A High Level Declaration on Pandemic Prevention, Preparedness and Response appeared likely to win approval by the United Nations General Assembly – but only later in the Assembly calendar. 

Objections by the United States and a few other states appeared to block a consensus agreement on the draft text at Friday’s high-profile UN HLM debate  – pushing the issue to a vote in the GA, likely to occur just before the close of the Assembly’s annual session in December. 

“The United States is not in a position to support this text in full,” said the US representative at the debate.  “Critical issues remain unresolved – whether it is the inclusion of divisive ideologies that lack definitional consensus or references to an unfinished negotiation on pathogen access and benefit sharing in an agreement that failed to achieve international consensus, the United States is not in a position to support this text in full,” she said.  

Strong support from Africa and Caribbean nations

The agreement drew strong support from African nations, led by Burundi and Cabo Verde, as well as other major Latin American and Caribbean countries at Friday’s debate. 

In Asia, developing countries like Bangladesh, said they “welcome the political declaration and its vision and call for solidarity.” 

The European Union expressed “overarching support” for the principles behind the agreement – signaling that the 27+ member bloc would not oppose the declaration’s passage. 

But the EU representative expressed reservations about language in the draft text that supported heavy reliance on international trade rules that allow for “compulsory licensing” by countries in health emergencies – saying that could undermine intellectual property. Emphasis should rather be placed on “voluntary” license and technology transfer arrangements to low and middle-income countries, the EU representative said.  

Italy went further, saying that it “had concerns regarding the political declaration,” noting that did not support he adoption of the WHO Pandemic Agreement,  nor the 2024 amendments to the International Health Regulations”, suggesting that they expand the WHO’s role beyond it’s constitutional mandate and impinge on national sovereignty.

WHO urges rapid approval of Pathogen Access and Benefit (PABS) arrangements

WHO’s Director General Dr Tedros Adhanom Ghebreyesus, meanwhile, affirmed that the recent WHO agreements do not impgine on national sovereignty and  urged member states to reach a rapid conclusion on the Pathogen and Benefit Sharing (PABS) annex to the WHO Pandemic Agreement, approved in 2025. 

A bitter standoff between developing countries and high-income European nations has stalled progress on the agreement, which aims to hammer out a more precise, rules-based approach for ensuring immediate sharing of pathogen samples and genetic templates – but also guarantee benefits to developing countries that participate in sample sharing, from the drugs, diagnostics and vaccines thus produced.

“Today, I leave you with just one request, just one,” said Tedros, “Get PABS done as soon as possible. Further delays are not just delays in procedure or process. They are delays that cost all countries daily when the next pandemic arrives. 

“We can never say the world is ready enough. The threat evolves and so must we. 

“Is the world more ready than it was before COVID-19? Yes and no. And if you fulfill the commitment you’re making today, you will make it a yes.”

Former Independent Panel Co-Chair echoes WHO appeals for PABS agreeement

Tedros’ appeal was echoed by former New Zealand Prime Minister Helen Clark, former co-chair of the Indedependent Panel, which issued a biting report in 2021 on shortcomings in global preparedness and response. She cited the recent outbreaks of hantavirus and the Ebola Bundibugyo virus as examples of heightened outbreak risks that the world faces today.

“We can and we must do better at anticipating and managing known risks before they become international emergencies.”

On the plus side, she noted how “ good, updated International Health Regulations,” had tightened countries’ reporting obligations to WHO – leading to rapid WHO declarations on the Bundibugyo outbreak within two days of its confirmation. 

“But we now know that the virus had been spreading for some time,” she added, noting that surveillance of emerging threats remains inadequate. 

Along with more pandemic finance, the world needs global coordination, she emphasized, also urging for rapid approval of the PABS annex. The 2025 WHO Pandemic Agreement cannot go to member state signature, ratification and implementation before the PABs annex is finalized, she underlined. 

“A path must be found through the current impasse in negotiations,” she said. “That path must support the fast sharing of pathogen samples and sequence information, and it must. and it must ensure guaranteed access to benefits. My call, like that of Dr. Tedros, to leaders around the world is to please put your weight behind these negotiations.” 

Developing nations call for approval of PABS annex 

The PABS agreement aims to set up an enforceable system for implementing a 20% set-aside of real-time health products to countries in need, as mandated in the overall Pandemic Agreement approved last year.  According to the agreement 10% would be provided free of charge and 10% would be provided at non-profit prices.  

“Kenya supports rapid WHO access targeting at least 20% of real-time production, clear positions on sequence information, and enforceable arrangements that deliver benefits when they are most needed,” said the Kenyan delegate at the HLM, as one expression of developing country positions. 

“We must ensure that the rapid sharing of pathogens and scientific information is matched by the rapid, fair, and equitable sharing of the benefits arising from their use, including vaccines, diagnostics, and therapeutics, and that countries contributing pathogens and genomic information can meaningfully benefit from the products and technologies developed from them,” added Egypt.  See related story here: 

Pandemic Agreement Negotiator Warns Against Losing Momentum

US bilateral deals are elephant in the room of PABS negotiations

 The elephant in the room holding up an agreement is, in fact,  the United States’ declared opposition to any multilateral pandemic accord, one former European negotiator noted to Health Policy Watch, just ahead of Friday’s debate.  

Instead, the US is setting up bilateral deals with dozens of low-income nations whereby it would be assured of access to pathogen data as a part of donor assistant packages, but with no express guarantees of real-time products for pandemics and health emergencies. 

Europe is therefore fearful that should it sign onto a PABS agreement that provides for strictly linked provisions on pathogen access and benefit sharing, its pharma industries will be hamstrung, in comparison to US-based manufacturing powerhouses that face no such financial or technical limitations. 

“That’s the elephant in the room holding up a PABS agreement,” the former negotiator said, on condition of anonymity. 

“The US has pursued specimen-sharing agreements with a number of countries, although the full extent and how it will practically interact with a future PABS system is unclear,” observed one Geneva-based NGO expert. “That potentially creates a competing pathway whereby pathogens/materials could reach US actors”  – while manufacturers participating in a PABS benefit-sharing system are left out in the cold. 

Civil society and industry response to HLM declaration  

Meanwhile, NGO access groups expressed disappointment to the delays in adoption of the Political Declaration – while pharma actors 

‘We are disappointed that UN Member States are putting off adoption of the Political Declaration, as we risk losing momentum at a time when global cooperation has never been more crucial, leaving the world less prepared for and protected from the next pandemic,” said Rachel Cohen, Senior Advisor at the Geneva-based Drugs for Neglected Diseases initiative (DNDi). 

‘Despite this setback, we have been encouraged over the last week to hear countries repeatedly recognize that research and development (R&D), including the goal of developing medical countermeasures within 100 days of an outbreak being identified, must be at the core of pandemic preparedness efforts and equitable access must be built into the R&D process by design. UN Member States can and should move ahead, especially within regional and cross-regional coalitions and alliances, to put the commitments in the draft Declaration into action.  

 Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), also took an indirect swipe at the bilateral US moves to secure pathogen access for just one nation or its pharma industries alone, saying: 

“We are calling for global frameworks that support rapid and effective action by facilitating the timely sharing of pathogen samples and scientific information, strengthening research and development, and enabling regulatory cooperation. They should also support practical measures such as day-zero financing and coordinated response mechanisms that allow partners to mobilize quickly when new threats emerge. The objective must be to accelerate collaboration and innovation, not create additional barriers or complexity during a crisis.  

One Health approaches need more development

While many member states spoke about the importance of strengthening One Health approaches, also endorsed in the declaration text, there is little detail in the text about how to do that.

Prevention of pathogens from escaping the wild into human communities through deforestation, wild animal trade, water and sanitation and other pathways, civil society actors have stressed.

“We particularly appreciate the Declaration’s endorsement of an integrated One Health approach, which recognizes the interconnectedness of human, animal and environmental health and the need to address the drivers of disease emergence and pathogen spillover,” said a Pandemics and Animal Welfare (PAW) Working group in a joint statement to the High Level Meeting.

“At the same time, we note that, despite the fact that most emerging infectious diseases are zoonotic, references to animals remain limited throughout the Declaration, while animal welfare receives no explicit recognition.

“To strengthen prevention efforts, Member States should place greater emphasis on addressing pandemic risks at their source. This requires a clear commitment to identifying and mitigating the practices and conditions that create opportunities for pathogen spillover, including biodiversity loss, habitat disruption, wildlife exploitation and trade, and animal production systems.”

Image Credits: Nature .