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The penultimate meeting of a World Health Organization (WHO) working group to amend the International Health Regulations (IHR) began in Geneva on Monday amid stakeholder praise and criticism for the latest 64-page draft.

The IHR are legally binding and sets out countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders. But they were found lacking during the COVID-19 pandemic and the Working Group on Amendments to the IHR (WGIHR) has been considering over 300 amendments over the past two years.

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An independent panel released its much-awaited report on Monday about the UN relief agency for Palestine refugees (UNRWA), providing 50 recommendations and noting that Israeli authorities have yet to provide proof of their claims that UN staff are involved with terrorist organisations.

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Earlier this week the Bureau of the Intergovernmental Negotiating Body released the latest draft of the Pandemic Agreement due for consideration at a resumed meeting beginning April 29^th that will see marathon negotiations with an aim to conclude this process by May 10^th.

The text is not markedly different from a previous version on which we reported on April 16th but there are certain changes – these we discuss below. The latest version has not been officially published by the INB yet.

What is also on the table is a draft resolution text that lays out the link between the main agreement and processes that would follow the adoption of the text at the Assembly including setting up of Intergovernmental Working Groups for certain provisions, immediate tasks for the WHO Director-General to follow through.  

This negotiation is taking place at the World Health Organization (WHO), but it is useful to reflect on negotiations that have taken place at the World Trade Organization (WTO), where delayed outcomes were disappointing outcomes. In the negotiations over the 2001 Doha Declaration on TRIPS and Public Health, paragraph 6 of that agreement concerned one of the most contentious topics, a restriction in the TRIPS on the exports of products manufactured under a compulsory license. That export restriction undermines the ability to benefit from economies of scale and comparative advantage, is clearly protectionist and designed to reduce the utility of compulsory licenses, has a negative impact on both exporters and importers, and has a particularly harmful impact on countries with smaller market (something noted by the WTO in DS114): 6. We recognize that WTO members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement. We instructed the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002.

A draft version of the proposed negotiating text for a Pandemic Agreement, currently being discussed internally, has no reference to a dedicated fund that would help implementation of new obligations on pandemic prevention, preparedness and response. Such a pooled fund previously articulated in a prior text was also meant to help finance existing obligations under the International Health Regulations.

The draft version of a proposed new text from the Bureau of the Intergovernmental Negotiating Body, also merges the provision on technology transfer with the article on sustainable production; and it merges parts of the language on compensation and liability management with the provision on supply chain and procurement.

And importantly, it presents a streamlined version on the Pathogens Access and Benefits Sharing provision with effectively no binding provisions on benefits, and kicks the can down the road, with modalities to be finalised two years in May 2026.

While the next draft of the World Health Organization’s (WHO) pandemic agreement is due to be sent to member states by Thursday (18 April), it is likely to be stripped of contentious clauses.

Instead, the draft – and indeed, the pandemic agreement to be put to the World Health Assembly (WHA) at the end of  May – will be an “instrument of essentials”; a basic text that will be fleshed out by further talks in the next couple of years, as reported recently by Health Policy Watch.

After the WHA has adopted the framework, more details will be fleshed out over the next 12 to 24 months. Thereafter, a  Conference of Parties has been proposed, but sources close to the discussions say this is only likely to convene in the latter half of 2026 – so fingers crossed that there’s no pandemic before that!

Comprising a million, informal, female health workers, India’s ASHA program, stands as the most prominent Community Health Worker (CHW) initiative both nationally and globally. Approaching nearly two decades since inception, ASHAs have become the cornerstone of India’s primary healthcare system and thereby a major contributor to the delivery of healthcare rights. At the 75th World Health Assembly (WHA) on May 22, 2022, ASHAs were honored with the Global Health Leaders Award, acknowledging their pivotal role in connecting marginalized communities with health services and recognizing their efforts in ensuring access to primary healthcare, amidst the challenges posed by the COVID-19 pandemic ¹. As we commemorate World Health Day 2024, we felt it is an opportune time to pause and reflect on the uncertainties and problematics confronting the programme, both at the level of policy and at the level of the workers themselves.

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 The Vice-Chair of the Bureau of the Intergovernmental Negotiating Body (INB), Dr.  Viroj Tangcharoensathien of Thailand, has proposed a new timeline of May 2026 to conclude negotiations on a Pathogen Access and Benefit Sharing (PABS) System.

The Vice-Chair made this proposal in his presentation during the informal session on Article 12 held on 8 April at the WHO Headquarters in Geneva, a hybrid mode. The last slide of his presentation contains the new timeline, which states: “Terms, conditions and operational modalities of the PABS System shall be further defined in a legally binding instrument that is operational no later than 31 May 2026”.

World Health Organization members' negotiations on a pandemic preparedness treaty remain rocky less than two months before the intended deadline, as industrialized and developing nations butt heads over technology access.

Talks began in December 2021 with countries hoping to apply lessons from the slow COVID-19 response to prepare for the next pandemic. After two years of negotiating the contents, the plan was to reach an accord at the negotiating body's meeting last month.

That meeting ended on March 28 with no agreement, after failing to bridge the gap between India and African countries pushing for greater fairness in areas such as drug distribution, and the U.S., Japan and European countries seeking to avoid heavy financial burdens and transfers of valuable technology.

Global interest in the issue is also ebbing as countries focus on new crises such as the wars in Ukraine and the Middle East.

"If we miss this opportunity, we risk losing momentum," WHO Director-General Tedros Adhanom Ghebreyesus said on the first day of the meeting.

A major point of contention is how to handle technologies developed by drugmakers.

In the Geneva Health Files, we proposed a robust Pathogen Access and Benefits (PABS) system that imposes binding obligations on users of biological materials and genetic sequence data (GSD) to make mandatory monetary contributions. PABS is necessary but not sufficient to ensure equity. There is still important work to do on intellectual property waivers and technology transfers. But PABS is important. The Africa Group and the Equity Group are unlikely to acquiesce to a treaty without a strong PABS system. At the same time, GHF recently reported that the pharma industry is warming up to PABS, but wants unconditional access sans benefit sharing obligations. That’s a non-starter.