Introduction
For the first time, an international treaty has enshrined the principle of “One Health,” the compelling idea that the health of animals, humans, and the environment all contribute to pandemic risks. SARS (2003), H1N1 (2009–10), Ebola (2014–16), and COVID-19 all emerged through zoonotic spillover from animal hosts—respectively, civets, hogs, and bats. Together, they underscore the need for a coordinated, cross-sectoral approach. The Pandemic Agreement responds to this call, requiring state parties to acknowledge the ecological interplay and commit to a comprehensive “One Health” strategy. Specifically, Article 5 charges governments to address “the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface,” including wild animal markets, deforestation, and antibiotic overuse.
Yet the effectiveness of this “One Health” vision depends equally on the free flow of scientific information and data among countries and institutions. Just as environmental and animal health factors have been neglected in past global frameworks, so too has data sharing been marginalized, despite its centrality to timely detection and response. The Pandemic Agreement takes an important step by requiring governments to enhance data collection and cooperate with the World Health Organization (WHO). However, these provisions will remain aspirational without a robust Pathogen Access and Benefit-Sharing (PABS) annex. The PABS system will determine whether countries and researchers can rapidly exchange pathogen samples and genetic data while ensuring equitable access to resulting research and development, including diagnostics, therapeutics, and vaccines. Without such mechanisms, the treaty’s promise to operationalize “One Health” and strengthen global preparedness will risk becoming largely symbolic, echoing earlier failures to translate shared principles into coordinated action.
Equity Concerns
When the 2025 Health Assembly adopted the Pandemic Agreement, it left the difficult question of access to pathogens and the sharing of resulting benefits to be addressed in a separate agreement. Negotiations on this separate agreement, PABS, are now underway in Geneva. Yet governments remain divided over fundamental questions of equity between the countries that primarily contribute to the system and those that primarily draw from it—and consequently benefit. For example, wildlife in countries bordering the equator is likely to produce PABS materials, but companies in Europe are likely to use them to develop lucrative products. The most likely contributor countries are likely to be those biodiverse countries around the equator, such as Brazil, the Democratic Republic of the Congo, and Indonesia, where the number of human-mammalian viral host interactions is large. Conversely, countries most likely to benefit from this material are those with the technology, investors, and infrastructure to capitalize on genomic data, such as the United States, EU member states, and Japan.
This imbalance reflects a broader pattern seen in prior international frameworks. Now, as in the past, the wealthiest countries in the world (a useful heuristic is membership of the Organisation for Economic Co-operation and Development (OECD)) disproportionately benefit from systems in which pathogens and genomic sequencing data are contributed to a common source. Under the International Agreement on Plant Genetic Resources for Food and Agriculture (the “Plant Treaty” or “Seed Treaty”) and the Pandemic Influenza Preparedness (PIP) Framework, companies from Europe and North America disproportionately withdraw biological samples and data for development into lucrative medical products. Their governments and companies have both statutory and contractual claims to the products that those companies correspondingly produce. PABS appears poised to follow the same pattern. The text calls for strong language on access to pathogens and associated data, but the corresponding benefits that should flow to poorer countries are couched in equivocal or non-binding language.
Common but Differentiated Responsibilities
To address these inequities, the principle of “common but differentiated responsibilities” should be formally incorporated into the negotiating agenda of the PABS annex. Common but differentiated responsibilities are often a feature of climate change negotiations. The basic principle is that, even though all countries should reduce carbon emissions, governments that became rich and powerful through massive carbon emissions (e.g., France, the United Kingdom, the United States) should have a greater obligation to address the resulting crises. Applied to PABS, it would require that governments hosting and supporting companies developing lucrative products carry greater obligations toward the cost of running the PABS system; share benefits or final medical products; and transfer technology to help countries worldwide develop their own capacities to innovate and manufacture vaccines during an emergency.
For example, an annex could mandate that any company based in an OECD country that withdraws PABS material would be obligated to donate the resulting diagnostics, therapeutics, or vaccines to the WHO during a public health emergency or pandemic. Questions remain about how robust those donations would be, but the principle is that they should deliver highly significant lifesaving benefits to be equitably shared. Theoretically, this approach mirrors the PIP Framework, in which companies withdrawing influenza samples are required to pay half of the operating costs. In practice, however, the framework has fallen short. The PIP Framework Secretariat has struggled to secure payments from companies, with companies often disagreeing over how much is owed. Additionally, without another pandemic influenza to test the strength of the agreement during a public health emergency, corporate compliance with sharing mechanisms remains unknown.
Even if these limitations did not characterize the PIP Framework, partially paying for operating expenses does not address the inequity in access to genetic data and pathogen samples that left less developed countries last in line for COVID-19 vaccines (and, before them, H1N1). Common but differentiated responsibilities would go further, addressing governments’ legitimate grievances regarding information sharing. It would make withdrawals of PABS material and resulting products more transparent, building trust across the board.
Enforcement and Enduring Success
A key implication of this approach is that the governing mechanism of the PABS must have real enforcement authority. The WHO Pandemic Agreement delegates its core governance responsibilities to a Conference of the Parties (COP)—a governing body composed of one representative from each participating government, similar to those established under the UN Framework Convention on Climate Change and the WHO Framework Convention on Tobacco Control. The proposed WHO Pandemic Agreement COP is charged with oversight functions but ultimately possesses no real authority to compel a government to take any action it does not wish to take. The text does not give the COP the ability to, for example, sanction a party that does not comply with either textual obligations or PABS provisions. In other words, there are no effective mechanisms in place to ensure compliance.
Perhaps just as significant, establishing a meaningful enforcement mechanism within the PABS system would strengthen the WHO’s credibility and its ability to ensure compliance across global health governance. By setting a precedent for accountability, such a mechanism could enhance the organization’s authority not only within the Pandemic Agreement but also in enforcing the revised International Health Regulations and other frameworks for public health emergencies.
Conclusion
The PABS annex can—and should—be different. It should establish clear responsibilities for funding as well as for sharing the diagnostics, therapeutics, and vaccines that result from contributions to the system. The system, in turn, must include a dedicated body empowered to hold governments and the corporations they sponsor accountable for their responsibilities before, during, and after pandemics. Doing so would restore trust in the broader agreement, which was eroded as commitments were repeatedly diluted while parties scrambled to meet their own self-imposed deadlines during the Pandemic Agreement negotiations.
A robust PABS Annex would cement a grand social bargain. Wealthier countries and their corporations would gain unimpeded access to scientific information essential for developing and manufacturing lifesaving medical products. As such, they would stand to gain considerable economic benefit. Yet that privilege must be matched with responsibility. The grand bargain must include not only the right to innovate, but also the duty to ensure that innovation serves all. As medical products are developed and produced through collective contributions, every person must have equal access. All human beings deserve an equitable chance to survive—to save their own life, the lives of their families, and the well-being of their communities.
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Sam Halabi, JD, MPhil, is the Bette Jacobs Endowed Professor at Georgetown University’s School of Health and the Director of the Center for Transformational Health Law at Georgetown Law. He serves as the co-lead for the WHO’s Working Group on Regulatory Consideration on AI and Health’s training workstream. He earned his JD from Harvard, his MPhil from Oxford, and undergraduate degrees from Kansas State University.
Lawrence Gostin, LLD (Hon.), JD, BA, is University Distinguished Professor and Founding Director and Timothy and Linda O’Neill Professor of the O’Neill Institute for National and Global Health Law. He is the author of Global Health Security: A Blueprint for the Future (Harvard University Press, 2021); Global Health Law (Harvard University Press, 2014); Public Health Law: Power, Duty, Restraint (University of California Press, 3rd ed., 2016); Public Health Law and Ethics: A Reader (University of California Press, 3rd ed., 2018); Law and the Health System (Foundation Press, 2014); Principles of Mental Health Law & Practice (Oxford University Press, 2010). He also directs the WHO Collaborating Center at Georgetown University.
Image Credit: United States Mission Geneva, CC BY 2.0, via Wikimedia Commons
