In Geneva, the WHO is negotiating rules that will determine how vaccines, diagnostics and treatments will be distributed during future pandemics.80 developing countries are demanding binding commitments for equitable access, while the European Union is blocking enforceable agreements.The European proposal would release only 20% of production during a pandemic (10% as donations), potentially repeating a “VIP line” in vaccine access.
With a new round of negotiations scheduled for late March in Geneva and the May 2026 deadline approaching, countries around the world continue negotiating the rules that will determine how vaccines, diagnostics and treatments will be distributed during future pandemics. Public health organizations warn that the European Union is blocking binding commitments on health equity, which could allow the next global health emergency to repeat the pattern seen during COVID-19: early access for wealthier countries and long delays for much of the rest of the world.
At the headquarters of the World Health Organization (WHO), Member States are negotiating the Pathogen Access and Benefit-Sharing (PABS) Annex, a key component of the Pandemic Agreement adopted in May 2025. This mechanism seeks to establish rules ensuring that when countries share virus samples and scientific data used to develop vaccines, diagnostics and treatments, the benefits derived from that information are also distributed equitably.
The pandemic agreement cannot enter into force until this annex is finalized, making the outcome of negotiations continuing through March and April decisive for its implementation.
During the fourth session of the WHO Intergovernmental Working Group held in December 2025, more than 80 developing countries proposed establishing mandatory standard contracts to regulate the use of pathogen samples and genetic data with pandemic potential. These contracts would include clear benefit-sharing conditions, technology transfer, scientific cooperation and equitable access to vaccines, diagnostics and treatments.
European Union delegations, particularly some Member States such as Germany, opposed beginning negotiations on these contracts and promoted a model based on voluntary commitments from the pharmaceutical industry.
Under this proposal, some manufacturers could choose to provide around 20% of their production of vaccines, treatments or diagnostics during a pandemic, of which only 10% would be guaranteed as donations, while the remainder would depend on commercial agreements.
During the COVID-19 pandemic, international initiatives such as COVAX managed to distribute nearly 2,000,000,000 vaccine doses across 146 economies. Even so, global distribution remained deeply unequal.
In 2021, Latin America represented around 8% of the world’s population but accounted for nearly 30% of recorded COVID-19 deaths.
Inequality was also reflected in advance vaccine purchases. According to analyses published in The Lancet, high-income countries representing just 16% of the global population secured at least 70% of available vaccines in 2021, leaving much of the world waiting for access to essential lifesaving tools.
Several studies estimate that more than 1,000,000 deaths in 2021 could have been avoided if vaccines had been distributed more equitably.
For Latin America and the Caribbean, the outcome of these negotiations has direct implications. The region actively participates in global epidemiological surveillance networks and shares key scientific information when new diseases emerge, yet during the pandemic many countries experienced significant delays in securing vaccines and treatments.
What is civil society asking to prevent another health inequality crisis?
Among the main demands directed at European Union decision-makers are:
1. No equity, no agreement:
The Pandemic Agreement cannot be ratified without the PABS Annex, and this annex should not be approved without binding health equity provisions.
2. Cooperation, not extraction:
Those who benefit from the system must contribute to the system. Manufacturers and commercial users must participate in mandatory benefit-sharing mechanisms through binding contracts. This includes equitable access to vaccines, diagnostics and treatments, non-exclusive licensing for manufacturers in developing countries during severe health emergencies, and annual financial contributions.
3. No registration, no access:
The system must include user registration and traceability mechanisms to identify who accesses pathogens and how they are used.
4. Meaningful civil society participation:
Transparency, accountability and community participation are essential elements to protect health equity.
5. Finalize the agreement with effective equity provisions:
A weak annex risks repeating the inequalities observed during the COVID-19 pandemic.
6. Protect regional production:
Without equitable benefit-sharing, efforts to develop regional production and strengthen health sovereignty in low- and middle-income countries could be limited.
“The lesson from COVID is clear: when rules are weak, inequality prevails. There must never again be a VIP line in the next pandemic,” said Francisco Rubio, AHF Director of Advocacy for Latin America and the Caribbean.
“During COVID we saw how countries with more resources secured vaccines and medical technology while millions of people in regions such as Latin America waited for access to basic lifesaving tools. Health equity cannot depend on late donations; it requires clear commitments.”
Negotiations on the PABS system will continue throughout 2026 and will define the global rules for access to vaccines, diagnostics and treatments during future pandemics.
For public health organizations, the current debate centers on a key question: whether the new agreement will establish clear obligations for benefit sharing — including access to vaccines, diagnostics and treatments derived from shared pathogens — or whether those commitments will remain voluntary.
