The recent finalisation of negotiations for the World Health Organization (WHO) Pandemic Agreement and its adoption at the 78th World Health Assembly heralds a new era for global health governance and security. Notably, this agreement is only the second binding international health instrument negotiated under WHO auspices via an Intergovernmental Negotiating Body (INB), following the Framework Convention on Tobacco Control (FCTC). 

For the WHO South-East Asia Region (SEAR), a region characterised by its dynamic and dense population, rich biodiversity and significant health vulnerabilities, the Pandemic Agreement carries profound implications. It presents an urgent call to action and a framework for collective preparedness against future pandemic threats.  

The COVID-19 pandemic disproportionately exposed the vulnerabilities of many SEAR countries, from strained health systems to the stark inequities in accessing vaccines and essential medical supplies (medical countermeasures). The Pandemic Agreement, born out of these lessons and a product of intense multilateral negotiations lasting more than three years, attempts to redress these gaps. Several of its provisions are particularly salient for the SEAR.   

At the forefront are the interconnected issues of Pathogen Access and Benefit Sharing (PABS) and technology transfer. The SEAR is a frequent incubator of novel infectious diseases. Commencing with Indonesia’s demand for greater equity arising from the world’s influenza surveillance system, the SEAR countries have contributed significantly to equitable approaches to pairing access to pathogens and data with derived benefits. The PABS system, though its operational Annexe is still under negotiation (due by May 2026), aims to ensure that such contributions are met with equitable access to the benefits of research and development, including vaccines and therapeutics. 

The proposed commitment for manufacturers to allocate 20% of pandemic products (10% donated, 10% at affordable prices) to the WHO for equitable distribution is just a starting point. 

For SEAR countries, some of which – like India, Indonesia (while noting its recent departure from WHO SEAR office but historical manufacturing role in the broader region) and Thailand – possess significant pharmaceutical manufacturing capabilities, the provisions on promoting technology transfer "as mutually agreed" offer both an opportunity and a challenge. While not mandating compulsory licensing as some had hoped, it opens doors for proactive partnerships and regional collaborations to diversify production ‘hubs’, reducing reliance on a few global suppliers. 

SEAR countries must strategically engage to translate these provisions into tangible access both between and during health emergencies. With countries like Singapore, Malaysia and Thailand emerging as biotech hubs in the broader Southeast Asia geographical area, and India and Bangladesh as expected beneficiaries – ‘spokes’ – of the WHO South Africa mRNA Tech Transfer Hub, clearer and harmonised regulatory regimes for technology transfer can accelerate the adoption of mRNA platforms and strengthen local supply chains.

The agreement’s strong emphasis on the "One Health" approach is profoundly relevant for SEAR. The region is a recognised hotspot for zoonotic disease emergence, driven by factors such as climate change, deforestation, wildlife trade and agricultural intensification. The agreement’s call for integrated surveillance systems encompassing human health, animal health, environmental, and for measures to prevent zoonotic spillovers, provides an additional, collaborative framework under which SEAR countries may strengthen their national action plans. 

This will necessitate enhanced cross-sectoral collaboration, investment in veterinary public health and improved environmental stewardship. Interconnected surveillance is the bedrock of early warning and rapid response during a health emergency.   

Additionally, the agreement underscores the critical need to strengthen health systems and invest in the health workforce. Many SEAR countries grapple with under-resourced primary healthcare, brain drain, workforce shortages and the need for resilient health infrastructure capable of surging during emergencies.

The agreement’s provisions for capacity building, developing national pandemic preparedness and response plans and investing in a skilled, protected health workforce deeply resonate with regional priorities.

Translating into regional contexts

The Pandemic Agreement is, however, not self-executing. Its true value will be unlocked through concerted national and regional efforts. Firstly, regional collaboration must be significantly enhanced. SEAR countries can potentially leverage existing platforms like SAARC and ASEAN to harmonise regulatory regimes and preparedness strategies, although the past effectiveness of these blocks in orchestrating unified regional health responses has faced limitations. 

The agreement should perhaps serve as a blueprint for these platforms to strengthen their health security mandates and cooperation mechanisms, backed by renewed political will from member states. Countries in the region can also explore pooling resources for research and manufacturing, establishing regional stockpiles of essential supplies, a regional PABS consortium to pool bargaining power, a regional technology transfer hub to facilitate South-South (or even South-North) partnerships, and share ‘effective practices’.

The current political landscape within SEAR, however, presents unique challenges to the Pandemic Agreement’s implementation. The humanitarian complexities in Myanmar, the unique position of DPRK (Democratic People's Republic of Korea, also known as North Korea), Indonesia’s recent departure from the SEAR office, and evolving intergovernmental relationships within the regional WHO structure will require careful navigation and context-specific strategies for fostering compliance in the region. 

Secondly, effective national implementation will require strong political will as well as community engagement. This includes translating the agreement’s provisions into national laws, allocating dedicated budgets for pandemic preparedness, and building sustainable capacities in surveillance, laboratory diagnostics, research and public health emergency response. Public health literacy and community engagement, as highlighted in the agreement, are essential foundations for public trust and adherence to public health measures during emergencies. 

Finally, the region must leverage its unique strengths. These include its pharmaceutical manufacturing prowess, experience managing large-scale infectious disease outbreaks and the potential to integrate traditional and complementary medicine systems into broader health resilience strategies.

Next steps

An Intergovernmental Working Group (IGWG) has commenced negotiations for a PABS Annexe, ambitiously expected to conclude by May 2026. The agreement will not be open for ratification until this Annexe is adopted by the WHO member states. Subsequent ratification by 60 member states will bring the agreement into force.

The Conference of Parties (COP) will play a key role in overseeing implementation, operationalisation and financing of the agreement. Learning from the enforcement gaps observed under the International Health Regulations (IHR, 2005), the COP will need to develop and support effective mechanisms that promote transparency, accountability and compliance among member states. Regional collaborations in COP deliberations can help amplify regional priorities. 

The agreement’s efficacy will be tested against the legacy of the IHR (2005), whose implementation during the COVID-19 pandemic revealed persistent challenges. Understanding the root causes of its compliance issues – ranging from national capacity constraints to political prioritisation and a lack of compelling enforcement – is crucial for anticipating and mitigating similar obstacles that the new Pandemic Agreement might face.

The WHO Pandemic Agreement is an opportunity to transform the hard lessons of past pandemics into a future of greater health security. This will demand unwavering commitment, strategic investment, and, above all, enhanced solidarity within both the region and the global community. 

Kashish Aneja is a visiting scholar, Harvard Law School; Consultant and Lead - Asia, O’Neill Institute for National and Global Health Law, Georgetown University.

Lawrence Gostin is a distinguished professor and Director, WHO Collaborating Centre for National and Global Health Law, O’Neill Institute and member of the WHO IHR Review Committee.

Sam Halabi is the director, Centre for Transformational Health Law, O’Neill Institute for National and Global Health Law, Georgetown University. 

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