Beyond diplomatic aspirations: Bridging the implementation gap in Pandemic Preparedness and AMR

2026-08-27

The upcoming High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response (PPPR) at the 81st UN General Assembly this September marks a critical juncture for reviewing global progress since the 2023 political declaration. The meeting also presents a timely opportunity to revisit the implications of the 2025 WHO Pandemic Agreement – specifically, how to actually operationalize the inclusion of AMR in the provisions for key areas such as prevention and surveillance, but also in relation to equitable access to medicines.

The pandemic agreement: A strategic blueprint for integration

In June 2025, the Seventy-eighth World Health Assembly marked a historic milestone with the formal adoption of the WHO Pandemic Agreement. This framework represents a paradigm shift towards bolstering global preparedness and preventing future health emergencies through a unified, multisectoral approach.

As ReAct has previously highlighted, this legally binding agreement offers a unique opportunity to address overlapping priorities between pandemic preparedness and response and the global response to antibiotic resistance. The final agreement recognizes the pandemic potential of AMR and embeds a One Health approach within global prevention frameworks.

While these are important elements embedded within a legally binding agreement, which carries far greater statutory weight than the voluntary Global Action Plan, the agreement’s scope pertaining to AMR remains rather restricted and primarily focuses on human health.

Ideally, a binding framework should encompass more detailed, robust and concrete mechanisms related to AMR, such as global and contextualised targets, an international structure for the management of equitable access to effective antibiotics and dedicated, enabling financing pathways.

This is why it has been suggested that AMR should be dealt with in a dedicated protocol to the Pandemic agreement which would allow more tailored legal obligations. Ultimately, for both PPPR and AMR, while an agreement provides a vision, implementation remains contingent on the development and availability of practical financing and accountability mechanisms.

Geopolitical roadblocks to equity

The momentum generated by the agreement’s adoption has been tempered by a global health funding crisis and a lack of consensus on the Pathogen Access and Benefit Sharing (PABS) mechanism of the agreement, which remains under negotiation. Similarly, the agreed ‘Coordinating Financial Mechanism’ is yet to be set up.

Geopolitical shifts, particularly the US withdrawal from the WHO and the dismantling of USAID, have challenged multilateralism with an “America First” bilateral approach. Millions of dollars in grants for disease surveillance were halted or cut from health programs. Development Assistance for Health (DAH) declined to 2009 levels in 2025, as major funders such as UK and Germany are refocusing on domestic priorities.

Efforts to establish the PABS system have stalled, prompting an extended deadline. European governments have been criticized for prioritizing pharmaceutical companies’ preference for voluntary measures, over mandatory systems for sharing technology and commodities, leaving the path to vaccine equity unclear. Negotiations must now conclude by May 2027 to allow the agreement to be formally signed and ratified by member states. This deadlock not only compromises future pandemic responses, but also delays vital synergies expected from integrating antibiotic resistance measures into the broader PPPR frameworks.

Recent months have offered a stark reminder of why these agreements matter. The contrast between a hantavirus outbreak aboard a luxury cruise ship, which triggered wide media reporting and specialist responses, and the far deadlier Ebola virus epidemic in the Democratic Republic of Congo, which went undetected for over a month and spread substantially faster than previous Ebola outbreaks, is telling. This disparity highlights how inequality in the global response to health threats continues to make the entire global population vulnerable.

Anchoring global health in prevention and resilience

The urgency of addressing the lag and weakness in the current system now sets the stage for the UN HLM on PPPR at the UN General Assembly in September. The meeting will convene under the theme: ‘Fostering a multilateral and intergenerational approach to prevent, prepare for, and respond to pandemics and public health emergencies, through the principles of equity and solidarity’.

Many global health stakeholders are urging that prevention serve as a central pillar of the 2026 political declaration. This should be accompanied by concrete actions to address the underinvestment in the first line of defence, made up of critical local communities, health workers and surveillance networks, particularly in LMICs. A similar emphasis on prevention and surveillance also likely represent the most effective strategy towards achieving the global target of reducing mortality related to antibiotic resistance by 10% by 2030. This would require a coordinated expansion of infection prevention and control (IPC), vaccination, alongside major strategic investments into improved antibiotic access and stewardship, and strengthening of health system components such as diagnostics, surveillance and primary healthcare.

In an earlier draft of the declaration shared by Health Policy Watch in July, action on antimicrobial resistance is recognised as important within pandemic prevention efforts, and antimicrobial stewardship is listed as one of the prevention measures that member states opt to strengthen.

However, for these and other measures to move from rhetoric to reality, the final text must establish stronger commitment, concrete timelines and dedicated financial resources to support these interventions.

As the summit approaches, the global community will need to transcend geopolitical friction and move towards making smarter and far more strategic investments in health infrastructure. Overall success will also depend on a solid resolution of the PABS negotiations, ensuring that equity and solidarity are translated from diplomatic aspirations into functional global responses.