London School of Hygiene & Tropical Medicine

UPDATE: On 20/05/2025 WHO member states formally adopted the pandemic agreement.

Members of the World Health Organization (WHO) will come together next week to discuss a proposed agreement to strengthen global collaboration on pandemic preparedness and response.

The draft pandemic agreement (‘treaty’) was finalised last month after more than three years of negotiations and a number of setbacks along the way including being undermined by a swathe of misinformation. Last year, LSHTM, led by the Director, Professor Liam Smeeth, responded publicly including by coordinating an open letter with other UK universities urging world leaders to ignore false claims circulating about what was in the agreement.

The latest version of the agreement – to be discussed at the 78th World Health Assembly in Geneva (19–27 May 2025) – has been drafted by the WHO’s Intergovernmental Negotiating Body established in December 2021, during the COVID-19 pandemic.

It confirms that countries would retain sovereignty to address public health matters within their borders but is intended to strengthen the world’s ability to tackle the next pandemic.

Proposals include:

• Setting up a pathogen access and benefit-sharing system to enable fair access to vaccines, tests, and treatments, especially for lower-income countries
• Better early warning systems, using a “One Health” approach that integrates human, animal, and environmental health to detect outbreaks sooner
• Greater knowledge and technology sharing, including temporary changes to patent rules during emergencies so that more countries can manufacture vaccines and treatments
• More predictable funding, including a sustainable financing mechanism and a capacity development fund

Commenting ahead of the World Health Assembly, Professor Mishal Khan, Professor of Global Public Health at the London School of Hygiene & Tropical Medicine, said:

“It’s been a huge challenge to get to this point so the fact there’s now a draft agreement, which hopefully will be formally agreed at the World Health Assembly, is very welcome.

“But in reality we won’t know how useful this agreement is until the next pandemic hits.

“A key question is around whether countries will voluntarily comply with the terms and, if not, how enforceable is it. Past experience, for example with the International Health Regulations, suggests that powers to enforce will be limited.

“The success of this treaty will also depend on each country’s capacity to contribute to potentially valuable elements such as the Pathogen Access and Benefit-Sharing System through collecting and sharing high-quality data.

“It’s concerning that the US will not be bound to the treaty and has not been part of the final discussions, leaving us unsure what its approach to resource and data sharing will be in future disease outbreaks.

“We must continue to strengthen and support capacity globally to ensure the agreement is equitable and has the best chance of being effective in protecting the world from pandemics.”

Dr Daniela Manno, Clinical Assistant Professor at the London School of Hygiene & Tropical Medicine, said:

“We know pandemics do not respect borders. COVID-19 demonstrated how quickly infectious diseases can spread and underscored the importance of international cooperation for early detection and response.

“Adopting this first global agreement on pandemic preparedness and response would be a major milestone. It would signal a global commitment to avoiding the fragmented and unequal responses of past crises, and to promoting greater solidarity and equity in future health emergencies.

“It would show that countries are willing to work together more effectively and more fairly, through timely data sharing, coordinated rapid responses, and fair access to vaccines, diagnostics and treatments.

“However, while the draft treaty marks important progress, concerns remain about its strength and enforceability. For example, the proposal to create a Coordinating Financial Mechanism is a positive step, but it lacks firm commitments to new, long-term funding streams, specifically for low- and middle-income countries. Without clear financial provisions, LMICs may face increased debt or be forced to divert funding from other essential health services to meet treaty obligations.

“While the draft references inclusiveness and community engagement there needs to be a greater emphasis on integrating local knowledge and enabling community-led decision-making. This is crucial to avoid top-down approaches that may not reflect the needs and realities of diverse communities, particularly in LMICs.”

Professor Martin Antonio, Professor of Molecular Microbiology and Global Health based at the MRC Unit The Gambia at LSHTM, and Co-Director of the LSHTM Centre for Epidemic Preparedness and Response, said:

“Having all WHO member states (except the US) endorsing the treaty is a big leap forward in the fight against future pandemics. Crucially it will accelerate appropriate action, for example the commitment we need to enable vaccines to be developed quickly and made globally accessible within the 100 days mission target set by CEPI.

“This is a global agreement and will only work with global support. But to make these measures effective, we must also push for investment in regional measures such as the development of ‘pandemic’ manufacturing facilities in Africa in support of diagnostics, vaccines, and other interventions.” 

If the World Health Assembly formally adopts the agreement, the WHO's procedural document sets out further steps in the process before the measures would come into effect, including member states signing to confirm their acceptance.