Bilateral Gambits and the Future of PABS

Invoking the “Speak now…” clause

At the end of a week in which most of the world sat down to the first text-based negotiations of the PABS Annex, the USA has rocked up as *that guest* at the wedding. Which would be salacious if it weren’t so incredibly serious.

Health Policy Watch today reports that Washington is tying the resumption of critical HIV, TB and malaria support to sweeping new obligations on pathogen and data sharing, via a draft PEPFAR Memorandum of Understanding (MOU) template circulated to African governments. Countries would commit to provide biological samples and genetic sequence data of “pathogens with epidemic or pandemic potential” within days of detection, backed up by a specimen-sharing agreement projected to run 25 years, while the associated health financing is confined to 2026–2030 (4 years max.) and tapers over time. All of this sits outside the WHO-led negotiations on a multilateral PABS system and without any parallel, binding guarantees of equitable access to resulting vaccines, diagnostics or treatments.

Taken at face value, the package reads less like routine conditionality and more like an effort to build a premium lane around Geneva. The PABS Annex, as we discussed in our first webinar, is premised on a single, politically fragile bargain: that higher-risk, higher-value pathogen information will be shared into a rules-based system that hardwires predictable benefits in return. The PEPFAR template, as described, inverts that sequence: it offers African states a unilateral fast-track back to essential programme funding, in exchange for long-term sovereign commitments on pathogen access, with benefits remaining discretionary, bilateral and revocable.

Disruption with a flourish: with unmistakeable intention to blow up the marriage contract, the United States appears to be approaching key guests at the reception with private side-letters. If enough sign, the centrepiece of the PABS design, a universal, predictable framework, risks being displaced by a mosaic of bespoke accords where leverage, not law, decides who gets first call on dangerous information and the tools to respond to it.

The immediate focus of these overtures is, unsurprisingly, and perhaps cynically, Africa. Many African states are facing fiscal shock after abrupt funding suspensions; many also host the surveillance labs, genomic capacity and clinical networks that any serious early-warning system depends on. The reported MOUs exploit that combination: they promise a reopening of the tap for life-saving services for priority infectious diseases while locking in privileged access to the very pathogen data now at issue in Geneva.

Africa is not simply being wooed; it is being instrumentalized. If a critical mass of African countries accepts such terms without clear safeguards, the signal to the rest of the world is stark: when the politics get rough, the path of least resistance is bilateral. That is intended to weaken the collective hand of the Africa Group in the PABS talks, invites other powers to field their own template deals, and accelerates the very race-to-the-top-of-the-queue behaviour the Annex, and indeed the entire Pandemic treaty was meant to discipline.

Even if African governments hold firm on PABS and treat any MOU with extreme caution, this episode exposes, in unusually sharp focus, what negotiation in a multipolar health order now entails. It is no longer “multilateral versus bilateral”, but an overlapping web of instruments in which major powers test how far they can stretch conditionality before it is called what it is: an attempt to shape the global rules of pathogen access through selective offers to those with the least room to refuse.

For companies working on vaccines, diagnostics and therapeutics and other countermeasures, this fragmentation is not an abstraction. Whether PABS emerges as a coherent, universal framework or is hollowed out by bilateral carve-outs will determine the level of legal certainty around access to samples, sequence data, benefit-sharing obligations and delivery expectations. A robust multilateral system offers clearer demand signals, more predictable allocation rules and a more stable environment for long-term R&D and manufacturing investment. A patchwork of MOUs, each with its own triggers and preferences, does the opposite: it clouds risk assessments, complicates supply chain planning and makes equitable access look negotiable again.

For negotiators, health agencies, companies and advocates, the due diligence questions are immediate: Do any proposed MOUs pre-empt, contradict or chill support for a strong, binding PABS system? Is there explicit language subordinating bilateral pathogen-sharing terms to future multilateral obligations, or is that left to hope? Are benefits, including access to countermeasures, defined, enforceable and proportionate to the duration and breadth of the sharing commitments?

If those safeguards are absent, what looks like an eternal promise today may be read tomorrow as the moment the integrity of PABS was traded away.

PABS November Webinar – Bilateral Shortcuts & the Integrity of the PABS System

Our second webinar will pick up directly from here: in addition to giving a readout of the progress of the multilateral negotiations, it will unpack the reported PEPFAR MOUs, mapping how they intersect with or undermine the draft PABS Annex. Our experts will share their views on concrete protections countries should insist on before signing away 25 years of pathogen access under bilateral pressure.

Tuesday 11th November
11am EAT / 9am CET

Signup now to secure your place