The 78th World Health Assembly approved the Pandemic Treaty on 20 May 2025, after more than three years of negotiations in a complex political context marked by the withdrawal of the US from the WHO.

The agreement represents a significant victory for health workers, the result of the mobilisation of PSI affiliates who succeeded in radically transforming the provisions on the health and care workforce.

However, the text remains insufficient on equity issues, with the articles on research and development, diversified production and technology transfer lacking binding measures, maintaining the status quo that perpetuates inequalities in access to health technologies between countries in the Global North and South.

The 78th session of the World Health Assembly (WHA) approved the Pandemic Treaty in the morning of 20 May 2025. The Intergovernmental Negotiating Bureau (INB) submitted the final text to the WHA after more than three years of negotiation, and more than 20 official negotiation sessions. The Pandemic Agreement is a landmark in global health. It is only the second binding instrument adopted by the WHO in its history.

The historical moment in which this happened is particularly relevant. Multilateralism as the world’s health governance system has been under threat for a number years, with the rise of far-right governments and the increasing power of corporations, pushing harder and harder to put their interest in the center of the global health policies.

From February on, since Donald Trump took office for his second term as the US president, the political context became even more complex and delicate. Trump has been putting in practice a series of actions that are reshaping the world or multilateralism. Trump is going after the global governance systems. The US are rising tariffs of a wide range of products to virtually all countries in the world and, therefore, dismantling the trade system in practice since early 90s.

Regarding the global health governance, Trump announced the US would withdraw from the WHO and, therefore, stop funding the organization. The US were responsible for 18% of the WHO’s funding and this decision puts the very future of the WHO as the main health organization in the world.

The South-North division

Since the first months of 2022, when the negotiations started, the main driver was the political momentum created by the inequities in the access to vaccines and other health technologies during the COVID-19 pandemic. However, countries from the global North have always defended the interests of pharmaceutical corporations from the day negotiations started. On one hand, Global South countries pushing for binding measures to promote technological transfer, strengthening production capacity, suspension of intellectual property rules and a fair Pathogen Access and Benefit Sharing System; on the other, global North countries defending the maintenance of the status quo that led to the tragedy of the inequalities in access to health technologies during the COVID-19 pandemic as well as stronger surveillance systems, with early warning mechanisms. That created, expectedly to some extent, a deadlock between global North and global South countries.

Other points of the negotiations were equally relevant, such as the article on Health and Care workforce. The first document released by the bureau had nothing but a few provisions on the training and deployment of workers during emergencies, and the creation of a sort of “international” workforce that could assist countries in times of emergency.

The key role of PSI affiliates

PSI and its affiliates had a crucial role in improving the health and care workforce-related text. Departing from a text that fell below the minimum, PSI affiliates mobilization, organization, and advocacy actions greatly and radically changed the text, including several key measures identified by those very same affiliates, during consultations organized by PSI during 2022 and 2023.

In the table below, it is possible to see the identified demands and their presence or not in the version released by the bureau throughout the negotiations. The actions by PSI affiliates, writing to their respective governments, conducting meetings, being part of expert committees, amongst others, reshaped the article related to health and care workforce. The Zero Draft published in February 2023 contained only two of the ten demands identified as key. In the following year, the text submitted to the 74th WHA, when Article 7 was greened, contained almost all the demands.

This is a huge show of workers’ power. Along the way, unions from all regions have sent letters to and held meetings with their respective governments, asking the positions they’d take to the negotiation table in respect to labor and equity-related provisions and demanding them to defend the above-mentioned points. Countries from all regions championed one or more points, what led to the improvement of the health and care workforce article. 

Equity Gap: Where the Agreement Falls Short

While the Pandemic Agreement can be considered a win for workers in terms of the healthcare workforce-related provisions and regarding the moment faced by WHO and multilateralism itself, the text falls short when it comes to the equity provisions.

Let’s recall the text of the Decision SSA2(5) that established the INB sets out reasons for a PA which includes, adopted in late 2021: “…address gaps in preventing, preparing for, and responding to health emergencies, including in development and distribution of, and unhindered, timely and equitable access to, medical countermeasures such as vaccines, therapeutics and diagnostics, as well as strengthening health systems and their resilience with a view to achieving universal health coverage”. It is difficult to argue that the text approved by 78th WHA meets the reasons outlined in that decision.

Articles 9 “Research and Development”, 10 “sustainable and geographically diversified local production”, 11 “Transfer of Technology and cooperation on related know-how for the production of pandemic-related health products”, and 12 “Pathogen Access and Benefit-Sharing (PABS) System” are the core of the equity provisions. Apart from Article 12, none of the other three articles bring binding measures.

Article 9 is divided into four pillars (1) building diversified R&D capacities, including in developing countries; (2) encouraging research collaboration and information sharing; (3) clinical trials for pandemic-related products; and (4) publicly funded R&D. This article is rather weak: it is filled with the so-called caveats (expressions that softens provisions) and other loopholes that allow Parties to avoid adopting more effective measures to fulfill the pillars’ objectives. Article 10 demands that Parties take action to meet three objectives: (i) achieve more equitable geographical distribution and rapid scale-up production of pandemic-related health products; (ii) increase sustainable, timely and equitable access to such products; and (iii) minimize supply-demand gaps during pandemic emergencies.

Article 10 ‘Diversification of productive capacity’ brings a commitment under paragraph 2. It calls to strengthen national and regional production of pandemic health products in developing countries through skills development, capacity-building, transparency, technology transfer, investment, partnerships, WHO initiatives, and local procurement. Rapid production scaling during pandemics will be ensured. However, this commitment has caveats – “as appropriate” and “subject to national laws”, that undermines it. This brings a list of three objectives that Parties need to achieve: (i) achieving a more equitable geographical distribution and rapid scale-up of production of pandemic-related health commodities; (ii) increasing sustainable, timely and equitable access to these commodities; and (iii) minimising gaps between supply and demand during pandemic emergencies.

Article 11 "Transfer of Technology and cooperation on related know-how for the production of pandemic-related health products” was one of the most controversial one. It demanded lots of negotiation efforts. Under this article, developing countries expected concrete commitments on technology transfer. Yet, developed countries blocked any language aimed at improving the status quo, particularly opposing cooperation on the "adoption and implementation" of "time-bound measures." In the end, all references to technology transfer were qualified with ‘mutually agreed terms’, on a voluntary basis. A footnote was included in, to make it clear that “mutually agreed terms” goes without prejudice to the right of governments to use measures permitted under international law, such as compulsory licensing, to facilitate technology transfer. The text also offers no new solutions for intellectual property barriers beyond confirming the use of TRIPS flexibilities.

Article 12 "Pathogen Access and Benefit Sharing System (PABS)" became an annex to be negotiated separately: operational details, including scope and definitions, are to be annexed to the PA through further negotiations. Article 12 is the only article that brings binding measures: there is a clear indication on ensuring equitable access to medical devices through legally binding contracts signed between participating manufacturers and WHO.

In practical terms, it creates a WHO system to promote rapid and timely distribution of "materials and sequence information on pathogens with pandemic potential" and on equal terms. Each participating manufacturer will make available to WHO, under legally binding contracts signed with WHO, rapid access to 20% of its real-time production of vaccines, therapeutics and diagnostics (VTD), with a fixed 10% to be provided as a donation and the remaining percentage to be provided depending on the nature and capacity of the manufacturer, to be reserved for WHO at affordable prices.

Conclusion

The Pandemic Agreement represents a historic milestone for health workers, demonstrating the power of trade union mobilisation by radically transforming the provisions on the health and care workforce - from just two of the ten demands identified in the initial draft to almost all the demands included in the final text. However, the Agreement still falls short of expectations in terms of equity, with Articles 9, 10 and 11 lacking effective binding measures and full of escape clauses that allow countries to avoid concrete commitments on technology transfer, diversification of production and equitable access to health technologies. Against this backdrop, it is essential that affiliates closely follow the development of the negotiations on Article 12 on the Pathogen Access and Benefit Sharing System, the only truly binding provision in terms of equity, while intensifying their efforts to translate the victories won at the multilateral level into robust national agendas that guarantee the effective implementation of the advances made in the area of the health workforce.