WHO Pandemic Agreement adopted by 78th World Health Assembly

On 20 May 2025 the 78th World Health Assembly, meeting in Geneva from 19 to 27 May 2025, adopted the WHO Pandemic Agreement in plenary by consensus through Resolution WHA78.1. The plenary adoption followed a recorded vote in Committee A the prior day, 19 May 2025, of 124 Member States in favour, 0 against, with 11 abstentions (Bulgaria, Egypt, Iran, Israel, Italy, Jamaica, Netherlands, Paraguay, Poland, Russia and Slovakia).¹² The Agreement is the first international instrument adopted under Article 19 of the Constitution of the World Health Organization since the WHO Framework Convention on Tobacco Control was adopted by the 56th World Health Assembly on 21 May 2003.³ Article 19 of the WHO Constitution provides that “[t]he Health Assembly shall have authority to adopt conventions or agreements with respect to any matter within the competence of the Organization. A two-thirds vote of the Health Assembly shall be required for the adoption of such conventions or agreements, which shall come into force for each Member when accepted by it in accordance with its constitutional processes.”⁴ The Agreement was negotiated by the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response, established by Decision SSA2(5) of the World Health Assembly on 1 December 2021 in special session, across thirteen rounds between February 2022 and May 2025 (with nine of the rounds held as resumed sessions extending a numbered INB).⁵⁶ The United States, having transmitted notice of withdrawal from WHO to the United Nations Secretary-General on or about 22 January 2025 under section 2 of Executive Order 14155 of 20 January 2025, did not participate as a member in the WHA78 deliberations or vote and is not a signatory or Party to the Pandemic Agreement.⁷

1. The Pandemic Agreement establishes a framework of substantive obligations on Parties addressing pandemic prevention, preparedness and response. The Agreement includes provisions on prevention (including a One Health approach), surveillance, regulatory strengthening, research and development, supply-chain resilience, pandemic-related products access (including the WHO Pathogen Access and Benefit-Sharing system to be established by an annex), financing, technology transfer, workforce, communication and community engagement, and coordinated international response. The Pathogen Access and Benefit-Sharing (PABS) annex, the most contested element of the negotiations, was deferred to a separate instrument to be negotiated by the Intergovernmental Working Group during 2025-2026 and adopted by a future World Health Assembly.⁸⁹

2. The Agreement is not yet open for signature. Article 31 of the WHO Pandemic Agreement gates the opening of signature on the adoption by a future World Health Assembly of the Pathogen Access and Benefit-Sharing (PABS) annex; the Intergovernmental Working Group (IGWG) established by WHA78.1 continues to negotiate the PABS annex with the aim of submission to a subsequent World Health Assembly. Once opened for signature, the Agreement enters into force in accordance with its terms upon deposit of the requisite number of instruments of ratification, acceptance, approval or accession with the United Nations Secretary-General as depository. Parties accept the Agreement “in accordance with [their] constitutional processes” under WHO Constitution Article 19; for the United States the constitutional process for acceptance of a multilateral instrument of this character would historically involve Senate advice and consent under Article II, § 2, clause 2 of the U.S. Constitution if treated as a treaty, or congressional authorisation in the form of executive-congressional agreement, neither of which is available given the U.S. withdrawal from WHO.¹⁰¹¹¹²

3. The practical composition of negotiating coalitions among Parties to the Agreement is shaped by the WHO regional groupings (African Region, Region of the Americas, South-East Asia Region, European Region, Eastern Mediterranean Region, Western Pacific Region) under WHO Constitution Chapter XI, Articles 44 to 54. The Pan American Health Organization, operating as the WHO Regional Office for the Americas under the 1949 agreement concluded under Article 54 of the WHO Constitution, retains its separate treaty-based existence under the Pan American Sanitary Code of 14 November 1924 and successor instruments; the PAHO membership includes the United States independent of the U.S. WHO withdrawal. The U.S. share of WHO assessed contributions for the 2024-25 biennium was approximately 22 per cent, the largest single Member State share; the U.S. withdrawal notice redistributes the assessed-contributions burden among the remaining Member States from the 2026-27 biennium forward.¹³¹⁴¹⁵

4. The Pandemic Agreement is the second binding international instrument addressing pandemic-scale public-health threats alongside the International Health Regulations (2005), adopted by World Health Assembly Resolution WHA58.3 on 23 May 2005 under the regulations authority of WHO Constitution Article 21 (which authorises the Health Assembly to adopt regulations concerning “sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease”). The IHR and the Pandemic Agreement operate in parallel: the IHR binds States Parties by default under Article 22 of the WHO Constitution and continues to bind the United States even after the 22 January 2026 WHO withdrawal, while the Pandemic Agreement binds only those Parties that ratify or accede to it. Amendments to the IHR (2005) adopted by the 77th World Health Assembly on 1 June 2024 by Resolution WHA77.17 entered into force on 19 September 2025 under Article 59 of the IHR, twelve months after the Director-General’s notification of 19 September 2024, for States Parties that did not reject or reserve within the 10-month rejection-and-reservation period that expired 19 July 2025. The relationship between the IHR amendments and the Pandemic Agreement on pathogen sharing and surveillance is to be developed through implementation guidance.¹⁶¹⁷¹⁸