Governments Face Defining Test in Geneva as Pandemic Agreement Annex Negotiations Enter Critical Phase
As governments prepare to convene in Geneva for the second session of the Intergovernmental Working Group (IGWG) on the Pathogen Access and Benefit Sharing (PABS) Annex, the stakes could not be higher. These negotiations represent one of the most consequential moments in the effort to build a stronger, fairer global health architecture after the devastation of COVID-19. The outcome will determine whether countries are truly ready to correct the glaring inequities laid bare by the pandemic—or whether national self-interest and industry profit-seeking will once again be allowed to dominate at the expense of global solidarity.
The PABS Annex is intended to form a core pillar of the broader pandemic agreement currently under discussion by World Health Organization (WHO) Member States. But with time rapidly running out before the text must be finalized for submission to the next World Health Assembly, governments face an extremely compressed window to resolve key issues. These include defining the scope of the Annex, determining which pathogens fall under its provisions, setting clear rules for benefit-sharing obligations, and ensuring that transparency and accountability are built into every level of the framework.
Correcting Inequities Exposed by COVID-19
The COVID-19 pandemic provided a sobering lesson in how existing systems fail the majority of the world’s population. While wealthy countries were able to secure vaccines, treatments, and diagnostics in record time, much of the Global South was left behind. Promises of solidarity were eclipsed by vaccine hoarding, export bans, and opaque contracts that favored private industry over public health. Many nations waited months or even years for access to lifesaving tools, with devastating consequences for health systems, economies, and communities.
The negotiations in Geneva are an opportunity to turn those painful lessons into meaningful change. As the AIDS Healthcare Foundation (AHF) and other civil society voices have stressed, a successful PABS Annex must go far beyond symbolic commitments or vague promises. It must create enforceable rules that guarantee timely, equitable access to pathogen samples, genetic sequence data, medical countermeasures, and the benefits derived from them.
Equity Must Be More Than a Percentage
One of the central dangers of the current talks is that equity will be reduced to simplistic formulas—such as a fixed percentage of products to be donated or discounted for low- and middle-income countries. While such measures are helpful, they are nowhere near sufficient. True equity requires addressing structural imbalances in how medical countermeasures are developed, manufactured, and distributed.
That means ensuring technology and know-how are transferred to enable regional production of vaccines, treatments, and diagnostics. It means committing financial and technical resources to build sustainable capacity across every region, rather than perpetuating dependency on a handful of manufacturers concentrated in the Global North. And it means embedding mechanisms of accountability so that commitments made in Geneva are actually implemented when the next public health emergency arises.
Defining the Scope and the Pathogens Covered
Negotiators must urgently resolve fundamental questions about what the Annex covers. AHF and its partners emphasize that the PABS system must encompass a broad range of pathogens, not just a narrow subset. Specifically, it should include any pathogens with pandemic potential, including those capable of triggering a Public Health Emergency of International Concern (PHEIC).
Limiting the scope would undermine the very purpose of the Annex by creating loopholes and leaving the world unprepared for future threats. After all, the next pandemic may not resemble COVID-19; it could be driven by influenza, a novel coronavirus, or another pathogen entirely. A comprehensive scope is therefore essential to ensure that the system is fit for purpose.
Establishing Fair Benefit-Sharing Rules
Another urgent priority is to define in advance how benefits will be allocated within the PABS system. The process and criteria for determining “public health risk and need” must be transparent, predictable, and grounded in evidence rather than politics. This means basing decisions on epidemiological risk—taking into account factors such as likelihood of transmission, morbidity, and mortality—without political bias or favoritism.
Equitable benefit-sharing also requires considering regional distribution. Countries facing the greatest risks, or those with weaker health systems, must not be left behind when benefits are allocated. A data-driven, risk-based framework can help ensure that benefits flow where they are most needed, not just where economic or political influence is strongest.
Decision-Making Authority and Governance
The question of governance remains contentious. AHF and other civil society groups argue that key decision-making power should not be left solely in the hands of WHO. Instead, it should rest with the Conference of the Parties (COP) to the pandemic agreement, or with a subsidiary body established by the COP. This would provide a more balanced and representative mechanism, while still ensuring WHO retains an important technical role.
Ensuring independence and accountability in governance is crucial. Decisions must be guided by public health needs, not by geopolitical pressure or the interests of powerful private actors.
Transparency in Contracts and Agreements
One of the most damaging features of the COVID-19 response was the secrecy surrounding contracts between governments, international organizations, and pharmaceutical companies. This lack of transparency fueled mistrust, delayed equitable access, and allowed industry to dictate terms that served its own financial interests.
The PABS Annex must break with this pattern. Contracts between WHO and participating manufacturers must be made public, with sufficient assurances of enforceability. Clear rules are needed to prevent secretive bilateral deals that undermine collective efforts. Transparency is not optional—it is the foundation of trust and accountability in global health governance.
Building Accountability Into the System From the Start
Accountability cannot be an afterthought. It must be designed into the PABS system from the very beginning. That means creating robust monitoring and compliance mechanisms, establishing clear consequences for non-compliance, and ensuring meaningful participation of civil society and other non-state actors in oversight.
Civil society engagement is especially vital. Non-state actors often serve as watchdogs, amplifying the voices of affected communities and holding governments and institutions accountable. Their role in ensuring transparency and legitimacy must be recognized and institutionalized.
A Narrow Window of Opportunity
The coming weeks will test whether governments are truly prepared to turn commitments into action. The compressed timeline before the next World Health Assembly leaves little room for delay or indecision. If Member States fail to reach clarity on the Annex, they risk undermining the entire pandemic agreement and sending a dangerous signal of weakness to the world.
The stakes are clear. An equitable, enforceable, and accountable PABS Annex would mark a decisive step toward a more just and resilient global health system—one that learns from COVID-19 rather than repeating its failures. But failure to deliver would squander this historic opportunity, leaving the world divided and dangerously exposed when the next pandemic inevitably emerges.
The Role of Independent Analysis and Advocacy
The AHF Global Public Health Institute, along with its partners, has been closely tracking these negotiations. Drawing on extensive expertise in public health and global governance, the Institute has provided detailed recommendations to strengthen the Annex. Its analysis underscores the urgency of creating a system that prioritizes collective health over private profit, solidarity over competition, and transparency over secrecy.
AHF and other civil society organizations have pledged to continue this work until the negotiations conclude. Their role will remain vital, not only in shaping the Annex but also in ensuring its effective implementation once adopted.
