Global South countries have brought negotiations on the World Health Organization’s pandemic treaty to a standstill, refusing to finalise a crucial annex unless they receive binding guarantees of equitable access to future vaccines and treatments – a direct consequence of the failures they endured during the Covid-19 pandemic. A coalition of those nations has continued to stonewall the talks, sending a clear signal that they will not accept the same status quo when the next crisis arrives.
The core of the deadlock lies in a document called the Pathogen Access and Benefit Sharing (PABS) annex. The main WHO Pandemic Agreement was adopted by 124 member states on May 20, 2025, but the PABS annex remains unresolved, stalling full implementation. Negotiations have been extended multiple times, with the latest deadline set for May 2027 or earlier through a special session. The impasse reflects deep and persistent divisions between high-income and low- and middle-income countries over how the benefits of pandemic research should be shared.
The impasse over pathogen access and benefit sharing
In broad terms, nations in the global north want countries in the global south to share information on any new pathogens their scientists encounter – research shows the next pandemic is most likely to emerge from their region. In return, global south states have organised to demand that treatments, including vaccines, developed from that information be shared on a mandatory basis. Western states, particularly in Europe, have historically preferred a voluntary arrangement and are hesitant to commit to binding obligations regarding intellectual property rights.
Vaccine equity is a long-held red line for these global south groups. The larger treaty cannot be fully implemented without agreement on this issue. The current negotiating position from global south countries demands that 20% of all pandemic-related medicines be earmarked for them, alongside technology transfer to allow local production. This proposal goes directly to the inequities laid bare during Covid-19, when global south countries received vaccines later, in smaller numbers, and often at a higher price than rich nations, resulting in avoidable death and suffering and extended economic malaise.
The pharmaceutical industry, represented by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), has opposed mandatory sharing, arguing that weakening intellectual property protections would disincentivise research and development and leave the world less prepared for future pandemics. The IFPMA has instead proposed a formula where free access to pathogens is exchanged for binding equity agreements, such as reserving a percentage of production for equitable distribution. Some wealthier nations have also reportedly linked the PABS system to a “One Health” policy – a collaborative approach across human, animal and environmental health sectors – a condition that has further complicated negotiations.
Governments could force pharmaceutical firms to address at least some of these demands by coercing or cajoling them through guaranteed profits or other subsidies. Critics have argued that if European and other western backers of the treaty had no plan to do so, they have been engaging in “fantasy negotiations” for half a decade – a charge echoed by some African states, who view the process as a “colonialist agenda” aimed at perpetuating wealth transfers from the Covid-19 era.
Broader consequences for global cooperation
The failure to resolve the PABS annex carries consequences far beyond global health. Europe, the greatest champion of the treaty process, had hoped to demonstrate that basic international consensus could still be brokered in a post-pandemic world – that frayed bonds could be reknit. Instead, each passing year has strained the multilateral system further. Shortly after negotiations began in 2021, global health scholars warned that no agreement would be possible without addressing the concerns of the global south.
The United States, having begun a year-long process of withdrawing from the WHO, did not participate in the vote to adopt the pandemic agreement. US Health Secretary Robert F. Kennedy Jr. criticised the WHO’s pandemic response and the agreement itself. Instead, Washington has been pursuing its own “America First Global Health Strategy”, signing bilateral health Memoranda of Understanding with numerous countries, particularly in Africa and Latin America. These agreements focus on disease surveillance and transition financial responsibility for health services to recipient governments, sometimes alongside broader economic interests such as access to natural resources. Critics argue this approach risks undermining multilateral efforts and creating new dependencies.
Human Rights Watch has noted that the adopted pandemic agreement provides little support for effective implementation, lacking enforcement mechanisms and concrete funding obligations. Many critics view the agreement as significantly watered down from its initial intent due to prolonged divisions between member states. Russia and some US Republican governors have raised concerns about the treaty potentially limiting national sovereignty, while The Heritage Foundation argues the treaty focuses on resource transfers and weakening intellectual property rights rather than addressing the shortcomings of the WHO’s Covid-19 response.
The Covid-19 pandemic prefigured and contributed to the current crises: “might makes right” and narrow national interest crowded out international cooperation. Avoiding a reckoning with that history suggests that the global north learned little from the Covid years and has no serious plan for the future. The world needs a functioning agreement to prepare for and respond to the next pandemic – and the custodians of the global order need to produce proof that the system can still work.