2 days ago
Will the world's first Pandemic Agreement live up to its promise?
Covid-19 was the first pandemic this century.
According to the World Health Organization (WHO), there were 778 million cases globally, with more than seven million deaths as of June 7 (2025).
The vast majority of cases occurred in 2020 and 2021.
One of the heartbreaking lessons of Covid-19 was that lives and livelihoods were destroyed by an invisible agent that had no respect for borders or anything else.
According to the Lancet Global Health 2050 Commission, there is a 50% likelihood of another new pandemic causing 25 million or more deaths between now and 2050.
Cognisant of the imperative to do better than during the Covid-19 pandemic, the member states of WHO agreed in December 2021 that a new legal instrument was needed to help countries prevent, prepare for and respond to future global health threats.
The work to draft the Pandemic Agreement was long, arduous and divisive amidst increasing global geopolitical upheaval.
What it is
The Pandemic Agreement was adopted by the World Health Assembly (WHA) on May 20 (2025).
This agreement is only the second legally-binding one that WHO has negotiated after the Framework Convention of Tobacco Control.
Many of the delegates at the WHA who spoke prefaced their measured enthusiasm with caveats and cautious hopes, as well as a sense that something was better than nothing, as the Agreement was not as transformative as the majority had hoped for.
The Agreement established principles, priorities and targets for pandemic prevention, preparedness and response.
The aim is to: Build resilience to pandemics
Support prevention, detection and responses to outbreaks with pandemic potential
Ensure equitable access to pandemic countermeasures, and
Support global coordination through a stronger and more accountable WHO.
A pandemic emergency was defined as such: 'It must be a Public Health Emergency of International Concern (PHEIC).
'A PHEIC means an extraordinary event which is determined (i) to constitute a public health risk to other States through the international spread of disease; and (ii) to potentially require a coordinated international response; being of communicable disease nature; having, or at risk of having, wide demographical spread; exceeding, or is at high risk of exceeding, the capacity of health systems; causing, or is at high risk of causing, substantial social and/or economic disruption etc.; and requires rapid, equitable and enhanced coordinated international action etc.'
The Agreement complements other initiatives, actions and measures aimed at making the world safer from pandemics, including the International Health Regulations, and global systems and institutions working towards equitable sharing of health technologies, information and expertise.
It will establish a Pathogen Access and Benefit-sharing System (PABS) to 'enable materials and genome sequences of pandemic pathogens to be shared and aims to promote equitable sharing of any resulting innovations, such as vaccines'.
WHO director-general Dr Tedros Adhanom Ghebreyesus (red tie) celebrating the adoption of the Pandemic Agreement by the WHA on May 20.
Money and monopolies
However, the Agreement stated that manufacturers would have to share only 20% of any vaccines, therapeutics or diagnostics.
Although 20% is better than nothing, no one could claim that it is equitable and just.
During the Covid-19 pandemic, a few high-income countries had early and excess access to vaccines through bilateral arrangements with manufacturers.
This undermined the global Covax initiative and contributed to death and illness in poor countries that were dependent on donations.
The Agreement does not stop some countries from again monopolising life-saving measures at the expense of others in the next pandemic.
It also does not provide for funding.
It encourages states to 'develop and implement national and/or regional policies, adapted to its domestic circumstances, regarding the inclusion of provisions in publicly-funded research and development grants, contracts and other similar funding arrangements, particularly with private entities and public- private partnerships, for the development of pandemic-related health products, that promote timely and equitable access to such products, particularly for developing countries, during PHEIC, including pandemic emergencies, and regarding the publication of such provisions'.
There is already a Pandemic Fund and development banks will likely have a role in funding.
A Coordinating Financial Mechanism will be established to promote sustainable financing for the implementation of the Agreement.
However, how it will operate together with existing financing instruments is unclear.
Countries still in charge
The Agreement recognises national sovereignty, i.e.: 'Nothing in the WHO Pandemic Agreement shall be interpreted as providing the Secretariat of the WHO, including the Director-General of the WHO, any authority to direct, order, alter or otherwise prescribe the national and/or domestic law, as appropriate, or policies of any Party, or to mandate or otherwise impose any requirements that Parties take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns.'
The issue of accountability is unclear in the Agreement as it states that: 'Each Party shall monitor its preparedness capacities, and periodically assess, if needed with technical support from the Secretariat of the WHO upon request, the functioning and readiness of, and gaps in, its pandemic prevention, preparedness and response capacities.'
There are no provisions for independent monitoring and enforcement mechanisms.
This means that there are no consequences for non-compliance with the Agreement.
Selective adherence by WHO member state(s) can undermine the effectiveness of the Agreement.
More work needed
The WHA established a new body, i.e. the Intergovernmental Working Group (IGWG), to draft and negotiate the Annex on PABS in Article 12 of the Agreement.
It will be submitted to the next WHA for adoption, after which the Agreement will be open for ratification and accession by member states of WHO.
The IGWG was also directed by the WHA to initiate steps to enable the setting-up of the Coordinating Financial Mechanism for pandemic prevention, preparedness and response, and the Global Supply Chain and Logistics Network (GSCL) to 'enhance, facilitate and work to remove barriers and ensure equitable, timely, rapid, safe and affordable access to pandemic-related health products for countries in need during PHEIC, including pandemic emergencies, and for prevention of such emergencies'.
After the WHA adopted the Agreement, WHO's Director-General stated: 'The world is safer today thanks to the leadership, collaboration and commitment of our Member States to adopt the historic WHO Pandemic Agreement.
'The Agreement is a victory for public health, science and multilateral action.
'It will ensure we, collectively, can better protect the world from future pandemic threats.
'It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during Covid-19.'
How the guiding principle in Article 3 of the Agreement, i.e. 'full respect for the dignity, human rights and fundamental freedoms of persons', would be addressed is an open question.
The weak requirements on the sharing of health technologies and the vague statements on accountability means that the Agreement is unlikely to prevent a repetition of one of the primary failures in the Covid-19 pandemic, i.e. the uncontrolled acquisition and consumption of crucial resources by a few high-income countries at the expense of the rest of the world.
It is unlikely that the current Agreement will ensure an equitable global response at the next pandemic.
Anyone who has read it can only hope that it will be strengthened before the next pandemic arrives.
While something is better than nothing, more needs to be done.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@ The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
