Ngaatendwe Murombedzi | Regional Advocacy and Policy | Marketing Manager | AIDS Healthcare Foundation (AHF) | mail me |
Experts at the World Health Organisation (WHO) have long argued that another pandemic remains an epidemiological certainty. However, the global systems designed to protect populations still raise serious concerns. This reality has become increasingly urgent.
It is both perplexing and inspiring that in 2026, we continue to address fundamental questions concerning the effective delivery of healthcare services to various populations. It is inspiring because it suggests a commitment to achieving optimal outcomes. However, it is also perplexing and discouraging because of the perceived lack of urgency. As we deliberate, lives are being lost and this will ultimately define the legacy of our actions and endeavours.
The disconnect between health systems and the people they should serve sits at the centre of ongoing negotiations around the global Pandemic Agreement. Adopted in May 2025, the agreement aims to guide future responses to global health crises. However, its success depends on a critical missing component: the Pathogen Access and Benefit Sharing (PABS) Annex. Increasingly, health equity can’t wait: policymakers must address structural inequalities before another crisis emerges.
Closing the gap between access and equity
The PABS Annex must ensure that when countries share pathogen samples and data, often originating in the Global South, benefits such as vaccines, diagnostics and treatments are distributed equitably. In essence, it should prevent a repeat of the COVID-19-era ‘vaccine apartheid’.
For southern Africa, equity cannot remain a principle that exists only in policy documents. Instead, it must produce real and measurable outcomes. A truly equitable Pandemic Agreement changes the lived reality. African countries should not stand at the back of the queue, cap in hand.
In practical terms, this means guaranteeing timely access to life-saving tools instead of relying on charity or delayed support. In addition, governments must implement structural reforms.
These reforms include pre-agreed allocations of medical countermeasures, technology transfers that support regional manufacturing, sustained financial contributions and open access to research outputs. Without these reforms, existing systems risk reinforcing the very inequalities they claim to solve. Consequently, health equity can’t wait: countries need binding frameworks that protect vulnerable populations before the next pandemic strikes.
Why voluntary measures fall short
We have consistently argued that the PABS Annex must remain binding. Voluntary mechanisms will simply fail. Benefit-sharing must be automatic and enforceable. Without it, we are left in a position of doubt.
There are four essential safeguards that African nations should demand during the upcoming negotiations. These include enforceable benefit-sharing mechanisms, standardised contracts agreed upfront, full transparency through user registration and traceability, and intellectual property rules that prioritise public health instead of monopolies.
Without these safeguards, powerful nations and pharmaceutical corporations could once again dominate healthcare access during future crises.
A particularly concerning proposal involves the so-called “dual-track” model. This model would allow companies to access pathogen data without binding obligations to share resulting benefits. This would create a loophole.
For southern Africa, the consequences could prove severe. Local resources could face commercial exploitation while communities receive limited access to resulting treatments. In addition, the region could once again experience inequitable distribution of essential healthcare resources, similar to what occurred during COVID-19. We don’t want that exploitation; we want people accessing such a platform with the mindset of doing good and giving back.
Lessons from COVID-19 not to ignore
The lessons from the COVID-19 pandemic remain impossible to ignore. Equity cannot remain optional, and delays continue to cost lives. Furthermore, regional production capacity is not a luxury. Instead, it represents a matter of continental security.
Most importantly, bad agreements are worse than none at all. Health equity must also extend beyond emergency responses. Instead, governments should embed it within everyday healthcare systems through continuous funding, alignment with existing health programmes and recognition of access to medicine as a fundamental right.
Health equity must be structural, not episodic, when a crisis arises. In other words, health equity can’t wait: sustainable systems must replace temporary crisis-driven responses.
Time, however, continues to run out. The current negotiation round represents the final realistic opportunity for nations to complete a meaningful PABS Annex before the World Health Assembly meeting from 18 to 23 May.
Delay benefits those already well-resourced and entrenches the global imbalance. For southern Africa, time equals lost lives.
In conclusion
Beyond policy discussions, my perspective reflects lived experience and a deep understanding of how people interact with healthcare systems. We always say that ‘public health’ should be replaced with ‘people’s health’, but often policies and their structures do not favour on-the-ground communities at all.
Ultimately, these negotiations extend far beyond technical agreements. They directly affect economics, dignity and survival itself. Healthy people make for stronger economies, and you will invest less in prevention than you do in treating an ailing population.
The question now is whether global leaders will act decisively or allow history to repeat itself once again. Increasingly, health equity can’t wait: the cost of inaction continues to grow with every delay.
