Pandemic Preparedness Infrastructure: WHO Reform and National Readiness Gaps

Executive Summary

The WHO Pandemic Agreement's May 2025 adoption marks the most significant structural reform to global pandemic governance since COVID-19, but its legal entry into force remains blocked by an unresolved pathogen-sharing annex negotiation, a US withdrawal from WHO, and a documented decline in major-economy research and preparedness budgets, meaning the new architecture exists largely on paper as of mid-2026.

Three parallel reform tracks have advanced since 2020: a new legally binding WHO Pandemic Agreement, amendments to the International Health Regulations (IHR) that entered into force in September 2025, and the World Bank's Pandemic Fund now deploying grants across more than 100 countries. Taken together, these developments represent genuine institutional progress. But the International Pandemic Preparedness Secretariat's 2026 report finds that the 100-day countermeasure target remains unachievable across diagnostics, therapeutics, and vaccine delivery, and the US withdrawal from WHO has created a structural financing gap that multilateral actors are unable to fully absorb. The interplay between geopolitical fragmentation and institutional reform is where the real risk concentrates.

The Reform Architecture Built Since 2020

Three institutional pillars now define the post-COVID preparedness landscape, and it is worth examining each on its own terms before assessing where they interlock, and where they fail to.

Pillar One: The WHO Pandemic Agreement. The coalition formation behind the agreement was itself an achievement. During the 78th World Health Assembly, WHO member states adopted the agreement by consensus on 20 May 2025, following its approval the day prior by vote with 124 in favor, zero objections, and 11 abstentions, with Bulgaria, Egypt, Iran, Israel, Italy, Jamaica, the Netherlands, Paraguay, Poland, the Russian Federation, and Slovakia abstaining, with reasons ranging from the perceived lack of consensus to concerns about state sovereignty.

The agreement's core operational innovation is the Pathogen Access and Benefit-Sharing system (PABS). According to PMC analysis of the treaty text, under this system, signatories agree to provide WHO with timely access to pathogen genetic sequence data in exchange for a commitment from participating manufacturers to make 20% of their real-time production of pandemic-related health products available to WHO, with at least half of that amount provided as donations and the remainder at affordable prices, a mechanism designed to prevent a recurrence of the hoarding and inequitable distribution that defined the early COVID-19 response.

The agreement also explicitly limits WHO's coercive authority. The Agreement strongly reaffirms that it does not give WHO authority to impose measures such as lockdowns or vaccine mandates on any country. This sovereignty protection was essential to achieving consensus, but it is also the feature that most constrains the treaty's enforceability, a trade-off that shapes every assessment of whether it will work in an actual emergency.

Pillar Two: The 2024 IHR Amendments. The IHR revisions that entered force in September 2025 addressed a distinct set of operational failures. Cambridge University Press analysis concludes that the amended IHR reflect lessons learned from the pandemic but raise questions about whether they deflect attention from the need for deeper structural reforms. The Cambridge analysis notes the key equity insertions: a revised Article 13 requires the WHO Secretariat to facilitate access to health products during a PHEIC, and strengthened obligations in Article 44 establish a commitment to promote and facilitate sustainable financing of national capacities, mostly for the benefit of developing countries, but qualify these commitments by references to applicable law and available resources.

Short-term gain, long-term cost: Both the IHR amendments and the Pandemic Agreement achieve consensus by making the most consequential obligations contingent on resources and domestic law, which means the provisions that matter most in a crisis are precisely the ones that will face the sharpest political resistance. The structural improvement in governance is real, but the enforceability remains aspirational.

Pillar Three: The Pandemic Fund. Operating under World Bank administration with WHO as technical lead, the Fund represents a different mechanism for change: financial rather than normative. The Pandemic Fund launched its fourth Call for Proposals on April 1, 2026, targeting countries with the greatest capacity gaps, highest pandemic risks, and significant socioeconomic challenges that had not been previously awarded single-country grants. Its portfolio has grown rapidly, but peer-reviewed analysis of the Fund's design confirms the Pandemic Fund is primarily a preparedness tool without ample consideration given to outbreak response funding mechanisms, and that to ensure all aspects of public health emergency management are accounted for, the Pandemic Fund should be accompanied by efforts to ensure response financing is available when epidemics and pandemics occur.

Where The Architecture Breaks: The Geopolitical And Financial Gaps

The interplay between geopolitical fractures and institutional reform is where the most durable vulnerabilities concentrate. The IPPS report documents what country-level data confirms: the US, United Kingdom, France, Germany, and others reduced their global health and research and development funding in 2025. This spending contraction intersects directly with the WHO's financial crisis, and the two effects are mutually reinforcing rather than independent.

Coalition fracture point: The WHO Pandemic Agreement is not backed by a unified coalition of major powers. Iran's representative at the 78th World Health Assembly explained their abstention by saying "key concerns of developing countries were not addressed," including the "lack of binding commitments on unhindered access and equitable access to medical countermeasures, technology transfer and knowhow." Meanwhile, the US Health Secretary stated at the same Assembly that the agreement would "lock in all of the dysfunction of the WHO pandemic response...we're not going to participate in that." These positions are not symmetric. Iran's objection is that the equity provisions lack teeth; the US objection is that the governance structure itself is unacceptable. The two abstentions reflect a fundamental divide over the nature of the problem, not merely its solution.

Under the Pandemic Influenza Preparedness Framework, some concrete supply gains have materialized. WHO signed eight new agreements in 2025, bringing the total to 19 contracts with pandemic products manufacturers, securing access to antivirals, diagnostics, syringes, and 900 million-plus vaccine doses for future influenza pandemics. These are real deliverables. But they apply to influenza specifically, not to a novel pathogen of the type that caused COVID-19.

The 2025 outbreak landscape illustrated the persistent detection and coordination gaps. The IPPS confirms a series of outbreaks in 2025, including mpox, H5N1, Ebola, Marburg, Rift Valley Fever, Chikungunya, and measles, demonstrated persistent weaknesses in early detection, coordination, and access. WHO's own February 2026 assessment is candid: the answer to whether the world is better prepared for the next pandemic is mixed - significant progress has been made, but it remains uneven and fragile.

The PABS annex negotiation, still unresolved as of July 2026, is the critical bottleneck. Peer-reviewed analysis published in PMC is direct: failure to reach consensus on the annex would render the historic 2025 adoption a symbolic but ultimately hollow victory.

Why The Pabs Annex Failure Would Matter More Than It Appears

The PABS debate is often framed as a technical dispute over intellectual property and benefit-sharing formulas. The deeper issue is that the annex determines whether the Pandemic Agreement can even be signed. PMC analysis confirms factors that remain to be negotiated in the PABS system include tracking and tracing materials and sequence information, pathogen digital sequence information, database access and use, and striking the right balance on intellectual property rights.

The pharmaceutical industry's engagement adds another dimension. The IFPMA delivered statements to both the 79th World Health Assembly in May 2026 and the sixth resumed IGWG meeting in April 2026, signaling continued but conditional private-sector participation. The industry notes the pharmaceutical industry brought forward vaccines against COVID-19 in record time, but despite these efforts, there were significant gaps and delays in access, particularly in many low- and middle-income countries.

Trajectory, not just level: What most assessments understate is that the momentum indicator for pandemic preparedness spending has reversed direction. The IPPS's 100DM Scorecard documents declining investment and heavy funder concentration, meaning the trajectory from 2025 onward is negative even as institutional architecture expands. Adding treaty commitments to a shrinking funding base is low confidence to produce the operational readiness those commitments promise.

Counterarguments

1. The treaty architecture is more durable than geopolitical assessments suggest. The conventional analysis focuses on the US withdrawal as a structural blow to WHO's pandemic preparedness capacity. A serious challenge to this view notes that the US withdrawal actually removes the actor most resistant to binding equity commitments, potentially allowing the remaining 193 member states to negotiate a more operationally robust PABS annex. CEPI's analysis observes that countries do not have to wait for the Pandemic Agreement's formal ratification to take action, and they can and should start now, though achieving true pandemic preparedness will require international commitment to sustained investment and collaboration in scientific research and development. The IHR entered into force in September 2025 regardless of US membership status, and the Pandemic Fund operates through World Bank mechanisms that are not contingent on WHO affiliation. A fragmented but partially functional architecture may be more resilient than a unified but unratified one.

2. The 100-day target analysis overestimates actual readiness gaps by conflating aspirational benchmarks with operational baselines. The IPPS finding that the 100-day target is not yet achievable is technically accurate but potentially misleading if read as meaning the world is no better prepared than in 2019. The WHO's February 2026 assessment points to concrete deliverables, including recent Ebola and Marburg outbreak responses that show clear progress at national levels with support from WHO. The Canada Pandemic Preparedness Plan 2025, cited in NATO Association reporting, reflects a genuine institutional upgrade in national-level readiness frameworks. The gap between aspirational speed targets and improved but still inadequate baseline capacity is analytically meaningful, and collapsing that distinction overstates current risk.

3. The equity-sovereignty tension in both the IHR and the Pandemic Agreement may be a feature rather than a bug. The argument that qualified equity obligations lack enforceability assumes that binding obligations would have been achievable and would have been respected. The historical record of IHR compliance before 2024 suggests that formally binding provisions do not reliably produce implementation in low-capacity states. The PMC editorial on the Pandemic Agreement notes national and political agreements on funding and biosecurity, as well as collaboration between world leaders, have stalled but could be activated by the 2025 WHO Pandemic Agreement. If the Agreement serves as a coordination catalyst rather than a compliance mechanism, weaker language may produce more actual cooperation than stronger language that triggers defection.

Indicators To Watch

The following table identifies observable signals that analysts and policy researchers can track to assess whether the reform architecture is consolidating or eroding.

Decision Relevance

Scenario A (~55%): Incremental progress, PABS annex adopted late 2026, partial treaty ratification by 2028. The IGWG negotiates a compromise PABS annex acceptable to the pharmaceutical industry and a sufficient majority of member states, the Pandemic Agreement opens for signature, and the IHR+Agreement architecture becomes the operational framework for the next decade, despite the US operating outside it. If you advise on global health policy or hold positions in the biopharmaceutical sector, begin scenario planning now for a two-tier market in pandemic countermeasures, where PABS-compliant manufacturers have preferred access to WHO procurement channels and non-compliant ones do not. If you are a risk officer in emerging-market healthcare or supply chain, the 79th WHA outcome is the single most important near-term signal.

Scenario B (~30%): PABS annex fails, Agreement remains legally dormant, IHR stands alone. Political fractures between the North-South equity camp and the industry-protection camp prove irreconcilable before the 79th WHA deadline. The Agreement becomes a statement of principles without legal force, and global pandemic governance reverts to the amended IHR plus the Pandemic Fund as the operative architecture. If you advise governments or multilateral institutions on health security financing, redirect advocacy toward strengthening IHR enforcement and expanding the Pandemic Fund's response financing capacity, since these operate independently of the Agreement's entry into force. If you are a policy researcher, the analogy to the Kyoto Protocol's fate is the appropriate historical frame for assessing long-run prospects.

Scenario C (~15%): Major novel outbreak before the architecture is operational, stress-testing unresolved gaps. A novel pathogen or a sustained H5N1 human transmission chain emerges before the PABS annex is finalized, the Pandemic Agreement has entered into force, or the 100-day countermeasure pipeline achieves operational readiness. If you operate in healthcare delivery, pharmaceutical manufacturing, or government emergency management, treat this scenario as the planning baseline for response exercises rather than a tail risk, given the IPPS's documented persistence of early-detection gaps across the 2025 outbreak series. If you lack direct exposure to health emergency operations, monitor the WHO's GOARN activation speed and the G7 Medical Countermeasures Platform's response timelines as proxy indicators of system readiness.

• The PABS annex negotiation is the central variable in this assessment, and its outcome is uncertain. No public draft text has been circulated, making independent analysis of its probable form reliant on official WHO summaries and IFPMA statements that carry participation bias.
• US withdrawal removes the single largest source of both financial contributions and scientific participation from WHO, but the counterfactual (what WHO preparedness capacity would look like had the US remained) cannot be precisely specified. The funding gap estimate reflects official WHO contribution records but does not capture the second-order effects on collaborative research, surveillance network access, or regulatory harmonization.
• The IPPS 100DM Scorecard provides the most systematic operational assessment available, but its methodology for rating "not yet achievable" applies aspirational speed benchmarks developed in 2021-2022. These benchmarks may not reflect what is technically feasible given current platform technology, meaning the gap may be overstated or understated depending on the specific pathogen class.
• Geopolitical dynamics compound existing analytical uncertainties. Canada's Pandemic Preparedness Plan 2025 reflects a different national-level framework than the US "America First Global Health Strategy," and regional divergence in preparedness investment is not fully captured by aggregate WHO or IPPS assessments.
• This assessment does not address bioterrorism-related preparedness or dual-use research governance, which intersect with pandemic preparedness but are governed by distinct frameworks outside the WHO treaty system.