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.

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.

Keith Diaz, Columbia University

For patients hospitalized with chest pain, the amount of time they spend sedentary afterward is linked to a greater risk for more heart problems and death within a year. That’s the key finding of a new peer-reviewed study my colleagues and I published in the journal Circulation: Cardiovascular Quality and Outcomes.

We asked 609 emergency room patients experiencing chest pain — average age of 62 — to wear a physical activity monitor for 30 days after leaving the hospital. The monitor measured movements, sitting time and sleep throughout the day. We then followed patients for one year to track whether they had additional heart problems or died.

We found that patients who averaged more than 15 hours of sedentary behavior daily — which does not include sleep — were more than twice as likely to experience more heart problems or die in the year after discharge than patients who accrued a daily average of 12 hours of sedentary time.

But our goal wasn’t just to document that sitting is harmful. It was also to figure out what patients should do instead to lower their risk.

We found that replacing 30 minutes of sedentary time with moderate or vigorous movement, like brisk walking or running, was most beneficial. It was associated with a 62% lower risk of experiencing more heart problems or dying in the year after discharge. But we also found that replacing 30 minutes of sedentary time with just light movement, such as slow walking or housework, lowered the risk of heart problems and death by 50%.

Sleep was also a healthier option. Replacing 30 minutes of sedentary time with sleep lowered the risk of heart problems and death by 14%.

Why it matters

Over 8 million people in the U.S. are admitted to the hospital with chest pain suggestive of acute coronary syndrome. annually. This covers a range of conditions involving reduced blood flow to the heart, including angina and heart attack.

Patients with acute coronary syndrome remain at high risk of having another heart problem even with optimal medical treatment.

The risk also remains high for patients with chest pain who are discharged without a diagnosis of acute coronary syndrome, as their unexplained chest pain may be a precursor to more serious heart problems. Given this risk, there is a need to identify risk factors that can be modified to improve a patient’s prognosis after hospitalization for chest pain.

In previous research, we found that patients with acute coronary syndrome had a fear of exercise and were sedentary, spending over 13 hours a day sitting.

Given that sedentary behavior has been linked to poor heart health in the general population, we were concerned that patients were unknowingly increasing their risk of having another heart problem.

Our latest findings confirm that sedentary time is a harmful behavior for these patients. But beyond telling patients to stop sitting so much, our work provides important guidance: Any movement, regardless of how intense, can be beneficial after hospitalization. This is especially relevant for people recovering from heart problems who may find exercise difficult or scary.

While exercise provides the best “bang for your buck” in terms of health benefits, our findings are good news for patients who may not have the time, ability or desire to exercise. And for those unable to fit in more movement, just getting an extra half hour of sleep is a small, doable step that can make a meaningful difference for your health after hospitalization.

What still isn’t known

Researchers don’t fully understand why sedentary time is harmful. Muscles help regulate blood sugar and lipid levels. It is thought that when muscles aren’t used, such as when patients sit for hours, this can lead to harmful elevations in blood sugar and lipids.

In turn, this can cause inflammation, plaque buildup in the arteries and organ damage. More research is needed to understand the biological mechanisms so that we can determine just how much movement is needed in a day.

What’s next

While our study highlights the potential risks of sedentary behavior after being hospitalized for chest pain, it was an observational study. Clinical trials are needed to confirm that replacing sedentary time with activity or sleep can improve prognosis.

The Research Brief is a short take on interesting academic work.

Keith Diaz, Associate Professor of Behavioral Medicine, Columbia University

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