Focusing on intellectual property rights (IPRs) and their role in global access to vaccines during the COVID-19 pandemic, this article argues that key aspects of the current institutional system align towards delivering individualistic state/regional/rightsholders priorities in the use of IPRs over pandemic health technologies. This played a key role in the vaccine nationalism and global vaccine inequity that emerged during the pandemic. It critically analyzes the IPR provisions within the World Health Organisation’s Pandemic Agreement and negotiation process. It argues that nationalistic/individualistic approaches toward the use of IPRs over health technologies also permeate such contexts. The final text of the Agreement leaves considerable discretion to states around IPRs, and much will depend on how it is implemented in practice. For effective future pandemic preparedness around how IPRs are used over health technologies, this article argues that a deeper bottom-up institutional change is needed — one which offers nuanced strategies to balance the potential incentivization role of IPRs with the implications certain uses of IPRs can have on access to downstream health technologies. A key element of this change is embedding a greater recognition of the range of resources provided by entities (e.g. funders, biobanks, and universities) necessary in the successful development of health technologies, including in pandemic contexts. Such entities should leverage these resources, including by attaching contractual conditions to access these, which mandate avenues for downstream access to pandemic health technologies. In the longer term such approaches could be part of a broader institutional change, which prioritises global collective health needs in pandemics.

The adoption of the main text of the Pandemic Agreement at the 2025 World Health Assembly is a milestone in global health law. The adopted text makes several key contributions, but there were several missed opportunities in the negotiating process, and key roadblocks remain for the future of the Pandemic Agreement.

This article discusses the prospects and pitfalls of a legally binding pandemic agreement under the auspices of the World Health Organization, currently under negotiation in Geneva. Such an agreement could foster a rules-based pandemic prevention, preparedness and response as a reaction to the failures by states during the COVID-19 pandemic, including a lack of effective coordination for sharing all kinds of data and the global inequity in the distribution of medical goods fueled by vaccine nationalism. Achieving these goals, however, will depend upon a meaningful engagement by delegations negotiating the agreement, a legally sound formulation of its provisions, and overcoming the currently pervasive emergency-bias in this field of global health law. Thus, as advocated by Lawrence Gostin in his seminal treatise on Global Health Law ten years ago, the pandemic agreement could help realize the transformative potential of law for facing one of the greatest health threats to humanity.

The COVID-19 pandemic has clearly demonstrated that international cooperation to combat pandemics is insufficient. The World Health Organization has, therefore, recently reformed the International Health Regulations based on the experience of the COVID 19-pandemic. The World Health Assembly also plans to adopt a new Pandemic Agreement to further strengthen international cooperation. However, negotiations have not yet been successful, and this year’s World Health Assembly agreed to extend the negotiations for the Pandemic Agreement by one year. Reason enough to analyse and critically evaluate the reform efforts in detail, and to give an outlook on the future of international pandemic law.