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The New WHO Pandemic Treaty and Global Health Governance: Incorporating Common but Differentiated Responsibilities into PABS  - Georgetown Journal of International Affairs

On May 20, 2025, the World Health Assembly unanimously adopted the World Health Organization (WHO) Pandemic Agreement, an international treaty designed to strengthen pandemic prevention, preparedness, and response. The product of three years of arduous negotiations, the treaty marks a new era of global cooperation in public health. However, core aspects of the agreement remain unresolved—notably the Pathogen Access and Benefit-Sharing (PABS) System, which is intended to ensure equitable access to pandemic-related materials and benefits. To support the successful implementation of the WHO Pandemic Agreement, the principle of “common but differentiated responsibilities” should be formally incorporated into the negotiating agenda of the PABS annex. Introduction For the first time, an international treaty has enshrined the principle of “One Health,” the compelling idea that the health of animals, humans, and the environment all contribute to pandemic risks. SARS (2003), H1N1 (2009–10), Ebola (2014–16), and COVID-19 all emerged through zoonotic spillover from animal hosts—respectively, civets, hogs, and bats. Together, they underscore the need for a coordinated, cross-sectoral approach. The Pandemic Agreement responds to this call, requiring state parties to acknowledge the ecological interplay and commit to a comprehensive “One Health” strategy. Specifically, Article 5 charges governments to address “the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface,” including wild animal markets, deforestation, and antibiotic overuse. Yet the effectiveness of this “One Health” vision depends equally on the free flow of scientific information and data among countries and institutions. Just as environmental and animal health factors have been neglected in past global frameworks, so too has data sharing been marginalized, despite its centrality to timely detection and response. The Pandemic Agreement takes an important step by requiring governments to enhance data collection and cooperate with the World Health Organization (WHO). However, these provisions will remain aspirational without a robust Pathogen Access and Benefit-Sharing (PABS) annex. The PABS system will determine whether countries and researchers can rapidly exchange pathogen samples and genetic data while ensuring equitable access to resulting research and development, including diagnostics, therapeutics, and vaccines. Without such mechanisms, the treaty’s promise to operationalize “One Health” and strengthen global preparedness will risk becoming largely symbolic, echoing earlier failures to translate shared principles into coordinated action. Equity Concerns When the 2025 Health Assembly adopted the Pandemic Agreement, it left the difficult question of access to pathogens and the sharing of resulting benefits to be addressed in a separate agreement. Negotiations on this separate agreement, PABS, are now underway in Geneva. Yet governments remain divided over fundamental questions of equity between the countries that primarily contribute to the system and those that primarily draw from it—and consequently benefit. For example, wildlife in countries bordering the equator is likely to produce PABS materials, but companies in Europe are likely to use them to develop lucrative products. The most likely contributor countries are likely to be those biodiverse countries around the equator, such as Brazil, the Democratic Republic of the Congo, and Indonesia, where the number of human-mammalian viral host interactions is large. Conversely, countries most likely to benefit from this material are those with the technology, investors, and infrastructure to capitalize on genomic data, such as the United States, EU member states, and Japan. This imbalance reflects a broader pattern seen in prior international frameworks. Now, as in the past, the wealthiest countries in the world (a useful heuristic is membership of the Organisation for Economic Co-operation and Development (OECD)) disproportionately benefit from systems in which pathogens and genomic sequencing data are contributed to a common source. Under the International Agreement on Plant Genetic Resources for Food and Agriculture (the “Plant Treaty” or “Seed Treaty”) and the Pandemic Influenza Preparedness (PIP) Framework, companies from Europe and North America disproportionately withdraw biological samples and data for development into lucrative medical products. Their governments and companies have both statutory and contractual claims to the products that those companies correspondingly produce. PABS appears poised to follow the same pattern. The text calls for strong language on access to pathogens and associated data, but the corresponding benefits that should flow to poorer countries are couched in equivocal or non-binding language. Common but Differentiated Responsibilities To address these inequities, the principle of “common but differentiated responsibilities” should be formally incorporated into the negotiating agenda of the PABS annex. Common but differentiated responsibilities are often a feature of climate change negotiations. The basic principle is that, even though all countries should reduce carbon emissions, governments that became rich and powerful through massive carbon emissions (e.g., France, the United Kingdom, the United States) should have a greater obligation to address the resulting crises. Applied to PABS, it would require that governments hosting and supporting companies developing lucrative products carry greater obligations toward the cost of running the PABS system; share benefits or final medical products; and transfer technology to help countries worldwide develop their own capacities to innovate and manufacture vaccines during an emergency. For example, an annex could mandate that any company based in an OECD country that withdraws PABS material would be obligated to donate the resulting diagnostics, therapeutics, or vaccines to the WHO during a public health emergency or pandemic. Questions remain about how robust those donations would be, but the principle is that they should deliver highly significant lifesaving benefits to be equitably shared. Theoretically, this approach mirrors the PIP Framework, in which companies withdrawing influenza samples are required to pay half of the operating costs. In practice, however, the framework has fallen short. The PIP Framework Secretariat has struggled to secure payments from companies, with companies often disagreeing over how much is owed. Additionally, without another pandemic influenza to test the strength of the agreement during a public health emergency, corporate compliance with sharing mechanisms remains unknown. Even if these limitations did not characterize the PIP Framework, partially paying for operating expenses does not address the inequity in access to genetic data and pathogen samples that left less developed countries last in line for COVID-19 vaccines (and, before them, H1N1). Common but differentiated responsibilities would go further, addressing governments’ legitimate grievances regarding information sharing. It would make withdrawals of PABS material and resulting products more transparent, building trust across the board. Enforcement and Enduring Success A key implication of this approach is that the governing mechanism of the PABS must have real enforcement authority. The WHO Pandemic Agreement delegates its core governance responsibilities to a Conference of the Parties (COP)—a governing body composed of one representative from each participating government, similar to those established under the UN Framework Convention on Climate Change and the WHO Framework Convention on Tobacco Control. The proposed WHO Pandemic Agreement COP is charged with oversight functions but ultimately possesses no real authority to compel a government to take any action it does not wish to take. The text does not give the COP the ability to, for example, sanction a party that does not comply with either textual obligations or PABS provisions. In other words, there are no effective mechanisms in place to ensure compliance. Perhaps just as significant, establishing a meaningful enforcement mechanism within the PABS system would strengthen the WHO’s credibility and its ability to ensure compliance across global health governance. By setting a precedent for accountability, such a mechanism could enhance the organization’s authority not only within the Pandemic Agreement but also in enforcing the revised International Health Regulations and other frameworks for public health emergencies. Conclusion The PABS annex can—and should—be different. It should establish clear responsibilities for funding as well as for sharing the diagnostics, therapeutics, and vaccines that result from contributions to the system. The system, in turn, must include a dedicated body empowered to hold governments and the corporations they sponsor accountable for their responsibilities before, during, and after pandemics. Doing so would restore trust in the broader agreement, which was eroded as commitments were repeatedly diluted while parties scrambled to meet their own self-imposed deadlines during the Pandemic Agreement negotiations. A robust PABS Annex would cement a grand social bargain. Wealthier countries and their corporations would gain unimpeded access to scientific information essential for developing and manufacturing lifesaving medical products. As such, they would stand to gain considerable economic benefit. Yet that privilege must be matched with responsibility. The grand bargain must include not only the right to innovate, but also the duty to ensure that innovation serves all. As medical products are developed and produced through collective contributions, every person must have equal access. All human beings deserve an equitable chance to survive—to save their own life, the lives of their families, and the well-being of their communities. … Sam Halabi, JD, MPhil, is the Bette Jacobs Endowed Professor at Georgetown University’s School of Health and the Director of the Center for Transformational Health Law at Georgetown Law. He serves as the co-lead for the WHO’s Working Group on Regulatory Consideration on AI and Health’s training workstream. He earned his JD from Harvard, his MPhil from Oxford, and undergraduate degrees from Kansas State University. Lawrence Gostin, LLD (Hon.), JD, BA, is University Distinguished Professor and Founding Director and Timothy and Linda O’Neill Professor of the O’Neill Institute for National and Global Health Law. He is the author of Global Health Security: A Blueprint for the Future (Harvard University Press, 2021); Global Health Law (Harvard University Press, 2014); Public Health Law: Power, Duty, Restraint (University of California Press, 3rd ed., 2016); Public Health Law and Ethics: A Reader (University of California Press, 3rd ed., 2018); Law and the Health System (Foundation Press, 2014); Principles of Mental Health Law & Practice (Oxford University Press, 2010). He also directs the WHO Collaborating Center at Georgetown University. Image Credit: United States Mission Geneva, CC BY 2.0, via Wikimedia Commons

Dec 11, 2025 • 12:00 AM EST • Health • gjia.georgetown.edu

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After rebooting the Pebble smartwatch, founder Eric Migicovsky is expanding his company's device lineup with a new smart wearable: an AI-powered smart ring known as Index 01. Named for the finger where the ring is meant to be worn, the new $75 ring is not meant to be a competitor to the always-on, always-listening AI devices, like the AI pendant Friend, but instead offers a way to record quick notes and reminders with a press of a button on the ring's side. AI only comes into play via the open source, speech-to-text, and AI models that run locally on your smartphone, via the open source Pebble mobile app. That is, if the Ring's button is not being pressed, it's not recording. (And this is a press-and-hold gesture, too, which means you can't start the ring's recording and then let go to surreptitiously record a conversation.) You can wear the stainless steel ring while in the shower, washing hands, doing dishes, or in the rain, but you would have to take it off for other water-related activities, like swimming. At launch, it's water-resistant to 1 meter. The ring is also not a fitness tracker or sleep monitor. It doesn't record details about your heart rate or health. And it's not there to be your AI friend. "I'm not trying to build some AI assistant thing," Migicovsky told TechCrunch in an interview. "I build things that solve one main problem, and they solve it really well," he explains. "I think of as external memory for my brain...that's what this is. It's always with you." Plus, the ring has been designed to be highly reliable and privacy-preserving, he says, as all your thoughts are stored on your phone, not in the cloud. There is no subscription. Migicovsky has been wearing the ring for three months now and says he cannot imagine going back to a world where he doesn't always have a memory device with him. "The problem is that, during the day, I get ideas or I remember something, and if I don't write it down that second, I forget it," he says. The ring solves this problem, he adds, without becoming another device you need to charge. "The battery lasts for years," Migicovsky claims. Technically, the ring is said to support roughly 12 to 14 hours of recording. On average, the founder says he uses it 10-20 times per day to record 3-6 second thoughts. At that rate, he'll get about two years of usage. When the ring's battery dies, you can ship it back to the company for recycling. When using Index, you can record up to five minutes of audio, which can be saved to the ring and synced to your phone later. This makes sense for recording briefer, personal thoughts and notes, even when you don't have your phone handy, but it wouldn't work for recording a longer chat, like a presentation, meeting, or in-person interview of some kind. The ring also supports 99+ languages and has a bit of on-device memory, in case you're not in Bluetooth range of your device, where the recording is ultimately saved and transcribed. (The raw audio is retained, too, in case the speech-to-text is garbled due to loud background noise). If you own a Pebble smartwatch or one from another brand, your recorded thought can even appear on the watch's screen so you can verify it's correct. The ring works with Pebble's mobile app, which offers notes and reminders, but can optionally integrate with your phone's calendaring system, too, or other apps, like Notion. And the ring's software is open source, which makes it hackable by the community, the founder points out. Because of its open nature, the ring's button is already programmable. In addition to the press-and-hold gesture, you can program the ring to do other things with a single or double press, like play or pause your music or control the shutter on your phone's camera. You could use it to send a message through the universal chat app Beeper, which Migicovsky also created, or you could add your own voice actions via MCP. A new approach to hardware Migicovsky acknowledges that hardware can be difficult to get right -- as the previous exit of Pebble to Fitbit showed. (Fitbit, too, was later acquired by Google in 2021). "I didn't earn any money during Pebble -- we exited, but it was not a great exit," Migicovsky admits. This year, however, he decided to reboot the Pebble project after Google open sourced the PebbleOS, which opened up the door to new hardware. With his new company, Core Devices, Migicovsky plans to do things differently. Still, the founder doesn't regret his previous choices, he clarifies. "I wouldn't have gone back and changed anything. I loved what we built. I loved what we did. I love the company that we built, but it's not the only way to build a company," he told TechCrunch. " And, speaking as an ex-YC partner, there are -- there's a time and a place for building a venture-backed startup. Some companies are phenomenal when they raise money and build a big team, and I tried that...I think what I'm doing now is trying an alternative path, which is start from profitability," he says. The new company is a small team of five, self-funded, and focused on sustainability. So far, Core Devices has shipped the Pebble 2 Duo smartwatch with a black-and-white display. Its first run sold out, and the company is now preparing to ship the upgraded version, the Pebble Time 2. The newer device, which has seen 25,000 pre-orders, is a stainless steel watch with a larger, color e-ink screen. As for the Index 01, the ring's pre-order offer ends in March 2026. After that, the price increases to $99. It currently comes in silver, polished gold, and matte black and works with iOS and Android devices. Customers can select from eight ring sizes and three colors.

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