Holzschei e , Anna; Weicka d Soa es, Ma ia
Resea ch Repo
In e na ional ules on heal h da a sha ing o a new
pandemic ag eemen
IDOS Policy B ie , No. 23/2024
P o ided in Coope a ion wi h:
Ge man Ins i u e o De elopmen and Sus ainabili y (IDOS), Bonn
Sugges ed Ci a ion: Holzschei e , Anna; Weicka d Soa es, Ma ia (2024) : In e na ional ules on heal h
da a sha ing o a new pandemic ag eemen , IDOS Policy B ie , No. 23/2024, Ge man Ins i u e o
De elopmen and Sus ainabili y (IDOS), Bonn,
h ps://doi.o g/10.23661/ipb23.2024
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In e na ional Rules on
Heal h Da a Sha ing o a
New Pandemic Ag eemen
Anna Holzschei e & Ma ia Weicka d Soa es
Summa y
The nego ia ions on he Pandemic Ag eemen
o e ed a key oppo uni y o he Wo ld Heal h
O ganiza ion’s (WHO) 194 Membe S a es o
add ess he weaknesses o exis ing in e na ional
egula ions go e ning global heal h – and o adop
a new legal ins umen a he Se en y-se en h
Wo ld Heal h Assembly in May 2024. Howe e ,
Membe S a es we e no able o success ully
conclude he nego ia ions. Be ween la e 2021 and
May 2024, an In e go e nmen al Nego ia ing
Boa d (INB) had been wo king on inding a pos -
COVID-19 consensus on a long lis o issues
ela ed o pandemic p epa edness, su eillance
and esponse. Ye , he high hopes o many WHO
Membe S a es as well as non-s a e ac o s had
gi en way o sobe ealism. The ailu e o each a
consensus, and o do so by he planned deadline,
which was e y ambi ious, can be in e p e ed in
a ious ways. F om he poin o iew o diploma ic
e o s as an “in es men ”, hese e o s may be
amed as a “was e o ime”. F om he pe spec i e
o subs an ial con o e sies, he decision o
p olong he deba e may allow o he necessa y
space o adop a widely endo sed in e na ional
ag eemen .
One o he mos con en ious issues on which
Membe S a es we e, up o he e y las minu e, no
able o each consensus conce ns in e na ional
ules on c i ical heal h da a, namely he ways in
which such da a is sha ed and accessible and he
p o i s and bene i s ha may be eaped om hei
use. This policy b ie discusses di e se and
mul iplying policy ames ha ha e in luenced and
con inue o in luence he in e na ional deba e on
heal h da a sha ing as well as discussions on heal h
da a wi hin he WHO. The analysis is based on an
ex ensi e s udy on he eme gence and di usion o
policy ames in global heal h s a ing in he mid-
1990s. Poin ing o he g owing poli icisa ion and
pola isa ion in heal h da a deba es o e all – wi h
signi ican po en ial o incompa ibili ies and colli-
sions be ween no ma i e belie s and legal ules,
his policy b ie elucida es why he nego ia ions on
he Pandemic Ag eemen ha e been a pa icula ly
ha d case o in e na ional coope a ion. O e ime,
pe spec i es and posi ions om low- and middle-
income coun ies ha e become mo e p ominen in
he deba e, emphasising p inciples o equali y and
bene i sha ing ela ed o heal h da a. This inding
is mi o ed in he ie ce poli ical s uggles o e
heal h da a no ms and ules in he nego ia ions on
he Pandemic Ag eemen .
IDOS POLICY BRIEF
23/2024
IDOS Policy B ie 23/2024
2
Backg ound
When in la e 2021, a new SARS-CoV2 Omic on
a ian was de ec ed in Sou h A ica, genomic
sequence da a was apidly published. Sou h
A ica complied wi h i s obliga ions o sha e
in o ma ion and da a on a po en ially dange ous
pa hogen – and was maximally sanc ioned o i s
compliance wi h a el bans and o he eco-
nomically de as a ing esponses. The example
ap ly illus a es he isks associa ed wi h sha ing
sensi i e pa hogen da a ha , om he
pe spec i e o global heal h secu i y, o many
should be ea ed as a global public good.
Coun ies complying wi h pa hogen and da a
sha ing ules bu unable o secu e access o he
bene i s gene a ed h ough he sha ed pa ho-
gens and da a, such as accines, ea men and
diagnos ics, lea ned a pa icula ly pain ul lesson
o ailed in e na ional solida i y and equi y du ing
he COVID-19 pandemic. The epe cussions o
hese lessons lea ned se he one o he
in e na ional deba e on a new WHO Pandemic
Ag eemen .
F om i s incep ion, in e na ional coope a ion on
global heal h has been shaped by deba es on he
app op ia e no ms and ules on he collec ion,
analysis and ci cula ion o heal h da a. This
includes hea ed discussions o he bene i s o
biomedical and echnological b eak h oughs. I is
hus ha dly su p ising ha he success ul con-
clusion o he nego ia ions o he new WHO
Pandemic Ag eemen depends la gely on he
willingness and abili y o WHO Membe S a es o
ag ee on he no ms and ules pe aining o he
sha ing o da a and i s bene i s (i.e., accines,
diagnos ics and medical ea men ). We de ine
heal h da a sha ing as all o ms o ha nessing
and p o iding heal h da a o (elec onic)
exchange in (pe sonalised) heal h ca e, public
policy and science. Heal h da a sha ing
encompasses pa hogen- ela ed da a, o which
gene ic (sequencing) da a is he mos poli icised
o m o heal h da a ha can also gene a e
eno mous e enue (Fo une Business Insigh s,
2024).
In he eyes o many expe s, any hal -baked
decision on hese subs an ial issues, no ma e i
he p ema u e adop ion o an un inished legal
ins umen (Wenham e al., 2022; Wenham &
Eccles on-Tu ne , 2024) o he con inua ion o
wha may become a ne e -ending d a ing
p ocess, may mise ably ail he in ended goal o
inding app op ia e, e ec i e and equi able in e -
na ional esponses o u u e pandemics. Du ing
he nego ia ions, i has become appa en ha
imp o ing pandemic p epa edness, p e en ion
and esponse is su ounded by majo con o-
e sies e lec ing his o ically e ol ed geopoli ical
con lic s and he g owing oice and weigh o
Membe S a es ha ha e been conside ed
pe iphe al o he global heal h sys em, especially
i s economic dimension.
The ma e s o pa hogen access and bene i
sha ing ha e e ealed g ea po en ial o con lic .
Pa hogens a e mic oo ganisms ha can po en-
ially cause diseases. Knowledge abou pa ho-
gens and access o pa hogen- ela ed da a a e
seen as he linchpin o pandemic p e en ion,
p epa edness and con ol – and cons i u e a
p ecious public good ha can be easily u ned in o
a ba gaining chip and commodi y. Pa hogens
cons i u e he mos impo an ma e ial esou ce in
esea ch and de elopmen o pandemic p e-
pa edness and con ol. The da a associa ed wi h
pa hogens and de i ed om hei analysis con-
s i u es he mos impo an imma e ial esou ce. I
is, be o e all, he ci cula ion o hese imma e ial
esou ces ha causes much con o e sy o e he
commodi ica ion and ma ke alue o such da a.
E ec i e in e na ional pandemic go e nance hus
depends on he possibili y o ind a middle g ound
be ween incen i ising bene i sha ing while
sa egua ding he alue o pa hogen- ela ed
knowledge as a public good. The p oposed WHO
Pa hogen Access and Bene i Sha ing (PABS)
Sys em is a he e y co e o he discussions.
This policy b ie highligh s he endu ing
challenges ha ha e shaped he pandemic nego-
ia ions and ha will likely s ay a ound o a
conside able ime. I p o ides a his o ical analysis
o he mos con en ious policy ames su ounding
IDOS Policy B ie 23/2024
3
he access o, sha ing o and use o heal h- ela ed
da a. F ames, mos gene ally, place policy issues
in a speci ic con ex and emphasise ce ain
aspec s o a poli ical p oblem while de-em-
phasising o he s (Go man, 1974). The ans-
na ional ci cula ion o heal h da a, o example,
can be amed as an indispensable p ac ice o
medical p og ess – o i can be amed as an
in ingemen on indi idual sel -de e mina ion and
pe sonal sa e y. The way in which ac o s ame
issues hus has a signi ican e ec on he
dynamics o poli ical deba es. A he same ime,
policy ames a e dynamic a e ac s ha change
wi h he ou come o policy nego ia ions and
discussions. We analysed he eme gence and
di usion o policy ames as hey appea ed and
ci cula ed bo h in public deba e (explici ly news-
pape s) as well as in in e go e nmen al bodies o
in e na ional o ganisa ions beginning in he yea
1995. Fo example, he WHO ecognised he
sha ing o heal h da a as a human igh s issue
back in he ea ly 2000s and he e o e ocused in
i s deba es on da a p o ec ion issues. O e he
pas ew yea s, his aming has g adually been
con es ed – no only by p i a e ac o s ad oca ing
o a libe alisa ion o he use o da a and o
pa hogens, bu also by ac o s om low- and
middle-income coun ies (LMICs) claiming o be
le ou o ansna ional discussions and decision-
making on he sha ing o heal h da a. As a gene al
end, ames su ounding human igh s – o
ins ance add essing p i acy and da a anonymi-
sa ion – ha e been iden i ied as ha ing he
g ea es dis up i e po en ial and leading o s ong
con es a ion o e ime.
By showing which policy ames ha e in luenced
in e na ional deba es on heal h da a sha ing and
how hey ha e e ol ed o e ime, his policy b ie
exposes he nego ia ions on he Pandemic Ag ee-
men as a pa icula ly ha d case o in e na ional
coope a ion. Why ha e con es ed policy ames
ega ding heal h da a sha ing e ol ed in o a majo
bo leneck owa ds a mo e e ec i e and legi ima e
global sys em o pandemic p epa edness,
p e en ion and esponse? And wha a e he
chances ha he new Pandemic Ag eemen –
should i e e ma e ialise – e lec s pe spec i es
and posi ions o ac o s om LMICs on access o
heal h da a and bene i sha ing, po en ially
con ibu ing o g ea e equi y in global heal h?
COVID-19 as a window o
oppo uni y o e-nego ia e
in e na ional heal h law
In May 2021, he Eu opean Council adop ed a
decision o suppo he launch o nego ia ions on
he in e na ional Pandemic Ag eemen . A g ea
many s a e and non-s a e ac o s seized his
excep ional window o oppo uni y wi h he aim o
signi ican ly e-w i ing in e na ional heal h law.
Global heal h as a policy ield is egula ed by e y
ew legally binding in e na ional ag eemen s.
These include he In e na ional Heal h Regu-
la ions o 2005, a WHO egula ion o p e en and
con ol c oss-bo de disease ou b eaks, and he
TRIPS ag eemen , a minimum s anda ds ag ee-
men on he ade o in ellec ual p ope y
(Walckie s e al., 2024). S e en Solomon, he
head o WHO’s legal depa men , emphasised
ha an e icien sys em o pa hogen access and
bene i sha ing is one o he co e a eas o
success ul pandemic nego ia ions (Me sh, 2023).
Es ablishing a link be ween he gene a ion and
ans e o da a and he equi able enjoymen o he
knowledge ob ained om he da a hus cons i u es
an inno a i e quid p o quo o mula.
The in ended o mula o he Pandemic Ag eemen
aims o o e a mix u e o binding and non-binding
p o isions. I is aligned wi h in e na ional no ms
and p inciples on human and p i acy igh s, ade,
biodi e si y and clima e change, in eg a ing
di e en a eas o in e na ional law in o a single
global heal h ag eemen . Among he many issues
discussed in he con ex o amending in e na ional
heal h law, he ques ion o access o heal h da a
and he sha ing o i s bene i s s ands ou as he
issue wi h he g ea es ans o ma o y po en ial
and is hus a poin o ie ce poli ical con en ion, as
he discussions on he WHO PABS Sys em ha e
e ealed. The PABS Sys em d aws on WHO’s
Pandemic In luenza P epa edness F amewo k, a
IDOS Policy B ie 23/2024
4
non-binding legal amewo k adop ed in 2011.
Despi e emphasising access o e bene i s in i s
language, he Pandemic In luenza P epa edness
amewo k o e s a benchma k, especially o
Membe S a es o LMICs, o ci cum en he
po en ial ade-o be ween p o iding access o
pa hogens and ecei ing equi able and ai bene i
sha ing. The goal o such a sys em is o make su e
ha da a abou new pa hogens is sha ed while
ensu ing equi able access o he bene i s.
Discussions inside and ou side he In e -go e n-
men al Nego ia ing Boa d (INB) make i clea ha
pa hogen access and bene i sha ing ha e
become he ocal poin o delibe a ions no only
ega ding e ec i e pandemic go e nance, bu
also wi h ega ds o he ecogni ion o co e in e -
na ional no ms o equi y, solida i y and in e -
na ional assis ance. In essence, o each equi -
able access o pandemic coun e measu es (mos
no ably accines), high-income coun ies (HICs)
mus be eady o wai e in ellec ual p ope y igh s,
while LMICs mus be willing o sha e c ucial da a
(pa hogen and genomic) and o he in o ma ion
(Swi ze e al., 2024).
In he Pandemic Ag eemen nego ia ions, he
G oup o Equi y (an amalgama ion o 29 LMICs)
and he PABS Coali ion (a collabo a ion o he
G oup o Equi y and he A ican Union) u ged o
inc eased mul ila e alism based on he p inciples
o accoun abili y and bene i sha ing. Lines o
con lic s on he Pandemic Ag eemen we e
especially e iden be ween he US – a ou ing
s onge p o ec ions o pa hogen pa en s – and he
UK – demanding anonymous sha ing o heal h
da a – on he one hand and he G oup o Equi y
and he PABS Coali ion on he o he . The la e
ad ocacy coali ions a gued, among o he hings,
ha “anonymous usage canno se e he
pu poses o public accoun abili y and igilance”
(Ramak ishnan, 2024), bu a he ha anonymi y
can indeed be de imen al o bene i sha ing in
global heal h. On ano he no e, he A ica G oup
men ioned ha he poli ics o knowledge mus
wo k bo h ways, i.e., o p e en u u e pandemics.
This means ha all ypes o knowledge mus be
aken in o conside a ion in global heal h law.
Discussions on he lack o anspa ency and
imely legisla ion a e no new o global heal h. As
examples such as he Global Ini ia i e on Sha ing
All In luenza Da a and he nego ia ions on he
PABS Sys em highligh , hese challenges ha e
become mo e p essing han e e in ecen yea s.
In a mul ila e al ag eemen o he magni ude o he
en isaged Pandemic Ag eemen , he assump ion
ha inc eased access o heal h da a au oma ically
leads o mo e bene i sha ing and equi y in heal h
becomes a allacy. One eason o his is ha
con o e sies o e human and pe sonal igh s,
such as p i acy and consen , as well as o e he
comme cialisa ion o pa hogens ha e no ye been
ully econciled. Mo eo e , access o da a does
no au oma ically imply ha his da a and he
knowledge gained om i a e equally bene icial o
all coun ies.
Pandemic p epa edness and con ol depend, o
a la ge ex en , on he abili y o mul ila e al ins i u-
ions o ha e access o and bene i om
“scien i ic esea ch and da a” ha can hen in o m
decision-making and ule implemen a ion
(McIne ney, 2024). The p ospec s o e en ually
adop ing a Pandemic Ag eemen in he u u e
depend on WHO Membe S a es’ abili y and
willingness o ind a comp omise on he c ucial
issue o heal h da a sha ing. Heal h da a and i s
de i ed knowledge s and ou as he mos
p ecious esou ce – bo h in e ms o li esa ing and
p o i abili y – ha WHO Membe S a es a e
deba ing. As con o e sies be ween WHO
Membe s S a es wi h s ong pha maceu ical
indus ies, ypically loca ed in a ew HICs, as well
as some LMICs, pe sis , many obse e s ail o
see cons uc i e solu ions ha conside he
diame ical s andpoin s, e en in he case ha
Membe S a es esume hei nego ia ions. Ye ,
how exac ly a e con o e sial iewpoin s ha
ha e in o med deba es on he sha ing o heal h-
ela ed da a o decades e lec ed in he
nego ia ions on he Pandemic Ag eemen ?
IDOS Policy B ie 23/2024
5
The Pandemic Ag eemen and he
his o y o deba es on heal h da a
(sha ing) in global heal h
go e nance
F om a his o ical pe spec i e, insigh s om he
INB discussions leading igh in o “adop ion
ailu e” a e a logical ou come o decades o pol-
i ical s uggle o e he use and sha ing o heal h
da a. These s uggles expose, in he i s place,
ha knowledge and da a policies cons i u e he
co e o global heal h go e nance and no m-
se ing. The e is a long-s anding end in global
heal h go e nance ha discussions and nego-
ia ion p ocesses ha e – o he mos pa –
e ol ed a ound egional in e es s, he eby
mi o ing geo-poli ical powe dynamics, pa ially
his o ically g own. While all global heal h ac o s
– a leas in some way – conside he sha ing o
heal h da a as undamen al o he imp o emen
o global heal h and he ealisa ion o uni e sal
heal h ca e, only a ew ac o s domina e he
aming o his policy ield, in pa icula in e -
na ional o ganisa ions such as he WHO and
co po a e non-s a e ac o s. Ci il socie y, on he
o he hand, is a he absen in o icial public and
expe deba es.
Con a y o he de elopmen s du ing he COVID-
19 pandemic, o he epidemic and pandemic
ou b eaks o in ec ious diseases since he mid-
1990s did no ha e such a s ong impac on
discussions on heal h da a (sha ing), bene i
sha ing and da a-based knowledge p oduc ion,
pa icula ly in in e na ional o ganisa ions as
Figu e 1 highligh s. Technological p og ess a he
han disease con ol o global heal h secu i y
conce ns has uelled he aming o his policy
issue. Se e al WHO expe s con i med in in e -
iews ha de elopmen s in he p oduc ion,
dissemina ion and sha ing o heal h da a ha e
been incen i ised on an i egula basis especially
by co po a e and philan h opic dono s and colla-
bo a o s in he pas wo decades.
Figu e 1: S a emen s pe yea ega ding discussions o heal h da a sha ing in in e na ional
o ganisa ions
Sou ce: Au ho s
IDOS Policy B ie 23/2024
6
Addi ionally, ou longi udinal s udy e lec s ha
he sha ing o heal h da a is mo e likely o be
add essed in he con ex o o he heal h- ela ed
policy ields, like elemedicine, o in discussions
on egional and in e na ional amewo ks, like he
Gene al Da a P o ec ion Regula ion, ins ead o
being ea ed as a sepa a e agenda i em in global
heal h go e nance. This has changed wi h he
COVID-19 pandemic and he PABS Sys em
nego ia ions ha a e de e mined by WHO
Membe S a es and hei ep esen a i es. The
INB was c ea ed as an in e go e nmen al
nego ia ing body ep esen ing and upholding he
in e es s o all WHO Membe S a es. Howe e , i
emains ques ionable o wha ex en di e en
pe spec i es on heal h da a and hei bene i
sha ing can be equally conside ed and included in
a mul ila e al pandemic ag eemen .
To s eng hen hei posi ion, Membe S a es wi h
geog aphic and poli ical ies ha e o med ad o-
cacy coali ions, such as in he case o he G oup
o Equi y. Such ad ocacy coali ions, pa icula ly
hose encou aged and domina ed by s a e ac o s
om LMICs, a e a a he new phenomenon in he
discussions on he sha ing o heal h da a and
da a-based knowledge, especially on his scale.
This allows o wo possible conclusions. Fi s ,
he e ha e been inc easing a emp s in ecen
yea s o decolonise global heal h by LMICs. In he
nego ia ions on he Pandemic Ag eemen , we ob-
se ed a culmina ion o he demands o a de-
colonial e o m o global heal h and in e na ional
heal h law (Phelan & Si lea , 2023). Second, and
s ongly ied o he p oblem o being excluded,
unlike o he disease ou b eaks in he pas se e al
decades, COVID-19 has been unique in e ms o
i s magni ude, including mo ali y a es and he
numbe o global in ec ions. This emphasised he
u gency o be e and mo e equal global heal h
p o ec ion and likewise e ealed he ine iciency o
cu en in e na ional heal h law in imes o c ises
(Laza us e al., 2024).
Figu e 2: Rela i e sha e o selec ed ames be ween 1995 and 2019 in he deba e on heal h
da a sha ing
Sou ce: Au ho s
IDOS Policy B ie 23/2024
7
As Figu e 2 highligh s, policy ames ha e
inc easingly di e si ied o e ime be ween 1995
and 2019. Following En man (1993), ames a e
de ined by one, se e al o all o he ollowing ou
componen s: p oblem de ini ion, ea men
ecommenda ion, causal in e p e a ion and mo al
e alua ion. Hence, he analysis only includes
s a emen s ha ei he de ine a p oblem, p o ide a
solu ion, e lec on how heal h da a (sha ing)
connec s o and is in luenced by o he policy
issues, o make a no ma i e claim on he opic. As
shown in Figu e 2, human igh s issues ha e
pa icula ly domina ed he discussions on he
sha ing o heal h da a be ween 1995 and 2000.
Policy ames on bene i sha ing and equi y
ela ed o heal h da a, hough, ha e only become
mo e p ominen in ecen yea s, leading o a
poli icisa ion ega ding jus ice and equi y
(Ndumbe-Eyoh e al., 2021). Be o e 2020, as he
policy ame analysis highligh s, bene i sha ing
was one o he less discussed ames – and be o e
2004, i was e en a non-issue in global heal h.
Gene a ing heal h da a and p o iding equal
access o i has been inc easingly pe cei ed o be
a c ucial ac o o knowledge p oduc ion in
global heal h and he es ablishmen o a uly
global heal h in as uc u e. Sha ing c i ical
heal h da a ac oss bo de s is hus likewise
ecognised as a p e equisi e o eaping he
bene i s o (bio-)medical and echnological
p og ess wo ldwide, especially in imes o heal h
c ises. While he pandemic in ensi ied discussions
a ound he sha ing o heal h da a, con en ious
dynamics eme ged e en be o e he ou b eak o
COVID-19, especially when da a c ossed na ional
bo de s o was sha ed be ween p i a e and public
ac o s, HICs and LMICs, as well as be ween s a e
and non-s a e ac o s.
Al hough a b oade consensus exis s pa icula ly
on s ic e access o heal h da a and he
o e whelming bene i s o his da a o indi idual
and popula ion heal h, nume ous challenges
pe sis , including ques ions o how o deal wi h
inancial sho ages and he lack o public heal h
in as uc u es. As a esul , he economisa ion and
inno a ion ames (Figu e 2) ha e become mo e
dominan since 2010.
LMICs a e o en po ayed as su e ing om
inancial, medical knowledge and human
esou ces sca ci y, in need o suppo om Eu o-
pean coun ies and he Uni ed S a es o ca ch up
on (bio-)medical and echnological de elopmen s
and hus o become be e equipped o (up-
coming) epidemics and pandemics. Simila ly, o e
he pas ew decades, mo e and mo e e o s ha e
been made a he in e na ional le el o implemen
e hical s anda ds o he collec ion and p ese a-
ion o pa hogens and associa ed da a. One such
aim is o p e en he po en ial abuse o low-
income coun ies as es ing g ounds o clinical
ials. In e na ional legisla ion on his policy issue,
hough, is s ill insu icien o da e, p esen ing he
de elopmen o a new pandemic ag eemen as a
window o oppo uni y o emedy legal gaps and
loopholes in in e na ional heal h law.
Recommenda ions
Based on he abo e analysis and conside ing he
open-ended na u e o he policy deba e a ge ed
in his b ie , he ollowing ecommenda ions on
policy op ions seem plausible.
Gi en he di isi e na u e o in e na ional nego-
ia ions on in ellec ual p ope y, knowledge p o-
duc ion and sha ing ac oss bo de s, i is
necessa y o acknowledge ha hese ques ions
canno be hough o as independen o und-
amen al ques ions o ins i u ional e o m and
shi ing geopoli ical weigh and alliances. Any
a emp o make global heal h ins i u ions mo e
legi ima e om he iewpoin o coun ies ha
ha e bo ne he b un o pas pandemics will hinge
on a deep ans o ma ion o he no ms and ules
go e ning he p oduc ion, sha ing and bene i s o
heal h knowledge and da a. I is unsu p ising ha
he many coun ies disappoin ed wi h he powe
imbalances ma king discussions on in ellec ual
p ope y igh s a he Wo ld T ade O ganiza ion
would wan o see he WHO becoming mo e
au ho i a i e in his ield.
IDOS Policy B ie 23/2024
8
The impasse in he nego ia ions on he Pandemic
Ag eemen can be p esen ed as an indica o o
poli icisa ion and lack o comp omise – o i can be
aken o e lec changing powe cons ella ions
wi hin he WHO, he g owing oice o coun ies
o me ly a he ma gins o global heal h
go e nance and an ongoing plu alisa ion o
pe spec i es on global heal h. In ac , success ul
adop ion o a b oadly endo sed ag eemen (and,
in he bes o cases, u he and mo e conc e e
amendmen s o such an ag eemen ) could se e
as a bluep in o no m se ing on o he global
heal h h ea s such as an imic obial esis ance.
Many obse e s o he INB nego ia ions con-
cluded ha , apa om he poli ical s uggles
discussed in his policy b ie , WHO Membe
S a es had al eady come qui e a in ag eeing on
a numbe o co e p inciples ha should in o m he
new Pandemic Ag eemen , including equi y. I is,
hus, e y likely ha a u u e pandemic ag ee-
men will e lec he collec i e desi e o add ess
he wide social, poli ical and economic
de e minan s o pandemics and o in eg a e a
g ea numbe o p inciples and no ms (e.g.,
equi y, non-disc imina ion, human igh s,
so e eign y, solida i y, anspa ency and many
mo e) in o a single legal ins umen . Howe e , i is
ye o be seen o wha ex en an ag eemen on
hese la ge p inciples can emedy he de i-
ciencies o a weakly legalised and s ongly
asymme ical global heal h sys em wi hou clea ,
unambiguous binding ules on pandemic
p epa edness and con ol. As we ha e seen wi h
so many ea ies be o e, he adop ion o an
ag eemen is one hing, a i ica ion, implemen a-
ion and compliance a e ano he . In any case, a
new pandemic ag eemen could become a
powe ul ins umen in he hands o ad oca es o
equi y, human igh s and access o medicines o
hold go e nmen s accoun able o hei ac ions.
Ge many, as a coun y ha has been o con-
side able ime a backbone o global heal h
ins i u ions and he WHO, in pa icula , mus keep
i s commi men o nego ia ing he “bee ” issues
(e.g., PABS Sys em, inancing and in ellec ual
p ope y) in any new a emp o inalise he
nego ia ions. Ge many should also use i s
powe ul posi ion wi hin he Eu opean Union o
educe esis ance o s onge in e na ional
legisla ion on in ellec ual p ope y, echnology
ans e and bene i sha ing. Policy solu ions, such
as he Medicines Pa en Pool (MPP) es ablished
by Uni aid in 2010, would be a easible s ep in his
di ec ion. In he MPP, coun ies hos ing accine-
manu ac u ing i ms ha ha e ecei ed public
unding would equi e such i ms o make pa en s
a ailable o hese pa en pools. An impo an
dimension o in e na ional coope a ion such as he
MPP, is he ac i e ans e o knowledge and
echnology, a he han jus he sha ing o bio-
chemical o mulas (Go e e al., 2023).
F om he poin o iew o e icien and success ul
diplomacy, WHO Membe S a es ha e clea ly
missed a window o oppo uni y o po en ially
s eng hen he WHO’s au ho i y in he a e ma h o
he COVID-19 pandemic. Howe e , he e dic o
“ ailu e” may no be sha ed unequi ocally, as
LMICs wi h limi ed delega ion capaci y will be
gi en mo e ime and space o “engage in
meaning ul dialogue and collec i e s a egizing”
(Sekalala e al., 2024). Ad oca es o ex ending
equi y conce ns o he p ocess o nego ia ing a
new pandemic ag eemen a gue ha “ o design a
ea y ha deli e s ai ou comes, a en ion mus
be gi en o bo h he p ocess and he esul s”
(Sekalala e al., 2024). In he ace o he looming
second T ump p esidency and o he po en ial
changes o geopoli ical cons ella ions, hough, i is
unclea i p olonged nego ia ions will enhance
p ocedu al and ime equi y o LMICs.
On he basis o a uni e sally sha ed belie ha
heal h da a sha ing is exis en ial o pandemic
p epa edness and esponse, coun ies wi h s ong
heal h economies mus play a cons uc i e ole in
add essing majo conce ns o e p o i and
na ionalism oiced by hose who we e las in line
o bene i om he medical b eak h oughs
gene a ed h ough his da a.
