From Monday to Saturday next week, delegates will convene in Geneva, Switzerland, for the World Health Assembly (WHA), one year after member states reached a landmark Pandemic Agreement. However, the agreement remains stalled on its most difficult component: the Pathogen Access and Benefit Sharing (PABS) annex, where a clear agreement has yet to be reached.
This is not a technical add-on. PABS is the agreement’s political core, where rapid sharing of pathogen samples and associated data is meant to be matched by credible benefit sharing — vaccines, diagnostics, therapeutics, and other countermeasures. With negotiations over PABS likely to extend into another year, the impasse says less about diplomatic quibbles over verbs than about a deeper structural problem: In a world of scarce trust, high stakes and unequal bargaining power, solidarity is easy to praise and hard to operationalize.
What the WHA is really negotiating is not simply a pathogen-sharing mechanism, but the credibility of a global health system — at a moment of strategic rivalry and unequal leverage.
Put plainly, the contest over PABS is the contest over the world we now live in — more polarized, more transactional and increasingly driven by countries’ capacity for self-reliance. One sign is how global health strategy is increasingly framed through security — through supply chains, stockpiles and strategic autonomy: solidarity, in other words, often alongside a national backup plan.
All of this lands on an institution already under permanent cross-examination. The WHO is an aging organization and the question of whether it remains fit for purpose never really goes away. Yet it is expected to keep pace with 21st-century mandates — pandemic bargaining over PABS, governance of artificial intelligence (AI) in health and intensifying geopolitical rivalry — without the very things that would make delivery possible: predictable financing, real authority and political unity when it matters most.
Recent hantavirus outbreaks are a reminder that the International Health Regulations (IHR) can work when countries share information rapidly and transparently, and when cooperation is sustained. However, outbreak governance is only as strong as the cooperation network that carries it. The WHO’s ability to deliver on that promise is weakened when capable public health jurisdictions are kept outside its formal channels, including Taiwan. Pathogens do not read agendas, check badges or bargain for a seat at the table. Cooperation should not either.
And even as attention fixates on PABS, two other developments at the WHA deserve scrutiny, each revealing how power politics are reshaping health cooperation.
The first is China’s move to take a seat on the Executive Board. Membership rotates, but the stakes are anything but routine. The board screens director-general candidates and narrows the field before the WHA makes the final decision. With China poised to join the board, procedural influence becomes strategic influence. The selection process is already underway, with the next appointment due next year. In a fragmented world, the power to shape agendas, alliances and nominations can matter as much as the power to fund programs. This is not inherently illegitimate — China is a major actor in global health — but it highlights, particularly amid US retrenchment from multilateral health leadership, what the WHA has become: It is not simply a venue for technical coordination, but a political arena where the WHO’s institutional direction is contested.
The second is the renewal of the WHO’s Global Strategy on Digital Health, with member states pressing to place AI explicitly on the agenda. Yes, the strategy is “soft law,” but in global health, soft law is often where hard consequences begin: It sets expectations, shapes donor priorities, legitimizes certain technical pathways and quietly disciplines what counts as “modern” policy. National digital health road maps — especially in resource-constrained settings — tend to follow the paths the WHO and its partners pave.
This is why global health law and diplomacy matter.
When an outbreak spreads, law determines who must notify whom, what gets shared and who gets access — quickly or too late. The WHA is not only where agreements are celebrated or annexes are negotiated. It is where the global health order is reshaped — and by extension, health outcomes — sometimes by headline, sometimes by footnote. Legal expertise in global health is scarce, and that gap costs time, clarity and access.
Navigating this shifting landscape takes more than technical competence. It would require the capacity to read the politics clearly, negotiate credible bargains and insist that modernization — whether through PABS or AI — does not come at the expense of equity, accountability, participation and human rights. Health is political whether it is acknowledged or not. Law can make power answerable before failure is counted in lives.
Lee Tsung-ling is a professor of law at Taipei Medical University’s Graduate Institute of Health and Biotechnology Law.
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