All Global Pandemics: A Historical Overview

The WHO Pandemic Agreement Is Getting Closer to Real

Here's some genuinely good news: the world is still moving, slowly but seriously, toward having an actual global pandemic treaty.

The sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement ran from March 23 to 28 in Geneva. The big item on the agenda was the Pathogen Access and Benefit-Sharing (PABS) annex; think of it as the last major piece of the legal puzzle before the agreement can go out for countries to sign and ratify.

The WHO Pandemic Agreement itself was formally adopted back in May 2025 at the 78th World Health Assembly. One hundred and twenty countries voted yes. None voted against. Eleven abstained, including Russia, Iran, Italy, Poland, and Israel. The United States wasn't in the room at all; the Trump administration had already initiated withdrawal from the WHO by that point.

So what's this PABS annex actually about? In simple terms: it creates a fair system for sharing pathogen samples and genetic sequence data between countries, and it sets the rules for how countries that share that data get access to the vaccines and treatments developed from it. That's been the sticking point between wealthy nations (which have the labs and money) and lower-income countries (which often have the viruses but not the resources). Without solving this, the whole agreement stays stuck on paper.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus opened the session with a message that was hard to ignore: "The next pandemic or major global health emergency is not a question of if, but when." African nations pushed hard for the annex to deliver tangible equity, not just symbolic language. The Coalition for Epidemic Preparedness Innovations (CEPI) added that benefit-sharing requirements need to apply across the entire vaccine development chain, not just at the end of it.

If the PABS annex gets adopted at the World Health Assembly in May 2026, the full agreement will go out for signatures. It becomes binding international law once 60 countries ratify it. One thing the agreement makes explicitly clear: the WHO cannot force lockdowns or vaccine mandates on any country. That clarification was deliberate; it addressed one of the loudest objections that held up negotiations for years.

PAHO to the UN: Global Health Starts at the Local Level

While Geneva was working through PABS, New York was having its own conversation about pandemic readiness.

On March 26, PAHO Director Dr. Jarbas Barbosa spoke at the Third Session of the Thematic Dialogue Series on Pandemic Prevention, Preparedness, and Response a UN-organized event co-hosted with WHO, Canada, Denmark, Qatar, and Sierra Leone.

His core message was one of those things that sounds obvious until you think about how rarely it actually drives policy: pandemics are global emergencies, but they begin, spread, or get stopped at the local level. A health worker in a rural clinic, a regional lab that can actually run a test, or a local disease surveillance system that flags something unusual that's where the difference gets made. Or not made.

To illustrate the point, Barbosa shared data from PAHO's own 2025 operations. In one year, PAHO's epidemiological intelligence team sifted through more than 1.8 million signals and detected 128 new public health events across Latin America and the Caribbean. That is a serious operational workload, and it's the kind of work that happens quietly, without headlines, until it becomes a headline.

He was straightforward about the funding gap. The money currently being invested in local and regional health systems both by national governments and international donors is not enough to sustain genuine preparedness. Without predictable funding, he said, the world stays stuck in a cycle of crisis and reaction rather than ever getting ahead of the problem.

This dialogue is part of the build-up to the 2026 United Nations High-Level Meeting on Pandemic Prevention, Preparedness, and Response a major event expected to shape international health security commitments for the next several years.

H5N1 Bird Flu Is Still Spreading, and Scientists Are Watching Carefully

This is the story that keeps evolving in ways that matter.

H5N1 avian influenza, the strain most virologists consider the top pandemic risk candidate right now, has spread to more species and more countries than at any other point in recorded history. The CDC's current assessment puts the risk to the general public as low, but that classification comes with significant caveats.

In mid-March, California confirmed H5N1 in 27 northern elephant seals, two California sea lions, and one southern sea otter, all in San Mateo County. This is the first time the virus has been detected in California's marine mammal population and the first confirmed case ever in northern elephant seals. Scientists pointed to a 2023 outbreak in Argentina where the closely related southern elephant seal population suffered massive die-offs from the same virus. The spread was fast, and the death toll among the animals was severe.

The Marine Mammal Center has updated its protocols for field workers and confirmed that none of its current patients have tested positive. NOAA, UC Davis, and UC Santa Cruz are all contributing to active surveillance.

In Iowa, six H5N1-infected flocks have been confirmed in 2026 so far: four backyard farms and two hatcheries. Authorities are paying extra attention as Easter approaches. Historically, the holiday drives a surge in backyard poultry activity and egg demand, and that increased contact can accelerate transmission. Agricultural economists flagged a possible repeat of the 2025 egg price spike, when a dozen eggs hit more than six dollars in some U.S. markets.

Across the Americas more broadly, PAHO's March 11 epidemiological report documented H5N1 in 37 mammalian species across two countries and 94 bird species across 11 countries and territories since January 2025. Wild bird detections have been declining since mid-2025, but mammalian spread continues.

The deeper concern, which virologists repeat consistently, is this: H5N1 does not currently spread between humans efficiently. But every new species the virus jumps into gives it more chances to mutate. University of Glasgow professor Dr. Ed Hutchinson described the situation bluntly earlier this year: the virus is "completely out of control" in the animal world. It's raging around the world, and there's no feasible containment method other than just watching it infect huge populations of animals."

Mpox Clade Ib Is No Longer Just an African Outbreak

Mpox is moving in a direction that public health officials were hoping to avoid.

The more severe subclade of mpox clade Ib has now been confirmed in individuals with no recent travel to Africa across all four major WHO regions: Africa, the Americas, Europe, and the Western Pacific. That shift from "imported cases" to "local community transmission" is significant.

As of the CDC's March 23 update, more than 53,000 cases of clade I mpox have been linked to the ongoing Central and Eastern African outbreak. The global clade IIb outbreak, which began in 2022, has now reached over 100,000 cases in 122 countries. In the United States, 15 clade I cases have been confirmed since November 2024, with four of those recorded just in March 2026. None of these U.S. cases are linked to each other, and all have some connection to Africa or to European countries where local transmission is developing.

In Europe, Spain, Italy, the Netherlands, and Portugal have all identified clade Ib mpox in individuals with no recorded travel history a clear sign that the virus has established local transmission chains. The ECDC is watching closely.

The situation in Africa has been complicated by USAID funding cuts. A senior USAID administrator warned in an internal memo that the funding stoppage created a situation in the Democratic Republic of the Congo where mpox samples literally could not be transported to labs for testing, not because the labs weren't there, but because there was no money to move the samples. The Africa CDC confirmed the disruption.

WHO's Standing Recommendations on mpox have been extended through August 2026. Most mpox cases resolve within two to four weeks, but complications are more likely for people living with HIV, young children, pregnant women, and those with weakened immune systems.

Tuberculosis Killed 1.23 Million People in 2024. It's Still Not Getting Enough Attention.

March 24 is World Tuberculosis Day, and this year's WHO numbers deserve to be read slowly.

In 2024, 10.7 million people got sick with tuberculosis: 5.8 million men, 3.7 million women, and 1.2 million children. Of those, 1.23 million died, including 150,000 people who were also living with HIV. TB was the world's leading cause of death from a single infectious agent and a leading cause of death for people with HIV.

These are not new numbers in the sense that TB has always been with us. It is one of the oldest documented infectious diseases in human history. But the scale in 2024 after decades of eradication efforts and billions spent on treatment programs is a sobering reminder of how persistent it is.

The harder problem is drug resistance. Multidrug-resistant TB (MDR-TB) is spreading, and only about two in five people with drug-resistant TB are actually getting treatment. That treatment gap is dangerous: untreated patients continue to transmit resistant strains, and once those strains establish themselves in a community, rolling them back becomes exceptionally difficult.

Making it worse: the funding cuts of 2025 hit TB programs directly. The U.S., UK, France, and Germany all reduced global health contributions. For countries where TB programs depend on international funding, which covers most high-burden countries that means fewer diagnostic tests, less drug access, and weaker surveillance.

The WHO Is Running a Significant Budget Gap

The U.S. officially completed its withdrawal from the WHO in 2026, and the financial impact is landing in the places you'd least want it to.

The United States contributed roughly $500 million annually to the WHO about 13 percent of the organization's total revenue. With that gone, Director-General Tedros told the Executive Board in February that WHO has mobilized about 85 percent of its 2026-2027 core budget. That sounds manageable. The problem is where the remaining 15 percent falls short: emergency preparedness, antimicrobial resistance, and climate-health resilience. Those are not optional programs.

China has stepped into a more prominent financial role. Argentina also filed a withdrawal notification. Both exits are creating governance complications the WHO Executive Board is navigating ahead of the May World Health Assembly.

A Congressional Research Service analysis laid out the strategic risk plainly: without U.S. participation in the WHO's pooled surveillance systems, coordinated clinical trials, and collective response frameworks, all of which proved essential during COVID-19 the cost and difficulty of future pandemic responses increase. The International Pandemic Preparedness Secretariat's January 2026 report confirmed that the U.S., UK, France, and Germany all cut global health funding in 2025, naming diagnostics as the single biggest gap in current preparedness.

AI Is Quietly Becoming One of the More Useful Pandemic Tools

Not everything in global health right now is a setback. AI-driven disease surveillance is one area where real progress is happening, and it's worth acknowledging.

WHO's Hub for Pandemic and Epidemic Intelligence updated the Epidemic Intelligence from Open Sources (EIOS) system this year. EIOS uses AI to scan news, social media, and official government reports across 110 countries, flagging signals that might indicate an emerging health event before it becomes a full outbreak. It doesn't replace human judgment; it surfaces patterns for experts to evaluate, but it meaningfully reduces the time between a signal appearing and someone acting on it.

The International Pathogen Surveillance Network has helped over 110 countries build genomic sequencing capabilities to track and characterize pathogens. The WHO BioHub, supported by 30 countries and territories, has coordinated 25 sample shipments to 13 laboratories and holds 34 variants of SARS-CoV-2, mpox clades, Oropouche virus, and MERS-CoV.

CEPI's 100 Days Mission — developing vaccines and diagnostics within 100 days of identifying a new threat — continues moving forward through prototype vaccine development for the highest-risk viral families. The consistent caveat from experts: all of this requires sustained funding and political commitment to be ready when it's actually needed.

Six Years After COVID-19, Where Does the World Actually Stand?

This week falls six years after the WHO declared COVID-19 a pandemic on March 11, 2020. It's a reasonable moment to take stock honestly.

The progress is real. A pandemic agreement has been adopted. International Health Regulations have been updated. Genomic surveillance is dramatically more capable than it was in 2020. One hundred and twenty-one countries now have national public health agencies focused on health emergency preparedness. Recent Ebola and Marburg outbreaks were contained faster than anything comparable a decade ago, partly because Ebola now has both a vaccine and rapid diagnostics, neither of which existed ten years ago.

The problems are equally real. Vaccine hesitancy and health misinformation are ranked among the most severe global risks in the World Economic Forum's 2026 Global Risks Report, not because they're new, but because they've eroded the public trust that effective pandemic response depends on. Measles is resurging in countries where vaccination rates have fallen. The diagnostic gap remains alarming: most lower-income countries still cannot rapidly identify a novel pathogen, let alone mount a scaled response.

Two lesser-known viruses were flagged this week that deserve watching. Influenza D has been spreading in livestock and wildlife since its discovery in 2011 and has shown the ability to infect humans. A canine coronavirus identified by researchers at the University of Florida could theoretically develop respiratory disease characteristics if it gains efficient human-to-human transmission. Neither is an immediate threat. Both are reminders that the next pandemic pathogen doesn't have to come from a source we're already watching.

The Pandemic Fund, managed by the World Bank, has awarded $1.4 billion across 128 countries through its first three rounds, mobilizing more than $10 billion in additional resources. In the second funding round alone, requests totaled $4.6 billion against a budget of $500 million — nearly ten times oversubscribed. That ratio says more about the gap between need and available resources than any official statement could.

FAQ's

Q: Does the WHO pandemic treaty mean the WHO can tell my country to lock down?

• No. The agreement explicitly prohibits the WHO from imposing lockdowns, vaccine mandates, or any domestic health measures on member states. Countries retain full sovereignty over their own public health decisions. The treaty focuses on coordination, data sharing, and equitable access to vaccines and treatments.

Q: Why did it take so long to agree on this?

• The main sticking point has been the PABS system: who shares what and what they get in return. Wealthy countries with advanced biomedical industries were cautious about obligations that could slow down vaccine development. Developing nations, many of which provided the virus samples behind past vaccines but received them last, wanted guarantees written into law. Reaching a balance that both sides could live with took years of negotiation.

Q: What happens if a country doesn't sign?

• Countries that don't ratify the agreement are not bound by it. The United States, which withdrew from the WHO in 2026, is currently outside the entire framework.

Q: Can I catch H5N1 from eating chicken or eggs?

• No. Properly cooked poultry and eggs are safe. The virus does not survive cooking temperatures. The risk comes from direct contact with infected animals or their environments' raw blood, feces, or contaminated surfaces. If you handle backyard poultry, wash your hands thoroughly and avoid touching your face.

Q: Has H5N1 ever spread between humans?

• There has been a small number of suspected or possible cases of limited human-to-human transmission historically, but no confirmed sustained spread. That is the key distinction scientists are watching for. Virtually all human cases have come from direct animal contact.

Q: Why isn't there already a vaccine for humans?

• Candidate vaccines and some government stockpiles do exist, but no widely distributed human H5N1 vaccine. Developing and manufacturing at scale requires knowing which specific strain is causing spread, and the virus keeps evolving. If human-to-human spread were confirmed, a vaccine push would begin immediately. But manufacturing at a global scale still takes months even in a best-case scenario.

Q: Are we actually better prepared for the next pandemic than we were for COVID-19?

• In some meaningful ways, yes. Genomic surveillance is faster and broader, new vaccines and diagnostics were developed during and after COVID-19, and coordination frameworks have improved on paper. But the funding to sustain these systems is shrinking just as the infrastructure need is growing. The honest answer is better, but not ready.

Q: What are scientists most worried about right now?

• H5N1 bird flu gets the most attention because of its spread across species and its historically high mortality rate in the limited human cases recorded. But scientists also watch for novel coronaviruses, filoviruses like Ebola and Marburg, and pathogens that haven't been identified yet, what the WHO calls "Disease X." The concern isn't just about known viruses. It's about having enough infrastructure to detect and respond to something entirely new.

Q: What can ordinary people actually do?

• Stay current on vaccinations, including the flu shot and any updated COVID-19 boosters. If you work with animals especially poultry or dairy cattle follow biosecurity protocols and report sick animals to local health or agriculture authorities. Beyond that, supporting accurate public health information in your community matters more than most people realize. Misinformation spreads faster than most viruses, and it does real damage to the systems that protect everyone.

Q: Does the U.S. withdrawal from the WHO actually matter for regular people?

• It matters indirectly but meaningfully. The WHO coordinates global outbreak surveillance, vaccine stockpiling, and rapid response. When that coordination weakens, the time between a new pathogen emerging and an effective response reaching people, including Americans, gets longer. The financial and human cost of future pandemic events tends to rise without that coordination layer in place.

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