The next Abraham Accords agreement should not just be the beginning of a partnership. By the time leaders are ready to normalize relations, institutions that can sustain that relationship should already exist.
Israel’s own history offers an instructive analogy.
Long before independence in May 1948, the Zionist Yishuv had built elected representative bodies, the Jewish Agency, health systems, universities, economic organizations and a viable defense structure. In the final weeks before the Declaration of Independence, the People’s Council and People’s Administration were created from existing institutions. At independence, they became the Provisional Council of State and Provisional Government.
The declaration did not create institutional capacity from nothing. It gave political form to institutions already built.
That principle deserves consideration as the United States seeks to expand the Abraham Accords. U.S. President Donald Trump is pressing Saudi Arabia and others toward normalization. Washington should ask: What strategic problems can Israel and its neighbors begin solving before normalization becomes politically possible? What institutions could use that cooperation to build trust? How can the United States enable countries not yet ready for formal relations with Israel to participate?
Pharmaceutical security offers one place to start.
What can be built before normalization? There is already a precedent to look to. Qatar has no diplomatic relations with Israel, yet both participate in Pax Silica, the initiative led by the United States on strategic technology and supply chains. So, participation in the same multilateral framework does not require bilateral normalization.
A Middle East pharmaceutical security framework could work in a similar way. Israel, the United Arab Emirates, Bahrain, Egypt, Jordan and Morocco could form the initial core of such a framework. Saudi Arabia, Qatar, Oman and Kuwait could join selected technical workstreams before normalization. Iraq, Syria and Lebanon could enter where political circumstances permit. The framework’s charter would state that technical participation does not constitute diplomatic recognition.
This framework should concentrate on pharmaceuticals because few responsibilities are more basic for a government than ensuring that its population can obtain medicines it cannot live without.
The initial focus should be essential generic medicines, including antibiotics, anesthetics, cardiovascular drugs and selected cancer treatments. They are often inexpensive; shortages, however, can disrupt hospitals and leave patients without substitutes.
The case for regional cooperation on this issue is straightforward: Egypt, Jordan and Israel have meaningful pharmaceutical manufacturing capacity, but all remain exposed to global supply chains. A medicine can be produced locally while its active pharmaceutical ingredient or another critical input still comes from a concentrated foreign source. Therefore, these countries’ shared weakness is upstream dependence and insufficient redundancy.
The Gulf has a different problem. Saudi Arabia, the UAE, Qatar, Oman, Kuwait and Bahrain bring purchasing demand, capital and growing industrial capacity, but remain substantially dependent on imported medicines. The Gulf Cooperation Council already has centralized drug registration and joint procurement.
A shared framework would address all these problems. Egypt, Jordan and Israel could contribute manufacturing, technical expertise and regulatory capacity. The Gulf countries would contribute market scale, capital and purchasing power. Pooled demand can make investments viable that may not make economic sense for one country alone, including a second source of an essential generic, an additional API supplier, backup manufacturing capacity or strategic inventories.
The countries would not solve one another’s problems simply by trading existing medicines. They would solve them by creating enough shared demand and investment to build the redundancy they all lack.
The goal? regional redundancy
How would it work? And what should Washington do to establish it?
Begin with perhaps 30 to 50 high-priority generic medicines selected from World Health Organization and national essential medicines lists.
For each one, a small secretariat facilitated by the United States would ask four questions: How much does the region need? Where can it be manufactured? Where do its APIs and critical inputs originate? What happens if one supplier, factory or country becomes unavailable?
Then address the gaps. If several countries rely on the same vulnerable source, pooled purchasing commitments could support a second qualified supplier or manufacturing site. Regulators could rely on one another’s inspections, align requirements for selected generics and share early warnings of shortages.
The goal would be regional redundancy. Losing one factory, supplier or country should not deprive populations of an essential medicine.
Countries without relations with Israel would not need bilateral agreements. Saudi, Qatari, Omani or Kuwaiti officials could participate through technical groups chaired by the United States on forecasting, procurement, manufacturing standards or shortage monitoring. This would create cooperation without requiring normalization first.
Washington already has tools that fit this approach. Congress has required the Food and Drug Administration to establish an Abraham Accords Office, with responsibilities that include regulatory convergence and cooperation related to medical product manufacturing. The State Department’s Regional Integration Office has a broader mandate that includes supply chain resilience, common regulatory standards and regional integration.
Trump could use the State Department to provide the political umbrella and the FDA to provide technical expertise. Over time, successful cooperation might support deeper regulatory reliance and perhaps a Middle East Medicines Agency. That would be the destination, not the first step.
The next Abraham Accords should identify strategic problems countries already need to solve, build institutions that allow them to solve those problems together and let useful cooperation create relationships before full normalization becomes politically possible.
Then, when another country is ready to sign, the agreement will not create cooperation from nothing. It will formalize what has already been built.
