Five years after the onset of COVID-19, significant gaps persist between high-income nations and Global South countries regarding equitable access to vaccines, diagnostics, and health technology transfer. A second reckoning, three years after the first This September's gathering will be the second UN General Assembly High-Level Meeting dedicated to pandemic readiness, following the first in 2023. It was formally set in motion by a resolution co-facilitated by Vietnam's Ambassador Do Hung Viet and Chile's Ambassador Paula Narváez, and will convene under the theme of fostering "a multilateral and intergenerational approach" to preventing, preparing for, and responding to pandemics and public health emergencies — grounded, organizers say, in equity and solidarity. Unlike a routine side event, the meeting is expected to produce a new Political Declaration on Pandemic Prevention, Preparedness and Response, building on the 2023 declaration and reflecting lessons from the WHO Pandemic Agreement adopted in May 2025. Heads of State and Government are being urged to attend in person rather than send lower-level delegations, with advocacy groups framing the meeting as a "whole-of-government and whole-of-society" moment rather than a technical health-sector affair. Civil society, academic institutions, and private-sector organizations not already in consultative status with the UN Economic and Social Council were required to register for special accreditation through the UN's Civil Society Platform, with registration for the preparatory multi-stakeholder hearing closing in mid-May 2026 — part of a broader push by the President of the General Assembly to widen participation beyond government delegations. The unfinished business of the Pandemic Agreement Looming over the September meeting is the unresolved status of the WHO Pandemic Agreement itself. Although the World Health Assembly adopted the framework in May 2025, the agreement cannot yet be signed or ratified by any country. That is because its most contentious component — the Pathogen Access and Benefit-Sharing (PABS) annex, which will define how genetic sequence data and outbreak samples are shared globally, and how resulting vaccines, therapeutics and diagnostics flow back to the countries that supplied them — remains under negotiation. An Intergovernmental Working Group has been meeting through 2026 to hammer out the annex, with a seventh negotiating round held in Geneva in July. But WHO member states have already concluded that a final negotiated outcome will not be ready for adoption until the 80th World Health Assembly in May 2027. Only once that annex is adopted can the Agreement be opened for signature — after which it still requires ratification by at least 60 countries before it enters into force, a threshold analysts say could take years to reach. For African health officials and Global South advocates, the PABS annex is not a technical footnote. It is the mechanism meant to prevent a repeat of what happened during COVID-19, when, according to Africa CDC's own account, fewer than 0.5% of more than 7 billion vaccine doses administered worldwide by November 2021 had gone to low-income countries — a consequence of wealthy nations' advance-purchase agreements and stockpiling that left the continent at the back of the queue despite contributing genomic data that helped the world track the virus's spread. Notably, the United States did not participate in the final round of negotiations that produced the 2025 Pandemic Agreement, having announced in January 2025 its withdrawal from the World Health Organization — meaning Washington will not be bound by the pact regardless of how the annex negotiations conclude. That absence is expected to shape the diplomatic tenor of September's High-Level Meeting, as other major donors and negotiating blocs recalibrate around a shrinking pool of traditional funders. Africa's manufacturing push, and its limits If the 2023 meeting was about diagnosing the inequities exposed by COVID-19, the 2026 meeting arrives as African institutions attempt to engineer their way out of dependency. The African Union and Africa CDC have set a target of manufacturing 60% of the vaccines the continent needs by 2040, up from a base of essentially zero domestic production during the pandemic. There are signs of momentum. Egypt became the first African country to reach the WHO's Maturity Level 3 regulatory rating for medicines and vaccines in December 2024, and has since begun producing insulin domestically. Gavi, the vaccine alliance, is expected to make its first cash disbursements this year to an African manufacturer under its $1.2 billion African Vaccine Manufacturing Accelerator — a milestone that shifts the continental effort from construction into commercialization. South Africa's Biovac has secured backing from the International Finance Corporation, the European Investment Bank and the European Commission for end-to-end manufacturing, and African Union leaders point to roughly $3.2 billion mobilized to date for local production of vaccines, medicines and diagnostics, with the African Development Bank targeting a further $3 billion for upstream research and development through the African Pharmaceutical Technology Foundation. Africa CDC has also been formally accredited as an implementing entity of the Pandemic Fund, giving it direct authority to access and manage international financing for preparedness work rather than routing every dollar through intermediaries — a structural change continental health officials had lobbied for since the fund's 2022 launch. But independent assessments caution against reading too much optimism into the headline numbers. A landscape survey conducted this year by the Clinton Health Access Initiative, in partnership with Africa CDC and NRL Enterprise Solutions, engaged 27 African vaccine manufacturers and found a sector making genuine progress but running into serious headwinds: regulatory delays, uncertain market demand, slow disbursement of committed financing, and stalled technology-transfer agreements with established manufacturers. Analysts also note that most African financing to date has concentrated on downstream "fill-and-finish" capacity — packaging and final production steps — while comparatively little has gone toward the upstream research and development, clinical-trial infrastructure and regulatory science that would let the continent design its own vaccines rather than package others'. Africa's overall research and development spending remains around 0.5% of GDP, against a global average of roughly 2.2%. What to watch in September The High-Level Meeting on PPPR is scheduled to convene during UNGA's High-Level Week, running from September 19 to 29, alongside a dense calendar of side events. Among them, the Pandemic Fund and Foreign Policy magazine are convening a session on September 23 at Rockefeller Center examining how countries are pairing domestic investment with catalytic international financing to close preparedness gaps — one indicator of how the financing conversation is shifting toward burden-sharing between governments and donors rather than donor-led response alone. For journalists, diplomats and public health officials converging on New York, three threads are likely to define whether the meeting is judged a success or another missed opportunity: whether the new Political Declaration contains enforceable commitments rather than aspirational language; whether major donor governments — several already retrenching on foreign aid budgets — put new money behind the Pandemic Fund and African manufacturing efforts; and whether the PABS annex negotiations, still unresolved and now pushed to 2027, retain enough political momentum to survive the gap between promise and ratification. Arozi Health Media will be reporting from UNGA 81 in September, with continuing coverage of the High-Level Meeting on Pandemic Prevention, Preparedness and Response and its implications for Kenya and the wider region. _Sources: United Nations Civil Society platform; UN General Assembly resolution A/79/333; World Health Organization; Coalition for Epidemic Preparedness Innovations (CEPI); Africa CDC; Clinton Health Access Initiative; Gavi, the Vaccine Alliance; Health Policy Watch; Geneva Graduate Institute Global Health Centre; Foreign Policy/Pandemic Fund event listing; New African Magazine; Semafor._