Turning international agreements into actual medicine in actual arms
In Istanbul, eighty-five representatives from thirty organizations gathered under the banner of WHO's interim Medical Countermeasures Network to confront a truth the last pandemic made undeniable: the world knows how to develop vaccines, diagnostics, and treatments, but has not yet learned how to share them equitably when it matters most. The meeting was neither a summit nor a celebration, but a working session — a collective attempt to close the distance between international commitment and medicine in human hands. With 1.6 million mpox doses already delivered to thirteen countries as proof of concept, the network is now pressing toward twenty concrete actions over the next twelve months, knowing that the architecture built in peacetime determines who survives the next emergency.
- The last pandemic exposed a brutal gap between global health agreements and the reality of who receives vaccines, diagnostics, and treatments — and that gap remains largely unrepaired.
- Fragile manufacturing in low-income countries, fragmented procurement systems, and chronically underfunded therapeutics create a chain of vulnerabilities that any new pathogen can exploit.
- Over 1.6 million mpox vaccine doses delivered to thirteen countries demonstrate that coordinated multilateral action can move medicine across borders — but the system is not yet reliable or fast enough.
- Partners are pursuing regional production capacity, bundled procurement models, and a 'viral family' approach to R&D that anticipates future threats rather than reacting to each one in isolation.
- Twenty priority actions over twelve months now serve as the network's operational test — a measurable commitment made while the WHO Pandemic Agreement's critical provisions remain under negotiation.
In late September, eighty-five people from thirty organizations — UN agencies, regional bodies, academic institutions, private companies, and civil society groups — gathered in Istanbul for the third annual meeting of WHO's interim Medical Countermeasures Network. The occasion carried quiet weight: the last pandemic had shown, in painful detail, how poorly the world distributes vaccines, diagnostics, and treatments when speed and equity matter most.
The network's most tangible achievement offered both encouragement and a baseline. Through the mpox Access and Allocation Mechanism, i-MCM-Net has delivered more than 1.6 million vaccine doses to thirteen countries — evidence that international collaboration can translate into medicine in actual arms. WHO's Maria Van Kerkhove described it as collaboration becoming country impact. The network exists so that the next emergency is met with coordination rather than chaos.
Yet Istanbul also mapped what remains broken. Vaccine manufacturing in low- and middle-income countries is fragile, with few facilities meeting WHO prequalification standards. Diagnostic procurement is fragmented across regions. Therapeutics attract limited investment because the market is small and unpredictable. These are not abstract vulnerabilities — they mean delays, inequity, and countries left waiting.
The proposed remedies are neither simple nor swift. Regional manufacturing requires political will, technology transfer, and predictable financing. Procurement systems need integration and collective bargaining power. Research must shift toward platform approaches that address families of pathogens rather than each new threat in isolation. Financing must blend public and private capital, with community engagement to sustain trust.
The meeting closed not with declarations but with commitments: twenty priority actions to be completed over the next twelve months, woven into a joint operational plan. The broader WHO Pandemic Agreement remains under negotiation, leaving i-MCM-Net as the interim mechanism where promises are tested against reality. Whether the next outbreak finds the world better prepared may depend on whether these twenty actions were finished, whether regional capacity was built, and whether the distance between agreement and delivery was finally closed.
In late September, representatives from across the global health system gathered in Istanbul for a quiet but consequential meeting. Eighty-five people from thirty organizations—UN agencies, regional bodies, academic institutions, private companies, and civil society groups—spent two days in rooms at the WHO's interim Medical Countermeasures Network, or i-MCM-Net, discussing how the world might do better the next time a pathogen spreads. The meeting, held from September 30 to October 1, was the network's third annual convening, and it carried an implicit weight: the last pandemic exposed how poorly the world distributes vaccines, diagnostics, and treatments when speed and equity matter most.
The concrete evidence of what the network has already accomplished sits in a single statistic. Through the mpox Access and Allocation Mechanism, the i-MCM-Net has delivered more than 1.6 million vaccine doses to thirteen countries. That number represents something the global health system has historically struggled with—turning international agreements into actual medicine in actual arms. Maria Van Kerkhove, the WHO's acting director of epidemic and pandemic management, framed it plainly: this is how collaboration becomes country impact. The network exists to ensure that when the next emergency arrives, the response is not a scramble but a coordinated deployment.
Yet the Istanbul meeting revealed how much remains broken. Participants identified three persistent vulnerabilities. Vaccine manufacturing capacity in low- and middle-income countries remains fragile, with few facilities meeting WHO prequalification standards. The financing is uncertain. Diagnostic procurement systems are fragmented across regions, creating inefficiencies and gaps in coverage. Therapeutics attract limited investment because the market for them is unpredictable and small. These are not abstract problems. They translate into delays, inequitable access, and countries left waiting while others receive supplies.
The solutions discussed were neither simple nor quick. Building regional manufacturing capacity requires political will, predictable demand signals, a trained workforce, and mechanisms to transfer technology from wealthy nations to poorer ones. Procurement systems need integration—bundled purchasing models that give countries collective bargaining power and reduce costs. Research and development needs to shift toward a "viral family approach," developing treatments and vaccines that work across related pathogens rather than waiting for each new threat to emerge. Financing models need to blend public and private money, with transparency and community engagement to maintain public trust.
Regional expertise matters more than global coordination alone. The meeting emphasized that countries in Africa, Southeast Asia, the Eastern Mediterranean, and other regions understand their own needs better than distant headquarters. When regional voices shape global strategy, the result is more durable and more locally rooted. The same applies to supply chains: integrated systems with shared data and early government involvement minimize delays and ensure continuity when crisis hits.
The meeting concluded not with declarations but with commitments. Partners agreed to advance twenty priority actions over the next twelve months. These will be woven into an operational plan developed jointly by the i-MCM-Net Secretariat and its partners. The focus is narrow and practical: strengthen collaboration across the entire chain from research through manufacturing to delivery. Make sure innovations in vaccines, diagnostics, and therapeutics actually reach the people who need them.
The larger context is a WHO Pandemic Agreement still under negotiation among member states, with a critical annex on pathogen access and benefit-sharing still being debated. Until that agreement enters force, the i-MCM-Net functions as the interim mechanism—the place where commitments are tested and translated into action. The Istanbul meeting was a checkpoint: evidence that the network is working, acknowledgment of what still needs fixing, and a roadmap for the next twelve months. When the next pathogen emerges, the difference between a coordinated response and a chaotic one may depend on whether these twenty actions were completed, whether regional capacity was built, and whether the world learned to move faster than the virus.
Citações Notáveis
This is a demonstration of how i-MCM-Net facilitates strong global collaborations into concrete country impact.— Maria Van Kerkhove, WHO Director a.i., Epidemic and Pandemic Management Department
A Conversa do Hearth Outra perspectiva sobre a história
Why does a network like this need to exist at all? Shouldn't countries just cooperate when there's a crisis?
They should, but they don't. The mpox response showed us that. When a vaccine is scarce, countries hoard. When there's no shared procurement system, prices spike and some nations can't afford doses. The network creates infrastructure before the crisis, so cooperation is already built in.
What's the biggest obstacle right now?
Manufacturing. Most vaccine production happens in a handful of wealthy countries. If you're in Africa or Southeast Asia and need doses fast, you're dependent on shipments from overseas. Building local capacity takes years and money, but without it, equity is impossible.
The meeting identified twenty priority actions. What does that actually mean in practice?
It means specific, measurable work. Technology transfer agreements with manufacturers. Regulatory harmonization so a vaccine approved in one region doesn't need separate approval in another. Pooled procurement contracts that give smaller countries negotiating power. These aren't grand gestures—they're the unglamorous infrastructure that makes distribution work.
Why focus on a "viral family approach" for research?
Because we can't develop a new drug from scratch every time a new virus appears. If you understand how a family of viruses works—say, all the coronaviruses—you can develop treatments that work across multiple members of that family. You build the knowledge before you need it.
Is there a risk that this network becomes just another talking shop?
That's the real test. They've already delivered 1.6 million mpox doses, so it's not purely theoretical. But the next twelve months matter. If those twenty actions get done, if regional capacity actually increases, if the next crisis shows faster response—then it's real. If nothing changes, it's just meetings.