TWN Info Service on Health Issues (May25/04)
21 May 2025
Third World Network

WHO: Pandemic Agreement Adopted by Vote; All Eyes on PABS Annex

Geneva, 21 May (TWN) – In a highly unusual step under international law, the 78th World Health Assembly (WHA78) decided to adopt the Pandemic Agreement in two parts.

The main part comprising the Agreement's articles across three chapters was adopted by plenary on 20 May. However, signature and ratification has been deferred until completion of an Annex on Pathogen Access and Benefit Sharing tentatively set to be agreed by the 79^th WHA in 2026.

The main part of the Pandemic Agreement (PA) which was agreed after 3 years of negotiations, deep North-South tensions, and significant compromises, was broadly welcomed by the majority of WHO Members.

Yet hope that the resolution adopting the PA would be approved by consensus by Committee A before being sent to the plenary for final adoption, were dashed when it emerged that Slovakia would call for a vote in the Committee.

When the vote by hands was called by the Chair of Committee A, the Minister of Health and Social Services of Namibia Dr Esperance Luvindao, 124 countries voted in favour of the resolution adopting the Agreement. Eleven countries abstained, while 46 countries were absent. Only 83 were needed for the adoption of the resolution.

As it became clear that no country opposed the adoption of the PA, a loud round of applause erupted from the assembled WHO Member States.

Several developing country delegations privately expressed profound discontent with the voting process, which some referred to as “nonsensical drama”.

According to sources, the abstaining countries are Slovakia, Poland, Netherlands, Italy, Bulgaria, Israel, Guatemala, Iran, Russia, Paraguay and Jamaica.

Several countries abstained as they were unable to complete their respective domestic processes to adopt the PA or because the Annex had still to be negotiated. Others were not agreeable to the content of the PA itself.

WHA78 is taking place at the United Nations office in Geneva, between 19 to 27 May 2025. (See  brief analysis on the WHO PA and the report on the subsequent negotiation on the draft resolution to adopt the PA.)

WHO Members have agreed on the text of 35 articles of the Agreement which was adopted via the draft resolution contained in document A78/10 Add1. Nevertheless, negotiations will continue for an Annex on the Pathogen Access and Benefit Sharing (PABS) System, under Article 12 of the Agreement. Since the PABS Annex is considered as the integral part of the PA, States can sign the agreement only after conclusion of the negotiations of the Annex and its adoption in the next World Health Assembly.  

With the approval of resolution A78/10 Add.1 adopting the PA, hailed by many as a milestone in global health cooperation, all eyes are now on the PABS Annex – a linchpin component of the Agreement that will govern how countries share virus samples, sequence data and the vaccines, therapeutics and diagnostics developed using such samples and data.

Widespread support for adopting PA

Many WHO Members supported the approval of the resolution adopting the PA.

South Africa on behalf of the Africa Group recalled the experiences of the COVID-19 pandemic that exposed the vulnerabilities within the global health architecture, notably the inequity in access to essential health products and technologies. It stressed that such experiences galvanized the Africa Group’s unwavering commitment to the WHO Intergovernmental Negotiation Body process and the PA. It expressed its belief that the implementation of the International Health Regulations (IHR) 2005 and the Pandemic Agreement will enhance States' capacity to address future health emergencies and pandemics.

Brazil said that the adoption of the PA is a historic mark on global health in a powerful reaffirmation of multilateralism, in a time of growing geo-political tension and fragmentation. It added that WHO is not celebrating the end of negotiations, “but the beginning of new global commitment to cooperation, equity and shared resilience”.

Ecuador stated that the PA allows them to move toward a more robust, equitable, and solidarity-based system of global health governance and that the same is guided by key principles of equity, solidarity, respect for human rights, national sovereignty, and international cooperation.

Iraq said it viewed the PA as a cornerstone for international solidarity and shared responsibility.

Indonesia argued that the WHA78 is opening a new chapter in global health security. It said, “What we are adopting here is more than an Agreement. It is the foundation of a safer and more equitable world that will protect future generations from the devastation we had to endure during the COVID-19 pandemic: the lives cut short, the inequitable access to life-saving tools, and the consequences of fragmented actions. Never again can we allow equity to be an afterthought. This Agreement may not be the most perfect one, but it reflects a hard-earned consensus, a victory of multilateralism, a timely victory we so desperately need, to prove that, in a world defined by division, unity is still possible”.

Malaysia recognised the urgency of international solidarity to prevent, prepare for and respond to future pandemics, adding that it “appreciates the rationale behind the calls for this legally binding instrument which must operate in full complementarity with IHR 2005” and called for the implementation of the PA to “be aligned with national legal frameworks to ensure that Member States can adhere to the obligations within the Agreement”.

Malaysia also stressed the need for countries to “retain the right to legislate public health response and govern access to biological materials. Equity, transparency and access must be translated into tangible mechanisms, especially benefit sharing for pathogens, fair vaccines access and sustainable financing”.

India argued that the adoption of the PA marks a defining movement of collective reaffirmation of the shared responsibility to protect humanity from future pandemics. It said that the foundational elements of the PA such as traceability measures in PABS, access to critical raw materials for diversification of production, and digital health, to which they have contributed, will not only safeguard equity, and accountability but also unlock pathways for scientific innovation empowering developing countries. 

Slovakia’s call for voting and justifications from abstaining states

Throughout the first day of the WHA, there was uncertainty as to the fate of the PA as it emerged that Slovakia would call for a vote on the draft resolution adopting the Agreement.

Slovak Prime Minister Robert Fico also made a public statement that the WHO Director-General Dr. Tedros Adhanom Ghebreyesus had urged Slovakia to not request a formal vote, which the Prime Minister referred to as an effort to “avoid a fundamental democratic institution – a vote.” Despite these efforts Slovakia pressed for the vote.

Justifying its actions, Slovakia (a member of the European Union) argued that the draft PA is “legally incomplete”. It added that “Article 12 itself refers to the annex, with explicit acknowledgement that this annex constitutes an integral part of the agreement – yet the annex has not been drafted. Without the annex, essential mechanisms, such as Pathogen Access and Benefit-Sharing System remain legally unclear and non-functional, creating uncertainty for both Member States and private actors”. 

Slovakia claimed that the PA process ignored proposals aimed at safeguarding fundamental rights and national sovereignty. It expressed concerns over overlapping obligations with IHR 2005 “without clear indication, which obligations take precedence and on what legal basis shall Member States act upon – whether on the basis of WHO membership, the IHR, or the Pandemic Agreement.”

It also expressed concerns over the increasing number of committees, financial mechanisms, and global surveillance systems which it argued would only further deepen the confusions around legal responsibilities rather than resolving them. Finally, Slovakia questioned the EU’s role in the treaty and also expressed concerns regarding regional economic integration organisations, including the EU, being allowed to become Parties to PA.

Slovakia’s intervention surprised many countries as Slovakia did not raise any of these concerns during the multi-year negotiation process. In addition, the EU was engaged in the negotiations from the beginning and sought many compromises from developing countries, weakening provisions safeguarding equity and sovereignty that were proposed by developing countries including those related to financing the implementation of the Agreement. 

Poland, while commending the efforts of WHO Members said it was unable to support the adoption because of its inability to complete the domestic review due to the pace and intensity of negotiations for the WHO.

Italy stressed the need to reaffirm the States’ sovereignty in addressing public health matters in explaining its abstention.

Bulgaria expressed concerns with the process agreed to negotiate the Annex under Article 12.

The Russian Federation said that during the negotiations on the Agreement, there were “repeated attempts” to turn the agreement into a tool of coercion, a means of lobbying for the interests of certain countries' industries. It recalled that the COVID-19 pandemic has demonstrated that the Global South is vulnerable to the frauds of the collective West and its pharmaceutical giants. It also offered assistance to developing countries without imposing conditions.

Iran said that the text falls short of addressing the key priorities of developing countries, stressing that “the absence of binding commitments on unhindered and equitable access to medical countermeasures (health products), as well as on the transfer of technology and know-how, undermines both the credibility and the effectiveness of the agreement”. It also expressed concerns regarding the lack of concrete and predictable financing mechanisms.

It said that it abstained because the negotiations are not complete and thus it was “not in a position to accept the draft in its current form” adding that while it “does not recognize the current draft as a finalized or conclusive text, it remains committed to constructive engagement towards a fair and inclusive pandemic instrument”.

Paraguay also abstained from voting, and said that it recognized the “historical value” of the negotiations that led to the PA, but cautioned that the instrument “can be beneficial, provided that it is legally clear, operationally viable, and equitable in its implementation.” It expressed reservations on technical issues regarding the final text, particularly concerning the definition of responsibilities, governance frameworks, and financial sustainability. Paraguay further stated that it “will closely monitor the outcomes of the Annex provided in Article 12 of the Agreement, which will be key to assessing the overall viability of the instrument”.

The fact that five of the 11 abstaining countries are EU Members raised uncomfortable questions – especially as the EU was one of the strongest advocates for fast-tracking the negotiations and compelling compromises from developing countries.

After the count and results of the vote, Egypt took the floor and registered discontent with the call for a vote and the subsequent proceedings. It said that Egypt has made efforts to try to steer this Agreement home through consensus, since the outset of negotiations, 3 years ago. It added that developments during the approval process revealed a complete absence of transparency from numerous Parties, who have endeavoured to impose their point of view on a large number of other countries, and who have sought to get this adopted by vote, which runs counter to collective work in democracy, which would have been preferable to join the consensus.

All eyes on PABS

Virtually every Member State – from both developed and developing countries – that spoke on the first day of WHA78 in Committee A expressed strong anticipation for the upcoming PABS Annex negotiations.

South Africa on behalf of the Africa Group stated that, “Looking ahead, the negotiation of the PABS (system) holds significance. As a region that has shared its pathogens, often without equitable returns, the PABS (system) is paramount in rectifying these imbalances and ensuring the realisation of genuine equity and equitable access. While our initial aspirations included a higher percentage for set-aside, we acknowledge the agreed target of 20 percent of real-time production by participating manufacturers, with a commitment of at least 10 percent to be made available to WHO as a donation for affected countries during future pandemics, as a positive first step”.

Kenya said PABS is key in realizing the collective aspirations of equity in the PA.

Uganda said it supported a “strong and operational PABS that ensures resources are allocated efficiently and equitably, without delay, to where they are needed most”.

Namibia expressed its aspiration that the PA will be used to address future health emergencies on the basis of principles of equity, solidarity and genuine cooperation and the PABS component lies at the core of achieving this aspiration.

Egypt on behalf of the Eastern Mediterranean (EMRO) Region said that the PA must go beyond early warning to ensure real time equitable access to countermeasures (health products) for all, while strengthening local capacities and reducing dependency. Equity is not optional, but a measurement of success, added Egypt.

It further said, “We acknowledge key work lies ahead, particularly in finalizing a fair and functional PABS system. Such a system must ensure that the countries, who share pathogens and information, are often in the midst of public health emergencies, and count on guaranteed timely access to benefits that arise from this data. Transparency, trust and mutual accountability will be essential in shaping this next phase. In this regard we affirm the Intergovernmental Working Group (IGWG) process must remain as Member State driven with a development of the PABS annex guided by proposals from Member States and Associate Member States.”

Pakistan acknowledged several compromises were made to arrive at this stage, adding that there should not be any compromise in protecting lives and expressed new hope and focus on developing and operationalizing PABS.

Jamaica made a statement on behalf of members of the Americas (AMRO) Region and said that the adoption of the PA is a bold and necessary step to ensure the world will never again be unprepared in the next pandemic. It acknowledged more work was needed to establish the PABS system and promised to work towards adopting PABS at the earliest point of time.

Colombia expressed hope for successful adoption of the PABS annex. It reiterated “the sovereignty of States over their genetic resources” and affirmed that “Colombia will act in accordance with its national capacity, legal framework, and commitment to the Andean regime and its ABS system”.

India said that the soul of the PA lies in the PABS Annex and stressed the need to focus next year on the negotiations for the development of the annex, and not to dissipate the focus by front loading other preparatory activities. It also emphasized the importance of traceability measures.

Sri Lanka on behalf of the Southeast Asia (SEARO) Region stressed that development and adoption of PABS is of paramount importance and committed the region’s engagement in the process following the adoption of the PA.

Bangladesh, while fully supporting the adoption of the PA, called for a robust PABS system with legal certainty for benefit sharing.  It said that “the Annex on Pathogen Access and Benefit Sharing System which was once called the heart of the treaty, would require the following at the crafting stage: First, access to vaccines, therapeutics and diagnostics (VTDs) to vulnerable and affected populations has to be ensured for effective prevention of public health emergencies of international concern (PHEIC) from progressing to a pandemic emergency. Second, manufacturing licenses are to be made available to manufacturers in all regions and developing countries, especially when there is a shortage of supplies of VTDs. Third, traceability and accountability in both access to pathogens and sharing of benefits; and finally, legal certainty and guarantees to the above are to be ascertained”.

Germany, recognized an effective PABS system as the core element to the PA, and that the work is not yet complete on the PA. It urged engagement in upcoming negotiations with a spirit of unity and compromise. Aligning with the EU, it said that it would have welcomed stronger provisions particularly with regard to prevention, but it recognized the PA as a critical and timely step towards global solidarity and multilateralism.

Norway said that there is an extra mile to go, and that the work is not complete. It urged continuation of the same collaborative spirit shown towards concluding the PA by WHA78, to concluding the PABS annex negotiations by WHA79.

Japan argued that “to attain a truly functional legal instrument, the PABS system needs to be reasonable and viable from the scientific and economic perspective. Otherwise, the PA will be a castle in the air, without being supported by the industry”. It also demanded that experts be invited to the IGWG process in this regard, a matter extensively discussed and addressed in the resolution.

Meanwhile, Switzerland called for pragmatic and voluntary approaches to benefit sharing, taking into account inputs from stakeholders.

Belgium on the other hand called for the involvement of “independent experts” in the development of the PABS annex. (Read concerns regarding expert and stakeholder engagement in the process relating to development of PABS here.)

Australia said “tonight we should celebrate. But we cannot afford to rest… the sooner we can realize a feasible, functional access and benefit sharing system, the sooner we can turn this Agreement from words on a page to action”.

Israel and Bulgaria expressed concerns on the development of the PABS system and abstained from voting on the adoption of the PA by WHA78.