Nicole Hassoun, Binghamton University, State University of New York

On March 20, 2025, members of the World Health Organization adopted the world’s first pandemic agreement, following three years of “intensive negotiations launched by governments in response to the devastating impacts of the COVID-19 pandemic.” The U.S., however, did not participate, in part because of its intention to withdraw from the WHO.

Global health experts are hailing the agreement as a historic moment.

What does the agreement mean for the world, and how can it make everyone safer and more prepared for the next pandemic?

The Conversation asked Nicole Hassoun, a professor at Binghamton University and executive director of Global Health Impact, to explain the pandemic accord, its prospects for advancing global health, and the significance of the U.S.’s absence from it.

What will the pandemic agreement do?

The accord will bolster pandemic preparation within individual countries and around the world.

Countries signing onto the agreement are committing to improve their disease surveillance and grow their heath care workforces, strengthen their regulatory systems and invest in research and development. It encourages countries to strengthen their health regulations and infrastructure, improve communication with the public about pandemics and increase funding for preparation and response efforts.

It also includes new mechanisms for producing and distributing vaccines and other essential countermeasures. Finally, it encourages countries to coordinate their responses and share information about infectious diseases and intellectual property so that vaccines and other essential countermeasures can be made available more quickly.

The agreement will take effect once enough countries ratify it, which may take several years.

Why isn’t the US involved?

The Biden administration was broadly supportive of a pandemic agreement and was an active participant in negotiations.

Prior to Donald Trump’s reelection, however, Republican governors had signed a letter opposing the treaty, echoing a conservative think tank’s concerns about U.S. sovereignty.

The U.S. withdrew from negotiations when President Trump signed an executive order to withdraw from the WHO on the day he was inaugurated for his second term.

Why could the lack of US involvement be beneficial for the world?

The lack of U.S. involvement likely resulted in a much more equitable treaty, and it is not clear that countries could have reached an agreement had the U.S. continued to object to key provisions.

It was only once the U.S. withdrew from the negotiations that an agreement was reached. The U.S. and several other wealthy countries were concerned with protecting their pharmaceutical industry’s profits and resisted efforts aimed at convincing pharmaceutical companies to share the knowledge, data and intellectual property needed for producing new vaccines and other essential countermeasures.

Other negotiators sought greater access to vaccines and other treatments during a pandemic for poorer countries, which often rely on patented technologies from global pharmaceutical companies.

While most people in wealthy countries had access to COVID-19 vaccines as early as 2021, many people in developing countries had to wait years for vaccines.

How could the agreement broaden access for treatments?

One of the contentious issues in the pandemic agreement has to do with how many vaccines manufacturers in each country must share in exchange for access to genetic sequences to emerging infectious diseases. Countries are still negotiating a system for sharing the genetic information on pathogens in return for access to vaccines themselves. It is important that researchers can get these sequences to make vaccines. And, of course, people need access to the vaccines once they are developed.

Still, there are many more promising aspects of the agreement for which no further negotiations are necessary. For instance, the agreement will increase global vaccine supply by increasing manufacturing around the world.

The agreement also specifies that countries and the WHO should work together to create a mechanism for fairly sharing the intellectual property, data and knowledge needed to produce vaccines and other essential health products. If financing for new innovation requires equitable access to the new technologies that are developed, many people in poor countries may get access to vaccines much more quickly in the next pandemic. The agreement also encourages individual countries to offer sufficient incentives for pharmaceutical companies to extend access to developing countries.

If countries implement these changes, that will benefit people in rich countries as well as poor ones. A more equitable distribution of vaccines can contain the spread of disease, saving millions of lives.

What more should be done, and does the US have a role to play?

In my view, the best way to protect public health moving forward is for countries to sign on to the agreement and devote more resources to global health initiatives. This is particularly important given declining investment and participation in the WHO and the contraction of other international health initiatives, such as USAID.

Without international coordination, it will become harder to catch and address problems early enough to prevent epidemics from becoming pandemics.

It will also be imperative for member countries to provide funding to support the agreement’s goals and secure the innovation and access to new technologies. This requires building the basic health infrastructure to ensure shots can get into people’s arms.

Nicole Hassoun, Professor of Philosophy, Binghamton University, State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kelly S. Mix, University of Maryland

Science funding is a hot topic these days and people have questions about how grants work. Who decides whether a researcher will receive funds? What’s the decision-making process? How is the money spent once a grant proposal has been approved?

As a veteran academic researcher, department chairperson and associate dean for research, I have seen this process play out from multiple perspectives – as a grant recipient, grant reviewer and university administrator.

Research organizations and major federal funders, including the National Institutes of Health, the National Science Foundation and the Defense Advanced Research Projects Agency (DARPA), all rely on careful systems of checks and balances to ensure high standards of scholarship and financial integrity at every stage of a grant’s lifecycle. Here’s how it all works.

The birth of a grant application

To receive research funding, scientists submit grant applications to specific programs. A cancer researcher might apply to the Bioengineering Research Grants program at NIH. Someone investigating sustainable fishing in freshwater habitats could seek funding from the Population and Community Ecology program at the NSF.

Applications must be responsive to the funding program’s specific request for proposals, or RFP. The RFP tells researchers what the agency wants to fund. For example, the NSF’s Education Core Research program currently only funds projects focused on STEM learning.

RFPs might have other application requirements, too, like explaining how a project will contribute to the public good, or supporting training for new scientists.

Grant applications have two main parts. First, the researcher presents an extensive literature review to explain why the new project is needed and what it will add to the existing knowledge base. Next, they write up a detailed description of the proposed research plan. This basic two-part structure ensures that funded research will yield important information that is both new and trustworthy.

Reviewers read the grant applications and compare them to the RFP. Applications that don’t address all the topics and research priorities listed there are unlikely to be funded. I once had a proposal rejected without further review because I left out a paragraph addressing one of the items in the agency’s new RFP. This initial review for RFP compliance is called “triage” and, believe me, nobody wants to see their hard work triaged out of the running.

Merit review: How funding decisions are made

Federal funding decisions are made through rigorous merit review.

For each round of funding, agencies assemble a panel of anonymous content experts who will look for strengths and weaknesses in the proposals – anything from innovation in the question posed to logical flaws in the hypotheses or technical problems with the planned data analyses. With a group of experts looking for every possible weakness, having your grant reviewed is a bit like running a gauntlet.

This careful review might help explain why 70% to 80% of grant applications typically go unfunded at agencies like the NIH and the NSF. But this level of scrutiny is necessary to prevent funding poorly designed or low-impact research.

Several safeguards head off bias or unethical influences during merit review.

First, reviewers must disclose any conflicts of interest with the pool of applicants before they can access the applications. Conflicts of interest can include situations like the reviewer having been the student of an applicant, the applicant and reviewer being divorced, or the proposal coming from the reviewer’s current institution.

When conflicts are identified, the reviewer can remain on the panel, but they are completely excluded from decisions related to that application. They cannot even be in the room when it is discussed.

Second, reviewers usually attend a meeting, supervised by program staff from the funding agency, where everyone debates the proposal’s merits before they score it. Sometimes panel members disagree in their initial critiques and use the meeting to hash out their differences. Other times, a reviewer might raise an important concern that others missed.

Group discussion helps ensure a transparent and thorough review. It also stops any single reviewer from dictating the fate of a proposal because everyone hears the discussion and then scores the proposal individually. Whether a reviewer thinks an application is outstanding or fatally flawed, they must convince the rest of the experts in the room for the group’s overall scores to be greatly affected.

Third, these discussions, along with the applications themselves and any written critiques, are strictly confidential. Reviewers sign written confidentiality agreements under penalty of perjury. This practice stops panelists from scoring political points by telling an applicant they defended their proposal, or divulging trade secrets and proprietary information.

Following the meeting, final decisions are made by program staff using the reviewers’ evaluations. Some agencies adhere closely to the reviewers’ numeric scores – like a grade – when making these decisions. Others ask reviewers to sort applications into “fundable” or “non-fundable” piles; program staff then have some discretion on the final decision. But all decisions are rooted in the peer critiques.

Spending the funds

Headlines about universities receiving large grants may leave the impression that such funds are simply added to the institution’s general coffers. But research funds are granted to support specific research projects, and agencies have strict rules about spending the money.

For example, if a researcher wants to present their findings at a conference, they can charge the grant for their travel costs, but they may not charge above a certain amount for their lodging or purchase business class airplane tickets. Similarly, if a researcher wants to have more time to devote to a funded project, they can use part of the money to pay their own salary in the summer, but there are precise limits on the amount of funding that can be used for this purpose.

It’s not up to the researcher alone to follow these rules. The organization that employs the researcher, usually a university, enforces the agency rules because it’s the employing organization that controls the grant accounts.

Returning to the conference travel example, a university researcher who wants to attend a conference must request permission and provide a budget for the trip before purchasing tickets. If the travel request is approved by their department chair, dean and the university travel office, they may go ahead with their reservations. However, if they don’t produce receipts when they return, they will not be allowed to charge the grant. The same process applies to buying new computers for the lab, ordering standardized tests for a study or purchasing gift cards for study participants.

Research organizations are highly motivated to enforce spending rules properly, because everyone in the organization is at risk of losing access to federal funds in the future if they let things slide. Funding agencies also require periodic reports and sometimes conduct audits to ensure compliance. These practices help guard against any misuse of funds.

The way agencies issue grants to researchers isn’t perfect. But processes like issuing detailed RFPs, conducting merit reviews and monitoring financial compliance go a long way toward protecting the integrity of the research funding process.

Kelly S. Mix, Associate Dean for Research, Innovation, and Partnerships in the College of Education, University of Maryland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Jason P. Joseph, University of Florida

Former President Joe Biden has been diagnosed with an “aggressive” form of prostate cancer that has spread to his bones. But what does it mean for this type of cancer to be called aggressive?

As a urologic surgeon who specializes in diagnosing and treating prostate cancer, I often explain to my patients that aggressiveness isn’t based on a single factor. Instead, it comes from understanding how abnormal the cancer cells look, known as the tumor’s grade; how far they’ve spread, known as the tumor’s stage; and their genetic fingerprint.

Grade: Decoding cancer cell appearance

One key piece of the puzzle is the cancer’s grade, which indicates the tumor’s potential to grow. After a prostate biopsy, a doctor specializing in examining tissues – a pathologist – grades the tumor by comparing the appearance of its cancer cells with that of normal prostate cells.

Imagine healthy prostate cells as organized workers in a factory, each performing specific tasks. In contrast, high-grade cancer cells appear chaotic, growing and dividing rapidly.

For prostate cancer, doctors use what are called grade groups that range from 1 (least aggressive) to 5 (most aggressive). These groups are a simplification based on an older classification called a Gleason score. Biden’s Gleason 9 cancer falls into grade group 5, indicating the cells appear extremely abnormal with a strong potential for rapid growth and spread.

While the cancer’s grade helps indicate how tumor cells might behave, it doesn’t tell the whole story. Some high-grade cancers can remain confined to the prostate for months or even years.

To understand where the cancer is and how far it has advanced, doctors determine its stage.

Stage: Mapping cancer location and spread

A tumor’s stage describes if, and how far, cancer has spread beyond where it first formed. Doctors use physical exams, imaging scans and lab tests to stage prostate cancer.

Medical professionals usually use a detailed system called TNM – short for tumor, nodes, metastasis – to classify a tumor’s stage. But prostate cancer stage can be broadly understood as:

• Localized (stages 1-2): The cancer is only within the prostate. Think of a weed confined to a small garden bed. Many localized cancers, particularly if low-grade, may not be deemed aggressive and can often be safely monitored.

• Locally advanced (Stage 3): The cancer has spread out from the prostate and is growing in very nearby tissues, like a weed sending roots into the surrounding lawn.

• Metastatic (Stage 4): The cancer has spread to distant parts of the body. For prostate cancer, this often means lymph nodes, bones – as in Biden’s case – liver or lungs. This is like the weeds spreading seeds down the street and across town.

A Stage 4 prostate cancer is considered advanced and aggressive because it has shown that it can travel and form new tumors.

A tumor’s stage heavily influences treatment options and goals. For localized or some locally advanced cancers (Stage 1 to Stage 3), treatments such as surgery or radiation may aim for a cure. For metastatic cancer, a cure is usually not possible. Treatment focuses on controlling growth, managing symptoms and maintaining quality of life.

Many prostate cancers rely on hormones called androgens as fuel for their growth. Therapies that block these hormones can be effective for some time – in most cases, years – especially for hormone-sensitive cancers like Biden’s.

Fortunately, thanks to improved screening options and increased awareness, about 69% of prostate cancers are found when they are still confined to the prostate (Stage 1 to Stage 2). About 8% of new cases are metastatic at diagnosis.

Genetics: Uncovering cancer’s DNA blueprint

In addition to grade and stage, doctors are increasingly using a cancer’s genomic profile – its specific genetic makeup – both for deeper insights into its aggressiveness and potential treatment pathways.

DNA acts like a detailed instruction manual for cells, dictating how they should grow and function as well as when they should stop dividing or die. In cancer, mutations act like typos in this genetic instruction manual, causing cells to ignore these normal controls, grow and spread.

Genomic testing can identify these specific genetic alterations. This can be performed on the tumor tissue itself to identify changes called somatic mutations that occurred after you were born. Or it can be carried out through blood or saliva samples to detect changes you inherited called germline mutations.

For men with early-stage prostate cancer, certain genomic tests on the tumor can help clarify the risk of the cancer progressing. This information is valuable in deciding whether active surveillance – closely monitoring the cancer without immediate treatment – is a safe approach, or whether more immediate treatment is warranted.

In advanced or metastatic prostate cancer, identifying specific mutations is particularly critical. For instance, mutations in genes such as BRCA1 or BRCA2 – more commonly associated with breast and ovarian cancer risk – can also occur in prostate cancer. These mutations can make the cancer more aggressive but also potentially susceptible to a specific type of drug called a PARP inhibitor, especially if the cancer becomes resistant to hormone therapy.

National guidelines now recommend genomic testing for all men with metastatic prostate cancer to look for these “actionable” mutations. This move toward personalized medicine means treatments can be increasingly tailored to the unique fingerprint of a patient’s cancer.

Understanding cancer ‘aggressiveness’

It’s essential to understand that “aggressive” isn’t just a simple label for cancer, but rather a multilayered evaluation. An aggressive-looking cancer caught early and confined to the prostate (Stage 1 and Stage 2) can have a nearly 100% five-year relative survival rate. However, if the same high-grade cancer has already spread widely (Stage 4), five-year relative survival drops significantly, to around 38%.

This stark difference in survival rates highlights a critical point. To obtain the clearest picture of a cancer’s potential threat, a comprehensive assessment combines insights from multiple qualities of a tumor to help patients and their health care teams make informed decisions.

Thankfully, advances in genomics, imaging and targeted therapies continue to improve how aggressiveness is defined, how its behavior is predicted and how treatment is personalized. This progress offers growing hope for better outcomes, even for patients with the most aggressive prostate cancers.

Jason P. Joseph, Assistant Professor of Urology, University of Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.