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The latest draft of the World Health Organization’s (WHO) pandemic agreement, which was sent out to member states on Wednesday (15 May), shows just how far the talks still have to go.

Health Policy Watch obtained a copy of the draft agreement, which we are sharing on our paywall-free site:

READ: Latest Pandemic Agreement Draft, reflecting progress up to 10 May

Around a third of the text is still white, indicating either that it has not been agreed on or not even discussed. According to a stakeholder briefing, there were some 300 paragraphs to negotiate on at the last meeting of the Intergovernmental Negotiating Body (INB).

However, some of the most significant articles are awash with yellow and green highlights, indicating progress.

Yellow means the text has been agreed to in a working group. Green means it has been agreed to in the plenary of the Intergovernmental Negotiating Body (INB).

Hours before the scheduled deadline on May 10^th to conclude the negotiations towards a Pandemic Agreement, unable to find consensus WHO member states struggled to find a way to extend the negotiations.

Diplomatic sources told us that countries were divided on devising a way ahead to continue the discussions. While some preferred to take “sufficient” time conclude these crucial talks carefully, groups of countries are keen on having an agreement “at any cost” ahead of the World Health Assembly that begins on May 27th.

Countries have now decided to continue to work till the last mile in an attempt to reach consensus. How they will do so, is less clear at this point.

In this story we describe the dynamics and events that unfolded at the close of the meeting of the Intergovernmental Negotiating Body on May 10.

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Governments of the world today agreed to continue working on a proposed pandemic agreement, and to further refine the draft, ahead of the Seventy-seventh World Health Assembly that starts 27 May 2024.

Governments meeting at the World Health Organization headquarters in Geneva agreed to resume hybrid and in-person discussions over coming weeks to advance work on critical issues, including around a proposed new global system for pathogen access and benefits sharing (i.e. life-saving vaccines, treatments and diagnostics); pandemic prevention and One Health; and the financial coordination needed to scale up countries’ capacities to prepare for and respond to pandemics.

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• Vaccines have saved 150 million children over the last 50 years

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The world is neither on track to meet the Sustainable Development Goals (SDGs) nor is it leveraging emerging opportunities to effectively address global concerns such as extreme hunger, poverty, conflict, and climate change. Global concerns have outpaced existing structures for international cooperation and coping.

To forge a global perspective, the United Nations Office in Nairobi is currently hosting the 2024 United Nations Civil Society Conference under the theme Shaping a Future of Global and Sustainable Progress. Bringing together more than 2,000 participants from civil society organizations, academic institutions, think tanks, member states, private sector companies, UN entities, change-makers, and other relevant stakeholders from across the globe.

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The negotiations on the Pandemic Agreement took a decisive turn this week, when at least two African countries became a part of a wider cross-regional group lending their support for a proposal that also reportedly has the backing of the EU and the U.S., in the context of the critical provision on Pathogen Access and Benefit Sharing, according to multiple sources.

Some of these countries are now being referred as the Group of Friends, who presented their proposal at a drafting group session this week, at the Intergovernmental Negotiating Body meeting underway in Geneva.

Countries discussed a revised proposal from the INB Bureau that builds on the informal proposal brought by the new group and on earlier feedback from member states. The drafting group is considering Article 12 on PABS, where countries are negotiating text in a plenary format in late evening sessions. Sources told us that what is now on the table is only a couple of paragraphs that capture, principles, components and proposed modalities for such a mechanism.

In this story we discuss the prevailing political dynamics, and the substantives elements of the PABS discussion.

Despite much lost sleep for members of the World Health Organization’s (WHO) intergovernmental negotiating body (INB) this week, it is impossible for consensus on a pandemic agreement to be reached by the end of Friday (10 May), the last day of this final round of negotiations.

Various negotiators Health Policy Watch that they did not see how the deadline could be met, especially as on Thursday co-chair Precious Matsoso ruled out extending talks to the weekend, saying that member states needed to travel back to their countries.

The agreement was supposed to be presented to the World Health Assembly (WHA)  which starts on 27 May, for ratification. But now that this will not happen, sources close to the process say that two possible scenarios are being discussed.

The negotiations for the WHO Pandemic Agreement have brought attention to issues of racism and colonialism in global health. Although the agreement aims to promote global solidarity, it fails to address these deeply embedded problems. This Viewpoint argues that not including the principle of subsidiarity into Article 4 of the agreement as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity, as a structural principle, empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. By integrating subsidiarity, the agreement could have ensured contextually appropriate responses, empowered local communities, and achieved justice in global health. This paper discusses the elements of subsidiarity—namely, agency and non-abandonment—and highlights the need to strike a balance between them. It also maps the principle of subsidiarity within the Pandemic Agreement, emphasising the importance of creating a practical framework for its implementation.

The draft text of the World Health Organization pandemic accord reaffirms countries’ rights to use to the full the flexibilities contained in the World Trade Organization TRIPS Agreement and the Doha Declaration on TRIPS and Public Health. However, in reality, countries that do use TRIPS flexibilities encounter complaints and pressure from the European Union and other countries (such as the United States) not to use them to their full extent.

It is, therefore, no surprise that countries are seeking additional assurances in the pandemic accord, which is in its final days of negotiations before it is meant to go to the World Health Assembly. In March, a group of developing countries proposed the following wording:

4bis. The Parties shall not challenge, or otherwise exercise any direct or indirect pressure on the Parties that undermine the right of WTO Members to use TRIPS flexibilities at any multilateral, regional, bilateral, judicial or diplomatic forum. 

The governance of intellectual property in health emergencies caused much grief during the pandemic of COVID-19, when countries struggled to agree on the trade response in swiftly addressing the access to medical products. The pandemic petered out, even as countries, as members of the World Trade Organization, ultimately failed in articulating such a response. Since then, the discussion has moved to the WHO, as countries are working to put in place legal mechanisms around Pandemic Prevention Preparedness and Response.

As the UN’s only technical agency, and as the nucleus of global health policy-making, WHO has been seen as an important venue for safeguarding health from commercial interests.