WHO races to finalize pathogen-sharing annex meant to prevent ‘vaccine apartheid’ in the next pandemic

Inside a fluorescent-lit conference room at the World Health Organization’s headquarters in Geneva, government negotiators are spending this week bent over bracketed treaty clauses projected onto giant screens. The sessions stretch late into the night, with interpreters waiting in booths and delegates shuttling between side rooms. After nearly five years of pandemic diplomacy, they have six days to settle a question that could shape the next global outbreak: when poorer countries hand over dangerous new pathogens, will they receive guaranteed access to the vaccines and treatments those pathogens help create?

A deadline for the treaty’s missing machinery

The meeting, which runs March 23–28, is the sixth — and what officials hope will be the last — session of the Intergovernmental Working Group on the WHO Pandemic Agreement. Delegates are trying to finalize a long-delayed annex establishing a Pathogen Access and Benefit-Sharing system, known by its acronym, PABS. The annex is due to go to the World Health Assembly in May.

PABS is designed as the operational core of the WHO Pandemic Agreement, a legally binding accord that member states adopted on May 20, 2025, under Article 19 of the WHO Constitution. That article allows the World Health Assembly to approve conventions or agreements on health matters, a power it has used only a handful of times.

In opening remarks to the Geneva meeting on March 23, WHO Director-General Tedros Adhanom Ghebreyesus framed the week as a make-or-break moment.

“This is what we all hope will be the final meeting of the IGWG before the 79th World Health Assembly,” Tedros told delegates.

The annex, he said, would “operationalize” key elements of the agreement, including the “rapid and timely sharing of pathogen information” and the “timely and equitable sharing of benefits.”

He warned that pushing the talks further would not necessarily help.

“More time will not change fundamental positions,” he said, adding that prolonged negotiations would take place in an “increasingly unfavourable climate.”

If countries fail to reach consensus, he said, “we are left with the status quo – no PABS System, and a Pandemic Agreement that exists only on paper.”

Why PABS became the central fight

The pandemic agreement emerged from bruising global experience with COVID-19, when scientists in several low- and middle-income countries shared samples and genetic sequences of the virus early, but populations in those same countries often waited months or longer for vaccines and therapeutics. Vaccine nationalism and export bans by some high-income states, combined with limited manufacturing capacity in poorer regions, left large parts of Africa and other regions behind wealthy countries in accessing shots.

The agreement adopted in 2025 aims to strengthen pandemic prevention, preparedness and response by improving surveillance, early warning, coordinated research and health systems. It also commits countries to pursue more equitable access to vaccines, therapeutics and diagnostics, and to establish new structures such as a global supply chain network and a coordinating financial mechanism for pandemics.

But those commitments will be largely theoretical unless countries agree on how PABS will work in practice.

What’s in the draft: pathogens in, benefits out

Under drafts discussed in Geneva, countries that join the system would be required to share “PABS materials” — pathogen samples and associated genetic sequence information for viruses and other agents with pandemic potential — as soon as they become available. Those materials would be sent to laboratories in a WHO-coordinated network, with sequence data uploaded rapidly to publicly accessible platforms.

In return, manufacturers that benefit from access to those materials would be expected to contribute to global access to the products developed from them. Negotiating texts under discussion refer to expectations that participating companies will:

• Donate at least 10% of relevant vaccines, therapeutics or diagnostics during a declared pandemic, and
• Provide another 10% at “affordable” prices for allocation by WHO.

Firms would also pay an annual fee to participate in the system and commit to some combination of technology transfer, non-exclusive licensing, capacity-building and other benefit-sharing options.

The core dispute: enforceable obligations or flexible commitments

The balance between hard obligations and soft expectations is at the center of the fight.

A broad coalition of low- and middle-income countries — including the Africa Group, countries from the WHO Eastern Mediterranean and South-East Asia regions, and a cross-regional “Group for Equity” — argues that PABS must be legally binding and quantifiable, not aspirational.

For them, the system is “operational, enforceable and central” to the agreement, according to language used by African negotiators in earlier sessions. South-based think tanks such as the South Centre have described PABS as the “soul” of the treaty, while former world leaders in the advocacy group The Elders have said it must be “equitable and operational from day one.”

Civil society groups active in global health have amplified those messages. The AIDS Healthcare Foundation, a large nonprofit that provides HIV care in dozens of countries, has campaigned under the slogan “EU: Stop Blocking Health Equity,” accusing some European governments of resisting stronger benefit-sharing obligations. Médecins Sans Frontières’ Access Campaign has warned that without enforceable commitments on distribution, pricing and technology transfer, the world risks “repeating vaccine apartheid.”

Several European states, including Germany and Switzerland, have taken a more cautious line on binding obligations for industry, according to people familiar with the talks and public statements by advocacy groups tracking the process. They argue that overly prescriptive requirements on donations, discounts and licensing could undermine incentives for research and development, and that voluntary partnerships and flexible arrangements may deliver more effective cooperation with the pharmaceutical sector.

The pharmaceutical industry, represented globally by organizations such as the International Federation of Pharmaceutical Manufacturers & Associations, has emphasized the importance of intellectual property rights and innovation. Industry officials have expressed concern that strict quotas and mandated licensing could discourage companies from engaging with the PABS system.

When would rules kick in—and who pays?

Another unresolved question is when the full force of the annex would apply. Negotiators are debating whether the strongest obligations should kick in only when WHO declares a pandemic, or also during lower-level emergencies such as a public health emergency of international concern, the category used during outbreaks like monkeypox. Many low- and middle-income countries argue that limiting strong benefit-sharing to formally declared pandemics risks delaying access to countermeasures in fast-moving outbreaks.

Financing and capacity-building add further complexity. While the pandemic agreement envisions a coordinating financial mechanism to support preparedness and response, details are still thin. Low- and middle-income governments and civil society groups have warned that current language leans heavily on domestic resource mobilization for countries already facing debt and budget pressures, without firm commitments of international support. Rights organizations have also pointed to recent cuts in global health funding by major donors, saying those moves cast doubt on promises of new pandemic financing.

Compliance, geopolitics and misinformation

Enforcement is another open issue. Proposals on the table include regular reporting on PABS implementation and peer-review-style processes to assess how countries are meeting their commitments. Advocacy groups are pushing for stronger compliance mechanisms and greater transparency, arguing that a system based mainly on goodwill will not prevent a repeat of inequities seen with COVID-19 vaccine distribution and earlier outbreaks.

The Geneva talks are also unfolding against a backdrop of broader geopolitical maneuvering. The United States, while participating in the WHO process, has in parallel pursued bilateral health security agreements that, according to public descriptions by health policy analysts, make rapid sharing of pathogen information a condition for certain types of support. Advocates worry that such side deals could create a two-tiered landscape in which powerful countries secure bespoke access to data and benefits, while the multilateral system remains weaker.

Outside the negotiating rooms, the pandemic agreement and the PABS concept have been targeted by online campaigns that falsely claim WHO is seeking authority to impose lockdowns, vaccine mandates or digital identification systems on sovereign states. WHO officials and independent legal experts have repeatedly said the agreement does not confer such powers and that countries retain control over their public health policies. Delegates in Geneva say the real debate is over how to structure sharing of scientific materials and the benefits that flow from them, not over national sovereignty.

Three paths as the clock runs out

For WHO, and for the wider system of multilateral cooperation, the outcome this week will serve as a test of whether governments can still negotiate binding rules that balance national interests with global public goods.

Supporters of a strong annex argue that clear, enforceable commitments on both pathogen access and benefit-sharing could speed the development and deployment of vaccines and treatments in future crises, potentially saving millions of lives and avoiding some of the trillions of dollars in economic damage seen during COVID-19. Critics of more rigid provisions say overreach could backfire, deterring industry participation and complicating implementation in national legal systems.

As delegates work through dense legal text late into the evenings — daily sessions are scheduled into the night, with a possible closing stretch on March 28 — Tedros has urged them to measure each compromise against recent history.

“Ask yourselves whether the text you produce will solve the problems we faced during the COVID-19 pandemic,” he told them on opening day. “Ask yourselves, ‘Can I live with this?’”

By the time they adjourn in Geneva, countries are expected to choose among three broad paths: a robust annex with binding, detailed obligations on both sharing pathogens and sharing the resulting benefits; a weaker text built largely on voluntary pledges and flexible language; or no deal in time for the World Health Assembly in May, leaving a much-heralded pandemic agreement without the machinery that is supposed to make it work.