In the wake of the COVID-19 pandemic and amidst rising biosecurity threats, the international community has taken significant steps to strengthen pandemic preparedness and response. Two major developments now define the next era of global health governance: the 2024 amendments to the International Health Regulations (IHR) and the 2025 WHO Pandemic Agreement. Both instruments were crafted through multi-year negotiations under the World Health Organization (WHO) and aim to correct systemic failures revealed by the pandemic while embedding equity, transparency, and legal authority into global health responses.
A recent editorial published in Medical Science Monitor provides an overview of how these reforms aim to reshape the global health architecture. These instruments are not intended to serve as reactive measures, but as foundational tools to proactively coordinate cross-border responses, ensure equitable access to health technologies, and foster resilience in health systems worldwide.
Key Reforms to the International Health Regulations (2024)
The International Health Regulations—originally adopted in 1951 and most recently revised in 2005—underwent significant amendments in June 2024 after nearly two decades of implementation. The 2024 revisions reflect lessons from the COVID-19 pandemic, emphasizing:
- Equity in Emergency Response: Revised Article 13 mandates that the WHO facilitate access to health products—such as vaccines and therapeutics—during declared Public Health Emergencies of International Concern (PHEICs).
- Pandemic Emergency Declaration Authority: Changes to Articles 1 and 12 clarify that the WHO Director-General can now declare both PHEICs and pandemic emergencies for communicable diseases.
- Sustainable Financing and Governance: Article 44 establishes a coordinating financial mechanism to support developing countries, while Article 54 forms a new advisory subcommittee to enhance multilevel implementation.
- Shift from Technical to Political Framework: While still a technical tool, the IHR now includes mechanisms that make it more explicitly political and legally binding, aligning national actions with international expectations for equity and solidarity.
These changes are set to take effect in September 2025, and they mark a shift toward a more enforceable and ethically grounded model of global health cooperation.
The 2025 WHO Pandemic Agreement: A Treaty for Equity and Resilience
Adopted by 124 countries during the 78th World Health Assembly in May 2025, the WHO Pandemic Agreement is the second major legally binding treaty negotiated under Article 19 of the WHO Constitution (following the 2003 Framework Convention on Tobacco Control). The agreement was born out of three years of negotiations aimed at addressing structural inequities and governance failures in the global COVID-19 response.
Key components include:
- Equitable Access to Health Tools: The agreement mandates timely and fair distribution of diagnostics, vaccines, and therapeutics, particularly for low- and middle-income countries.
- Global Supply Chain and Logistics Network (GSCL): A newly envisioned system to coordinate rapid, affordable access to health products during emergencies.
- Support for Research and Development (R&D): Article 9 emphasizes the importance of sustained investment in R&D infrastructure, clinical trials, and data-sharing networks.
- Pathogen Access and Benefit Sharing (PABS): Though still under development, the PABS system aims to ensure fair sharing of pathogen samples and genetic data alongside benefits like vaccine access and IP-sharing arrangements.
Critically, the Pandemic Agreement lays a foundation for operationalizing equity not just in principle, but through concrete legal and financial mechanisms.
Implications for National and Global Health Security
For the general public, these legal frameworks are more than bureaucratic exercises. They directly influence how quickly a country can access vaccines during an outbreak, how fast a novel pathogen is detected and reported, and how well local health systems can respond without being overwhelmed.
From a national interest perspective, these frameworks help stabilize geopolitical relationships, protect economies from pandemic shocks, and ensure that national responses are informed by global data and best practices. For the U.S. and other high-income nations, investment in these multilateral systems reduces long-term risk, protects supply chains, and enhances soft power through global health leadership.
The growing risks of airborne zoonotic transmission—such as the recent detection of transmissible H5N1 avian influenza from a Michigan dairy farm worker—underscore the urgent relevance of these frameworks. With measles resurging in unvaccinated populations and global health funding under pressure, a globally coordinated response mechanism is no longer optional—it is essential.
Looking Ahead: Implementation Challenges and Opportunities
While the adoption of these instruments is historic, their success will depend on implementation. Critical questions remain:
- How will equity commitments be operationalized in real-time emergencies?
- Can Member States agree on key details of the PABS system, such as intellectual property rights, indigenous data access, and fair benefit-sharing?
- Will there be sufficient political and financial will to support global R&D infrastructure, especially as donor fatigue and domestic pressures grow?
Continued negotiation is planned through 2026 to finalize the PABS annex and further refine implementation tools. The next year will be pivotal in determining whether these agreements can fulfill their promise.
The 2024 amendments to the IHR and the 2025 WHO Pandemic Agreement together represent a major evolution in how the world prepares for and responds to pandemics. Their success will depend on robust governance, sustainable financing, and unwavering commitment to equity. For the global health community—including government agencies, NGOs, academic institutions, and private-sector partners—these instruments provide both a roadmap and a mandate to build a safer, more resilient world.
Parums, D.V. (2025). Editorial: The 2025 WHO Pandemic Agreement and the 2024 Amendments to the International Health Regulations Combine for Pandemic Preparedness and Response. Medical Science Monitor, 1 July 2025.