The World Health Assembly (WHA) adoption of the Pandemic Agreement sent a powerful message: Multilateralism remains alive and countries can still find common understandings on collective problems. Many steps still need to be completed, and thus the agreement will not be open for signature for at least another year, as negotiations continue on contentious issues around an Annex on the Pathogen Access and Benefit-Sharing System (PABS). This sixth issue of the Governing Pandemics Snapshot explores the trade-offs made in a final agreement and the steps remaining for it to be ready for parties’ signature, setting off the countdown for it to enter into force.

The 78th World Health Assembly (WHA) adoption of the Pandemic Agreement (PA) on 20 May was the end of an arduous three-year negotiating process. But it also marked the beginning of another round of difficult negotiations on an annex for Pathogen Access and Benefit Sharing (PABS). 

The agreement will not be open for signature for at least another year as negotiations continue on the PABS Annex. It must be signed by at least 60 countries for it to enter into force, a process that could take years.

This article reviews the tense 11th hour debates and tradeoffs that led to the final agreement, as well as the next steps to expect in the PABS negotiations. 

Tone shifts in late negotiations

In 2025, the International Negotiating Body (INB) met twice. The 13th meeting of the INB took place on from 17 to 21 February, based on a new text proposed by the Bureau, a group of six country representatives leading the process. 

The list of unresolved articles was long and included some of the most contentious issues that had seen little convergence over the previous years: prevention and One Health, technology transfer, PABS, supply chain and logistics, and governance elements in Chapter III. 

This was also the first session held without the participation of the United States, following the announced withdrawal from the World Health Organization (WHO) after the inauguration of the second Trump administration. Against this backdrop, progress was made – albeit slowly.

Some observers suggested that the absence of the US, combined with a heightened sense of urgency due to mounting pressures on the global health architecture and ongoing funding cuts, might have contributed to a more constructive attitude of delegation and a shift in tone. 

The resumed session of INB13 – the final meeting on the INB calendar – took place on from 7 to 11 April, with nightly sessions stretching into the early hours of the morning on each day of negotiations. 

Progress was steady. Negotiators gradually cleared all remaining articles, reaching consensus on the framework for the PABS System – including a fixed commitment for each participating manufacturer to share a percentage of real-time production during pandemics, one of the key requests of developing countries – followed by agreement on prevention and One Health (see Ricardo Matute’s piece for an analysis of this topic). 

One by one, key issues began to fall into place during an extenuating week of negotiations. 

On the final day, negotiators worked continuously for over 24 hours to achieve full consensus. However, one final point of contention remained: Article 11 on technology transfer. Divisions persisted between countries favoring a strictly voluntary approach and those advocating for stronger obligations, including mechanisms to compel access to manufacturing know-how for pandemic-related health products during crises. 

With consensus on the full text within reach, the meeting was suspended around 9am on Saturday 12 April, after 24 hours of deliberation, and scheduled to resume on Tuesday 15th.

In the early hours of April 16th, the text was fully greened – culminating in an emotional and symbolically powerful moment. 

The deadlock on technology transfer was resolved by inserting a footnote defining the expression “as mutually agreed” after each reference in the text. (A more detailed analysis of the outcome of this compromise is provided by Ellen ‘t Hoen in the Snapshot.)

Adoption survives a surprise last-minute vote 

Following the green-lighting of the text in April, the INB transmitted the final draft of the agreement along with a draft resolution that was agreed upon shortly after the finalization of the agreement, to the 78th World Health Assembly (WHA) for formal adoption. 

The PA was the first item for consideration in Committee A, one of the main committees of the WHA focusing on programmatic and technical issues, and with a consensus ready text, agreement should have been straightforward. 

Yet, a last-minute curveball came from Slovakia, which unexpectedly called for a vote. A statement released by the Slovak Prime Minister Robert Fico claimed that the agreement “violates the principle of the sovereignty of the member states and disproportionately interferes with the area of human rights.” 

Despite this challenge, member states overwhelmingly showed support for this hard-won treaty: the final vote recorded 124 in favor, zero objections and 11 abstentions. A number of countries were absent from the meeting or had their right to vote suspended due to their arrears in assessed contributions. 

The following day, the text moved to the plenary session, where it was adopted by consensus, surrounded by cheers and a surge of emotion in the room.

Several crucial steps before entry into force

Negotiators deliberately designed the PA’s architecture to accommodate further negotiations, particularly those required to operationalize the PABS System. 

Although the PA includes a dedicated article on PABS, it merely establishes the system’s foundational principles. The specifics — such as how benefits will be shared and what obligations apply to countries and companies — remain to be determined. 

To this end, the WHA mandated the creation of an Intergovernmental Working Group (IGWG), open to all WHO Member States, to negotiate the elements necessary to operationalize the PABS System in the form of an annex to the agreement that will have to be adopted separately by the WHA.

A consequential addition was made to Article 33 on signature: the PA will only be open for signature once the PABS Annex has been adopted by the WHA. 

The IGWG is scheduled to hold its first meeting no later than 15 July 2025, during which it will presumably determine the composition of the Bureau that will lead the next phase of negotiations, and its program of work. It is unclear whether former INB Bureau members will be reappointed or if new leadership will step in. 

The IGWG must present the outcome of its work – whatever this may be – to the 79th WHA in May 2026. This leaves less than a year to resolve one of the agreement’s most complex and contentious components. (A detailed analysis of what to expect from these negotiations is addressed by Adam Strobeyko in another piece of this Snapshot.)

Should consensus prove elusive, it will fall to the WHA to decide how to proceed. 

Importantly, the IGWG’s mandate extends beyond finalizing the Annex. It is also tasked with laying the groundwork for the agreement’s implementation and eventual entry into force. 

These tasks include drafting the rules of procedure for the Conference of the Parties, establishing financial rules and a draft budget; defining the structure and functions of the Global Supply Chain and Logistics Network; suggesting reporting obligations; and proposing details on the functioning of the implementation mechanism for the PA. (These institutional and procedural issues are explored further by Gian Luca Burci in in Snapshot.)

Once the annex is adopted, the PA will be open for signature and ratification. It will require ratification by at least 60 countries to enter into force — a process that could take years. 

As many analysts have indicated, the adoption of this historic agreement marks not an endpoint but rather a beginning. As negotiations continue on the PABS Annex and the operational structures needed to implement the agreement, the focus must now shift to ensuring that these ambitious commitments are translated into real-world impact, strengthening global preparedness and response to future pandemics.

This is one of six article in the latest Governing Pandemics Snapshot produced by the Global Health Centre at the Geneva Graduate Institute.

Daniela Morich is Senior Manager and Adviser at the Global Health Centre, Geneva Graduate Institute. 

Ava Greenup is Project Associate of the Governing Pandemics Initiative at the Global Health Centre, Geneva Graduate Institute.

Image Credits: WHO.