March 27, 2026
Pandemic treaty negotiations ahead of the World Health Assembly in May show rising tensions, as countries push for equity in pathogen sharing, alongside the expansion of US bilateral health deals and the evolving role of the Global Fund within this shifting architecture. This issue also covers calls to declare recent US global health policy shifts a Public Health Emergency of International Concern, deepening instability at the US Centers for Disease Control and Prevention (CDC), and updates on US government bilateral agreements.
Pandemic Agreement Deadline Nears as Key Countries Put Equity at Center of Pathogen Sharing Negotiations
Negotiations on the Pandemic Agreement’s Pathogen Access and Benefit-Sharing (PABS) system entered a tense new phase. At the Intergovernmental Working Group (IWG) meeting, tasked with negotiating and drafting the annex, many African and low- and middle-income countries pushed back on a revised draft of the PABS, rejecting elements of the text they say weaken commitments to equitable access, particularly around guarantees that countries sharing pathogen samples will receive timely access to vaccines, diagnostics and treatments in return. The PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics.”
IMPLICATIONS: Key African governments, with the support of civil society, have successfully forced a recalibration of negotiations, putting equity and sovereignty at the center of the debate over how pathogen data is shared and who benefits. If the PABS annex is not agreed upon by Saturday, it may not be presented in time for the World Health Assembly to ratify it in May. The EU member representative noted, “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited.”
- Tense Start To Final Pandemic Agreement Talks As Africa Rejects New Draft Text –Health Policy Watch
- “We Mean Business”: Key African Countries Force Recalibration of the Negotiations on Pathogen Access Benefits Sharing System at the WHO—Geneva Health Files
- African CSOs call for equity as pathogen access talks hit final stretch—Devex
Experts Urge WHO to Declare US Policy Actions a Global Health Emergency
A group of global health and legal experts are calling on the World Health Organization (WHO) to declare recent US policy actions, including the massive cuts to global health funding, withdrawal from the WHO, attempts to alter the US pediatric vaccination schedule and disruptions to programs like PEPFAR, a Public Health Emergency of International Concern (PHEIC). These decisions constitute an “extraordinary event” under the International Health Regulations, they argue, which creates a high risk of cross-border disease spread even before outbreaks fully materialize. The authors warn that halted HIV, TB, malaria and vaccination programs could lead to millions of additional deaths by 2030, with early signs already visible in disrupted services and rising vulnerability across low- and middle-income countries.
IMPLICATIONS: It would be unprecedented for WHO to declare a PHEIC in response to political decisions and not specific pathogens. But even the consideration of it could catalyze urgent action to bring in more resources, enable tools like compulsory licensing to expand access to vaccines or other lifesaving medications and reinforce multilateral cooperation. Declaring a PHEIC could result in backlash from the US administration and further strain global institutions. Ultimately, this brings to light the shift underway: global health threats are driven by pathogens AND by policy choices. How existing systems adapt and those being reenvisioned respond to this new era of politically driven health emergencies will be telling.
Continued Instability at US CDC Raises Concerns for US and Global Health
New developments within the US’ CDC underscore even deeper instability. Wednesday night marked the deadline for the US President to nominate a new CDC Director, but uncertainty remains as the administration missed the deadline. At a CDC staff meeting on Wednesday, Acting Director Jay Bhattacharya, who also leads the National Institutes of Health (NIH), told employees he would continue leading the agency by serving “in the capacity” of director during the process to identify and confirm a new director. STAT reports that in the staff meeting, Bhattacharya struck a different position from other administration officials, stating: “I think it is vital that every kid in this country get the measles vaccine—absolutely vital,” while urging staff to “remove politics” and “focus on what we know how to do.”
At the same time, turmoil continues within the CDC’s Advisory Committee on Immunization Practices (ACIP) following the departure of controversial committee member Robert Malone. This comes following last week’s ruling from a federal judge who blocked Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s attempt to restructure the committee. RFK previously replaced all 17 members with a mix of anti-vaccine and anti-science representatives, including Malone. The ACIP remains unable to convene amid ongoing litigation. Adding to concerns, a recent New York Times investigation based on interviews with 43 current and former CDC employees describes staffing losses, political interference and a shift away from science-based decision-making, showing an agency under significant instability.
IMPLICATIONS: While Bhattacharya’s efforts to emphasize scientific norms this week may try to offer some reassurance, it’s clear week after week with the erosion of stability and independence, that there is intentionality to the dismantling of the CDC and its ability to effectively respond to current and future health threats. This will have ripple effects for global health governance and confidence in US scientific and health leadership.
- Inside the Turmoil at Robert F. Kennedy Jr.’s C.D.C.—New York Times
- CDC vaccine adviser Malone steps down to avoid ‘drama’—Roll Call
- ACIP conflict is test of Trump’s support for RFK Jr.’s vaccine policy overhaul—STAT
- Kennedy’s Vaccine Agenda Hits Roadblocks, Diminishing His Clout—New York Times
- RFK Jr. Is Losing His Grip on the CDC—The Atlantic
- Bhattacharya addresses CDC director role, works to bolster staff morale in first all-hands meeting—STAT
- A leadership vacuum adds to strains on the CDC—NPR
US Bilateral Health MoUs Expand as Global Fund Steps In
Senegal became the 26th country overall and 21st in Africa to sign an agreement with the US as part of the $12.6 billion effort under the America First Global Health Strategy, with agreements combining US funding and domestic co-investment to support HIV, malaria and health system strengthening. At the same time, attention is turning to the role of the Global Fund to Fight AIDS, Tuberculosis and Malaria within this new architecture. While not a formal party to the bilateral agreements, Devex reports that Global Fund experts have been involved in negotiations and implementation discussions, and its procurement platform is being considered as a mechanism to support broader commodity delivery and coordination.
IMPLICATIONS: The expansion and complexity of the US’ shift toward bilateral global health agreements is real. With reduced and restructured US funding, countries and advocates are increasingly looking to the Global Fund to help fill gaps, particularly for HIV services and key populations that may not be prioritized in bilateral agreements.
- What role will the Global Fund play in the US bilateral health deals—Devex
- U.S. aid returns to Africa as Senegal signs onto $12.6B health deal as 26th nation—Business Insider Africa
What’s New & Next in the HIV/AIDS Response
AVAC Executive Director Mitchell Warren joined Congressman Herb Conaway, Judith Feinberg, Greg Millett, and JD Davids at the SYNChronicity conference for a discussion on Opportunities, Controversies & Cruel Ironies.
What We’re Reading
- Is PEPFAR about to run out of money?—Devex
- Another round—The Forsaken Substack
- This lab that’s determined to discover new drugs isn’t where you might expect—NPR
- Four truths about covid that have become clouded over time—Washington Post
- Le grand invité Afrique – Santé en Afrique: «Nous voulons que nos pathogènes, nos maladies, puissent être d’abord traités par les Africains—RFI
- US aid deals with religious element risk ‘fanning flames of division’—The Independent
- UK lays out the development priorities of a shrinking aid budget—Devex
- Waste, Fauci and ‘Transgender’ Mice: How MAGA Is Warming to Animal Rights—New York Times
- NIH grant terminations affected women scientists more than men, study finds—STAT
- Stop pretending USAID’s takedown was about doing development better—Devex
- Here’s what we know about Trump’s expanded Mexico City Policy—Devex
- America is getting sicker, not healthier, under Trump and RFK Jr. | Opinion—Newsweek
- The AI push in health care is deepening medicine’s trust crisis—STAT
- Artificial intelligence for public health in Africa: moving beyond pilots to public value—The Lancet Regional Health Africa
- Why the expanded global gag rule is a deadly triple tripwire for recipients of US foreign aid—The BMJ