Nations Gather to Decide Who Gets the Next Pandemic Vaccine

UNITED NATIONS — When the first SARS-CoV-2 sequences were uploaded to a public database in January 2020, they came from scientists in Wuhan, China. Eighteen months later, when the world had produced three billion vaccine doses, more than 80 percent had gone to wealthy nations. The countries that detected the threat earliest were among the last to receive protection against it.

That asymmetry is what the United Nations General Assembly convenes to address in its second high-level meeting on pandemic prevention, preparedness and response on Thursday — and whether the outcome reverses it will depend on negotiations over one unfinished technical annex.

The meeting, co-facilitated by Armenia and Rwanda, will adopt a political declaration under the theme “Fostering a multinational and intergenerational approach to prevent, prepare for and respond to pandemics and public health emergencies, through the principles of equity and solidarity.” The language is diplomatic. The stakes are not.

At the center of the debate is the Pathogen Access and Benefit-Sharing system — known as PABS — the proposed mechanism under the WHO Pandemic Agreement that would require pharmaceutical manufacturers receiving pandemic pathogen samples to allocate 20 percent of their real-time production to the World Health Organization, with 10 percent donated outright. The eighth session of the Intergovernmental Working Group on PABS concluded September 18 in Geneva without resolving the final text. Negotiators carry that unfinished work into Thursday’s session.

“The world remains insufficiently prepared for the next pandemic,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said ahead of this week’s General Assembly meetings. He has used that assessment repeatedly since 2021, but the September 25 meeting carries different weight: it is the first time a political declaration will be formally adopted by UN member states since the WHO Pandemic Agreement was finalized in May.

For low- and middle-income countries, PABS is not a technical footnote. It is the mechanism by which the terms of the COVID-19 response — where Global South nations shared pathogen data under international health law and received vaccines on a delayed, rationed basis — would be structurally reversed. Under the proposed system, a pharmaceutical company that uses a pathogen sample originating in sub-Saharan Africa or Southeast Asia would be legally obligated to return production in real time, not as charitable surplus after wealthy-nation demand had been satisfied.

The United States, under Donald Trump, withdrew from the World Health Organization in early 2025 — a decision that removed the largest single WHO contributor from the table and that Global South negotiators now factor into their calculus about whether production-sharing commitments from American manufacturers could be enforced.

The BRICS grouping — which met in New Delhi on September 13 — explicitly endorsed completing the PABS annex in its summit communiqué, with the WHO welcoming that commitment. India, China, Russia, Brazil, and South Africa speaking collectively in support of the mechanism reflects how comprehensively the politics of pandemic equity have shifted since 2020, when individual vaccine nationalism was the operating norm even among nations that publicly endorsed multilateralism.

What remains contested is whether pharmaceutical industry interests will accept the 20 percent production-sharing threshold. Industry associations have argued that mandatory production-sharing at that scale could reduce commercial incentive for the rapid surge manufacturing that pandemic vaccines require. The counterargument from Global South negotiators — and from the WHO’s own modeling — is that voluntary sharing in a crisis has already been tested and found inadequate: COVID-19 produced more than 12 billion doses before the pandemic’s acute phase ended, with distribution concentrated in the countries that had paid advance purchase agreements rather than those at greatest epidemiological risk.

An Ebola outbreak in the Democratic Republic of Congo has claimed 3,759 lives as of September 22, with an unproven vaccine being deployed under emergency authorization in North Kivu. The situation exposes precisely the gap PABS is designed to address: pathogen data shared globally, experimental countermeasures controlled locally. The WHO launched a clinical PARTNERS trial in the DRC this summer to evaluate treatment protocols, and the evidence it generates will feed directly into the preparedness frameworks member states are being asked to commit to on Thursday.

COVID-19 has not receded from the evidence base. The “Nimbus” variant — formally NB.1.8.1 — and its companion lineage “Stratus” are expanding across 27 US states as of this week, according to public health surveillance data. Neither requires emergency intervention. Both carry a reminder that the pandemic which exposed the PABS vacuum has not concluded.

What Thursday’s political declaration cannot resolve is the question Thursday will leave open: whether the final PABS annex, once adopted, will contain language strong enough to compel production-sharing, or whether it will produce another voluntary-in-practice, mandatory-on-paper arrangement of the kind that governed COVID-era technology transfer commitments. That gap — between the text member states adopt and the behavior pharmaceutical manufacturers exhibit in a crisis — is the one outcome no declaration is positioned to determine.

The world failed in 2020 not for want of vaccines. It failed because the system had no mechanism to require that vaccines reach the people most at risk before they reached the people most able to pay. Thursday is the day member states decide whether they have finally built one.