Pathogens without payback: when sharing isn’t caring

Why in the News?

Negotiations on the Pathogen Access and Benefit Sharing (PABS) framework under the recent WHO Pandemic Agreement (May 2025) are set to begin again. This highlights a long-standing global inequity: countries that share pathogen data, mainly low- and middle-income countries (LMICs), continue to receive minimal benefits from vaccines and treatments developed using that data.

What is PABS Framework?

1. The Pathogen Access and Benefit-Sharing (PABS) System, established under Article 12 of the WHO Pandemic Agreement adopted in May 2025, is a global framework designed to ensure that the sharing of dangerous pathogens is matched by the equitable sharing of the vaccines and treatments derived from them. 
2. While the core Agreement was adopted in 2025, the PABS Annex containing the specific operational rules is currently being finalized by an Intergovernmental Working Group (IGWG). The IGWG aims to conclude negotiations by May 2026 for presentation at the 79th World Health Assembly.

Core Pillars of the PABS Framework: 

The system operates on a “grand bargain” principle intended to rectify inequities seen during the COVID-19 pandemic: 

1. Rapid Access: Member States commit to quickly sharing biological materials (pathogens) and their Digital Sequence Information (DSI) with the World Health Organization (WHO) and designated laboratory networks.
2. Mandatory Benefit-Sharing: In exchange for this data, manufacturers using PABS materials must provide 20% of their real-time production of pandemic-related products (vaccines, diagnostics, etc.) to the WHO for global distribution.
   1. 10% as free donations.
   2. 10% at affordable, not-for-profit prices.

Why do pathogen-sharing countries fail to receive proportional benefits?

1. Structural Inequity: Low- and Middle-Income Countries (LMICs) share pathogen samples via WHO but lack binding guarantees for access to vaccines or diagnostics.
2. Innovation Asymmetry: Developed countries control pharmaceutical R&D, enabling them to monopolize end products.
3. Voluntary Framework Failure: Existing systems rely on goodwill rather than enforceable obligations.
4. Example: During COVID-19, LMICs contributed samples but faced vaccine hoarding by high-income countries.

How did COVID-19 expose failures in global health equity?

1. Vaccine Apartheid: High-income countries hoarded vaccines; LMICs experienced prolonged shortages.
2. Data Evidence: Africa received only 3-14% of global vaccine supply.
3. COVAX Limitations: Delivered ~1/5th of WHO’s 2 billion dose target by mid-2021.
4. Economic Impact: Delayed vaccination caused 1.3 million preventable deaths and $28 trillion global economic loss (IMF).
5. Drug Inequality: Ebola drug Inmazeb cost ~$6,000 per treatment, unaffordable for poorer nations.

What does the PABS framework aim to change structurally?

1. Legal Linkage: Connects sample-sharing with mandatory benefit-sharing obligations.
2. Access Mandate: Requires pharmaceutical companies to provide 20% of real-time production during pandemics.
3. Pricing Mechanism: Ensures at least half of allocated doses are free and the rest at reasonable prices.
4. Capacity Building: Includes provisions for technology transfer and licensing to expand production in LMICs.

Why is there resistance from developed countries and industry?

1. Innovation Concerns: Binding mandates may reduce incentives for private pharmaceutical investment.
2. IP Protection: Firms resist compulsory sharing of intellectual property and technology.
3. Bureaucratic Burden: Concerns that compliance mechanisms may delay research and innovation.
4. Example: EU favors voluntary systems like Global Initiative on Sharing All Influenza Data (GISAID) over binding legal frameworks.

What are the limitations of existing global mechanisms?

1. Non-binding Agreements: Current frameworks lack enforcement provisions.
   1. Enforcement Void: Current WHO systems (like the PIP Framework) are limited in scope (mostly influenza) and lack the “teeth” to penalise a company that refuses to share its patents during a crisis.
2. Fragmented Governance: Multiple overlapping systems reduce accountability.
3. Technological Gaps: LMICs lack manufacturing capacity despite access to data.
4. Example: WHO’s existing system ensures access to data but not equitable outcomes.
5. The GISAID Paradox: While GISAID is excellent for surveillance, it provides zero guarantees for equity. A country can upload thousands of sequences to help track a variant but still be the last to receive the vaccine developed from that very data.

Is there a viable middle path between equity and innovation?

1. Tiered Obligations: Lower commitments during normal times, stronger during pandemics.
2. Global Fund Mechanism: Supports LMIC manufacturing without overburdening companies.
3. Incentive-based Sharing: Rewards companies that share IP rather than coercing compliance.
4. Balanced Governance: Combines legal enforceability with flexibility in implementation timelines.

What are the broader implications for global health security?

1. Future Pandemic Preparedness: Ensures faster and equitable response mechanisms.
2. Trust Deficit Reduction: Addresses Global South concerns about exploitation.
3. Geopolitical Stability: Prevents vaccine nationalism and supply chain disruptions.
4. Emerging Risks: Addresses threats like mpox, engineered pathogens, and AI-driven bio-risks.

Conclusion

The PABS debate reflects a deeper structural imbalance in global health governance where risks are shared but rewards are concentrated. Without enforceable equity mechanisms, future pandemics risk repeating COVID-19’s failures. A balanced framework combining legal mandates, incentives, and capacity-building is essential to ensure that global cooperation translates into equitable outcomes.

PYQ Relevance

[UPSC 2020] Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.

Linkage: The PYQ covers GS-II (International Institutions, Global Health Governance) by evaluating the effectiveness and limitations of WHO in managing pandemic response. It links to current issues like WHO Pandemic Agreement and PABS, highlighting the need for stronger enforcement, equity, and coordination in global health security.