The World Health Organization (WHO) plans to reconvene between 27 April and 1 May 2026 to continue negotiations on the WHO Pandemic Agreement, which aims to strengthen global cooperation and equity in future pandemic prevention, preparedness, and response. 

Participants will discuss the Pathogen Access and Benefit Sharing (PABS) system, which involves the rapid sharing of pathogens that have pandemic potential and the equitable sharing of associated vaccines, diagnostics, and therapies.

While it was approved in May 2025 at the World Health Assembly after 3 years of negotiations, the Pandemic Agreement has yet to be ratified in any country as discussions continue around the PABS annex.

Current clauses state that manufacturers who sign legally binding contracts with the WHO should allocate 20% of vaccines, therapeutics, and diagnostics to the WHO during a pandemic emergency. They further stipulate that at least 10% of production should be offered as a donation, with the remainder made available at an affordable price.

“A PABS system underpinned by contracts concluded by a wide array of big and small pharmaceutical companies, securing donations of vaccines, therapeutics, and diagnostics to boost the response capacity of the international community will be a very significant success for global health,” a spokesperson at the European Commission told Medscape News Europe. 

“Failure to attract the private sector through the conclusion of contracts with the WHO would amount to a failure to the detriment of global public health,” they continued. 

The EU’s Main Issue

“The main point of the debate in this annex today is how to avoid what happened to low- and middle-income countries during the COVID pandemic in case of a new crisis,” Antoine Flahault, MD, PhD, professor of public health and medicine at the Université Paris Cité, Paris, France, told Medscape News Europe.

He noted that insufficient local production meant that much of Africa’s population of 1.5 billion people faced longer wait times for vaccines from the Serum Institute of India or from donations from Western countries, Russia, or China.

Transfer of technology knowhow to low- and middle-income countries is thus essential to remedy this situation, he said. The question for the EU, however, is how this transfer will be carried out.

While the EU wants rapid access to pathogens and sequence information, it also wants benefit-sharing obligations to be acceptable to manufacturers, Jose M. Martin-Moreno, MD, PhD, professor of medicine and public health at the University of Valencia, Valencia, Spain, told Medscape News Europe.

“The EU appears keen to preserve a system that industry will join and operate in practice. In that sense, its preference seems to be for arrangements that are legally binding once concluded, but entered voluntarily, with a degree of flexibility according to the capacity and product portfolio of each manufacturer,” he said.

As Europe is home to several major pharmaceutical and vaccine manufacturers, member states are cautious about any model that they believe could complicate research and development, manufacturing, licensing, and rapid scale-up in future pandemics, added Martin-Moreno.

The EU prefers a system in which obligations are defined through contractual agreements rather than through a broad layer of binding obligations that could be difficult to implement across jurisdictions, he continued.

Global Development

Flahault is optimistic about increasing pandemic preparedness in low- to middle-income countries. He noted that African leaders today are no longer calling for humanitarian aid from the global north and are instead claiming more economic sovereignty.

“Africa’s economic growth is vigorous, at 6% in Côte d’Ivoire, for example, meaning that middle classes will emerge in the coming years in sub-Saharan Africa, with potential for capitalistic manufacturers to make profits from their sales in the African market,” he said, noting that countries including South Africa, Sénégal, Côte d’Ivoire, Kenya, and Ethiopia are ready or close to ready to manufacture vaccines.

While the continent produced less than 1% of its vaccine needs as of 2025, change is afoot. In 2023, the African Union announced plans for the continent to produce 60% of its vaccine needs by 2040.

In line with this goal, South African company Biovac announced the launch of a phase 1 safety trial for a cholera vaccine in November 2025, following a technology transfer partnership with the International Vaccine Institute in South Korea in 2022.

Meanwhile, Aspen Pharmacare’s South African pharmaceutical manufacturing site delivered 250 million doses of Johnson and Johnson’s COVID vaccine between 2020 and 2021, demonstrating the continent’s growing capacity to satisfy its own vaccine demands.

“The COVID-19 experience made it clear how quickly solidarity can erode under pressure, even within Europe,” said Martin-Moreno.

“The real challenge will be to ensure that any eventual agreement translates into genuinely equitable access to vaccines, diagnostics, and treatments in future pandemics, avoiding both internal disparities and the wider global inequities we have already witnessed,” he concluded.

Flahault and Martin-Moreno reported having no relevant financial relationships. 

Annie Lennon is a medical journalist. Her writing appears on Medscape, WebMD, and Medical News Today, among other outlets.