As the US steps out, the rest of the world steps up on global health security with vaccines as a pillar of a new global pact
Next week, discussions in Geneva resume on the Pandemic Agreement, advancing the work to draft an annex on Pathogen Access and Benefit Sharing (PABS).
When countries first sat together to start work on a new pandemic treaty more than three years ago, they were seized by the chance to improve a pandemic system that had let millions down.1 A treaty presented the opportunity of a generation to build a more effective, fairer, global system to prevent, prepare for, and respond to future outbreaks.
A main objective, and constant sticking point of the treaty talks, was access to vaccines—how poorer countries could get them fairly, faster, and cheaper. Vaccines are a key component of global health security. They protect individuals’ health and can contain and control the spread of disease, preventing viruses from crossing borders. When the text of the historic treaty was adopted by the World Health Assembly this week, it included provisions to address this problem. Countries agreed to implement a range of measures to improve vaccine equity.2
Unfortunately, by the time the agreement was adopted, the United States (US) had already withdrawn from the treaty process and global health more broadly.3 They also made it clear that under the current administration, they do not intend to contribute in any way to this global effort.
The Trump administration’s withdrawal of billions of dollars of funding was a dramatic policy shift. For decades, the US has played a leading role in supporting the vaccine ecosystem, including support for robust disease surveillance, research and development capacity, regulatory systems strengthening, and vaccine delivery and distribution.4 They had deployed staff from the US Centers for Disease Control for virus surveillance and testing around the world, invested in early research and development at the National Institutes of Health and the Biomedical Advanced Research and Development Authority, and even supported last mile vaccine rollout and delivery through the World Health Organization, UNICEF, and Gavi, the Vaccine Alliance.
From smallpox to polio, the US has taken a lead role in eradication efforts, as well as in investing in science to produce new vaccines against endemic diseases, such as pneumonia and malaria, as well as emerging infectious diseases like Zika, MERS, and Ebola. The policy rationale was enlightened self-interest.5 Global disease control directly protects US citizens by stopping the spread at its source.
The recent withdrawal of financial support has led to an immediate dismantling of this ecosystem, including cutting-edge scientific research, surveillance systems that helped countries worldwide detect and respond to deadly disease outbreaks. These are systems that also directly protect the health and security of Americans by providing real-time access to global data and information underpinning our ability to respond to new outbreaks, identify emerging threats, and develop and distribute responsive vaccines.
In the wake of the US withdrawal, the pandemic treaty has arrived just in time to meet the moment. First, the treaty includes some near-term fixes to how vaccines are allocated in the event of a pandemic. Specifically, it commits countries that typically manufacture vaccines to share a certain percentage of doses with low-income countries. This is a partial salve to address the “vaccine nationalism” that arose during COVID-19. Wealthy countries bought the lion’s share of the doses. The result was that well before vaccines had reached most of the rest of the world, the US and other countries were already throwing doses away because they had more than they could use.6 This scenario, in which some countries have an overabundance of a given vaccine while the rest of the world has none, is common.
More importantly, and in the longer term, the treaty also helps fix the structural asymmetry in vaccine development, production, and distribution. It proposes ways to diversify where and how vaccines are researched, developed, and ultimately made. Manufacturing vaccines in more regions of the world would make vaccine development more responsive to the health needs of people beyond the US and Europe. Helping countries protect themselves is a less costly, more effective way to prevent the spread of disease.
Concrete actions outlined in the treaty to facilitate this include facilitating technology and knowledge transfer, sharing the results of publicly funded research, and enhancing supply chains and logistics. The text also outlines a new system that allows access to viruses’ genetic information and ensures that the benefits, like vaccines or treatments developed from that information, are shared fairly, beyond just the wealthiest countries. This more localized regional approach will make countries more self-sufficient and result in more appropriate vaccines for the places they will be used.
The recent outbreak of mpox offers an example of what change could look like. Mpox is a virus endemic to parts of West and Central Africa, where people have faced it for decades without a vaccine.7 However, when mpox began spreading more widely in 2022, including to the US and Europe, wealthy countries utilized their stockpiles of smallpox vaccines to halt the spread of mpox—and the outbreaks were contained within months. Even still, the US and Europe paid a premium to order the manufacture of millions more doses, which they kept for themselves. The most affected countries in sub-Saharan Africa were priced out and, as with COVID-19, left without access.8 Had a system for facilitating the technology transfer to enable regional manufacturing been in place, African manufacturers could have started making mpox vaccines years ago, meeting a local public health and market demand, while containing what is now a deadly, spreading, and mutating outbreak.
With the US withdrawal, the agreement on the treaty is testament that other countries are ready to invest, innovate, and create a more robust ecosystem—better, fairer, and less dependent on a single country.9 And while there is still a long road ahead to put the treaty into action, its recent agreement and the convening next week to take forward the work to draft and negotiate the PABS annex, are a clear show of solidarity and an encouraging step that, with or without the US, the world is willing to step up collaboration on global health security, including for vaccine equity.
Nina Schwalbe, MPH, PhD, is the CEO of Spark Street Advisors and a Senior Scholar at Georgetown’s O'Neill Institute for National and Global Health Law. She has held leadership roles at Gavi, the Vaccine Alliance, UNICEF, and as the director of USAID’s COVID-19 Vaccine Access and Delivery Initiative.
References
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2. Schwalbe N. Pandemic treaty is a win for multilateralism and global health. BMJ. 2025(389):r970. doi:10.1136/bmj.r970
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4. WHO. Increases in vaccine-preventable disease outbreaks threaten years of progress, warn WHO, UNICEF, Gavi. WHO. April 24, 2025. Accessed May 28, 2025. https://www.who.int/news/item/24-04-2025-increases-in-vaccine-preventable-disease-outbreaks-threaten-years-of-progress--warn-who--unicef--gavi
5. Noam Unger. Enlightened Self-Interest and U.S. Foreign Assistance: Throwing Away our Toolbox does not Make us Safer. CSIS. February 26, 2025. Accessed May 28, 2025. https://www.csis.org/analysis/enlightened-self-interest-and-us-foreign-assistance-throwing-away-our-toolbox-does-not
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8. Oxfam. Africa to receive just 10% of doses needed to control mpox outbreak by end of year. Oxfam. December 27, 2024. Accessed May 28, 2025. https://www.oxfam.org.uk/media/press-releases/africa-to-receive-just-10-of-doses-needed-to-control-mpox-outbreak-by-end-of-year
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