TO NO one’s surprise, the recent deliberations of the Intergovernmental Working Group (IGWG) in Geneva failed to reach agreement, and the Pathogen Access and Beneficiary Sharing (PABS) annex to the World Health Organization’s Pandemic Agreement has not been signed off. This prevents the Pandemic Agreement from progressing at this year’s World Health Assembly in May and thus puts the brakes on WHO regulating many aspects of WHO members’ public health policies.
At stake is the influence of donors who exert control over the WHO, including pharmaceutical companies, the Gates Foundation and G6 countries with pharma industries against poorer countries who see the pandemic agreement as a Trojan horse to take further control of their national public health strategies and obtain virus samples and genetic data without providing a fair return when vaccines and treatments are developed from them.
The IGWG for the Pandemic Agreement annex, chaired by the UK, was meant to have negotiated and finalised operational details after the sixth negotiation session, but has now rescheduled a seventh meeting in July. The impasse centres around monetary benefits, or more accurately the lack of them, for the Low- and Middle-Income Countries (LMICs) who are seeking training and laboratory costs to be fully or partly covered as a condition of providing pathogen data and pharma making profits from using that information to develop vaccines or treatments.
In particular the EU representatives attending the negotiations sought to defend their pharmaceutical interests, with Germany acting as its main stakeholder.
While the EU agreed to some funding of labs as a proxy basis for a pharma fee to access the pathogen data-gathering, it balked at covering other costs associated with the surveillance system and fully rejected any form of financial transfer associated with vaccine profits. So, the Low- and Middle-Income Countries would still be required to divert large sums of their scarce resources to the system, with little certainty that they will see the benefits.
Also of no surprise was the reaction of the WHO director general Dr Tedros Ghebreyesus, who admonished everyone and added the next pandemic is ‘when not if’ and laid on the usual fearmongering with a trowel.
He pushed hard for agreement, suggesting that passage was paramount and that finer details could be worked out once the Pandemic Agreement and its Conference of Parties governance system was in place, but trust was not strong enough for anyone to buy that line. Yet again many delegates argued that the WHO is aligned too closely with the EU and G6 position rather than being an honest broker for the interests of all member states.
The Africa Group of countries continues to be the force blocking an agreement, and more countries now appear to agree with it. The momentum is on their side.
What those keen to rush into adopting the ‘agree now, sort the details later’ approach have not woken up to is that several opposing countries believe the current draft wording violates their national laws and other international agreements and thus requires time for national legislation. To some bureaucrats it’s just a technical concern, but to African and other legislators it is a serious stumbling block.
The detail matters because, without a finalised annex on pathogen access and benefit sharing, the pandemic agreement adopted last May cannot be opened for signature or ratification. The treaty is, in the words of one leading public health researcher, frozen in time.
What the failed negotiations illustrates is that the core dispute remains straightforward. The pandemic agreement, as it stands, concentrates authority in the WHO Secretariat without genuine accountability to member states, locks in an emergency-governance model as a permanent feature, and transfers increasing responsibility for health policy from national governments to a body that answers, in practice, to its funders rather than its members.
Nothing at all appears to have changed except the EU has looked even more protective of its corporate interests.
What we see with the internal dispute at the WHO is what we have seen with that other multilateral unaccountable behemoth, the EU itself. The question around its powers and its interests with its leading funders – including the Gates Foundation, Big Pharma and the countries that host many of its core companies – comes down to who has the authority to make decisions.
There are many philanthropist donors, of whom Bill Gates is undoubtedly the most active. He has visited 10 Downing Street multiple times to discuss global health, development and climate change with UK Prime Ministers, including a meeting with Sir Keir Starmer on October 17, 2024. According to Freedom of Information requests, these visits often focus on the partnership between the UK government and the Gates Foundation.
Pushback against the WHO’s directorate and the vested interests comes not just from marginalised low- and medium-income countries but also many leading public health academics. Professor Garrett Wallace Brown, Chair of Global Health Policy at the University of Leeds, is a member of the International Health Reform Project (IHRP). This expert and academic group argues the WHO’s Pandemic Agreement is a poor deal for the majority of the world’s population.
The IHRP makes three points; the WHO’s structural dependence on already earmarked donor funding means it answers to its financiers such as Gates rather than its member states; that low- and middle-income countries are being offered only aspirational provisions in the face of pharmaceutical carve-outs instead of binding benefit-sharing; and the financing architecture loads poorer states with obligations they cannot afford to meet, meaning burden transfer is dressed up as solidarity. This would result in their existing public health programmes being raided to meet the financial commitments, which according to the WHO and World Bank, will require $26.4billion annually from LMIC countries.
President Trump has withdrawn the United States from the WHO. This leaves the UK as the country making the largest donation, contributing directly and also indirectly through the Gavi vaccine programme, an astonishing £232million in 2026/27 – more than the World Bank on £180million and ahead of Germany, Japan and France.
The UK is pushing the Pandemic Agreement and giving the largest country contribution to the WHO – without demanding much in the way of accountability. That is bad enough. Given its position as the largest funding nation and chairing the IGWG meetings, the UK could be a change leader, but so far has been part of the problem.
Without any proper scrutiny in the House of Commons and without any transparency in the relationship with all philanthropist donors, the need for a genuine reckoning about what the WHO is for, who it actually serves and if it can ever be made accountable is long overdue.
