Author: Kat Lay Global health correspondent

A pandemic agreement governing how the world should work together to tackle future disease outbreaks has been adopted by global leaders after three years of negotiation.Dr Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO), said it was “a victory for public health, science and multilateral action”.“It will ensure we, collectively, can better protect the world from future pandemic threats. It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during Covid-19,” he said.The WHO Pandemic Agreement was passed with applause by delegates at the World Health Assembly (WHA) in Geneva. The US will not be part of the agreement, having withdrawn from the WHO and negotiations after Donald Trump took office.Plans for a pandemic treaty, governing how the world should respond to future global disease outbreaks, were first announced in March 2021. World leaders, including Boris Johnson, promised a “legacy that protects our children and grandchildren and minimises the impact of future pandemics on our economies and our societies”.However, the initial deadline of the WHA in 2024 was missed amid mistrust between the global north and south. There were high levels of disinformation surrounding negotiations, including false claims that the accord would cede sovereignty to the WHO or give it the power to impose lockdowns and vaccine mandates.In order to reach the agreement this week, some key points of contention have been pushed back for later talks. The issue of pathogen access and benefit sharing (Pabs) – or what countries can expect, in terms of access to vaccines and treatments, in return for sharing data on any novel bugs emerging in their territory – will be governed by an annexe to the treaty, to be negotiated over the next 12 months.The Independent Panel for Pandemic Preparedness and Response recommended an agreement of this kind four years ago after reviewing the international response to Covid-19. The panel co-chair, former prime minister of New Zealand Helen Clark, said the agreement should be considered “a foundation from which to build, starting today”.She warned: “Many gaps remain in finance, equitable access to medical countermeasures and in understanding evolving risks. Don’t wait to get started. Dangerous pathogens are looming, and they certainly will not wait.”The agreement will not open for signatures until the Pabs annexe is completed. It will then come into force after at least 60 countries have signed. However, it is already being seen as a key achievement for the WHO at a time of crisis, with lower funding after the US withdrew necessitating dramatic cuts.Dr Teodoro Herbosa, secretary of the Philippines Department of Health, and president of this year’s WHA, said: “Now that the agreement has been brought to life, we must all act with the same urgency to implement its critical elements, including systems to ensure equitable access to life-saving pandemic-related health products.“As Covid was a once-in-a-lifetime emergency, the WHO Pandemic Agreement offers a once-in-a-lifetime opportunity to build on lessons learned from that crisis and ensure people worldwide are better protected if a future pandemic emerges.”

Last year saw more than 3,600 attacks on health workers, hospitals and clinics in conflict zones, a record figure reflecting “new levels of horror”, a new report has found.The total is 15% higher than in 2023 and includes air, missile and drone strikes on hospitals and clinics, as well as the looting and takeover of facilities and arrest and detention of health workers.More than a third of the attacks took place in Gaza and the West Bank, but there were also hundreds recorded in Ukraine, Lebanon, Myanmar and Sudan.Leonard Rubenstein, the chair of the Safeguarding Health in Conflict Coalition (SHCC), which authored the report, warned that the rise comes at the same time as “attempts by perpetrators to limit legal protections for healthcare and civilians in war”.He cited sanctions imposed on international criminal court (ICC) staff by US president Donald Trump for having charged Israelis with war crimes, and a 2023 law passed by Russia’s Duma that criminalised cooperation with the ICC.Rubenstein said: “On average, in 2024, healthcare came under attack 10 times a day across the world’s war zones. Each of these assaults brings terror, trauma, and in too many cases, injury, destruction and death.“Attacks on healthcare undermine the ability to care for people when it is needed most, in war.”There were 3,623 recorded incidents in 2024, including 1,111 where health facilities were damaged or destroyed, 927 where health workers were killed, 473 where health workers were arrested and 140 where health workers were kidnapped. Most of the incidents – 81% – were attributed to state actors.More than 55% of health worker arrests in 2024 were made by the Israel Defense Forces (IDF) in Gaza, the West Bank and East Jerusalem. The SHCC points to reports of physical and sexual abuse inside detention facilities. Nearly half of the deaths were reported from Lebanon, and most were emergency medical responders killed during the IDF’s Operation Northern Arrows.Explosive weapons are used in an increasing proportion of attacks against healthcare, the report warned, up from 36% of incidents in 2023 to 48% last year. Much of the rise was accounted for by the increased use of drones.The figures in the report are probably an undercount, it said, due to the difficulty of collecting accurate information during conflict.Christina Wille, director of Insecurity Insight, who led the report’s data collection, said: “There has been a complete erosion in the respect for international humanitarian law and the responsibility to protect healthcare in conflict.”She called for a “decisive response”, adding: “Justice must be pursued and accountability enforced.”The report calls on UN member states to “collectively reject efforts to reinterpret international humanitarian law that undermine their purpose of protecting healthcare in armed conflict” and “end impunity by encouraging investigations, data sharing, prosecutions through the ICC and empowering monitoring bodies”.It also calls for support for declarations and treaties that would strengthen protections for civilians in armed conflicts, and a review of military doctrines and protocols to put greater emphasis on safety for healthcare.