In May 2025, after more than three years of negotiations sparked by the COVID-19 pandemic, the member states of the World Health Organization (WHO) adopted the WHO Pandemic Agreement, a treaty meant to help the world prevent, prepare for and respond to future pandemics more fairly and effectively [1]. More than a year later, not a single country has been able to sign it. The reason is a missing piece known as the PABS annex, and the talks to finish it have repeatedly run past their deadlines.

What PABS is

PABS stands for Pathogen Access and Benefit Sharing. It is meant to answer one of the most contentious questions in global health: if a country detects a dangerous new virus and shares samples and genetic data with the world, what does it get in return [2]? During COVID-19, scientists in South Africa and Botswana quickly identified and shared information about the Omicron variant. Many countries responded by restricting travel from southern Africa, and lower-income countries later struggled to obtain vaccines while wealthy nations secured large supplies. Many developing countries came away convinced that the system rewarded the countries that made vaccines more than the countries that shared the data needed to create them. The PABS system is designed to change that. It would create a multilateral system for the rapid, safe and traceable sharing of pathogen samples and genetic sequence information, linked to fair and reliable sharing of the benefits, such as vaccines, tests and treatments [3]. The Pandemic Agreement cannot open for signature and ratification until the PABS annex is adopted [1][2].

Deadlines come and go

WHO member states set up an Intergovernmental Working Group (IGWG) in 2025 to negotiate the annex, with the goal of adopting it at the World Health Assembly in May 2026 [4]. That goal slipped repeatedly. Negotiators extended talks in March, held another session from April 27 to May 1 and still could not reach agreement [2][5]. On May 19, 2026, the Seventy-ninth World Health Assembly decided to continue negotiations. Member states agreed to submit the outcome either to the next Assembly in May 2027 or to a special session of the Assembly in 2026 dedicated to the annex [1]. A seventh round of negotiations was scheduled for July 6 to 17, 2026 [1]. As of this writing, no final annex text had been announced. The sticking points are both technical and political. Developing countries, represented in part by blocs of African and other nations, want legally binding guarantees that manufacturers who use shared pathogens will provide a set share of vaccines and treatments to WHO for distribution during an emergency. Some negotiators have pushed for binding WHO contracts with companies [6]. Countries with large pharmaceutical industries have been more cautious about obligations that could affect intellectual property and commercial research. "The PABS annex is the last piece of the puzzle not only for the Pandemic Agreement but all initiatives that WHO and Member States have implemented as a result of lessons learned from the COVID-19 pandemic," WHO Director-General Tedros Adhanom Ghebreyesus said in May, warning that the next pandemic is "a matter of when, not if" [2].

What happens after the annex is adopted

Finishing the annex would not put the treaty into effect immediately. Once the World Health Assembly adopts the PABS annex, the Pandemic Agreement can open for signature. Countries must then ratify it through their own domestic processes, which in many nations requires a vote by the legislature. Under the agreement's terms, it enters into force only after 60 countries have ratified it. For comparison, WHO's only previous treaty, the Framework Convention on Tobacco Control, took about 21 months to go from adoption to entry into force. That timeline means that even in the best case, the new pandemic rules would likely not be legally binding until 2028 or later. The IGWG is also responsible for preparing for the first Conference of the Parties, the body that will govern the agreement once it takes effect, and for designing a financing mechanism to support countries' preparedness [4].

The United States steps away

The negotiations are taking place without the WHO's historically largest funder. The United States formally completed its withdrawal from the WHO on January 22, 2026, one year after President Trump signed an executive order on his first day back in office [7][8]. In a joint statement, Secretary of State Marco Rubio and Health and Human Services Secretary Robert F. Kennedy Jr. cited what they described as the WHO's failures during the COVID-19 pandemic and its resistance to reform [8]. All U.S. funding to the WHO has ended, and the administration says it will pursue global health goals through bilateral partnerships instead [7]. The withdrawal raises legal and financial questions. WHO rules require a one-year notice and full payment of outstanding dues. The United States owed roughly $260 million to $280 million for 2024 and 2025 and has said it will not pay [9]. The U.S. also did not take part in adopting the Pandemic Agreement and is not bound by it.

Other pieces already in place

Not all of the post-COVID reforms are stalled. Amendments to the International Health Regulations, the binding rules that govern how countries report and respond to public health emergencies, entered into force on September 19, 2025 [4]. The amendments include a new "pandemic emergency" alert level above the existing public health emergency of international concern.

Why it matters

Supporters of the agreement say the world cannot afford to repeat the inequities of COVID-19, and that a functioning PABS system would encourage countries to share outbreak information quickly instead of holding it back. The current Ebola outbreak in the Democratic Republic of the Congo, caused by a strain with no approved vaccine, is a reminder that new threats do not wait for diplomatic deadlines. Skeptics, including the U.S. government, argue that the WHO needs deeper reform and that national sovereignty and bilateral deals are better tools. Whether the PABS annex is finished at a special session this year or slips to May 2027, the outcome will determine whether the Pandemic Agreement becomes a working treaty or remains an unfinished promise.

Sources

  • 1. World Health Organization, "Seventy-ninth World Health Assembly – Daily update: 19 May 2026." https://www.who.int/news/item/19-05-2026-seventy-ninth-world-health-assembly---daily-update--19-may-2026
  • 2. World Health Organization, "WHO Member States agree to extend negotiations on Pathogen Access and Benefit Sharing annex," May 1, 2026. https://www.who.int/news/item/01-05-2026-who-member-states-agre e-to-extend-negotiations-on-pathogen-access-and-benefit-sharing-annex
  • 3. Konrad-Adenauer-Stiftung, "PABS Annex to the WHO Pandemic Agreement: Member States extend negotiations into 2027," Geneva Telegram, May 2026. https://www.kas.de/en/web/multilateraler-dialog-ge nf/geneva-telegram/detail/-/content/pabs-annex-zum-who-pandemieabkommen-who-mitgliedstaaten-verlae ngern-verhandlungen-bis-2027
  • 4. World Health Organization, "Member States advance vital work in support of WHO Pandemic Agreement," September 25, 2025. https://www.who.int/news/item/25-09-2025-member-states-advance-vital-work-in-sup port-of-who-pandemic-agreement
  • 5. World Health Organization, "WHO Member States agree to extend negotiations on key annex to the Pandemic Agreement," March 28, 2026. https://www.who.int/news/item/28-03-2026-who-member-states-a gree-to-extend-negotiations-on-key-annex-to-the-pandemic-agreement
  • 6. Nithin Ramakrishnan, "WHO: IGWG recommends extension of PABS negotiations to WHA79," Third World Network, May 7, 2026. https://twn.my/title2/health.info/2026/hi260501.htm
  • 7. CDC/HHS, "Fact Sheet: U.S. Withdrawal from the World Health Organization," January 2026. https://cdc.gov/global-health/resources/us-withdrawal-who.html
  • 8. "US Completes WHO Withdrawal After Nearly Eight Decades," Bernama/Anadolu, January 23, 2026. https://bernama.com/en/news.php?id=2516026
  • 9. "The U.S. says its divorce from WHO is final on Jan. 22. Does WHO agree?" (summary of NPR reporting), Observatorio Global UDLAP, January 2026. https://observatorioglobal.udlap.mx/?p=3557 Information in this article is current as of October 9, 2026. Bracketed numbers refer to the sources listed above.

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