Global Health Architecture Fractures: Pathogen Deal Stalls, Epidemics Surge

The global response to major health threats shows signs of fragility. Momentum to finalize the pandemic agreement is waning in the face of persistent blockages on pathogen sharing, while the fight against HIV is deemed "faltering" by multilateral agencies, despite notable progress over the past decade. The international AIDS2026 conference highlighted critical gaps in treatment access for millions of people and the decline in external funding, particularly in Africa.

On the ground, the humanitarian situation is deteriorating, marked by an out-of-control Ebola epidemic in the Democratic Republic of Congo (DRC), where insecurity is severely hindering the response. In contrast, the health financing sector has recorded a major victory with the restoration of the U.S. contribution to Gavi, the Vaccine Alliance, a strong signal for global vaccination. The back-to-school agenda will be dominated by the resumption of pandemic agreement negotiations in September, a decisive meeting for the credibility of the global health security architecture.

Pandemic agreement: pathogen sharing negotiations (PABS) at the heart of tensions

Negotiations to finalize the most sensitive aspects of the World Health Organization (WHO) pandemic agreement continued in July without reaching a definitive agreement. The seventh meeting of the Intergovernmental Working Group (IGWG), which ran until July 17, focused on the annex relating to Access and Benefit-Sharing for Pathogenic Agents (PABS). This system is considered the heart of the political compromise of the agreement: to guarantee rapid access by States to samples of pathogens with pandemic potential in exchange for equitable sharing of benefits derived from them (vaccines, diagnostics, treatments).

According to the WHO, member states reaffirmed their commitment to developing this system, but technical discussions on its practical modalities, particularly legally binding arrangements and manufacturer contributions, remain complex (WHO News, 18/07). These talks take place in a context of intense political pressure, following a joint appeal by the WHO Director-General and Brazilian President Luiz Inácio Lula da Silva in June, urging leaders of the G7, G20 and BRICS to demonstrate political will to conclude (context — Tedros WHO (@DrTedros), 15/06). Negotiations will continue until September, with an eighth IGWG meeting scheduled for September 14-18 (WHO News, 18/07; Medical Xpress, 20/07). In parallel, citizen opposition campaigns continue to target the treaty, illustrating a persistent climate of mistrust (citizengo.org, 29/04).

Ebola epidemic in DRC worsens, humanitarian response overwhelmed by insecurity

The Ebola outbreak (Bundibugyo strain) declared in May in the Democratic Republic of Congo (DRC) has taken an alarming turn. As of July 23, the death toll exceeded 1,000 deaths for more than 2,500 reported cases, with more than 500 people recovered (WHO (@WHO), 23/07). The WHO Director-General, Tedros Adhanom Ghebreyesus, warned that the response was "being overwhelmed by the epidemic," with chronic insecurity limiting access to many areas. He estimates that the actual number of cases could be more than double official figures, with most deaths occurring within communities rather than treatment centers (WHO (@WHO), 23/07).

In response to this crisis, international mobilization is intensifying to support the Congolese health system. The WHO, in partnership with the DRC Ministry of Health, has launched health preparedness strengthening initiatives in provinces such as Bas-Uélé, with financial support from the European Union (EU), the United Kingdom and Germany (Tedros WHO (@DrTedros), 26/07). On the R&D front, a major advance was announced: the first experimental vaccine against the Ebola virus of the Bundibugyo strain entered Phase 1 human clinical trials to assess its safety and immune response (Gavi, the Vaccine Alliance, 23/07; WHO (@WHO), 27/07). This step, supervised by the WHO, is crucial for developing prevention tools against this often-neglected strain.

The fight against HIV falters, AIDS2026 conference sounds the alarm

The 26th International AIDS Conference (AIDS2026), which began in Rio de Janeiro on July 27, was the scene of an alarming finding. According to a report from UNAIDS, the global response to HIV "is faltering" and a "resurgence" of the epidemic is a real threat (Global Fund News, 27/07).

On this occasion, the WHO launched its mid-term review of global strategies on HIV, viral hepatitis and STIs (2022-2030). The report confirms real but fragile progress: since 2010, new HIV infections have declined by 43% and deaths by 57%. However, nine million people still do not have access to vital treatment (WHO (@WHO), 28/07). Africa, while reducing new infections by 40% since 2010, continues to bear the heaviest burden, even as external health financing to the continent is in decline (Tedros WHO (@DrTedros), 23/07). This fragility is illustrated by field studies, such as in the Central African Republic, where despite broad access to modern therapies, patient retention in care programs remains a major challenge due to insecurity and systemic barriers (BMJ Global Health, 27/07).

Financing and access: U.S. return to Gavi contrasts with threats to treatment effectiveness

The period was marked by major news for global health financing: the restoration of U.S. financial contributions to Gavi, the Vaccine Alliance (GAVI), was officially welcomed on July 30 (GAVI Alliance — News, 30/07). This decision represents a significant shift and a breath of fresh air for the vaccination ecosystem, strengthening funding predictability as Gavi's next replenishment cycle approaches.

The Alliance continues its work in the field. In Nigeria, a new initiative supported by Gavi in Sokoto State aims to reduce the number of "zero-dose" children by 80% (Vanguard News, 28/07). In the DRC, a joint Gavi/WHO mission was deployed to intensify childhood vaccination efforts (GAVI Alliance — News, 23/07).

This positive context for vaccine funding is, however, darkened by the growing threat of antimicrobial resistance (AMR). A study published in Nature Medicine on August 17 highlighted the emergence and rapid spread in Uganda of Plasmodium falciparum parasite polymorphisms associated with reduced sensitivity to antimalarial drugs. This discovery is a warning signal about the erosion of the effectiveness of first-line malaria treatments.

Surveillance and regulation: Europe assesses avian flu risk and approves new treatments

On the European side, the European Centre for Disease Prevention and Control (ECDC) has drawn attention to the potential pandemic risk from avian flu. In a podcast aired on August 14, agency experts examined factors likely to increase human risk and analyzed European countries' preparedness for possible human cases (ECDC, 14/08).

On the regulatory front, the European Medicines Agency (EMA) continues its activities. At its July meeting, its Committee for Medicinal Products for Human Use (CHMP) recommended approval of twelve new medicines, one biosimilar and four generics. It also issued positive opinions for indication extension of eight already-authorized medicines, signaling a dynamic innovation pipeline (EMA, 24/07).

To watch

• Pandemic agreement: The eighth meeting of the Intergovernmental Working Group (IGWG) will be held from September 14-18, 2026 to continue negotiations on the PABS annex. The outcome of this session will be decisive for the next steps in the process.
• Ebola epidemic in DRC: The evolution of the death toll and the international community's ability to overcome security obstacles to contain the outbreak will be key indicators in the coming weeks.
• Gavi funding: The concrete implications of restoring U.S. funding on Gavi's strategy and preparation for its next fund replenishment cycle will need to be closely monitored.
• Antimalarial resistance: Monitoring the spread of malaria PX1 polymorphisms in Uganda and neighboring countries will be critical to adapt treatment strategies.

Photo: Salya T / Unsplash