Debt-relief to Safeguard health & Reflections on the Pandemic Accord
The Polycrisis just got bigger
Dear Friend of Global Health Conversations,
It has been an eventful week in this changing world we live in. But for tonight, I will try to confine my commentary this evening to the world of global health. Nevertheless, the interesting thing about this field; whether approached as a science or a humanity, is the Interconnectedness of Everything.
I had an interesting conversation this week with an industry colleague involved in the Pandemic Accord negotiations. You’ll recall that the Pathogen Access and Benefit Sharing (PABS) Annex still needs to be negotiated and finalised. And as the WHO senior legal advisor pointed out this week at the Next Steps for the Pandemic Agreement meeting and panel discussion - which I also attended in Geneva - there are only about 300 days left to finalise discussions on the Agreement’s most contentious issue, ahead of the next Assembly. Health Policy Watch broke down this event and the key takeaways here.
This comes at a time when global health itself feels pulled in many directions: efforts to build stronger regional manufacturing infrastructure and workforce, reimagining of equity mechanisms and tackling structural imbalances. And all of the developments in Global health that we will discuss this evening unfold against a global backdrop of deepening instability.
The spectre of escalation in the Middle East - including the potential closure of the Strait of Hormuz - threatens to drive up global oil and commodity prices, which could compound economic pressures already straining health budgets worldwide. In parallel, prolonged conflict, death and destruction in Sudan and the Democratic Republic of Congo, coupled with growing levels of starvation and low access to medicines in Gaza, has created what my Dad referred to this afternoon as a “disease cauldron” - where health systems are decimated and the conditions for infectious disease outbreaks are ripe. With global health financing in retreat, and no functional fail-safe mechanisms in place, the scaffolding for coordinated pandemic response is fraying just as the risk environment intensifies. If a new outbreak were to occur now, the world might well be walking into the fire with fewer tools and potentially even weaker systems than we had in 2020.
While the timeline for negotiating the PABS annex is relatively tight, the stakes remain high. These issues go beyond logistics and touch nearly every corner of global health governance: trust, fairness, and power. Midweek, I found myself wondering: in a world of rising precarity, is a legally binding agreement still enough? But then I remembered why we need the Accord even more, especially now. In codifying the encouragement of national research financing (Article 9), embedding a one-health approach and pushing for more open genomic data sharing, it’s not a silver bullet - but the necessary and invaluable scaffolding that we need at a time when research funding has waned significantly and surveillance systems in the most pertinent regions try to keep up amidst funding constraints.
As TIME put it, the Accord is not a blueprint, but a “starting point” — a fragile architecture on which the hard work of implementation must now be built.
Every time I sit down to write about this, I feel certain I’ve covered PABS before in a podcast of newsletter - only to realise that while I’ve dug deep once or twice, it has always been part of broader discussions on the pandemic accord generally. So, here’s a short explainer: the PABS annex will determine how pathogen samples and genetic sequences are shared globally - and crucially, how benefits (i.e products) like diagnostics, vaccines, and therapeutics are equitably distributed and credited in return. You can find my previous commentary on the Pandemic Accord here, here, here or here.
Earlier this week, at a different panel on ‘International Geneva’ and the humanitarian sector, we were reminded of what happened to the League of Nations (predecessor to the United Nations) 20 years after the U.S. withdrew. We were also reminded that safeguarding Geneva jobs in that sector cannot be the focus while frontline responders are losing theirs in staggering numbers. A new report by the Vatican’s Jubilee Commission warns that without global debt reform, many low- and middle-income countries face a decade of lost progress. When countries are spending more on debt repayments than on public health or education, the foundation of global health equity itself is under threat.
Meanwhile, AI continues to reshape the global knowledge economy - and the job market. OpenAI’s Sam Altman recently said AI could match PhD-level expertise in many domains, and Anthropic’s CEO has raised the alarm that 50% of entry-level jobs could soon be displaced. These developments are both energising and unnerving - especially in areas where contextual understanding, equity and humility can’t be automated.
At the G20 Health Working Group in Johannesburg, WHO announced Phase 2.0 of its mRNA Technology Transfer Programme (2026–2030), focused on scaling commercial-grade production. Manufacturers in Argentina, Brazil, Indonesia and South Africa are already developing their investment cases. A WHO and South Africa co-hosted side event also spotlighted novel TB vaccines and the need for sustainable access mechanisms.
This week, while trying to enjoy the smouldering heat, I finally read Year of the Rat by Harry Shukman. A fascinating, chilling read about the far-right in the UK, with Chapter 8 (IQ and embryo screening) particularly worth your time. I also began The New Age of Sexism by Laura Bates - author of Men Who Hate Women - and I must say, her latest is even more sobering and dystopian. Both reads made me reflect on how the fictional and the real increasingly blur in our daily lives.
On a serious note, at this point we need to hold onto what we believe in. There will always be compromises, but the safety of populations, especially marginalised populations, their dignity, their outcomes and the imperative for progress - broadening access in the North and the South - even at a time when the tide feels high, still rests in our hands and those of our colleagues. We are not safeguarding health alone; we are ensuring humanity.
Thank you, as always, for reading. If you have thoughts on the new format - longer letters with shorter FiRs entries - I’d love to hear from you.
Have a lovely fortnight, Friend.
Christiana
1. G20 Health Working Group: From Rhetoric to Roadmaps
The fourth G20 Health Working Group (HWG) meeting was held this fortnight in Johannesburg, with South Africa anchoring the discussions in its declared priorities of solidarity, equality, and sustainability. Taking place just weeks after the adoption of the WHO Pandemic Agreement, the session served as a litmus test for how global rhetoric on equity is beginning to translate into concrete action.
One major outcome was the formal launch of Phase 2.0 of the WHO-led mRNA Technology Transfer Programme, covering 2026–2030. While the initiative initially focused on enabling low- and middle-income countries to access mRNA technology in the post-COVID landscape, this new phase pivots towards GMP grade commercial-scale production which I think is an excellent move for sustainability, potential profitability and readiness. According to a WHO press release, regional hubs in Argentina (Sinergium Biotech), Brazil (Bio-Manguinhos/Fiocruz), Indonesia (Bio Farma) and South Africa have started developing detailed investment cases, including market modelling, regulatory timelines, and cost-of-goods-sold estimates.
WHO emphasised that the long-term sustainability of the programme will depend on national and regional procurement commitments, pooled purchasing mechanisms, and better-aligned cross-border regulatory systems.
Also on the sidelines in Joburg, WHO and the South African Department of Health co-hosted a side event on novel tuberculosis (TB) vaccines, bringing together governments, researchers, and international partners. The event focused on the chronic underfunding of TB vaccine development, urging new financing models and market-shaping strategies to advance late-stage candidates and ensure future access once licensed.
Antimicrobial resistance (AMR) was another key issue on the plenary agenda. Delegates endorsed continued work on developing regional surveillance systems, stewardship frameworks, and scaling technical support, particularly across African and South Asian health systems. WHO will soon provide regional implementation guidelines and follow-up tools. Financing remained a through-line across multiple sessions. The Chair reiterated the importance of moving beyond traditional aid paradigms to more resilient co-investment models and public-private partnerships.
In opening remarks, South Africa’s Minister of Health, Dr Aaron Motsoaledi, urged G20 members to “match the ambition of the Pandemic Agreement with real investments in distributed production and equitable access frameworks.” Deputy Minister Dr Joe Phaahla stressed that declarations alone are insufficient, and called for a results-oriented G20 health architecture based on practical reform metrics.
The HWG closed with a collective commitment to develop a roadmap that will translate these ambitions into concrete operational tools. These include pooled procurement, regional regulatory collaboration, and long-term systems funding for LMICs. The Johannesburg meeting was one of the clearest recent signals that pandemic preparedness and equitable access are moving from policy principles into programmatic frameworks - whether this momentum holds will depend on funding, coordination, and accountability in the months ahead.
(Sources: WHO; SDG Knowledge Hub)
2. Global Debt Crisis Threatens Health and Development: Developing countries need more debt relief to fund health & education
A new Vatican-commissioned report, led by Columbia University economist Jeffrey Sachs and published by the Pontifical Academy of Social Sciences, warns that without urgent reforms to the international financial system, heavily indebted low- and middle-income countries could face a decade of stalled progress across health, education, and sustainable development.
The analysis finds that around 60% of LMICs are either in or at high risk of debt distress, with many spending more on debt servicing than on health or education combined—often to private creditors unwilling to restructure. In Sub-Saharan Africa, this financing squeeze is already undermining health system resilience and pandemic preparedness.
Key recommendations included establishing an independent international debt workout mechanism with automatic crisis standstills, expanding debt-for-climate and debt-for-health swaps, and encouraging more flexible lending frameworks from institutions like the IMF and World Bank. Without bold financial reform, the report argues, countries will remain trapped in a cycle of debt repayments at the expense of investments in universal health coverage, primary care, and climate adaptation—threatening long-term health equity and global health security
3. What’s Next on Pandemic Accord Negotiations
While the adoption of the WHO Pandemic Agreement during the 78th World Health Assembly was widely welcomed as a historic milestone, the hardest part may still lie ahead. With the main text adopted, attention now turns to the remaining - and highly contentious - Pathogen Access and Benefit Sharing system (PABS), which has been left to a separate negotiation track. Countries have roughly 300 days to agree on the annex’s terms before the next WHA session in May 2026.
The PABS annex is critical because it governs how pathogen samples and genomic sequence data are shared globally during outbreaks—and crucially, how the resulting benefits (like vaccines, therapeutics, and diagnostics) are distributed fairly in return as well as financial contributions and benefits arising from data provided. As it stands, the lack of a finalised PABS mechanism creates a serious gap in the new legal framework. Without it, critics argue that the principle of equity at the heart of the agreement risks being undermined.
Negotiators are grappling with longstanding divides. On one hand, low- and middle-income countries have long argued that the current system - where high-income countries and private manufacturers gain rapid access to pathogen samples without formalised benefit-sharing obligations - repeats colonial patterns of scientific extraction. Most of the Equity group, the Africa group and LMICs in general have called for a legally binding mechanism that guarantees timely and affordable access to resulting medical countermeasures. Article 12 ended up streamlined with PABS moved to an annex to be negotiated later based on the difficulty of reaching full agreement on the text in this area before the last deadline.
On the other hand, most of the higher-income countries and industry stakeholders have expressed concerns that overly rigid terms could deter cooperation. Trust, transparency, and enforcement mechanisms remain thorny issues.
A recent panel discussion in Geneva hosted by WHO and partners: Next Steps for the Pandemic Agreement highlighted both the urgency and complexity of the road ahead. WHO's senior legal adviser, Steve Solomon, noted that the timeline is tight (citing this to the week and day - and that much of the legal and technical work remains incomplete.
If this proves anything, it is that multilateralism is still, for the most part, alive and well - at least in this regard. For now, the PABS annex remains the litmus test for whether this agreement can truly shift the centre of gravity in global health governance. The upcoming months will be a test of political will, institutional resilience, and whether multilateralism - under strain from funding shortfalls, geopolitical tension, and eroding trust - can still deliver equitable solutions in times of crisis.
(Sources: Health Policy Watch)
4. Missed headline: WHO Tracks New COVID Variant NB.1.8.1
Late last month, the WHO’s Technical Advisory Group on Virus Evolution (TAG-VE) designated a new COVID-19 subvariant, NB.1.8.1, as a Variant Under Monitoring (VUM) due to its rapid rise in multiple regions—accounting for around 10.7% of sequenced cases globally as of late April. While early lab analyses suggest only marginal increases in immune evasion and no increased severity, the variant highlights the continuing need for vigilant surveillance and targeted vaccine strategies. NB.1.8.1 is not added to the WHO’s official R&D Blueprint of priority pathogens, which focuses on agents with high epidemic potential due to limited countermeasures. Instead, it remains under cautious watch as part of the evolving response to SARS-CoV-2’s shifting landscape.
Behind the scenes:
At the end of this busy, exciting and eventful week, I ran too short on time this evening to make a Behind the Scenes collage. So instead, I’ll share these past podcast episodes that you might have missed! :) Have a lovely fortnight ahead.