What Pakistan Should Carry to the September High-Level Meeting

On Friday 25th September 2026 the President of the General Assembly convenes the second high-level meeting on pandemic prevention, preparedness and response at United Nations Headquarters in New York. It sits under General Assembly resolution 79/333 of 8th September 2025; its theme is “Fostering a multilateral and intergenerational approach to prevent, prepare for and respond to pandemics and public health emergencies, through the principles of equity and solidarity”; and the concept note issued by the President of the General Assembly states in one line what the day is for, which is that the meeting “will review the implementation” of the high-level political declaration of 2023.

That word governs everything a delegation does. A review of implementation does not ask a country what it intends; it asks what the country has done since 20th September 2023, when the first such meeting adopted the political declaration that the Assembly took as resolution 78/3 on 5th October 2023. Nor is the declaration of this September written on the day, since the concept note records that it is “agreed in advance by consensus through intergovernmental negotiations”, led by the co-facilitators appointed for that purpose, being the Permanent Representatives of Armenia and of Rwanda. Hence the useful question for Islamabad is not what the Minister will say from the rostrum on the twenty-fifth but what the delegation carries in its hand when it arrives, and there are four things it could carry that would cost the exchequer almost nothing.

First, the designation that is already owed

The amendments of 2024 to the International Health Regulations (2005) came into force on 19th September 2025, and Pakistan has been a State Party since 15th June 2007. Article 4 as amended now reads that each State Party “shall designate or establish, in accordance with its national law and context, one or two entities to serve as National IHR Authority and National IHR Focal Point”, and the new paragraph 1 bis says what the first of those is for: the “National IHR Authority” shall coordinate the implementation of the Regulations within the jurisdiction of the State Party.

These are two different offices and the difference is the whole point of the amendment. A “National IHR Focal Point” is a communications channel, its functions under Article 4(2) being to send urgent communications to the World Health Organization and to disseminate and consolidate information across the administration. A “National IHR Authority” coordinates implementation, which is to say it makes other departments do things. Pakistan has held the first of these for two decades, the National Institutes of Health at Islamabad recording on its own pages that it “is designated as national focal point for National International Health Regulation (IHR) and AMR by Ministry of NHSR&C”. I have found no notification designating the second, and if one exists it has not been published where a practitioner would look for it.

This is not an expensive obligation. Article 4(2 bis) obliges States Parties to take measures to implement paragraphs 1, 1 bis and 2, “including, as appropriate, adjusting their domestic legislative and/or administrative arrangements”, and the phrase “administrative arrangements” is there precisely so that a country need not wait for a statute. A notification in the Gazette of Pakistan naming the “National IHR Authority”, stating which Division it sits in and what it may require of the provinces, could issue this month. A delegation that arrives on the twenty-fifth able to say that Pakistan designated its “National IHR Authority” in September 2026 is reporting implementation. A delegation that arrives without it is reporting an obligation that has been in field for a year and a week.

Second, a delegation that describes the country

The concept note encourages Member States to include in their delegations “ministers from all relevant ministries”, together with parliamentarians, mayors and governors. For most countries that is a courtesy. For Pakistan it is a description of where the powers actually are.

Since the Constitution (Eighteenth Amendment) Act, 2010 abolished the Concurrent Legislative List, public health has been a provincial subject, and almost every measure the September declaration will speak of, being surveillance, isolation, quarantine, hospital capacity and the movement of persons within the country, is exercised under provincial law by provincial officers. A federal delegation may bind the State in international law and cannot by itself deliver a single one of those measures. Since the Federation carries the responsibility while the provinces hold the powers, therefore a Pakistani delegation that contains no provincial health minister is a delegation that misdescribes its own constitutional position to the room, and it will do so in the very session convened to ask whether commitments made in 2023 were carried out.

Third, an implementation record and not a request

Pakistan is in an unusually strong position on the financing limb, and it is not using it. In October 2024 the Pandemic Fund awarded Pakistan USD 18,675,609.63 under its second call for proposals, for a project on pandemic preparedness and response through operationalising the One Health approach, which has drawn a further USD 4.1 million in co-financing and USD 49.7 million in co-investment; the implementing entities are the Asian Development Bank, the Food and Agriculture Organization and the World Health Organization, the Ministry of National Health Services, Regulations and Coordination leads it, the National Institutes of Health hosts the secretariat, and implementation was launched in June 2025.

The second multi-stakeholder panel on the twenty-fifth is to consider how donors, development banks and global health initiatives “better support country-led preparedness and response priorities, while avoiding fragmentation and duplication”. Pakistan can answer that question from experience rather than from theory, and it should. It should also state the weakness in its own arrangement, which a lawyer sees at once: the One Health Units the project creates are administrative creatures of a grant and of a memorandum, and no enactment in field obliges any of them to exist, to meet, or to answer to anybody once the money is spent. A country that reports a large grant is reporting an input. A country that reports the statute which will keep the machinery alive after the grant closes is reporting preparedness.

Fourth, candour about what cannot be promised

The one commitment Pakistan should not offer is the one most likely to be asked of it. The WHO Pandemic Agreement was adopted by resolution WHA78.1 on 20th May 2025, and it does not open for signature until the World Health Assembly adopts the annex on pathogen access and benefit sharing. That annex was not delivered by the deadline of May 2026; the Assembly agreed on 1st May 2026 to extend the negotiations, with a final negotiated outcome to be presented for adoption in May 2027; and the eighth meeting of the Intergovernmental Working Group sits from 14th to 18th September 2026, eleven days before the high-level meeting. Hence no State can sign the Agreement in September 2026, and a pledge to sign it is worth exactly nothing.

What is worth something is a date. Pakistan acceded to the International Health Regulations (2005) and has, nineteen years later, no federal statute transposing them, which is the reason its second Joint External Evaluation, conducted from 15th to 24th May 2023, scored 43 per cent overall, being 121 points of a possible 280, with the indicator on legal instruments for implementation scored at 2 of a possible 5. That is the same overall figure the country scored in 2016. A delegation that carries a drafting timetable for the implementing legislation, with the months in it, is answering the review question; a delegation that carries an intention to ratify is answering a different and easier one.

The limb where Pakistan has something to add

The Lancet carried on 26th March 2026 a piece by Alexandra Finch, Lawrence O. Gostin, Neil M. Vora and their colleagues of the Lancet-PPATS Commission on Prevention of Viral Spillover, “Elevating spillover prevention at the 2026 UN High-Level Meeting on pandemic prevention, preparedness, and response”, pressing that primary prevention be raised in the negotiated text rather than left where the 2023 declaration left it. The concept note has taken part of that up already, listing action “to address the drivers of infectious disease emergence and re-emergence, including through a One Health approach” among the requirements of resolution 79/333.

Pakistan should support that language and has a reason of its own for doing so, since the country’s animal health powers and its human health powers sit in different statutes administered by different governments, and no enactment in field obliges the veterinary officer who confirms a zoonotic disease to tell any health authority anything. A country arguing for spillover prevention in New York while its own two statute books do not speak to each other is arguing for the thing it most needs.

Four items, then: a Gazette notification, a delegation list, an implementation report with its weakness named, and a drafting timetable. None of them requires a rupee of new money, and none of them requires anybody’s consent but Islamabad’s. It is highly recommended that all four are settled before the delegation boards.