Implications of the Pandemic Agreement for South and Southeast Asia

COVID-19 revealed that the Global Health Governance (GHG) system was deeply fractured, most visibly in inequitable access to vaccines and other lifesaving medical countermeasures for countries with low incomes.

A Fragmented Global Health Framework

COVID-19 revealed that the Global Health Governance (GHG) system was deeply fractured, most visibly in inequitable access to vaccines and other lifesaving medical countermeasures for countries with low incomes. Existing international mechanisms for health, such as the International Health Regulations (2005, amended in 2024), the Nagoya Protocol (2010), the Convention on Biological Diversity (1992), and the Pandemic Influenza Preparedness framework (2011), failed to provide an overarching framework for managing COVID-19. Global leadership was needed on several fronts in areas such as timely detection of the outbreak, trustworthy communication, pathogen data analysis, and coordinated response between governments, multilateral bodies, and private actors to develop and distribute medical products.

Unless the PABS is adopted by consensus, the PA cannot be ratified.

In this context, the WHO Pandemic Agreement (PA), adopted in May 2025 after four years of negotiations, was a historic moment for global health. However, many experts and practitioners argued that the agreement was too little, too late, for it lacked the accountability and binding commitments needed to institutionalise the ‘equity principle’ in global Pandemic Prevention, Preparedness and Response (PPPR). A key limitation of the PA is the Pathogen Access and Benefits Sharing (PABS) system, an annex dealing with contentious aspects of the equity provisions, such as pathogen data ownership, collection, analysis, access, and benefit distribution among countries. This is being negotiated separately before the World Health Assembly (WHA) in May 2026. Unless the PABS is adopted by consensus, the PA cannot be ratified.

A Fragmented Global Health Framework

Existing international mechanisms for health, such as the International Health Regulations (2005, amended in 2024), the Nagoya Protocol (2010), the Convention on Biological Diversity (1992), and the Pandemic Influenza Preparedness framework (2011), failed to provide an overarching framework for managing COVID-19. Global leadership was needed on several fronts in areas such as timely detection of the outbreak, trustworthy communication, pathogen data analysis, and coordinated response between governments, multilateral bodies, and private actors to develop and distribute medical products.

In this context, the WHO Pandemic Agreement (PA), adopted in May 2025 after four years of negotiations, was a historic moment for global health. However, many experts and practitioners argued that the agreement was too little, too late, for it lacked the accountability and binding commitments needed to institutionalise the ‘equity principle’ in global Pandemic Prevention, Preparedness and Response (PPPR). A key limitation of the PA is the Pathogen Access and Benefits Sharing (PABS) system, an annex dealing with contentious aspects of the equity provisions, such as pathogen data ownership, collection, analysis, access, and benefit distribution among countries. This is being negotiated separately before the World Health Assembly (WHA) in May 2026.

Negotiations around the PA and the PABS have revealed important fault lines between the Global North and South—between those who have the technology and financial resources to analyse pandemic-causing pathogens and develop vaccines and those who do not. This divide overlaps with even more fundamental asymmetries across health systems, including infrastructure, workforce, supplies, governance, and financing for research and development, surveillance, and regulatory systems. Without equity, accountability, and inclusivity, the PPPR regime being proposed would fail to achieve its core objective of protecting the global community. These concerns are central to Global South countries. At the same time, the adoption of the PA treaty by 124 WHO members highlights that regional groupings and cross-regional alignments are important mediums for furthering an inclusive GHG architecture.

Understanding Pandemic Preparedness at a Regional Level

Against this backdrop, The Asian Collective for Health Systems (TACHS), with its secretariat at the Centre for Social and Economic Progress (CSEP), is undertaking an ongoing study on the PA following a closed-door high-level webinar in September 2025 titled “Power Shifts and Pandemic Preparedness: What has the Pandemic Agreement Meant in a Multipolar World?”  The study examines a) the implications of the equity provisions in the PA treaty for national-level PPPR and b) the role of regional groupings in the PA and their potential in strengthening regional health governance. It aims to highlight pathways for stronger regional health cooperation in South and Southeast Asia to enhance PPPR.

The methods include a) closed-door expert discussions and key informant interviews with 28 stakeholders from Member States, WHO, academia, and civil society, b) analysis of Intergovernmental Negotiating Body (INB) documents and proceedings, and c) roundtable discussions in South and Southeast Asian countries with national-level stakeholders.

This blog draws on insights from our research on PPPR in Sri Lanka from the perspective of the PA, a recent roundtable held in Sri Lanka in March 2026, and interviews with experts across the world.

Sri Lanka’s Pandemic Preparedness in Practice

Sri Lanka has a long-standing focus on health security and pandemic preparedness, supported by systems such as the National Influenza Pandemic Preparedness Plan (NIPPP), launched in 2005 and revised in 2006 and 2012, and inter-ministerial coordination between health, livestock and agriculture, ports and aviation, and defence ministries. It also has strong disaster management protocols in place that were deployed during COVID-19 and tested most recently during Cyclone Ditwah in 2025.

We have analysed Sri Lanka’s PPPR priorities and existing initiatives across bilateral (e.g., India–Sri Lanka cooperation), regional (ASEAN, BIMSTEC, etc.), and multilateral (WHO, UNDP, ADB, etc.) domains. We explored Sri Lanka’s ‘asks’ from the global and regional domains, as well as its strategic interests in the PA and ongoing PABS negotiations.

Lessons from Sri Lanka for PPPR

A strong PPPR regime may still face limitations in the face of other national priorities.

• Best of PPPR initiatives may be weakened because of other national priorities: Sri Lanka’s preparedness for pandemics, bolstered by Universal Health Coverage (UHC) and immunisation coverage, enabled a strong response in the early phase of COVID-19, including an effective vaccine roll-out, experienced public health staff in contact tracing, and a politically supported vaccination programme. However, in later phases, Sri Lanka’s economic crisis, which continues to influence the country’s priorities and response, necessitated that it reopen the economy. This led to high levels of morbidity due to the pandemic. This highlighted an important insight regarding the efficacy of the new PPPR regime under the PA: A strong PPPR regime may still face limitations in the face of other national priorities. From this lens, the accommodation of certain provisions in the PA through qualifiers such as ‘mutually agreed’, ‘as per national circumstances’, may reflect essential pragmatism needed in a global treaty.
• Multi-sectoral planning integrates disasters, animal and human health, and pandemic preparedness, but implementation is challenging: Given Sri Lanka’s vulnerability to disasters such as tsunamis and cyclones, its disaster planning has been steered by the National Disaster Management Centre with a mandate for early warning and response. Similarly, Sri Lanka has strong surveillance capacities to integrate animal and human health, which has now received prominence through ‘One Health’ provisions in the PA. Despite these interlinkages at the level of planning, several experts shared that when it comes to implementation, there is still fragmentation, and the burden falls on the Ministry of Health.
• Addressing fragmented surveillance systems: The discussion shed light on fragmented surveillance systems in Sri Lanka, a challenge that several countries face as well. While the epidemiology unit collects data for diarrhoea and many other infectious diseases, there exists a different system for malaria and dengue. The need to integrate these for a comprehensive surveillance system was highlighted. Yet, more recent crises in Sri Lanka, like Cyclone Ditwah, demonstrated enduring fragmented surveillance systems.
• Maintenance of pandemic infrastructure: In Sri Lanka, while infrastructure was developed during the pandemic (laboratories, strengthening testing capacities, etc.), its maintenance has been a key priority as well as a challenge. Without a strong base-level infrastructure and surveillance, its scale-up during health emergencies would weaken.

Lessons from Sri Lanka for PPPR

• Best of PPPR initiatives may be weakened because of other national priorities: Sri Lanka’s preparedness for pandemics, bolstered by Universal Health Coverage (UHC) and immunisation coverage, enabled a strong response in the early phase of COVID-19, including an effective vaccine roll-out, experienced public health staff in contract tracing, and a politically supported vaccination programme. However, in later phases, Sri Lanka’s economic crisis, which continues to influence the country’s priorities and response, necessitated that it reopen the economy. This led to high levels of morbidity due to the pandemic. This highlighted an important insight regarding the efficacy of the new PPPR regime under the PA: From this lens, the accommodation of certain provisions in the PA through qualifiers such as ‘mutually agreed’, ‘as per national circumstances’, may reflect essential pragmatism needed in a global treaty.
• Multi-sectoral planning integrates disasters, animal and human health, and pandemic preparedness, but implementation is challenging: Given Sri Lanka’s vulnerability to disasters such as tsunamis and cyclones, its disaster planning has been steered by the National Disaster Management Centre with a mandate for early warning and response. Similarly, Sri Lanka has strong surveillance capacities to integrate animal and human health, which has now received prominence through ‘One Health’ provisions in the PA. Despite these interlinkages at the level of planning, several experts shared that when it comes to implementation, there is still fragmentation, and the burden falls on the Ministry of Health.
• Addressing fragmented surveillance systems: The discussion shed light on fragmented surveillance systems in Sri Lanka, a challenge that several countries face as well. While the epidemiology unit collects data for diarrhoea and many other infectious diseases, there exists a different system for malaria and dengue. The need to integrate these for a comprehensive surveillance system was highlighted. Yet, more recent crises in Sri Lanka, like Cyclone Ditwah, demonstrated enduring fragmented surveillance systems.
• Maintenance of pandemic infrastructure: In Sri Lanka, while infrastructure was developed during the pandemic (laboratories, strengthening testing capacities, etc.), its maintenance has been a key priority as well as a challenge. Without a strong base-level infrastructure and surveillance, its scale-up during health emergencies would weaken.

Sri Lanka’s Strategic Priorities in PPPR at the Global and Regional Level

• Timely access to vaccines and medicines and a fair PABS system: Like several lower and lower-middle income countries, Sri Lanka too faced the consequences of a delayed and unpredictable vaccine delivery system during the pandemic, which paralysed the health system as COVID-19 progressed. Experts also pointed out that, given a high incidence of non-communicable diseases in the country, the existing health issues of the population were neglected during the pandemic. It was pointed out that the PABS system, which at its core deals with driving equitable access and benefit sharing of pathogen data, would be important for Sri Lanka as well.
• Strengthening diplomatic capacity within multilateral health negotiations: Sri Lanka has regularly cooperated with global bodies on international health agreements such as the Joint External Evaluation (JEE) to assess their core capacities for the IHR. Yet, Sri Lanka’s voice in regional and global forums and participation in PA negotiations was somewhat muted. Some factors discussed were the high barriers to participation for smaller countries in Geneva-based consultations and competing priorities, mostly around addressing the severe economic and debt crisis. To advance health diplomacy capacities, Sri Lanka has taken important steps, such as working with countries like Thailand in 2025 to strengthen health diplomacy capacity building and expanding units within the health ministry to cover health diplomacy specifically.
• Strategic partnerships with regional players like India and Bangladesh on strengthening pharmaceutical supply chains: The discussion focused on Sri Lanka’s dependence on imports for pharmaceutical products, including vaccines and pandemic products. To address this, it was recommended to strengthen strategic partnerships with regional players like India and Bangladesh, which are large manufacturers of these products.

Regional Cooperation as an Emerging Opportunity

• Reinvigorating the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC)’s mandate covering health cooperation: Sri Lanka is leading the Science, Technology and Innovation cluster for BIMSTEC, of which Health is a sub-component. Previously, there were agreements around technology transfer, including priority areas of biotechnology, pharmaceutical technology, health technologies, and technologies pertinent to DRR and climate change adaptation. MoUs were also signed on diplomatic training. It was highlighted that while BIMSTEC’s focus on health is currently muted, it can potentially serve as a springboard for regional cooperation.
• Need to develop a regional health security agenda in South Asia: The increasing securitisation of health, including the surge of global health security agendas and partnerships, necessitates a regional health security agenda in South Asia. While it was acknowledged that the South Asian region faces political deadlock and a semi-functional SAARC, the need for strengthening health security regionally and utilising health that can serve as an area for further cooperation was strongly recognised.
• Regional health coordination platform for countries of South and Southeast Asia: The need to develop a US Centres for Disease Control (CDC) like body for Sri Lanka, which could be taken further to the regional level, was highlighted. This could be a similar platform that engages with other countries in the region on key aspects of PPPR, such as surveillance, detection and response.

The CSEP–TACHS research continues as an ongoing effort to understand how global, regional, and national dynamics will shape the PA in practice and explore how regional cooperation and cross-regional diplomacy can help navigate fragmented global systems.

Way Forward

The Sri Lanka roundtable highlighted that institutionalising pandemic preparedness in national systems and priorities and translating these to regional and global cooperation arrangements can offer a more grounded, bottom-up pathway for an equitable GHG system.

As we move toward the 2026 WHA, the CSEP–TACHS research continues as an ongoing effort to understand how global, regional, and national dynamics will shape the PA in practice and explore how regional cooperation and cross-regional diplomacy can help navigate fragmented global systems. We value insights and opportunities to learn from practitioners/ experts who are focused on areas of health security, pandemic preparedness, and regional health cooperation in South and Southeast Asia.