The Pandemic Agreement: Surveillance, 'One Health', & A fresh manufacture Of Government Grift

Authored by REPPARE (REevaluating the Pandemic Preparedness And REsponse agenda) via The Brownstone Institute,

After three years of negotiation, the delegates of the Intergovernmental Negotiating Body (INB) agreed on the text of the Pandemic Agreement, which now goes for vote at the 78th World Health Assembly (WHA) at the end of May 2025. This text comes after the negotiations were extended for an additional year due to ongoing disagreements about intellectual property and technology transfers (Article 11), access to ‘pandemic-related health products’ (Article 12), and One Health.

After extending the negotiations into a series of last-minute 24-hour sessions in April 2025, a draft was ‘greenlined’ with many countries suggesting that they had gone as far as they could via negotiation, and it was now time to bring it to vote.

There are several interesting elements within the new draft of the Pandemic Agreement. For example, the Pandemic Agreement foresees ‘participating manufacturers’ (yet to be determined) to make 20% of their related pharmaceutical production available to the WHO, half as a donation, and half at ‘affordable prices’ (also to be determined). The expectation is that the WHO and other international partners will pool these and other resources for distribution (in an improved COVAX-like mechanism yet to be determined). In addition, a still relatively undefined ‘Coordinating Financial Mechanism’ (CFM) will be established to support the implementation of both the Pandemic Agreement and the amended International Health Regulations (IHRs), as well as to disburse surge funding to developing countries in the event of a pandemic.

These commitments build on the IHR amendments that come into force in September 2025, which authorise the WHO Director-General to declare a ‘Pandemic Emergency.’ This represents an escalation of the Public Health Emergency of International Concern (PHEIC), with a ‘Pandemic Emergency’ now representing ‘the highest level of alarm,’ which is meant to trigger a host of national and international responses. The PHEIC has been declared eight times since 2005, including for the ongoing Mpox outbreak in Central Africa, and there remains ambiguity about whether an outbreak like Mpox would now also qualify as a Pandemic Emergency. The Pandemic Agreement also now defines the first somewhat tangible effects of declaring a Pandemic Emergency, although these triggering effects are currently most clear regarding the mobilization of ‘pandemic-relevant health products.’

In general, the text reads as one might expect when diplomats from almost 200 countries spent years negotiating and scrutinising every sentence. Although the United States and Argentina withdrew from these negotiations earlier this year, the document still had to navigate the manifold and often conflicting interests of delegates from Russia and Ukraine, Iran and Israel, India and Pakistan; not to mention members of the Africa Group who largely saw the Pandemic Agreement as a raw deal for Africa (see below). The result is therefore 30 pages full of vague declarations of intent, often qualified by references to the preservation of national sovereignty in an attempt to neutralize opposition. As it stands, the ‘Agreement’ looks primarily of symbolic importance, since a failure to reach an agreement would have been embarrassing for everyone involved.

Yet, it would be churlish not to understand that the Pandemic Agreement consolidates ‘pandemic prevention, preparedness, and response’ as a definitive ‘space’ of global political action, for the purpose of which numerous new institutions and funding streams have already been created. Its potential passage into international law is unusual in global health and represents only the second time such a global health covenant has been created (the WHO Framework Convention on Tobacco Control being the first), with the potential to mobilize substantial resources and policies.

For example, according to estimates by the Institute for Health Metrics and Evaluation (IHME), expenditure on preparing for future pandemics had already more than quadrupled between 2009 and 2019 before the Covid-19 pandemic unmistakably moved the topic into international ‘high politics.’ In the Agreement, governments pledge to ‘maintain or increase’ this funding for pandemic prevention, preparedness, and response and to support mechanisms for its execution. As reported elsewhere by REPPARE, the requested funds for pandemic preparedness are $31.1 billion a year (for comparison, about 8 times global expenditure on malaria), of which $26.4 billion must come from low-and middle-income countries (LMICs), while $10.5 billion in new overseas development assistance (ODA) would need to be raised. Presumably, the WHO’s preferred mechanism for the distribution of this ODA is via the yet-to-be-defined CFM.

Vaccine Equity

The declared guiding principle of the Pandemic Agreement is ‘equity.’ The focus on ‘equity’ is driven largely by the WHO and associated philanthropists, NGOs, scientific advisers, and several LMICs (particularly in Africa), who view a lack of equity, primarily ‘vaccine equity,’ as the main failure of the Covid response. Representatives of poorer countries, but also important donors, have criticised the inequitable access to vaccines against SARS-CoV-2 as a key failure of the Covid response and the reason for increased Covid mortality. This inequitable access has been labelled ‘vaccine nationalism,’ which refers to the stockpiling of Covid vaccines in high-income countries (HICs) during the pandemic, limiting availability to vaccines by LMICs. The World Economic Forum, for example, claims that a fairer distribution of vaccines would have saved over a million lives.

While enough Covid vaccine doses were ordered in Europe to immunise the entire population from infants to the elderly more than three times over, and are now being destroyed, many African countries were denied access. In fact, developing countries only received large quantities of coronavirus vaccines months after richer countries had been ‘fully vaccinated.’ Even after vaccination had been universally available in most HIC countries by summer 2021, under 2% in low-income countries had been vaccinated, many of them with Chinese vaccines that Western countries deemed inferior and thus not qualifying for travel clearance.

The proponents of the Pandemic Agreement do not question the success of universal vaccination despite its limited and rapidly declining protective effect, nor the numerous reported adverse effects. But even if we assume that coronavirus vaccines are safe and effective, global comparisons of vaccination rates remain nonsensical. In HICs, most Covid-19 deaths occurred in people over 80, suggesting the need for context-specific interventions in the case of the most vulnerable.

In most low-income countries (LICs), this risk group comprises only a tiny fraction of the population. For example, the average age in Africa is 19, presenting an entirely different pandemic risk and response profile. In addition, a meta-analysis of blood tests by Bergeri et al. suggests that by mid-2021 most Africans had already had post-infection immunity to SARS-CoV-2. Yet, despite these variables, the manufacturers of the vaccines were encouraged to mass produce vaccines for global rollout, were given emergency authorisation, were released from liability, cashed in on advanced purchasing commitments, and were able to make record profits at the expense of taxpayers.

As reported elsewhere, committing large resources to pandemic preparedness, particularly expensive surveillance, diagnostic, R&D, and the manufacturing of biomedical countermeasures, threatens to produce high opportunity costs since many LMICs must confront other more pressing and destructive disease burdens. This was at least implicitly recognised by many African countries during the Pandemic Agreement negotiations. Many resisted the inclusion of One Health into the Agreement, arguing that it was unaffordable and not a priority within their national strategic health plans.

To paraphrase an African delegate on the INB, ‘We have difficulty doing coordinated surveillance within the health sector, let alone integrated surveillance across sectors.’ This concern not only suggests the need for more locally owned strategies to assure the efficient use of scarce resources, but also the need for strategies that better capture contextualised need to deliver greater effectiveness and true health equity, not just ‘product equity.’

Yet, even if product equity is a desired and justified outcome in particular cases, there is nothing in the Pandemic Agreement that guarantees this, since, in practice,e poor countries without their own production capacities will always be last in line. Although the ‘pathogen access and benefit system’ (PABS) in Article 12 of the Pandemic Agreement seeks to improve product equity, it is reasonable to expect wealthy countries to meet their own demand before making larger quantities available to LICs or the WHO for distribution (leaving it reliant on donations – which proved problematic during COVAX). As a result, it is hard to see what the Pandemic Agreement has improved in this regard, other than the codification of extremely loose normative commitments aiming to improve equitable access to pandemic products – an area on which countries would already broadly agree.

The Pandemic Agreement also calls for more transparency for contracts between countries and manufacturers. This measure is seen as a mechanism that can expose rampant vaccine nationalism and profiteering, albeit only ‘as appropriate’ and ‘in accordance with national regulations.’ Thus, it is questionable whether such flimsy wording would have stopped EU Commission President Ursula von der Leyen from fixing billion-dollar deals with the Pfizer CEO through undisclosed text messaging nor stopped other countries from engaging in their own bilateral pre-purchasing and stockpiling activities.

Of course, LMIC negotiators in the INB were aware of all this, which is why the fault line in the Pandemic Agreement negotiations mainly centred on issues of intellectual property and technology transfer. In essence, developing countries do not want to rely on handouts and want to produce vaccines and therapeutics themselves without having to pay expensive licensing fees to the pharmaceutical giants of the North. In contrast, the North has been steadfast in their commitments to intellectual property protections as outlined in TRIPS and TRIPS-Plus, seeing these legal mechanisms as important protections for their pharmaceutical industries.

As a ‘compromise,’ the Pandemic Agreement contains provisions for ‘geographically diversified local production’ of pandemic products and closer international cooperation in research and development, with simplified licensing procedures intended to ensure technology transfer. However, the wording within the Pandemic Agreement is nonspecific and the EU insisted on adding last-minute footnotes to the technology transfer provision to ensure they only take effect ‘as mutually agreed.’ Thus, the Pandemic Agreement looks like the solidification of business as usual.

Surveillance and One Health

Whereas a lack of ‘equity’ is understood by advocates of the Pandemic Agreement as the main failure of the Covid response, a ‘failure of preparedness’ is also seen as allowing the emergence and subsequent global spread of the novel coronavirus in the first place. The goal of eliminating the ‘existential threat’ of emerging infectious diseases (EIDs) is dominant within the policy lexicon, endorsed by the G20 High Level Independent Panel, the World Bank, the WHO, The Elders’ Proposal for Action, and the Global Preparedness Monitoring Board. As we have argued elsewhere, these assessments are largely based on weak evidence, problematic methodologies, the use of political eminence over expertise, and simplified modelling, yet they remained unquestionable mainstays within INB negotiations.

In response to future zoonoses, the Pandemic Agreement calls for a ‘One Health’ approach. In principle, One Health reflects the self-evident fact that human, animal, and environmental health are closely connected. Yet, in practice, One Health requires the targeted monitoring of soil, water, domestic animals, and farm animals with the view to identifying possible spillover to humans. As highlighted above, implementing One Health necessitates integrated systems across sectors with sophisticated laboratory capacities, processes, information systems, and trained personnel. As a result, the costs of implementing One Health are estimated by the World Bank to be approximately $11 billion a year, which would be in addition to the $31.1 billion currently estimated as required to finance the IHRs and Pandemic Agreement.

With more laboratories looking for pathogens and their mutations, it is guaranteed that more will be found. Given the current practice of over-securitized knee-jerk risk assessments, it is foreseeable that more discoveries will be deemed ‘high risk,’ even though humans have coexisted with many of these pathogens without major incident for centuries, and even though the risk of geographical spread is low (e.g., reactions to Mpox). The logic of the Pandemic Agreement is that, based on genomic advancements, ‘pandemic-related health products’ can then be quickly developed and distributed via the ‘WHO Pathogen Access and Benefit-Sharing System’ (PABS).

This is disquieting for at least three reasons. First, large resources will be poured into responding to these low-burden potential risks while everyday killers like malaria will continue to receive an underwhelming response. Second, this aspect of the Pandemic Agreement will undoubtedly engross under its own momentum, where new perceptions of threat legitimate ever-more surveillance, which will uncover even more potential threats in a self-perpetuating regress of securitization and over-biomedicalization. Lastly, nowhere in the Pandemic Agreement is there any mention of the fact that dangerous gain-of-function research will continue to be conducted to develop the ‘pandemic benefits’ expected under PABS, although biosafety and biosecurity obligations are mentioned in passing.

This suggests that the risk assessments associated with the Pandemic Agreement are singularly focused on natural zoonosis spillover events, ignoring an area of risk that may have actually been responsible for the worst pandemic in the last 100 years. Thus, the recent Covid-19 pandemic is likely irrelevant to the Pandemic Agreement in terms of pandemic preparation and prevention.

Infodemics

The calamities of the Covid response have eroded trust in the WHO and other public health institutions. This has manifested in a clear scepticism of pandemic preparedness. For example, hundreds of thousands of people signed petitions warning of the WHO’s ‘power grab’ to undermine national sovereignty. These messages arose primarily after the proposed amendments to the IHR started to circulate, which contained original language allowing the WHO to issue binding recommendations to national governments during a pandemic. Ultimately, such plans did not materialise.

The drafters of the Pandemic Agreement have seemingly agreed with such concerns. Article 24.2 states in unusually clear terms: ‘Nothing in the WHO Pandemic Agreement shall be interpreted as providing the WHO Secretariat, including the WHO Director-General, any authority to direct, order, alter or otherwise prescribe the national and/or domestic laws, as appropriate, or policies of any Party, or to mandate or otherwise impose any requirements that Parties take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns.’

In practice, this clause has no effect, as there is no way of arriving at the interpretations Article 24.2 rules out, since the WHO simply does not have legal jurisdiction to force compliance. Regarding non-pharmaceutical measures, the signatories to the Pandemic Agreement merely agree to conduct research into their effectiveness and adherence. This includes not only epidemiology, but also ‘the use of social and behavioural sciences, risk communication and community engagement.’

In addition, states agree on taking ‘measures to strengthen science, public health, and pandemic literacy in the population.’ Here, nothing is binding nor specified, leaving sufficient room for countries to determine how and to what degree to deploy non-pharmaceutical measures (for better or worse). It is just putting (again) in writing what States are already doing – an arguably pointless exercise.

That said, references to the behavioural sciences are likely to trigger suspicion from those critical of the WHO. In particular, those concerned about the Covid response remember how behavioural scientists advised the British government to make people feel ‘sufficiently personally threatened’ and how UK Secretary of Health Matt Hancock shared WhatsApp chats about how he planned to ‘deploy’ the announcement of a new variant to ‘frighten the pants off everyone.’ Although it is the job of public health authorities to issue recommendations to guide the public, there are honest and more effective methods of doing so. Otherwise, public perceptions of disingenuousness undermine trust, something advocates of the Pandemic Agreement suggest is crucial for an effective pandemic response.

In some ways, the explicit ruling out of WHO-imposed lockdowns or vaccine mandates is an excellent example of what the WHO calls ‘infodemic management.’ In the WHO’s ‘Managing Epidemics’ handbook, an infodemic is defined as ‘an overabundance of information, accurate or not, in the digital and physical space, accompanying an acute health event such as an outbreak or epidemic.’ Infodemic management also made it into the revised IHR, where “risk communication, including addressing misinformation and disinformation” is defined as a core capacity of public health.

It is understandable that critics of infodemic management understand ‘addressing misinformation’ as a euphemism for censorship, especially given how scientists who spoke against mainstream narratives during Covid were sidelined and ‘cancelled.’ However, the first principle of infodemic management highlighted in ‘Managing Epidemics’ is ‘listening to concerns,’ which the Pandemic Agreement appears to have done by proactively ruling out lockdowns that they could not legally impose anyway. While the ‘zero draft’ three years ago still foresaw countries being expected to ‘tackle’ misinformation, this is now only mentioned in the preamble, where the timely sharing of information is said to prevent the emergence of misinformation.

Nonetheless, the language around infodemics raises several concerns that remain unaddressed and require greater reflection.

First, the criteria by which information is meant to be judged as accurate, and by whom, are unclear. Although this leaves the process undefined, allowing countries to design their own control mechanisms, it also leaves room for abuse. It is entirely feasible that some countries (with WHO support) could silence dissenting views under the guise of infodemic management. It is also not beyond imagination that mission creep will occur, where non-health-related information is also controlled under the pretext of ‘maintaining peace and security’ during a health or other emergency.

Second, there is a serious risk that the poor management of information will exclude good science by accident, undermining overall public health. As witnessed during Covid, messages proclaiming that ‘the science is settled’ proliferated, and were often used to discredit credible science.

Third, there is an underwritten presumption within the logic of infodemics that public health authorities and their affiliates are correct, that policies are always based entirely on the best evidence available, that those policies are free of conflicts of interest, that information from these authorities is never filtered nor distorted, and that people should not expect reason-giving from authorities via immanent critique or self-reflection. Clearly, public health institutions are like any other human institution, subject to the same potential biases and pitfalls.

The Future of Pandemics and This Agreement

Wenham and Potluru from the London School of Economics estimate that the protracted negotiations on the Pandemic Agreement had already cost over $200 million by May 2024. Of course, this is only a fraction of the public expenditure on preparing for hypothetical future pandemics. The amount of ODA that the WHO, World Bank, and G20 have called for annually would correspond to about five to ten times the annual expenditure on combating tuberculosis – a disease that, according to WHO figures, has killed about as many people in the last five years as Covid-19, and at a much lower average age (representing higher years of life lost).

Although the $10.5 billion a year in development aid for pandemic prevention, preparedness, and response is unlikely to materialise, even a more cautious increase will come with opportunity costs. Moreover, these financial demands come at an inflection point in global health policy, where development assistance for health (DAH) is under massive pressure from serious stoppages and reductions from the United States, the United Kingdom, Europe, and Japan. Thus, increase in scarcity requires the better use of health financing, not simply more of the same.

Furthermore, as REPPARE has shown, the alarming statements of pandemic risk by the WHO, World Bank, and G20 are not well-grounded in empirical evidence. This means that the entire basis for the Pandemic Agreement is questionable. For example, the World Bank claims millions of annual deaths from zoonotic diseases, although the figure is less than 400,000 per year in the half-century before the Covid-19 pandemic, extrapolated to the current world population, 95% of which is attributable to HIV. The fact that many more new pathogens are being found today than just a few decades ago is not necessarily evidence of an increased risk, but rather the consequence of increased interest in research and, above all, the use of modern diagnostics and reporting processes.

In many ways, the Pandemic Agreement is just a figurehead of a new pandemic industry that has already grown more robust in the last five years. This includes, for example, projects for pathogen surveillance, for which the Pandemic Fund set up at the World Bank in 2021 has already received $2.1 billion in donor commitments while raising almost seven billion for implementation (when additionality is calculated). In 2021, the WHO Pandemic Hub was opened in Berlin, where data and biological material from all over the world are collated as an early warning system for pandemics. In Cape Town, the WHO mRNA hub seeks to promote international technology transfer.

And the 100 Days Mission, driven primarily by the public-private partnership CEPI, aims to ensure that vaccines are available in just 100 days during the next pandemic, which not only requires substantial investment in R&D and production facilities, but also a further speeding up of clinical trials and emergency use authorisation, posing potential risks regarding vaccine safety

To coordinate the complex ecosystem of different pandemic initiatives, the signatories to the Pandemic Agreement will need to develop ‘whole-of-society’ pandemic plans that will presumably be ignored in the event of a real crisis, as happened with the existing plans in 2020. They are further expected to ‘report periodically to the Conference of the Parties, through the Secretariat, on their implementation of the WHO Pandemic Agreement.’ The WHO Secretariat, in turn, publishes ‘guidelines, recommendations and other non-binding measures.’ This suggests that the Pandemic Agreement will set global norms and seek compliance through the usual mechanisms of nudging, naming, and shaming, and through conditionalities imposed by the CFM or through other World Bank development loans. It is in the case of the latter where policy choices designed within the Conference of Parties could become more coercive on low-income countries.

However, the importance of this new global pandemic bureaucracy should also not be overestimated, and the potency of the Pandemic Agreement is not immediately clear. After all, it is just one in a long list of United Nations agreements, only a few of which, such as the Climate Change Conference or the Nuclear Non-Proliferation Treaty, receive any broader attention. Thus, it is feasible that both the Conference of Parties and Pandemic Agreement will become politically inert.

Nevertheless, what tempers this moderate view is a key similarity between the three aforementioned policy areas. Namely, nuclear proliferation, climate change, and pandemics are all continually presented as an ‘existential threat,’ which drives media coverage, consequent political motivation, and continued investment. In the case of pandemic risk, the official narratives project an apocalyptic vision of ever-increasing pandemics (e.g., every 20 to 50 years), with ever-increasing severity (2.5 million dead per year on average), and ever-increasing economic costs (e.g,. $14 to $21 trillion per pandemic if investments are not made). Therefore, it is to be expected that the Pandemic Agreement will continue to enjoy a status of high politics and increased investment through perpetual fear and vested interests.

Consequently, if the draft Pandemic Agreement is adopted at the 78th WHA and subsequently ratified by the required 60 countries, the key to its potency will be how various legal obligations, governance processes, financial instruments, and ‘partner’ commitments are defined and implemented into policy via the Conference of Parties (COP). In many ways, the drafters of the Agreement merely ‘kicked the can down the road’ regarding the most difficult and contentious disagreements in hopes that future consensus will be found during the COP.

Here, comparisons and contrasts between the Climate COP and Pandemic COP could help to glean some useful insights on how the politics of the Pandemic Agreement might play out.

Both have become industries with significant levels of vested governmental and corporate interest, both use fear to motivate political and fiscal action, and both rely heavily on the natural proclivities of the media to propagate fear and justify states of exception as dominating narratives.