Our global health architecture needs urgent reform: the Pandemic Agreement could be the catalyst
There are few public goods more vital than an effective plan for pandemic response. The Pandemic Agreement could pay dividends for future generations, but must draw on the strengths, experience and comparative advantages of the current global health ecosystem.
- 11 March 2026
- 4 min read
- by Sania Nishtar
In the myriad discussions around the future of our global health architecture, the one area that unites all parties, interests and stakeholders is the need to transition to an ecosystem that is not beset by duplication, fragmentation, mission creep or competition among agencies.
This principle of “Focused Mandates” is a key tenet of the Gavi Leap, Gavi’s own process of organisational transformation, which I have argued could also serve as a blueprint for broader reform of global health. It is also a principle that should be at the heart of an effective Pandemic Agreement.
There are few public goods more vital than an effective plan for pandemic response. And it is exactly for this reason that when the Pandemic Agreement was adopted by WHO Member States, it was rightly applauded as a major step towards a more equitable, more comprehensive and coherent global system for preventing, preparing and responding to pandemic risks.
My concern is that, as negotiations on the Pathogen Access and Benefit Sharing (PABS) system of the Pandemic Agreement move towards their conclusion, the direction of travel on key operational aspects of PABS may appear to be at odds with the principle of clear and focused mandates, and may run counter to the spirit of collaboration, coherence and complementarity that must be at the heart of the Pandemic Agreement’s implementation.
Necessarily, an effective Pandemic Agreement needs to draw on the comparative advantages of many different stakeholders, including key implementing partners.
Many of these partners, such as Gavi, CEPI and UNICEF, are already stewards of tried and tested operational capabilities and financial instruments that could and should be fully integrated as foundational elements of both a Coordinating Financial Mechanism (CFM) and a Global Supply Chain and Logistics Network (GSCL) for pandemic prevention, preparedness and response.
Many of these capabilities and instruments have been built in collaboration with countries and donors, and have been designed based on the lessons learned during and after the COVID-19 pandemic.
A case in point is Gavi’s establishment and inauguration of the First Response Fund in 2024, which ensured that mpox vaccines were procured at scale within days of an mpox vaccine receiving WHO prequalification.
Discussions are ongoing with multiple partners to build on the liquidity arrangements that backstop the First Response Fund to create a truly “pandemic-scale” financing facility, with a potential role for multilateral development banks.
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The First Response Fund was a capability Gavi developed to fill an essential niche in the emergency response ecosystem. Through the Gavi Leap, we are continuing to strengthen Gavi’s capacities predicated on the assumption that we will, in the future, operate as part of a holistic ecosystem in which agencies play to their comparative advantages: precisely the spirit of the Focused Mandates pillar of the Gavi Leap.
Focusing on fostering greater coordination and complementarity not only makes sense in today’s resource-constrained environment, it will also help to ensure the speed, predictability, and flexibility required to respond effectively to a pandemic threat.
Building on existing governance bodies also reduces execution risk alongside fragmentation, cuts down on delays, and consequently increases coherence and effectiveness.
At a minimum, negotiations on the operational aspects of the Pandemic Agreement should conclude having established clarity over mandates, and a pragmatic and flexible response structure anchored to clear mechanisms and sequencing for the mobilisation of funds from various sources.
Gavi supported the creation of a Coordinating Financial Mechanism (CFM) during the initial Pandemic Agreement negotiations, but it is crucial that any CFM is designed to reinforce and enhance proven financial instruments, rather than create parallel structures or crowd out existing mechanisms.
We cannot wait until an emergency is declared to put these elements into place. That is the point at which a plan should be pressed into action, not the point at which we start to plan. In a crisis, time is always the scarcest of commodities. Duplication and fragmentation among partners in the response can only ever mean delay.
The investment of time and energy of countries in the Pandemic Agreement negotiations has shown there is still a huge appetite for multilateral cooperation. On this measure alone the Pandemic Agreement is already a success.
Investing the time now to get the finer details of the Agreement right will be an investment that will pay dividends for future generations.
