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Behind the scenes of the pandemic agreement
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In May 2025, the world adopted a landmark agreement to prepare for future pandemics. It was the product of 3 years of negotiation across deep political divisions, including the withdrawal of the United States from the World Health Organization. How did the countries with the smallest delegations build real influence at the table? How do health leaders keep people's health at the center of a deeply political process? And what does this achievement signal about cooperation in a divided world?
In this episode, host Garry Aslanyan explores these questions with two guests who bring deeply complementary perspectives. Anne-Claire Amprou is the French Ambassador for Global Health and co-chaired the intergovernmental negotiations that delivered the pandemic agreement. And joining her is Lia Tadesse Gebremedhin, Executive Director of the Harvard Ministerial Leadership Program at the Harvard T.H. Chan School of Public Health and former Minister of Health of Ethiopia, who helped build one African voice — 47 countries speaking together — during the negotiations.
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Hello and welcome to the Global Health Matters Podcast. I'm your host, Garius Lion. In May of 2025, the world adopted a landmark agreement to prepare for future pandemics. It took three years of negotiation across deep political divisions at a time when many doubted countries could still work together at all. Behind that achievement lies a bigger question. How do health leaders build cooperation across deep differences for the good of all? In this episode, we explore what it took to reach the pandemic agreement and what it really teaches us about leadership and cooperation in global health. For that, I'm joined by Anne-Claire Amprot, French Ambassador for Global Health, who co-chaired the intergovernmental negotiations that delivered the pandemic agreement. Joining her is Lia Tadese Gebramedin, former Minister of Health of Ethiopia. Now she's the executive director of the Harvard Ministerial Leadership Program at the Harvard T.H. Chan School of Public Health. During the negotiations, she helped build one African voice. 47 countries speaking together at the table. Hi Leah. Hi Anne-Claire, how are you today?
SPEAKER_02Very good. Very good. Thank you. And you, how are you?
SPEAKER_00Great, thank you. We're gonna dive deep into this probably very complex and very big issue of the world-level agreement. But before we do that, I do want to get to know you better. So maybe I can start with you, Anne-Claire. How did you come to work in this area? And what drew you to global health? And how did you end up leading this kind of negotiations and working on behalf of France? Take us through that.
SPEAKER_02First of all, I would say it was not obvious because I was not a diplomat. I come from the health sector. After starting my career as director of hospital, I joined the Inspectorate General of Social Affairs. And then I became Deputy Director General for Health at the French Ministry of Health. But I have an experience of health crisis actually. That's the explanation. First Ebola in 2014, and COVID-19. And it is right after the COVID-19 pandemic that I arrived in the global health. First as a French negotiator for the pandemic agreement. And then I became co-chair of the intergovernmental negotiation body, the INB, in 2024, which was not expected, to be honest. It is because the European co-chair has to step down. And in addition, I am the French ambassador for global health, and I am involved in several global health initiatives, such as the Global Fund, the Pandemic Fund, and since December 2025, I've been the chair of the United Executive Board. So that's the story, actually.
SPEAKER_00And Leah, you also started as a practicing doctor and then ended up leading the health ministry in Ethiopia. Walk us through your journey and how you came to speak, not just actually on your own country. At the end, you were speaking for much of Africa in some of these global-level conversations.
SPEAKER_01Yeah, thank you, Gary. And I did start out, as you said, as a physician. I was trained as an obstetrician and gynecologist and was practicing. But very early, I had envisioned I would continue as a clinician, but very early in my career, I moved to leading a big uh teaching a big hospital under the Ministry of Health. Actually, Dr. Tedros, who was the minister at the time, had a role in my shift in that regard. And then it was a hospital which undergoing a reform, but also becoming a teaching medical school. So I spent many years in that leadership role. And then also moved into country-level maternal and child health programs. And then I had actually, because of the work at the teaching hospital I had, I had a chance to work at the University of Michigan coordinating programs in Ethiopia and Rwanda in reproductive health. So that actually kind of expanded my work. But then I went back to Ethiopia and assumed as deputy minister first and then became minister of health in 2020, which was right at the beginning of the COVID pandemic, which of course had its own huge challenge for also opportunities in terms of using it as a crisis that can support or improve the health systems. And in towards in that role as minister, of course, as you uh rightly pointed out, Gary, I had to engage in many global uh roles where I was part of the Gabi board, I was actually a co-chair of the COVAX engagement, uh, AIMS Engagement Group, and also co-chair of the investment investors group for the global financing facility, which uh uh increased my role and engagement in in the global uh health, but also in the negotiations of the pandemic treaty as well.
SPEAKER_00Let's switch to the actual situation around the negotiation. End of 2024, Claire, you mentioned um you were already involved, and then comes 2025, health experts, diplomats uh in the same room. Maybe you tell me, Anne-Claire, it's maybe other types of professionals in the room as well. Then you have all the global health crisis, United States leaves uh WHO, uh, a lot of cuts in health. How do you keep everyone focused on this topic amidst of that geopolitical and other tension, and also this different types of negotiators in the room?
SPEAKER_02Thank you for that question, Gary, because I think it's um it was quite unique. Uh well, first of all, the negotiation of the pandemic agreement was a multilateral negotiation of public health issues following a World War II pandemic that brought health to the top of the political and diplomatic agenda. That means that there was a political momentum and it was very important. But you're right, uh what made the situation unique was having public experts and diplomats in the same room who didn't always speak the same language, definitely. And I think that my background in pubic has helped me build that bridge between two worlds, which was also possible by the political momentum. And again, this political momentum was key in bringing together pubic health experts and diplomat. And of course, geopolitics crept into the negotiations: the war in Ukraine, the US withdrawal from the WHO, the war in Gaza, but it was important to always return to the public health objective to prevent, prepare for, and respond to the next climate. And I believe that to go back to the public health when we had some geopolitical considerations or statements coming from a few delegations was key. And I believe that we can be proud that we managed to overcome our differences and geopolitical tensions, especially in the names of FBK and global health security. Also because health security is an important component of peace. And I think that very late during the night when we had to finalize the negotiation again, just to remember why we were in the room together, even at 4 a.m., 5 a.m. You know, that was key in uh the determination to finalize the the negotiation and to go beyond geopolitical tensions and political divergences.
SPEAKER_00So Anclaire, you make it sound so easy. I am really um uh thinking, oh my god, that was uh such an easy thing to do, but I'm sure it was not easy. Uh Leah, is that how you felt too when in the room? And as Anne-Claire described, at some point you were like, where am I going with this or what's happening?
SPEAKER_01Well, the the it was very challenging, of course. Um yes, I mean, especially uh in the beginning, as as um we're trying to understand what are we coming out of this and uh creating common uh positions, common voices, especially for the Africa group. It was not uh an immediate uh uh process. So it took time to formulate how we want to come out and uh come to agreements and uh come as one voice. So member states and uh uh others like Africa CDC also played a role. So the first was actually how can we strengthen uh our voice, but also be clear on what we want to achieve. Um and and be even before um having that uh position for the negotiations. And then it was about also the capacity that was a challenge. Uh, because uh particularly for most African countries, uh the number of people who negotiated, for example, was really imbalanced. Uh, you can see um some countries may have diverse about 20-25 experts, and we may have one or two experts from for each country. So uh it it required working intentionally in two ways. So one is how can we is it within each country also increase the capacity? For example, for Ethiopia, initially we had just two public health uh experts. Um, and then we had to um work with the Ministry of Foreign Affairs to find an international law expert and increase uh that capacity. But also the other piece was working as a group because uh you can build intensive technical uh capacity by different players from different countries, uh scientific, uh legal and regulatory and other policy experts coming. And and I think that the what also helped was um uh really having a series of internal deliberations, both at technical level and at political ambassadorial level before the actual sessions and after the the sessions uh uh to discuss this uh the textual proposals, uh, and and really having live coordination sessions even during those while while the sessions were happening. So I think all this really helped in terms of uh uh building coalitions, but but but also going beyond the mim the groups, working with other countries to build coalitions on those uh on the key areas that we are trying to uh negotiate on.
SPEAKER_00Right. But Leah, how do you deal with the fact that some are big delegations are very small delegations? And how do you uh make sure that the bigger ones are not the ones influencing just because of the size? How did that play out, uh Leah?
SPEAKER_01Yes, absolutely you're uh absolutely right. That's uh uh as as I was trying to say, because it was hard to create that kind of capacity at individual country level, the approach was really for to work as a um uh as a group. So the Africa group really worked well together. Um the coordination being uh supported by uh regional bodies like the Africa CDC, but also there was alternating member states who are doing coordinating coordination.
SPEAKER_00Ah, okay.
SPEAKER_01So um at some point Ethiopia took that coordination role. So we had uh a role specially and uh uh maybe close to the last piece of it, but um uh that so working having the different member states bring different kinds of diverse expertise was really key to create that capacity because individual member states could not bring that kind of capacity.
SPEAKER_00And then maybe I can go back, Uncle, to you. Uh you touched upon the fact that there are really different types of experts in the room. But how hard was it to have health and diplomats and other trade and uh intellectual property and other types of research, other types of experts? Uh how hard was it for you to deal with all those kinds of expertise and maybe possibly tension?
SPEAKER_02Well, I would say it was hard.
SPEAKER_00Yeah.
SPEAKER_02I cannot say it was easy. Uh, we need to be honest. And especially for multilateral negotiation led usually by diplomats, the first priority was to have experts, representatives from the industries and so on, accepted at least as stakeholders to discuss. Yes, it was a member states-led negotiation, definitely, because it's a UN institution and it's a member states negotiation, and at the end, member states will have the last word to say yes, we do agree or we don't agree. But regarding the issues and especially the scope, which was broader and broader when we were negotiating, I'm not sure that at the beginning of the negotiation we were aware of the scope of what we had to agree on, and that's why experts were very useful. So to be clear, we had to make a distinction between what was the formal negotiation between diplomats or at least representative of member states, and informal discussions with experts to try to understand because we have to be clear, it was a very complex negotiation because some public health issues were very complex and they are still very complex, uh, in addition to the scope, which was broader and broader. So it was not easy to bring together in the same room public health experts and diplomats to discuss and to have the same language, but to be clear about the distinction about the two kinds of discussions we need, which are complementary, help us to say, okay, we have an informal discussion to try to have the same understanding of what is at stake and the constraints on what is feasible, and then we will go to the formal negotiation to finalize the text. And this distinction was always used, uh, and we had formal negotiation and informal discussions, and even in the work plan, when we had session in Geneva, we included this distinction in the work plan. And it was very powerful. And the last point is that every day, every morning, we started the negotiation with the stakeholders, NGOs, public health sector, um uh private sector, industries, and so on, also to listen to everybody. Because stakeholders are involved and they needed to be involved when we talk about intellectual property, when we talk about something else. Of course, the industries they need to give their position. And we the NGOs, they need to give their position. So we were very clear about the distinction between the different types of discussions to make sure that we can listen to everybody.
SPEAKER_00So in in that process, though, to reach an agreement, did you feel that sometimes you had to compromise on wording and uh sort of to make sure that sort of that deal is reached, uh rather than saying, okay, let's prep postpone for another six months or a year and discuss more. How how did you at what what point you felt that okay, I think we're there, even though some not everything was perfect? When was that moment?
SPEAKER_02Oh, that's a good question. I'm not sure that for every issue it was the same moment, I would say. Because we had different sessions and uh different issues, and sometimes one issue was ready, we could find a compromise, for another one it was not, and we had to admit that and to deal with that. But to be clear, it it was a multilateral negotiation, so that means that we need a compromise, and as every multilateral uh negotiation, we start with countries' initial positions, which are usually very different, divergent, and even opposed. That's the beginning of the negotiation. Uh so of course our job is to bring together a closer and to get the parties to agree to move away from the initial positions. That's the first step. But usually you know, when we um have delegations sticking to the initial position sometimes, again, it's because they don't have the same understanding of what is at stake, what is feasible, and of the constraints of the other parties. That's why the informal discussions are very important. Just to ask very informally, okay, what is important for you? What can you accept and what can you accept? And why? And we can work on a compromise. So sometimes people argue that that will weaken uh the agreement at the uh at the end because it's a compromise. Yes, of course, it's a compromise, it's not perfect, but it's better to have something which is maybe less ambitious than the initial wish than nothing. Because after that, we can build on that. And we we were as a bureau of the INB because I was a co-chair, but I was not alone, it's a it was a teamwork. Um we were very clear, okay. That will not be perfect, we know that, and that will not be the solution for every health issue. We have to be clear, but at least let's try to provide tools and response for the next pandemic and we will build on it. And you know, when we have a multilateral negotiation, at the end of the negotiation, we need to have everybody disappointed. If it's not the case, that means that the agreement is not balanced. And if an agreement is not balanced, it can't survive because it's quickly withdrawn by the parties that lost out. So that was the reflection we try to have. So it was not perfect, definitely. But at least we have something and we can build on it. And I think that everybody in the room at the end was aware of that. And that makes made it possible at the end.
SPEAKER_00Mm-hmm. So Leah, um one important part of the agreement, which is an annex, uh, is still not finished. I mean, as we record this, it's still in the process of being discussed through again an intergovernmental working group established for that. It's focusing on how countries share the the actual samples of viruses and how they benefit from it. Um there's a push to finish it done by the end of this year, hopefully. What do you think has to happen to really truly help that the treaty helps not to have the similar situation we had with COVID when some countries were left behind in terms of the vaccine distribution, etc.? How do you see the last part of the agreement be resolved?
SPEAKER_01It's not an easy question. But first I think we all agree that we have uh come a long way in terms of having the pandemic treaty in place and uh uh uh uh having that resolution. But I the the pubs, um although we call it annex, it's really a foundational piece for the pandemic treaty to make a difference. Um and and yes, the negotiations are still ongoing, and um what what I really hope for this um to come out for the for the pandemic treaty really to come out strong and uh the uh uh the PAPS to be concluded, one would be, I think uh how Anne-Claire was mentioning in terms of the different uh sides of uh the ideas that we all have, having a shift in that mindset, I think, would be critical uh because we are not really on different sides. We are all in the same side of uh having a collective commitment to ensure the collective protection and preparedness of all of all nations. So I think that that uh would be key and also uh uh really listening to each other more uh in addition to trying to convince uh the position to the other side. I think the heart, at the heart of it is really um for leaders to listen to each other so that we can come out different from the status quo of where we were before the pandemic or during the pandemic. Um and I think there are, well, we we don't have to go into all the technical details of the pubs, but uh it needs to come out having a transparent system, especially for the pathogen access, and then the the benefit sharing to be really having meaningful commitments that would make a difference. Uh, but also having uh a clear way of how it would be operationalized, because um that's really fundamental of having a clear uh operationalization and in a way that can align with what we already agreed upon in the in the treaty, in the treaty itself. And and this is not just for pandemic during pandemic, uh, when pandemics happen, but also when public health emergencies of international concern, which are more frequent, happen and during inter-pandemic times where we need to really work collectively on building country capacities uh um uh across the board. And and I think especially when you think of the the next step that's required for uh uh after the PAPS is is finalized, countries need to ratify this to make it practical. And that requires clarity of each of the instrument, really clarity, and then especially on the uh the governance operationalization of it, and also the legal certainty of it for countries' parliaments to be easily ratified or confidently ratified into action. And I hope that we really don't miss this window of opportunity because window of opportunities like this for global health may not come frequently and may close. So I'm I'm hoping this will be finalized very soon.
SPEAKER_00And Claire, how do you feel about the unfinished agreement and where it's going?
SPEAKER_02Well, of course, I would like to have it finalized very soon, because as it was mentioned by Leah, without that annex, the Panic Agreement cannot be implemented. I think it's quite risky to have a too long negotiation because that means that we will lose diplomats and public health experts who were involved at the very beginning. And I think that what we need is the memory of the negotiation. Because I could see in the room, even you know, um uh last week, that with new delegates they wanted to reopen everything and to negotiate a new pandemic agreement. And that's normal, but that's risky. So that's why I hope we will be able to finish everything on the basis of what we have already discussed, negotiated, and agreed on. To make sure that what we we will have and we will achieve what we call during the negotiation the package. The pandemic agreement and the annex. We wanted it as a package because we understood that it was very, very important for delegations. And we we we we we understood that, and I think we uh it was consensual. Um of course there are still um uh I would say initial positions regarding the annex, even if we move forward, but again, the issues are very, very complex, and I think that all the delegations discovered the complexity of the different issues. We need to keep this political momentum I mentioned uh earlier.
SPEAKER_00Let's hope for that. Leah, you're not at the moment doing this, but observing the process from outside. Do you feel that let's say when you have an Ebola outbreak in Africa at the moment, in few countries involved, does that you think help reach consensus and finish the unfinished business? Or does it have any effect at all, you think?
SPEAKER_01We are looking at practically the the continued series of uh uh challenges we're facing, emergencies. Um I do believe it will it will help actually accelerate and and also see the context that it we need to um uh see with the lens of not just pandemic but also um uh emergencies that happen of international concern. Uh in a way it may also have its own impact of slowing down because there are the the there's a shift in in uh focus and so on. But I I do hope those kinds of emergencies when they are happening and you see that the system needs more, it actually keeps us going in in that momentum of really finishing this and coming out better.
SPEAKER_00Thanks for that. Anne-Claire, can I go back to our initial question in terms of how you ended up doing this kind of work and and really no training really prepares you for it in a way? Uh something you expressed in the beginning. Going through this process, are there any particular things that you've learned while sitting around the table? And you now feel that that experience enriched uh your in a way, you said, accidental uh kind of uh entry into this world. And what are they?
SPEAKER_02Well, um that's true. First, I learned a lot. Um, because as I told you, I didn't have a background in diplomacy. Uh so this environment of multilateral negotiations was unfamiliar to me, so I had to learn on the job and understand the rules of the multilateral negotiation first. And thanks to the support of my fellow diplomats, whom I would like to thank, uh I could do it. On the other hand, um actually I was surprised to find that um my negotiation with flex had come back to me because I had a lot of negotiations, but in a very different context. It was a context of social dialogue. And even though the environment on the issues at stake are very different, actually I was very surprised to see that the reflex are almost the same. And that I think it helped me uh a lot actually. Um and uh funny, I think I have have learned to to be patient and to accept that we didn't succeed, succeed this this time around, but that time that uh with time communication and listening to one another, we will surely succeed next time. So it was a mix of frustration and determination that keeps keep us believing in it until the very end. And let me remind you that we didn't finish until the end of the night, actually. And the last point, we it was said that there was a lack of trust, especially between delegations, between the bureau and delegations, and I I think it was true, unfortunately. But I said I will place my trust in the delegations because I knew that everyone wanted the agreement. I knew that everybody told me informally in bilateral that everybody wanted this agreement. And I have one example I cannot tell you everything because there are still some issues which are confidential for geopolitical reasons. But two delegations who had high geopolitical tensions didn't agree on one provision in the pandemic agreement. And I thought it was maybe 6 a.m. in the during the night, that okay, we will not make it because they can't agree. And after a break, 20 minutes later, they came and they said, Oh, we have an agreement. I thought it was a joke, to be clear. No, they found an agreement and I said well it's fine. So it's regarding my very my personality, it was very strange for me to trust people I knew they couldn't agree on something, and they did, and I have learned a lot. It's not something that you can learn at school, definitely, but with experience and with dialogue with uh the delegations, and uh actually I I would like to thank, I've already said that, but I would like to thank the delegation for their trust, uh the secretariat, the director general of the WHO for their trust and support on the INB Bureau for the engagement, because it was not an easy job. I think after two years or one year, that nobody was ready for this multilateral negotiation for many reasons, but it was a teamwork and we did it. So now we have to formalize everything, and even as it was said by Leah, uh it's it's um it's necessary to have this annex with even if it is very, very complex. So just in a nutshell, I think that for this kind of mission, I would say, or job, we cannot learn everything at school. But we need to trust people. And especially when it is said that there is a lack of trust, it's your responsibility of your of coach to trust people and to showcase that you will trust people. Uh and I think it was very useful, and it can be very useful for any negotiation tactic.
SPEAKER_00That's very interesting reflection. Thanks for sharing that, uh, Anne-Claire. Leah Anne-Claire said that no school will prepare you for this, but I'm gonna ask you, because you are now leading a program at Harvard University that brings health ministers together to build exactly some of these skills, right? Why is that kind of support really needed? And clearly a lot is going to be learned in the room, like uh Anclair explained, uh, and how things actually work out. What does a strong team around these health leaders actually look like? What kinds of skills do they need? And what are you trying to achieve with your own?
SPEAKER_01I definitely agree with Anclair that a lot is learned on the ground. Uh so you you any anyone in that role, especially for ministers who don't get trained for it, and uh a lot is trained, uh learned on the ground. But the the Harvard Ministerial Leadership Program is uh a program that tries to at least support ministers, kind of play a catalytic role in supporting them, uh uh deliver on transformative uh changes that they are in that they have uh set out to. So um we we bring ministers uh for a few days at Harvard, but we also engage with them uh uh virtually uh for a longer time for those who are in office. So it's not focused only on health ministers, it's in different sectors. Uh, but it's really to help them uh uh deliver better and be transformative in their tenure. Having a strong core team is actually a topic that we spend a lot of time on uh during our program because that's really critical for be it delivering on your transformative goal that you have set out as minister, but also in such kind of international uh um deliberations. And not just a strong team, but also a diverse team with different uh capabilities. Um ministers need a diplomat strategist and a political navigator as much as they need a data analyst or a public health expert to really um uh uh bring strong analysis, context-relevant linkage between national regional priorities for with global ones. Uh uh these are really key. And also working multisectorally, uh, bringing experts from uh diverse sectors, like I said earlier, Ministry of Foreign and the Foreign Affairs, to get international law experts because you really may not have them in your ministry. So, really seeking for a strong multisectoral collaboration to deliver on uh bigger agenda and public health and emergency preparedness is not a health-only issue. It's a multisectoral issue which requires really strong uh coordination. And uh those kinds of um teams who uh understand geopolitical dynamics and implications, who can read the room in during negotiations and know how and when to intervene, because the dynamics of negotiations always depends on who is at the negotiating table and um having strong teams that support countries ministers is really key in those regards, but also in deliver in being able to deliver in any of their uh priorities, uh it all depends about having a strong team.
SPEAKER_00Just to close our conversation, um we have many types of listeners, and if a health leader is listening, takes away just one approach or one uh tip uh for building cooperation across different groups with a lot of differences. What would you want it to be? What would that tip or that approach you'd want to leave them with? And Claire, maybe you can give yours and then followed by Leah.
SPEAKER_02Um it's not an easy question, definitely, but maybe maybe two aspects. First, negotiation and cooperation are not a solitary endeavor. We must rely on others and we and we have to try them first. Furthermore, I believe that public health concerns must always take a precedence. If political or geopolitical considerations cause disruptions, I think that we we must return to science and public health and to put public health and health security at the center. I think that it is what the public experts and a capable policy maker will listen to, and it is what uh I think our population will expect. And just as a health leader or as a diplomat in the health sector, I think it is very important to keep it in mind.
SPEAKER_00Thank you for that. Leah, what are your tips or one one aspect?
SPEAKER_01Uh well, I think um, as Anclair said, collective responsibility of for public health is really key. Um, but my message for health readers, particularly, is when we are in such uh challenging decision uh in in spaces which require challenging decisions, taking time to connect and listen to as many stakeholders as possible. And really to seek to understand the different perspectives is really key, the different positions and even the fears and concerns of uh uh different uh uh players and stakeholders, because this is key to build trust and then to narrow the gap in finding common ground uh for a win-win solution for all of us. And I think that will help us balance those uh either sovereignty or but with the protection of global public ends, but really seeking to understand to come to a common ground is key.
SPEAKER_00Leah and uh Claire, thanks so much for finding time today and share this time with our listeners and sharing your thoughts and insights into very complex issues and very complex processes going on. I really wish you the best for the future endeavors and for this whole process for the best of the global health for the world.
SPEAKER_02Thank you very much. Thank you, Anne-Claire.
SPEAKER_00I found today's conversation with Anclaire and Leah candid and inspiring. Some reflections stay with me. First, when politics threatens to pull a negotiation apart, the way through it is to return to the shared objective, people's health. As Anne Claire reminded us, health security is a component of peace. Second, influence is not about the size of your delegation. By working as one group and pulling experts across 47 countries, the Africa Group turned limited capacity into real influence. And finally, cooperation is a craft built on trust. A balanced agreement leaves everyone a little disappointed, but it becomes a solid foundation to build upon in the future. These are skills no school can teach, but they can be learned. I hope this episode strengthened your resolve to build cooperation across differences in your own work. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcasts. Global Health Matters is produced by TDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
