In December 2021, as the COVID pandemic continued to rage, WHO Member States established an Intergovernmental Negotiating Body (INB) to draft an international agreement on pandemic prevention, preparedness, and response (PPPR).

The outcome of the negotiations is to be presented at the 77th World Health Assembly, which will meet next week in Geneva.

Over the past two years, negotiators have worked tirelessly to meet this challenge, facing numerous obstacles along the way, including a very ambitious timeline for extremely complex negotiations.

As we await the outcome of this last-minute, adrenaline-fueled effort, the progress made so far is significant and represents the foundational steps toward improved global pandemic preparedness.

Even if some elements are left open for more detailed discussion in future negotiations, the advancements already achieved are significant – and should be secured by the WHA.

The proposal: an improved global PPPR set of rules

At the launch of the negotiating process, after extensive consultations with a broad spectrum of stakeholders, Member States spearheading this initiative began outlining the foundation for a new global, equitable system of PPPR.

Since the release of the Conceptual Zero Draft, in November 2022, the ambition for this instrument has remained high. Over the six iterations of the draft treaty text released in the past 18 months by the INB Bureau—two co-chairs and four vice-chairs from each of the WHO regions leading the process—the aim has been to cover the entire framework of pandemic prevention, preparedness, and response. 

The intention of negotiators has also been to ensure synergy and complementarity with the International Health Regulations (IHR), a task made more complex by the parallel process to amend the circa 2005 IHR  launched by the Health Assembly in 2022.

The draft pandemic document addresses diverse and complex areas such as One Health, global supply chain, local production of health products, research and development, transfer of technology and know-how, access to pandemic products, pathogen and benefit sharing, and sustainable and predictable financing for PPPR. Its overarching goal is to achieve health security with equity in all these aspects.

At each step of the negotiations, the scope of the work has largely remained true to the original ambition. The depth of certain provisions has certainly evolved, based on political acceptability. 

Some key provisions of initial drafts have now disappeared

Some significant exceptions have emerged on key provisions. For instance, reference to human rights and accountability mechanisms, such as a strict reporting system and an implementation and compliance committee, have largely been eliminated from the current draft. However, the core building blocks of the agreement remain intact.

In this final negotiating stage, Member States are negotiating each article line-by-line. As they progress on their work, they use green highlights for parts with consensus and yellow highlights for parts that have reached consensus in working groups but not yet in plenary sessions.

While it is not possible to predict the outcome of these negotiations, an analysis of the green and yellow text as displayed in the draft document on May 10 indicates there would be significant changes, and to some extent improvement, in global readiness and response if the agreement is to be adopted.

Local production and R&D: a first-time step towards equity

On local production of pandemic products, the draft text attempts to respond to the concentration of manufacturing in a few countries in the world. It requests Member States to take measures to achieve more equitable geographical distribution and rapid scale-up of the global production of pandemic-related health products.

This aims to increase sustainable, timely, and equitable access to such products, and reduce the potential gap between supply and demand during pandemic emergencies. The text goes on to identify other collaborative measures Member States will endeavor to take, such as, for instance, supporting skills development and capacity-building, and promoting and incentivizing public and private sector investments. 

While it is not perfect, this is the first time that, to our knowledge, an international, legally-binding instrument seeks to expand local production of health products.

The provisions on research and development (R&D) yields a similar conclusion. While some delegates remain concerned about the imposition of new transparency obligations on R&D and tying global access conditions to publicly funded R&D, there appears to be consensus on the rest of the article. 

Notably, this would also be the first time an international treaty seeks to make R&D for health products more equitable and collaborative.

Pathogen and benefit sharing: a make-or-break article

The draft agreement ambitiously aims to establish a Pathogen Access and Benefit-Sharing (PABS) system as part of the Agreement, which would represent a new and binding obligation for nations that ratify the treaty.

Ensuring timely and reliable sharing of pathogen samples and genetic sequence information, along with equitable sharing of benefits arising from their utilization, is crucial for PPPR and access to health technologies. However, over time, it has become clear that a detailed articulation of PABS would be impossible to achieve by the May 2024 deadline – partly due to the complex technicalities that are involved.

For instance, while draft versions of the text had aimed to define a fixed proportion of vaccine and medicines set-asides to be offered for free or at concessionary prices in the event of a pandemic, agreement on a percentage has remained elusive and may not be responsive to changing conditions in a crisis. Similarly, how to ensure equity alongside other disease priorities remains an issue. 

Additionally, agreement is still lacking on other key aspects of the future system. Issues such as the use of standardized, legally binding contracts, user registration requirements, intellectual property rights, its relation with other international instruments, and equitable access to scientific and monetary benefits are still under discussion.

The negotiators of the PABS system will also have to take into account the parallel discussions concerning the establishment of a multilateral access and benefit sharing mechanism under the UN Convention on Biological Diversity.

Agreement on ‘principles’ seems to be most likely outcome

In light of such complexities, negotiators seem to be close to agreeing on principles to be included in a future PABS instrument, listed under draft Article 12, with a proposal to finalize the details by May 2026 through a process open to all WHO member states – and to be launched by the World Health Assembly.

There is, however, agreement on a reaffirmation of  the principle of national sovereignty over biological resources.

Additionally, the emerging broad international recognition that the rapid sharing of pathogen samples and associated genetic sequence information should be linked to equitable benefit-sharing is significant. It responds to a key ask by developing countries to operationalize equity – even if some argue it doesn’t go far enough. 

Overall, it would be the first time governments agree on principles tailored for addressing ABS for pandemics in a legally-binding instrument.

The outstanding points can be addressed in future negotiations regarding the full operational details of the PABS system. 

One Health 

Negotiators have worked intensively on how to integrate the One Health approach into the Pandemic Agreement. This approach acknowledges the interconnection between the health of people, animals, and ecosystems, marking its first inclusion in an international legally binding instrument.

Developed countries are the main supporters of this approach, while several developing countries have shown concern about the binding regulatory burden as well as the associated costs that One Health provisions in the agreement might impose on them.  Some developing countries have also expressed a concern that tight prescriptions on One Health may result in unpredictable obstacles to their agricultural trade. 

Despite these concerns, there seems to be a consensus on the importance of the inclusion of One Health as an essential approach to PPPR, especially in light of the fact that it is estimated that 75% of all emerging infectious diseases are zoonotic, along with the adoption of selected measures that consider national circumstances. Further discussions after the World Health Assembly have been proposed, potentially to be included in a future Annex, but the outcome remains uncertain and will likely depend on the negotiations’ final stages. 

A glass half full: the road ahead

The current state of the Pandemic Accord can be seen as a glass half full. The green and yellow text represent a considerable step forward from the state of international law before the launch of the negotiations, promising significant improvements in global pandemic readiness and response.

To ensure the glass continues to fill, countries must establish a robust framework for ongoing work. This framework should list a common agenda of unresolved questions, outline guiding principles, and set a strict timetable for completion.  Delegates, on their side, must demonstrate the same determination and resilience they have shown over the past two years.

As the WHA approaches, the international community awaits the outcome with keen anticipation. If the international community can maintain its focus and commitment, the Pandemic Accord will not only represent an improvement over the status quo but also pave the way for a more resilient and equitable global health system.

Daniela Morich is Manager and Advisor at the Governing Pandemics Initiative hosted by the Global Health Centre at the Geneva Graduate Institute. 

Adam Strobeyko is a postdoctoral researcher for the Governing Pandemics Initiative.

Suerie Moon is co-director of the Global Health Centre.

Gian Luca Burci is Adjunct Professor of international law at the Geneva Graduate Institute.

Ava Greenup is a Project Associate of the Governing Pandemics Initiative. 

Image Credits: @RicardoDGPS, Chris Black/WHO, Rodger Bosch for MPP/WHO, NIAID-RML , lihkg.com.