I can put this question on the on the table. If they take the chair, it could be treading water for a year, for with G20,” said Clark, who is a former Prime Minister of New Zealand.

Role of EU in talks

Speaking shortly after the World Health Assembly (WHA) plenary adopted the pandemic agreement, Matsoso said that the “Slovakia drama” raised questions about how regional blocs operated during negotiations.

Slovakia, whose Prime Minister Robert Fico is opposed to mRNA vaccines, demanded a vote on the pandemic agreement resolution during a committee discussion on Monday night. The resolution was passed by 124 votes in favour, zero objections, and 11 abstentions.

But Matsoso said Slovakia was part of the European Union (EU), which had negotiated as a bloc, so it should have been party to the regional position.

Matsoso added that some of the countries that had abstained had explained they “were still going through their own internal processes, and had not been given a mandate to vote” as they had expected the agreement would be adopted by consensus.

Dr Raj Panjabi, former White House official under Joe Biden, said there were three things to watch to ensure the pandemic agreement was implemented: independent monitoring and clear accountability; adequate financing, and “increasing regional self reliance”.

“Ensuring that financing is stepped up [is] very hard in this moment when overseas development assistance is being pulled back, not just by my country, the United States, but by several others,” said Panjabi.

“The WHO is more strained than ever, and that’s why ensuring that assessed contributions are increased is going to be critical, as is harmonising and leveraging other funds in the system,” said Panjabi.

Regional self-reliance

Panjabi defined regional self reliance as “an entire end-to-end focus, from research and development, investment and innovation to enhancing manufacturing and ensuring that the delivery of counter-measures in the next pandemic occurs,” said Panjabi.

However, Brazil’s deputy minister of health, Mariângela Simão, warned that, while there is a G20 coalition on local and regional production, “there’s so much that you can do at country level”. 

“Research and Development is one of the things that I’m more worried about – the capacity to copy what’s already developed and make safe and quality-assured products. We don’t need reinventing the wheel everywhere. We need to recognise what are global public goods and then make sure they are available at country level… you can’t have everyone producing everything.”

UNAIDS special adviser Michel Kazatchkine said that he could not see a world “that is just a juxtaposition of regions without any glue, without any coordination, without any compass”. This,  he added, is the role of the WHO, providing “vaccine blueprints, pre-qualification, its normative role”. 

In the future, global health “will not look like a top-down construction that it has been with money flowing from Geneva to various places”, Kazatchkine stressed. “The international money will be there to complement the national and the regional efforts, because global health is also about global solidarity.”

But Eloise Todd, who leads the Pandemic Action Network (PAN), noted that one of the biggest learnings from the COVID pandemic is “definitely no country, and certainly no region that can do it all themselves”. 

“We’re in a very uncomfortable place in which we know that there are modernisations and ways in which we need to reform to support the regionalisation agenda and the country agenda, but we certainly shouldn’t be doing it at the pace and with the disregard being done at present.

“We’re in this tension between the excellent work that some global entities do to fill a gap. And so what do you do about that? You can’t cut it away and risk lives, but we have to have, like, a 10 ,15, 20-year conversation about powering that down and getting towards proper national and regional level intersectionality.”