[GENEVA, SciDev.Net] Global health leaders warn that more needs to be done to protect the poorest countries, following a landmark agreement on how to tackle future pandemics.

The WHO adopted the Pandemic Agreement at the World Health Assembly in Geneva on Tuesday (20 May) after more than three years of negotiations by member states in the wake of the COVID-19 pandemic.

The agreement, voted for by more than 120 countries, is aimed at tackling the inequity seen during the COVID-19 pandemic, when people in low- and middle-income countries were left waiting for months for vaccines while wealthier nations stockpiled supplies.

The legally binding treaty will require drug companies in participating countries to allocate 20 per cent of their vaccines, treatments and diagnostic tests to the WHO during a pandemic to ensure poorer countries have access.

However, the agreement, which comes as rich countries slash their aid budgets, was made without the participation of the US, following its announced withdrawal from the WHO.

“In a time of growing geopolitical tensions and seismic changes, this agreement is proof that the world is still together,” said Precious Matsoso, co-chair of the WHO Intergovernmental Negotiating Body, and former director-general at South Africa’s Department of Health.

Precious Matsoso, co-chair of the WHO Intergovernmental Negotiating Body. Copyright: A. Lwin (CC BY-NC-ND 2.0)

“We see before us that countries have raised their voices and demonstrated that the international community of nations still matters,” she said at an event on the sidelines of the World Health Assembly.

She warned, however, that questions over funding remained unanswered.

Low- and middle-income countries continue to be disadvantaged by fragmented global health governance, limited manufacturing capacity, and lack of access to medicines, Matsoso added.

“The accord must secure these rights ­— voluntary pledges are not good enough.

“Equity is not charity, it’s not [a] favour but a right, we cannot afford to forget that delay in access costs lives and livelihoods.”

Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, hosting the event, praised the persistence of countries in working towards the treaty after the negotiations had failed to meet an earlier May 2024 deadline.

But she cautioned not to water down the ambition in its final stretch.

The treaty will only be ratified after members agree on a system for sharing data on pathogens between countries. A draft text will be considered at next year’s World Health Assembly following talks over the next 12 months.

Clark urged countries to move forward on health financing, risk assessment, disease monitoring and manufacturing vaccines, tests and treatments.

“The message we could send out to countries is: start looking at your national procedures … and be ready to run on ratification when the annex [on pathogen sharing] is actually agreed,” she said.

Countries are still negotiating on how they can share samples that they discover within their borders, and access to essential tools including drugs, vaccines and diagnostic tests.

Matsoso said there were tensions between WHO member states about how to approach the final negotiations on pathogen sharing, including at what stage experts should be invited to contribute to the process.

Raj Panjabi, a former White House senior director who participated as an independent expert on the panel, emphasised that while the world is more awake to pandemics than before, progress is still uneven.

“Pandemic preparedness is not just having a plan on paper — it’s about delivering for people especially those marginalised,” he said.

With the WHO more strained than ever following the loss of US contributions, ensuring that assessed contributions are increased, and leveraging other funds, will be critical, Panjabi added.

Matsoso pushed for investments in regional manufacturing hubs to stop dependency on high-income countries, especially in times of crisis.

“We can’t keep going back to the same handful of countries for vaccines and diagnostics, that’s not resilience,” she said.

WHO director-general Tedros Adhanom Ghebreyesus said the agreement was “a victory for public health, science, and multilateral action”, after it was formally adopted without opposition. Eleven countries abstained while 124 voted in favour of the treaty.

“It is also a recognition by the international community that our citizens, societies, and economies must not be left vulnerable to again suffer losses like those endured during COVID-19,” he added.

This piece was produced by SciDev.Net’s Global desk.